Concussions Hape's experience

http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11264856

A really interesting read. Reinforces the case for independent assessment and overseeing of clubs.

Speechless.

I don't know where to begin, it beggars belief.

Not a good reflection on the French Top 14 either especially after the Florian Fritz incident. Hape's description of players as being pieces of meat is something that all players thinking of going there need to consider, especially those who are also internationals as the demands are extreme, and it is likely to shorten your career ( and maybe your life) and should be taken in to account.

That is truly staggering.

Is it fair to say the players should shoulder some responsibility too? I know they're under a whole lot of pressure but it beggars belief that he was so obviously suffering severe brain trauma and he kept playing.

You better believe it RDW, it happens a lot more often than most people believe.

RDW_Scotland wrote:That is truly staggering.

Is it fair to say the players should shoulder some responsibility too? I know they're under a whole lot of pressure but it beggars belief that he was so obviously suffering severe brain trauma and he kept playing.

You can't blame the players. I think we'd all do the same in their positions, with the money on offer for playing, the love of the game and the pressure from fans/coaches/other players etc I can understand why they feel the need to play at all costs.

The blame falls squarely at the feet of the coaches. They are the ones in control here and are the only ones that can change things for the better.

There's playing at all costs but thjs was such an extreme example that it beggars belief that he kept playing!

At the end of the day the players are the only ones that can put the foot down and say they're not playing.

RDW_Scotland wrote:There's playing at all costs but thjs was such an extreme example that it beggars belief that he kept playing!

At the end of the day the players are the only ones that can put the foot down and say they're not playing.

And lose their job, income etc? Not to mention stigmatised widely and looked down on.

In less extreme circumstances maybe but I'm talking about Hape here - sounds like he was barely able to function, was regularly blacking out and kept playing rugby for months despite having very obvious head trauma.

I fully sympathise with him for the pressure he was under, but to keep going for months in his condition is staggering.

What a mess.

Well done Hape for speaking up about this. I suspect players are nore likely to take heed of this than they are to listen to us medics telling them.

Of course players have to take responsability for their own wellbeing but we are talking about brain injured/damaged people here. They are not in a position to act reasonably and we need to find better independant means of assessing their fitness to play.

Something that we are doing a lot more in Auckland especially in the amatuer ranks of the game, is the Auckland RU has a relationship with Saint Johns Ambulance at School games, and if a player gets a head knock it is dealt with by the paramedics and not the coach or trainers.

RDW_Scotland wrote:There's playing at all costs but thjs was such an extreme example that it beggars belief that he kept playing!

At the end of the day the players are the only ones that can put the foot down and say they're not playing.

As a Scotland fan RDW, how do you feel about us (and I do mean us) calling Rory Lamont "Mr Glass" because he kept refusing to play when injured?

Was the Mr glass name not more because he kept getting injured, us opposed to us thinking he was faking it? There's a massive difference.

RDW, if you read his comments he felt that the SRU was constantly making him feel he was faking it.

Just wondering, but why does Guy Novès still have his job?

doctor_grey wrote:Just wondering, but why does Guy Novès still have his job?

Because none of the MEN in charge of rugby give a rats @@@ about how players are treated. They don't give 2 hoots how many of their players end up with their lives ruined.

Just so long as they can continue to sit in their offices and collect their money!!!!

  

There's not a real man amongst them!

I think some people would be surprised what 'normal' people will ignore because they think it's nothing or they fear it IS something. Working in Radiotherapy we see a lot of people who have ignored large growths on their face (golf ball sized) that they've had for years and not gone to the doctors. You can't understand why they didn't go earlier but it's not that simple. I'd imagine it's worse for players (having to fear the possibility their career is over on top of the fear they might lose there place). Although I don't think the money comes into it other than as an excuse. In the amateur era I expect the players would have carried on regardless anyway. Martin Johnson says he can't remember his first cap as he took a head knock early on.

The players can't make rational decisions on this by themselves (and certainly with the paltry information we have on it at the moment).

Do you think we have paltry information?

John Fogarty
Michael Lipman
Paul Tito
Andy Hazell
Shontayne Hape

All recently retired because of concussion with symptoms which are affecting their lives outside rugby.

Ben Robinson. Dead because of concussion aged 14.

Those are just a few I can remember easily.

MrsP wrote:Do you think we have paltry information?

John Fogarty
Michael Lipman
Paul Tito
Andy Hazell
Shontayne Hape  

All recently retired because of concussion with symptoms which are affecting their lives outside rugby.

Ben Robinson. Dead because of concussion aged 14.

Those are just a few I can remember easily.

I was talking about it being up to the players if they want to take those risks. At the moment we don't know enough to be able to say to the players "Right, there are the risks, are you willing to accept them?". Too many unknowns, too much variation. So we need to shelter the players (I'd say being over cautious is better than under cautious at the moment) by taking the decision out of their hands until more information can be determined.

Ultimately, in the long term, it will be up to the player to accept or reject those risks.

On a more positive note, Glasgow and Leinster showed at the weekend how you should treat concussed player.

Chris Cusiter was subbed off after 50 mins due to a head knock, and Leinster's physio actually ran onto the pitch to stop a scrum and tell the ref that Shane Jennings was concussed and had to be replaced. Cusiter has since been removed from the Scotland summer tour squad.

So it is not all bad news - a lot of clubs and countries are looking after their players.

RDW,

It is good that both players were removed from the pitch and not allowed to return but that is something we should not ever have to praise. It is the most basic of care, so basic that I would suggest that anything else at this point in time should be considered negligent.
I think it shows how badly this is often handled when their example is note worthy.

And Hammer, I am not sure that I completely agree that it should be up to the players. There are clear guidelines in place that are being ignored by clubs from the initial removal of a concussed player to allowing players to return far too soon or worse, bullying players to return far too soon. Sure, players take the initial risk to play the game but they do not have the final say in if or when they take the field week by week.
I also disagree that money is not a consideration. Hape clearly considered it. Some clubs seem to treat their players as disposable commodities who are there solely to further the business interests of the club.

http://www.bbc.co.uk/sport/0/rugby-union/27655550

scariest article i have read

I wonder if the IRB is scared of engaging more with the problem because of the NFL class action? Any admission of liability could lead to court action and costs that could sink it.

Scary business though. Its worth a thought that although you can fix some aspects of collisions through better training, its more or less impossible to avoid the accidental blows ( team mates knees to the head etc)

Absolutely disgraceful.

lostinwales wrote:I wonder if the IRB is scared of engaging more with the problem because of the NFL class action? Any admission of liability could lead to court action and costs that could sink it.

Scary business though. Its worth a thought that although you can fix some aspects of collisions through better training, its more or less impossible to avoid the accidental blows ( team mates knees to the head etc)

If anything the IRB should be leading the way in this, not reluctantly following. You can draw a line on the past and decades ago and claim that they weren't aware of the future impact on players lives from concussion. But once brains are donated for testing and those results are in the public domaine then no coach, club, doctor, Union or board can claim to be unaware any longer.

It only seems to be ex-players speaking out on this at the moment. It needs to be current players showing the true courage that they naively believe playing on with concussion demonstrates, and acknowledge they were concussed during a game (obviously not at the time, as chances are they didn't even know where they were). For it being said though that credit to the doctor for pulling Jennings during the game, how many times were Boss, D Kearney, BOD clearly KO'd this season alone only for them to continue playing on in the game. Strauss also, though that might have been last season.

It is changing, but it is far too slow for my liking.

Poor guy, sounds like this is a ticking time bomb for a lot of former and present players.

More time has gone by and still no comment from Guy Novès. No comment from his management?

To me this is a clear illustration of the difference between amateur sport and proper modern professional sport. This guy, Novès, represents everything wrong with the old world mentality. I would be happy to be the guy who strings him up by his genitals.

Dr G i'm not sure if it is old world mentality - amateur v pro - it's more of a win at all cost mentality where coaches try to keep their bets players on the pitch, although why Noves and others think that someone who can barely stand is going to help I don't know.  What happened with Fritz is little different to George Smith in the Lions test.  Everyone could see he was out cold, but after a brief assessment he was allowed to continue playing.

As a mini's coach I have attended a concussion course run by Saracens and we are told that we have to remove any child who receives a bang to the head - the difficulty is in working out how hard the knock was - and then telling the parents to take them to A and E for a check up...sorry I digress.  The course was excellent and scary at the same time and one of the problems is that players act thicker than they are so that they can pass the SCAT test.  The RFU are actually being very proactive on this and have launched Headcase which highlights the dangers and signs of concussion.  anyone who coaches or is interested should look at the RFU website - search for Headcase.

Good points, mate. The way I see it is that proper medical attention and care for our players is a basic part of pro sport. In the old days, which were really not so long ago, virtually anything that kept a player on the pitch was good enough. This has clearly changed and continues to evolve. But we have information available which clearly shows injury leads to injury if not treated properly. Head trauma is the same. When I say amateur v. pro, perhaps it is better to say old school v. modern? Win at all costs, for sure.

I coach kids too, my sons are 15 and 17. We have very strict guidelines and rules at my club which are shared across clubs and schools in my area and were developed by my hospital. Kids and players are not wrapped in bubble wrap, but re-injury rates appear low. So something is working.

I simply cannot understand how this doesn't filter out to all clubs regardless of level. or maybe it has, but not uniformly. Or maybe there is simply not consistent impetus to ensure these are followed uniformly? It ain't rocket science.

I suspect the fact that you are living in a more litiginous and perhaps risk averse country combined with the fact that rugby is quite a new sport there so is not shackled by the "old school" attitude of "I was concussed everytime I played and it never did me any harm" nonsense we get here, means you don't have the same mountain to climb in changing attitudes.
Coaches, teachers etc have seen this whole thing played out in other sports so applying it to rugby is easy. Over here we are still trying to convince everyone of the dangers.
Remember when we started to discus this way back? I bet we were pretty much the only 2 posters on here who had even heard of SIS at that stage.
We WILL get through if we keep on chipping away at the wall of ignorance and misapprehension.

America is bizarrely litigious.  But their attitudes about concussion seem to have traditionally been stronger at youth, club, school level than in the pros.  Where Rugby is fairly new as a growth sport, they have always had American football, ice hockey and lacrosse.  They make Rugby look like knitting time at the nunnary.  The injury standards apply equally at youth level across all sports, though American football appears to me to have been the last to get onside.  

you are so right we need to keep pushing at every opportunity.  My medical group back home which also works with a lot of athletes at all levels all just received extra diagnostic and emergency surgical training specifically for head trauma.  We are just a bunch of orthopods, but the group felt it necessary, especially as we all volunteer as pitchside docs at various youth sports.  So things are changing for the better in UK as well.  All it took was some pushing and the logic becomes crystal clear.

The shame is that it also takes someone famous like Lamont or Hape to tell their story when we know there are so many more who won't.

The SRU are once again coming out favourably in this regard with David Denton not being included in the summer tour squad due to a concussion he received in the last game of the season, even though it was 6 weeks ago.

It is definitely a bold call, because Scotland are completely struggling for fit backrowers just now, especially next week against SA (outside the international window so only local based players are available), where we only have 2 fit backrowers in the entire squad.

Bit of necromancy but rather than a new thread I thought I'd put it here

http://www.telegraph.co.uk/sport/rugbyunion/news/11150094/Headguards-in-rugby-would-add-to-the-concussion-problem-not-solve-it-says-doctor.html

HammerofThunor wrote:Bit of necromancy but rather than a new thread I thought I'd put it here

http://www.telegraph.co.uk/sport/rugbyunion/news/11150094/Headguards-in-rugby-would-add-to-the-concussion-problem-not-solve-it-says-doctor.html

I have not read this but its interesting that it appears that the idea ties in with the (non) use of headguards in boxing at the commonwealth games. Unfortunately with boxing what the headguards did reduce was the number of cuts.

There has always been the argument with American football that the excessive use of pads lead to harder collisions. I would guess that padding helps with the impact but may not help with deceleration of the brain - i.e. the brain bashes itself against the inside of the skull. Its quite shocking seeing the number of people who get killed in that game.

lostinwales wrote:

HammerofThunor wrote:Bit of necromancy but rather than a new thread I thought I'd put it here

http://www.telegraph.co.uk/sport/rugbyunion/news/11150094/Headguards-in-rugby-would-add-to-the-concussion-problem-not-solve-it-says-doctor.html

I have not read this but its interesting that it appears that the idea ties in with the (non) use of headguards in boxing at the commonwealth games. Unfortunately with boxing what the headguards did reduce was the number of cuts.

There has always been the argument with American football that the excessive use of pads lead to harder collisions. I would guess that padding helps with the impact but may not help with deceleration of the brain - i.e. the brain bashes itself against the inside of the skull. Its quite shocking seeing the number of people who get killed in that game.

I read that 3 high school students died playing american football within a week last month. That is not the shocking thing though - the fact that this is below the average death rate for a month is.

16 high school pupils died during a 4 month season in 2013 - which apparently is "normal"

And the crazy irony is American Football broke off from rugby because of concerns around safety. Similar irony is that one of the main reasons rugby broke off from soccer is because they wanted to keep leg hacking, which you see much more often in soccer than rugby now.

LT,

Those figures sound shocking but I suppose we have to remember just how many high school kids actually play American football. Given the enormous number of participants those figures might gain a better perspective?
It is also possible that some of those deaths were due to undiagnosed medical conditions rather than the sport?
How many high school kids die each year from other causes.

I am no apologist for American football but we would need more information on those data to really understand the size of the problem I think.

edit: Just looked it up and apparently 1,088,158 play high school football.

I wonder if there is a breakdown of causes anywhere? In the UK we get a certain number of deaths due to undiagnosed heart conditions in otherwise fit young men. (It actually happened to a guy I used to play rugby with at school, apparently he died in a football match of a heart attack in his early 20's)

The RFU are making some of the right noises about concussion at least.

http://www.bbc.co.uk/sport/0/rugby-union/29638234

aye, I posted that in your sticky thread. Glad that taking (and passing) a module on this is compulsory just a shame it is online.

Rugby's setting great example. There was a good article in the paper recently outlining how Andre Villas-Boas' (Tottenham's goalkeeper) head injury was dealt with compared to Scott Wilson's suspected-concussion after the heavy tackle by Chris Hala'ufia at the weekend. Villas-Boas received a 30 second assessment after which he was allowed to continue playing. He left the game 10 minutes later bleeding from the ear. Conversely, the Newcastle game was halted and Wilson given a thorough assessment. 

Quite a juxtaposition.

bluestonevedder wrote:Rugby's setting great example. There was a good article in the paper recently outlining how Andre Villas-Boas' (Tottenham's goalkeeper) head injury was dealt with compared to Scott Wilson's suspected-concussion after the heavy tackle by Chris Hala'ufia at the weekend. Villas-Boas received a 30 second assessment after which he was allowed to continue playing. He left the game 10 minutes later bleeding from the ear. Conversely, the Newcastle game was halted and Wilson given a thorough assessment. 

Quite a juxtaposition.

Sometimes!!!

But many times rugby has set an appalling example. Hopefully the ratio is shifting.

MrsP wrote:

bluestonevedder wrote:Rugby's setting great example. There was a good article in the paper recently outlining how Andre Villas-Boas' (Tottenham's goalkeeper) head injury was dealt with compared to Scott Wilson's suspected-concussion after the heavy tackle by Chris Hala'ufia at the weekend. Villas-Boas received a 30 second assessment after which he was allowed to continue playing. He left the game 10 minutes later bleeding from the ear. Conversely, the Newcastle game was halted and Wilson given a thorough assessment. 

Quite a juxtaposition.

Sometimes!!!

But many times rugby has set an appalling example. Hopefully the ratio is shifting.

You're right, I should have specified. Most clubs except French ones!!

Here's a couple of podcasts on Vimeo, but are available free in itunes, that are fascinating and will make you rethink everything you ever thought about 'just a little bump to the head'. They are about 3 hours long each, but once you get past the ads at the beginning are just a straight up discussion for the duration. Joe Rogan is not to everyones taste, but his guests are well worth the listen.

http://vimeo.com/110204211 - JRE #568 - Dr. Rhonda Patrick

http://vimeo.com/111690690 - JRE #574 - Dr. Mark Gordon, Matthew Gosney & Jason Hall

http://www.bbc.co.uk/news/uk-wales-30086898

Dementia fears for rugby players, academic warns

http://www.bbc.co.uk/programmes/p02bhk4l

Discussion about concussion at the beginning of Radio Manchester's rugby show features Prof Allyson Pollock.