Concussion

Just reading an interesting article on the BBC website regarding the current sensitivity over concussion that is all apparent this season.

In 2010, the NFL acknowledged that many of its ex-players were suffering from chronic traumatic encephalopathy (CTE) following repeated brain trauma

Several ex-players who suffered from CTE have committed suicide, including Junior Seau and Ray Easterling
In July 2014, a federal judge approved a settlement that would see thousands of former American football players compensated for concussion-related injuries

Saracens' Chris Wyles can be seen wearing the device behind his ear against London Irish on Saturday
Saracens players wore impact sensors behind their ears in Saturday's win against London Irish as they launched a new concussion research programme.

The device, called the xPatch and produced by a US company, measures the size and angle of hits to the head.
"We don't want to meet our players in 20 years' time to find them suffering from dementia and reflect we suspected something was going on but didn't really know," said Edward Griffiths.
"We want to know - we want answers."
The Saracens chief executive added: "We feel obliged to ask these questions, however uncomfortable they may be."

Concussion is an issue of concern in rugby, with many retired players and medical experts warning that repeated impacts during a player's career may cause profound health issues later in life.
Former England players Shontayne Hape (external) and Michael Lipman are among those who have been forced to retire because of the effects of concussion, with Hape complaining of "depression, constant migraines and memory loss". (external)

The International Rugby Board introduced an enhanced Head Injury Assessment (HIA) protocol (external) in June in an effort to improve player safety, and it has been in use in the Premiership this season. (external)
Saracens players will wear the patches, made by Seattle-based X2 Biosystems, in matches and training sessions. The patches can then be removed and the data uploaded to a computer, where it will be logged.
Griffiths added: "We aspire to be a club that genuinely looks after its players, and nothing is more important than their medium and long term welfare.

"The findings will be reported in due course."

Saracens get knocked alot but this is great to see.

Cant find the report anymore as it was a fair few years back but during the time when players started getting bigger and bigger I remember reading a report/study that some of the impacts players have these days are equivalent to being involved in a car crash

Probably just a coincidence, but I was recently reading about Peter Ogden who was fullback for Victoria, British Columbia that played against the All Blacks on 22 November 1913.

"Early in the game he went down to stop a forward rush and struck his head against someone's knee, knocking himself out. He was soon on his feet again, insisting that he was alright. he was knocked out on a second occasion but again carried on, although he seemed a little dazed. Two minutes from time he collapsed and was carried off to an ambulance, but died on his way to hospital".

aucklandlaurie wrote:
Probably just a coincidence, but I was recently reading about Peter Ogden who was fullback for Victoria, British Columbia that played against the All Blacks on 22 November 1913.

"Early in the game he went down to stop a forward rush and struck his head against someone's knee, knocking himself out. He was soon on his feet again, insisting that he was alright. he was knocked out on a second occasion but again carried on, although he seemed a little dazed. Two minutes from time he collapsed and was carried off to an ambulance, but died on his way to hospital".

do you have a reference for this extract?

When you say,

"Probably just a coincidence..."

Did you mean that he died?

Gwlad:

Yes I do, the book is called "centenary 100 years of All black Rugby"  by R.H.Chester & N.A.C McMillan  ISBN 0 908570 75 9. Page 101.

MrsP: when I meant it was a coincidence, it was because I just happened to be reading about this event and I find this active thread about concussion. I wasnt saying that he got knocked out twice, then just by way of coincidence died (him not me), which I think is the question you are asking me??

But yes he did die,

And to carry on the quote since I doubt its online:

"As a result of this unfortunate occurrence all official functions set down for after the match were cancelled and two All Blacks, McDonald and Douglas were subpoenaed for the inquest, held on the Monday after the game. The coroner's finding was that death was entirely accidental, no blame being attached to anyone. Ogden's funeral took place on Wednesday, 26 November, and a handsome wreath was sent by the All Blacks, who were then in vancouver."

By the way the All blacks won 36 nil, which included 8 x 3 point tries.

bedfordwelsh wrote:Cant find the report anymore as it was a fair few years back but during the time when players started getting bigger and bigger I remember reading a report/study that some of the impacts players have these days are equivalent to being involved in a car crash

Didn't adam Jones say that "the hit" under the previous scrum laws often caused black outs..


Anyone know how Sexton is getting on post concussion?

"A pitchside test to determine concussion could be available within five years after academics began work on a study hoping to use examination of a rugby player’s eye to detect the brain injury within a matter of seconds.

Using equipment already available in hospitals or at opticians, the study, being carried out at Sheffield Hallam university, proposes to identify change to the structure of the eye when concussion occurs. By comparing the data with healthy readings, an injured player could be diagnosed on the field."

http://www.theguardian.com/sport/2015/oct/28/rugby-union-pitchside-concussion-test

Great post, mate.
From what I see there are multiple promising investigations currently in progress to properly and more objectively assess concussion.  The one in the article seems a very plausible one, especially as it is based upon existing technology.  The problems are that concussionn is a functional injury and not a structural one.  Makes the immediate pitchside diagnosis harder to get right.  Wearing those monitors, as mentioned above, is a great start and the analysis of the data is really pouring in now.  

But it will always start with awareness of performance and observing the players.  The Geroge North example was so glaring because it happened in front of 75000 people in the MS and a worldwide tv audience.  And the only people who appeared to miss it were the pitside medical team.    

Ice Hockey players in particular have high rates of consusion.  Despite thier pads, their collisions are much more violent than American Football or Rugby, though oddly concussion rates are lower than American Football.   Even soccer have significant concussion rates.

doctor_grey wrote:Great post, mate.
From what I see there are multiple promising investigations currently in progress to properly and more objectively assess concussion.  The one in the article seems a very plausible one, especially as it is based upon existing technology.  The problems are that concussionn is a functional injury and not a structural one.  Makes the immediate pitchside diagnosis harder to get right.  Wearing those monitors, as mentioned above, is a great start and the analysis of the data is really pouring in now.  

But it will always start with awareness of performance and observing the players.  The Geroge North example was so glaring because it happened in front of 75000 people in the MS and a worldwide tv audience.  And the only people who appeared to miss it were the pitside medical team.    

Ice Hockey players in particular have high rates of consusion.  Despite thier pads, their collisions are much more violent than American Football or Rugby, though oddly concussion rates are lower than American Football.   Even soccer have significant concussion rates.

Would this not be because in the NFL they deliberately tackle with their head, aiming to dislodge the ball with it as they hit? Ice hockey is higher speed but the hits are generally made with the shoulder.

And then you look at the faces of Hooper (and Pocock after his last game) and McCaw They virtually use their very heads as weapons (I don't mean intent to injure opponents!) to squeeze in and effect the turn overs. Boxers get a few weeks or months off between fights. Rugby players are impacting at greater speeds, therefore stronger forces, every week. And certainly in a high intensity climate like the WC, those collisions get even more violent.

But how do you protect players from playing a sport they love to play? - and for many of them, that combative element is the very part they most love. How will the information be used?

Will the new more direct information coming from technological advances force many players to have much shorter careers? I'm not saying that's wrong btw. But that is the only conclusion that can be reached if rugby is serious about acting on the information that will increasingly be provided by sensors and technology.

I can't see how the sport's physicality can be watered down as a response though. The athletes are better trained in this modern world - they're mostly all bigger, stronger, faster etc. They are athletes and they want to compete. The game requires a physical commitment in order to win. Those players will be wanting to win and so there will always be a desire to force your physicality onto the opponent rather than the other way around.

So maybe the final question in years to come will be a direct rugby or no rugby.

screamingaddabs wrote:

doctor_grey wrote:Great post, mate.
From what I see there are multiple promising investigations currently in progress to properly and more objectively assess concussion.  The one in the article seems a very plausible one, especially as it is based upon existing technology.  The problems are that concussionn is a functional injury and not a structural one.  Makes the immediate pitchside diagnosis harder to get right.  Wearing those monitors, as mentioned above, is a great start and the analysis of the data is really pouring in now.  

But it will always start with awareness of performance and observing the players.  The Geroge North example was so glaring because it happened in front of 75000 people in the MS and a worldwide tv audience.  And the only people who appeared to miss it were the pitside medical team.    

Ice Hockey players in particular have high rates of consusion.  Despite thier pads, their collisions are much more violent than American Football or Rugby, though oddly concussion rates are lower than American Football.   Even soccer have significant concussion rates.

Would this not be because in the NFL they deliberately tackle with their head, aiming to dislodge the ball with it as they hit? Ice hockey is higher speed but the hits are generally made with the shoulder.

Makes sense. Very likely. Also, similar to Rugby, Ice Hockey is somewhat self-policing: On attack one second, on defense the next. It's a guress on my part.

Good points Fly.

If you watch games from years ago there are far fewer of the big head collisions at ruck time. This is (I think) mainly because the laws have changed. Rucks were meant to be a contest whereby you pushed the opponent off the ball and used your feet to obtain the ball. Now we have the "Jackal" position and players putting their heads downwards in dangerous places.

We got rid of rucking because it was "dangerous", has it been replaced by something more dangerous?

I wonder would a helmet in repeated impacts be an issue in itself.  When logic presents a problem (lower rates of concussion rates in rugby than in American football) then the first thing would be looking at the differences.

Rather like a car theoretically protects a person from the full ravages of an impact with something solid.... it also in and of itself adds danger, as it halts the trajectory of the person (ie - being thrown clear, which can often save a life) and instead imposes a series of close quarter collisions inside the vehicle.

Does a helmet potentially contain the resonant shock of an impact and amplify the effects of that single impact or cumulatively influence repeated bangs into the brain?  Research required to find out I suspect.

Probably a simple case of stopping the large issues (blunt impact to the head) and therefore a higher rate of the smaller issue (brain swooshing around inside the skull). By large and small I mean in terms of obviousness. Givers of false confidence. Like anyone wearing a scrum-cap for head protection when they only really protect from superficial injuries.

Last Olympics (was it?) they got rid of head guards for the boxers for similar reasons. Unfortunately they then had the problem of more cuts but that's another issue

I know it's going off-topic somewhat but I do have a funny feeling the helmets are an issue in their own right though in American football, and not just in giving players a false sense of security.  After all, helmets, in most sports, are not intended to be used as tools of the trade but merely there in case they might be required once, twice, or three times in an entire career (unless you're a jump jockey, which obviously ups that frequency).  Helmets are meant to protect the head a few times in a career not repeatedly used week after week.  

I'm just wondering has any studies been done on the balance of protection afforded by helmets and the frequency of them being used in that context?

lostinwales wrote:Last Olympics (was it?) they got rid of head guards for the boxers for similar reasons. Unfortunately they then had the problem of more cuts but that's another issue

Oh sorry, didn't see your post there, lost.

Fly

with regard to the NFL, there were probably about 40 years where helmets were as much used as an 'offensive weapon' as for protection (i.e. players deliberately hitting with their head / helmet to inflict pain / injury on an opponent). Started once the helmets got strong enough to offer short term protection (early 60s) until the NFL started seriously cracking down on this in the 00s, firstly as a drive against neck injuries and now supplemented by the attempts to protect players against concussion.

I don't think the issues in rugby are as serious as they are for the NFL, both because of the absence of helmets and so at least some attempts by most players (other than the suicidal, lie Lewis Moody)to avoid head collisions, and because there are probably fewer impact in rugby than for some NFL players (I'm thinking of the offensive linesmen and defensive linesmen and linebackers, who block or are blocked at least once every play they are on the field).

However, as we have seen, there certainly are issues with concussion from what you might consider unintentional contact with a player's head ( when tacklers get in poor positions, tackled players fall into legs/knees/feet and when someone dives on a loose ball amongst the flailing feet and legs). It is sensible that World Rugby and the national leagues are looking at this as a serious issue, as at the very least it raises awareness amongst the players of the longer term risks they may be running. I'm not convinced that there is any protection that would be more beneficial than detrimental - scrum caps aren't designed to offer protection against concussion, only against cuts, and anything more robust brings the likelihood both of a feeling of invulnerability and the potential for it to be used aggressively (as with the American Football helmet).

SecretFly wrote:I wonder would a helmet in repeated impacts be an issue in itself.  When logic presents a problem (lower rates of concussion rates in rugby than in American football) then the first thing would be looking at the differences.

Rather like a car theoretically protects a person from the full ravages of an impact with something solid.... it also in and of itself adds danger, as it halts the trajectory of the person (ie - being thrown clear, which can often save a life) and instead imposes a series of close quarter collisions inside the vehicle.

Does a helmet potentially contain the resonant shock of an impact and amplify the effects of that single impact or cumulatively influence repeated bangs into the brain?  Research required to find out I suspect.

It can do but very rare - whats more likely with a helmet is that players feel safer so take more risks "risk compenstion" this is what appears to have happened in american football. also helmets can increase rotational forces which cause concussions / diffuse brain injury and by making the head bigger means its more liely you will hit your head. these effects are well known in other sports

TJ wrote:

SecretFly wrote:I wonder would a helmet in repeated impacts be an issue in itself.  When logic presents a problem (lower rates of concussion rates in rugby than in American football) then the first thing would be looking at the differences.

Rather like a car theoretically protects a person from the full ravages of an impact with something solid.... it also in and of itself adds danger, as it halts the trajectory of the person (ie - being thrown clear, which can often save a life) and instead imposes a series of close quarter collisions inside the vehicle.

Does a helmet potentially contain the resonant shock of an impact and amplify the effects of that single impact or cumulatively influence repeated bangs into the brain?  Research required to find out I suspect.

It can do but very rare - whats more likely with a helmet is that players feel safer so take more risks "risk compenstion" this is what appears to have happened in american football.  also helmets can increase rotational forces which cause concussions / diffuse brain injury and by making the head bigger means its more liely you will hit your head.  these effects are well known in other sports

I think you are over-simplifying the helmet in American Football.  The current helmet at the top level is designed to diffuse/disperse shock around the helmet in an increasinglty muted manner.  In other words, absorb shock waves rather than transmit them around the helmet.  Further, concussion doesn't always derive from players (mostly defence) spearing the other player.  A lot is from incidental helmet to helmet at high speed.  The NFL and major American colleges have given unofficial direction to not lead with the head.  Some of it is working.    

In Rubgy terms, I agree with comments above, the purpose of the scrum cap is to keep the ears attached, and also prevent a little cranial blood.  But nothing to do with concussion.  Larger helmets will not help in Rugby unless we go the American Football route, which would be a disaster for our sport.

We can never eliminate concussion from physical sport.  But, in Rugby, we can train better to stay away from the head and officiate it better.  But we can evaluate, treat, and help players recover a lot better than now.

I was making a more general point about the use of protective helmets - and as you say oversimplifying a complex and multifactorial situation. However risk compensation is real and I have seen it discussed that in american football since the use of hard helmets people are more reckless with the use of their heads in tackles and blocks hence the direction not to led with the head - you wouldn't do it with an unhelmeted head. That is risk compensation in action - you feelsafer so you take more risk.

For rugby I think the analysis of the data from these impct trackers will be very interesting - it will actually provide some hard evidence and my guess is some of what is found will be unexpected - perhaps repeated small blows over the course of a game causing issues as well as single large blows and also indirect impacts / whiplash type issues - but until we have a solid body of data to analyse we are really guess and extrapolating from other dissimilar sports - I have read a lot of data on cycle helmets and the results there are both counter-intuitive and often contradictory. cycle helmets make injuries worse in some types of impacts - the incidence of this is hotly disputed but the effect is there.

TJ wrote:I was making a more general point about the use of protective helmets - and as you say oversimplifying a complex and multifactorial situation.  However risk compensation is real and I have seen it discussed that in american football since the use of hard helmets people are more reckless with the use of their heads in tackles and blocks hence the direction not to led with the head - you wouldn't do it with an unhelmeted head.  That is risk compensation in action - you feelsafer so you take more risk.

For rugby I think the analysis of the data from these impct trackers will be very interesting - it will actually provide some hard evidence and my guess is some of what is found will be unexpected - perhaps repeated small blows over the course of a game causing issues as well as single large blows and also indirect impacts / whiplash type issues - but until we have a solid body of data to analyse we are really guess and extrapolating from other dissimilar sports - I have read a lot of data on cycle helmets and the results there are both counter-intuitive and often contradictory.  cycle helmets make injuries worse in some types of impacts - the incidence of this is hotly disputed but the effect is there.

Sorry if I missed you point.  I agree in general the helmets do make the athletes feel they are safer than they likley are.  Also in general, helmets are needed because of the immediate risk, which is well before effects of rules/laws changes and training can take effect.  Seems the balance is wrong and training, rules don't get it either.

I am worried about the data from the Rugby sensors.  Without accurate benchmark data about concussion, except perhaps the past few seasons, and only at the top level, I hope the wrong conclusions are not made.  These same sensors are now included in American Football helmets so some fairly direct cross sport comparison can be made.  Further, the same type Virginia Tech sensors are being trialled in Ice Hockey and Lacrosse, but I don't know the status and timing for thier investigations

Interesting article and is already showing one of the things I fear in rugby - its not just the big knockout blows that cause issues - its the repeated smaller impacts. early days yet and obviously its not clear how this relates to rugby but I do fear as we find out more about this that there will build a real body of evidence showing these minor injuries cumulate over time
http://www.theguardian.com/football/blog/2015/nov/01/football-heading-brain-damage

TJ wrote:Interesting article and is already showing one of the things I fear in rugby - its not just the big knockout blows that cause issues - its the repeated smaller impacts.  early days yet and obviously its not clear how this relates to rugby but I do fear as we find out more about this that there will build a real body of evidence showing these minor injuries cumulate over time
http://www.theguardian.com/football/blog/2015/nov/01/football-heading-brain-damage

That is a great article.  I have to admit my concern which is that raw data without proper analysis and evaluation will put people in a panic mode.  

I agree with you it is likely the smaller repeated impacts which over time might accumulate to be more severe than any individual blow.  I saw a report a few years ago conducted in American college sports showing a surprisingly high brain trauma rate, mostly CTE, for athletes engaged in many sports.  Basketball, for one, had a very high rate.   As  did Volleyball. Most major American sports were included. Rugby was not.

doctor_grey wrote:

TJ wrote:Interesting article and is already showing one of the things I fear in rugby - its not just the big knockout blows that cause issues - its the repeated smaller impacts.  early days yet and obviously its not clear how this relates to rugby but I do fear as we find out more about this that there will build a real body of evidence showing these minor injuries cumulate over time
http://www.theguardian.com/football/blog/2015/nov/01/football-heading-brain-damage

That is a great article.  I have to admit my concern which is that raw data without proper analysis and evaluation will put people in a panic mode.  

I agree with you it is likely the smaller repeated impacts which over time might accumulate to be more severe than any individual blow.  I saw a report a few years ago conducted in American college sports showing a surprisingly high brain trauma rate, mostly CTE, for athletes engaged in many sports.  Basketball, for one, had a very high rate.   As  did Volleyball.  Most major American sports were included.  Rugby was not.

It's all wonderfully/annoyingly complex. Most of those sports listed above do not notionally have a 'contact' component (regardless of how much actually occurs). People are not going into them expecting to get head trauma, where as its much more of a risk in Rugby therefore player's training (e.g. neck strength) may actually help.