Knock out

First topic message reminder :

Despite some great performances and a very welcome win what will stick in my mind is George North. He d already had 1 concussion check and took another hefty blow to the noggin and stayed on. How and why it was allowed is beyond me. Its too serious a pointtobe ignored. Does the tmo need to be involved more here?

I have not asked for TMO review of collisions. I am not at all convinced but, the IRB are so, by your logic, it must be a good idea.

And if North is making decisions with an impaired brain then morally that is not fine.

PS IRB are no more.

http://www.telegraph.co.uk/sport/rugbyunion/11404557/Jonny-Wilkinson-I-could-have-thrown-my-life-away-with-concussions.html

An interview with Wilkinson on the topic, the most interesting part is this I think:

“I needed someone to tell me, clearly, if I was playing or not,” Wilkinson argues. “Who is qualified to make that decision? You tend to know your own body the best. But sometimes, the person looking after you has his or her hands tied by the club, by the pressures of promotion or relegation. No wonder it is a tough area. No wonder no one can find the answer.”

Reading the posts on this thread made over the past few days seems most people (as expected) understand the big picture here. Increased and better head trauma testing is needed and is coming.  This is for many reasons which include:  
The short term and long term health of our players as well as the longevity of their careers.  
The continued positive public impression and long term viability of our sport  (and most professional sport in general)
The ability to attract the youth to play our sport

There now appears no question with most people about whether North should have gone off after the second impact.  Many of us thought so right from the off and it is nice to see the IRB and WRU have caught up to us.  Whether we accept the explanation made by the WRU or not, it is clear there will be increased focus in the future.  I truly believe this kind of thing improves in fits and starts and this would be a text book example of that.  It is always unfortunate that players can get caught up in the meantime.  For the record, I am still incredulous that the entire Rugby world, both in the MS and around the globe, saw North take the impact from Hibbard's head and only the Wales team staff did not.  But there is no way to prove anything, so it is best to move on.  

Finally should North play this weekend?  Obviously none of us have the medical file, so we really cannot say confidently either way.  If he passed every test none of us have a leg to stand on, though I would be opposed based upon the visual evidence.  However, from a purely political point of view, it would be a shock if he plays.

I can only think that Gwlad has been lucky enough never to have been concussed, and also believes that every decision he has made while under the influence of alcohol (or anything else) to be totally rational and sensible.

We all want to see the big collisions. I think all we are suggesting is that if a collision results in a serious head injury, then that injury should be treated responsibly. If it is like Biggar where there was blood but he was basically fine the responsible treatment was to patch him up and send him back. North should have stayed off.

Players are nothing more than pieces of meat these days.

Last Friday was not a good advert for the game, so imo Wales should have received some sort of fine to set an example, everyone knows George shouldn't have continued so why didn't the Welsh coaching staff when they were watching the same replays as the rest of us.

I guess some games are more important to some than others, so player safety will always play 2nd fiddle.

doctor_grey wrote:Finally should North play this weekend?  Obviously none of us have the medical file, so we really cannot say confidently either way.  If he passed every test none of us have a leg to stand on, though I would be opposed based upon the visual evidence.  However, from a purely political point of view, it would be a shock if he plays.

Of course Doc, according to Barry O'Driscoll (or Dr BoD) the tests are not comprehensive enough and are a tick box exercise driven by the desire to avoid punitive lawsuits as seen in the US. until the authorities care about player welfare rather than financial loss that will not change.

I agree, mate.  As Mrs.P has stated there is no substitute for good clinical judgement.  So simple and logical. But these are the agreed protocols of the moment.  And consequently, the ones we have to go with for now.  In the future, they will be more detailed and involved.  That is something about which we can be confident.  

Although the NFL is clearly in trouble over head trauma, I know a small number of the sideline docs, and I wouldn't ever describe these people as signing up to simply tick a box.  These are good docs and take s**t and direction from no one. Not even me.

Nothing wrong with a tick box checklist. Just one of the boxes should be "In your medical opinion, is this player fit to continue".

HammerofThunor wrote:Nothing wrong with a tick box checklist. Just one of the boxes should be "In your medical opinion, is this player fit to continue".

As the Independent Doctor on Friday verified after he inspected him, that North was fit to resume after the first collision, NOT TOLD (Mrs P), a different scenario developed over the second incident, hopefully common sense will prevail and George will be stood down for this weekends game.

I didn't say he didn't.

The PSCA actually contains these statements,

-The PSCA does not replace clinical judgement and the doctor is responsible for all return to play
decisions.

-Clinical suspicion should always overrule a ’normal’ result from any concussion support tool
including all PSCA Tools

Has anyone watched the interview with Prav on the WRU website?

http://supporters.wru.co.uk/matchdaytv/?play=media&id=20198

When asked about the first incident he says,

"...we weren't quite sure whether..."

It sounds to me that he stops himself from saying that they weren't quite sure whether.....George had been KO'D????

If they weren't sure then North should have been removed from the game. There is no need to perform the PSCA to make this decision. Suspected LOC = removed from the game.

Was the independent doctor fully informed of North's condition on the pitch?

North isn't playing on Sunday. Glad they've seen sense

BamBam wrote:North isn't playing on Sunday. Glad they've seen sense

+1

He could do with a rest

MrsP wrote:

BamBam wrote:North isn't playing on Sunday. Glad they've seen sense

+1

+2

MrsP wrote:The PSCA actually contains these statements,

-The PSCA does not replace clinical judgement and the doctor is responsible for all return to play
decisions.

-Clinical suspicion should always overrule a ’normal’ result from any concussion support tool
including all PSCA Tools

Has anyone watched the interview with Prav on the WRU website?

http://supporters.wru.co.uk/matchdaytv/?play=media&id=20198

When asked about the first incident he says,

"...we weren't quite sure whether..."

It sounds to me that he stops himself from saying that they weren't quite sure whether.....George had been KO'D????

If they weren't sure then North should have been removed from the game. There is no need to perform the PSCA to make this decision. Suspected LOC = removed from the game.

Was the independent doctor fully informed of North's condition on the pitch?

What part of nobody in the Welsh Medical Staff knew that George was KO'D don't you understand, if they didn't know why would it be referred to the ID, it was referred to him over the first incident and he carried out the inspection and he deemed him fit to return.

I fully understand that they are saying that nobody knew he was KO'd in the second incident.

I was talking about the first incident.

That was why I said,

"When asked about the first incident he says,..."

IMHO North was KO'd in that FIRST incident and therefore the PSCA should not have been used to allow him to return to the pitch.

MrsP wrote:I fully understand that they are saying that nobody knew he was KO'd in the second incident.

I was talking about the first incident.

That was why I said,

"When asked about the first incident he says,..."

IMHO North was KO'd in that FIRST incident and therefore the PSCA should not have been used to allow him to return to the pitch.

So even though an Independent Doctor has examined him, and verified he is fit to resume, and there were a few on this topic that have said there should be an Independent Doctor, this is still not good enough for you.
You're NOT worth the bother.

'Wales’ national medical manager Prav Mathema defended their actions, saying: “In the first incident, George took a blow to the head from an accidental boot. Following that, we attended to him on the field of play, and we weren’t quite sure as a medical team at that point about his diagnosis. Because of that, we decided to use the head injury assessment protocol, and he went off for 10 minutes for a review. That was deemed negative, so he returned to the field of play.'

Think it's important we take the full quote rather than just insert what we want. I highly doubt professionals would willingly risk the health of a person.

Correct choice both formwise and politically.

No 7&1/2

Have you read what Wilkinson says? What happened to Lamont? Hape? Fritz?

Wayne,

You don't seem to appreciate the difference between suspected concussion and suspected LOC and the bearing that has on how these incidents are supposed to be handled.

Well I believe what they're saying and to be honest we shouldn't be altering or insinuating quotes to mislead.

I don't think I altered what he said when talking about the first incident was,

"...And we weren't quite sure as a medical team at that point whether.....or we weren't quite sure about his diagnosis at that point."

I was suggesting that he may have been about to say that they weren't quite sure if he had been KO'd. He definitely changes his mind about the way he finishes that sentence.

Sorry for the twist away a little from the topic.  Not altogether away from the topic but approaching it from a new angle.

Are players now just quite dumb?

Yes, designed to get a snort of derision from the righteous horde.... but hear me out.

Yes players are bigger, stronger, faster cliche, cliche. cliche.... yap, yap, yap.

We've heard all that stuff - grand - let's bank it.

Yes too the game has moved on in Professional terms with more money coming in, more responsibility with clubs and Nations, more responsibility on players to both live up to their increasing price tags and/or play well enough to have a good enough CV to ask for the big bucks when contract periods are up.

So, the end result is that players have to train harder, work harder, be more honest with themselves and their owners/bosses, keep themselves in the shop window and make hay whilst the sun shines on an all too brief career.

But only a few short weeks ago, Mike McCarthy decided he was going to give an English player a rattle in the Saxons game.  He set him up, he had him mentally pinned even before the player recieved a ball and then out of his traps went a mad hatter McCarthy, full speed directly at the English player.  The impact was so hard that his mind couldn't even think about wrapping his hands legally around the English player.  I believe he fully meant to but his mind was so fully on hitting the guy as absolutely hard as he could (legally) that his mind had already melted on the hit and he had to be taken off.

Dangerous situation too in the concussion department - for BOTH players.  But at the time I hadn't sympathy; I simply called him an absolute idiot because I knew his intention was not simply to stop the English player but to make a bit of a name for himself on the hit.  So I said he was an idiot.  What did he expect to happen when the violence of the impact was a fair few degrees above the necessary? He came off the worst but it might very well have taken two players out of the game - and all to impress a coach.

So I ask is the modern player dumb (yeah I include Mr Repeat offender concussionist O'Driscoll just in case some people think I might have a presumed bias)?

How much do these guys think the call of duty requires from them?  Do they fear not being picked so much that they would put their heads anywhere regardless of personal safety?  Adrenalin is up is the excuse?  Yeah, perhaps; but brains are often down when you look at where exposed vulnerable heads willingly go at top speed.
And I'm increasingly seeing this absolute abandoned, almost crazy, desire to 'impact' head, necks and shoulders with an opponent player at the greatest force possible - and much of it encouraged by increasingly demanding coaches.

Are players dumb to accept from coaches that overdone physicality (the version that's not required to recover a ball or stop an attacker) is okay, that they'll be fine, that they have the conditioning to keep doing it?  Are the players dumb enough to believe ambitious coaches, with no medical training, when they declare that ever increasing impacts between ever larger men is "okay", "it's fine", "everyone else is doing it", "it's what's done", "it's fine", "you're conditioned to be able to withstand it", "just do it", "you don't and I have others who will"?

You do it Gats!  You do it Schmidt!  You do it Lancaster!  Let's see how okay it is on your heads and necks and shoulders for a few seasons.

Gwlad, it’s the” I Can’t believe that a person that has the intelligence to push down that many keys in the right order to make a sentence could be so thick” look.

I wonder if Roberts re-read his Hippocratic oath before making that statement.

Miners used to go down the pit everyday knowing that it was likely to bring an early death, it was their choice as well. Funny how things like family and need to earn a living can affect personal choice. Coming from Wales, I thought that might have crossed your mind.

Claiming that the IRB to do anything sensible and are capable of administering a case like this is like saying Sepp Blatter is as honest as the day is long and FIFA are a capable of managing football fairly and dispassionately.

Too much talk about the first incident and very little about how they could not have seen the second and more important incident which everyone is shouting about. North was clearly in gaga land for a least a short time and most of the rugby playing world saw it.
It would be interesting something like a H&SE report on the incident and the lack of care shown to a workman in the workplace. Companies have been fined big money for such lack of care and it is a professional game now, so it applies to every player

wayne wrote:

MrsP wrote:

BamBam wrote:North isn't playing on Sunday. Glad they've seen sense

+1

+2

However, it has been stated by the Welsh 'team' that his lay-off wasn't because he had his jaw knocked off its hinges on Fiday, it's because he was 'concussed in November' and they want to give him an extended rest.

What a load of rubbish. They havent selected him because he IS concussed and the ridiculous platitude about last November's injury is just a retrospective attempt to redeem the Welsh management in the eyes of the rugby world.

It probably wont work.

There should be an enquiry into the health and saftey policy of the WRU. This government is good at setting up enquiries, keeping their mates in highly paid jobs at the tax payers expence.

Seriously, this is not or should not be allowed to go away. Someone HAS to be accountable for what is becoming a fiasco. we can play him in a game, put him back out after he had his head kicked in; even though we were not sure about his fitness to return, we can ignore him collapsing in a heap after another bad head contact, but we can't play him on Saturday because he was concussed in NOVEMBER !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

MrsP wrote:I don't think I altered what he said when talking about the first incident was,

"...And we weren't quite sure as a medical team at that point whether.....or we weren't quite sure about his diagnosis at that point."

I was suggesting that he may have been about to say that they weren't quite sure if he had been KO'd. He definitely changes his mind about the way he finishes that sentence.

So you not only know he was KOd or concussed in the first incident contrary to what the Welsh Medical Team and the Independent Doctor have evaluated, and you also have Medical experience that you can read peoples mind.
Beyond Belief
Fly in the later post, yes I entirely agree with you, I can remember a hit Dale McIntosh had on Andy Robinson for Pontypridd against Bath in the HC, it was shown repeatedly for years and people wanted to see more and more of it.
You want to see JPR Williams walk from the Princess of Wales Hospital in Bridgend into town, it is a sight to behold and NOT in a good sense, all because of the force he went into tackles and how he was tackled when in possession.

SecretFly

I think you have two issues intertwined there:

1) Personal ambition - a common thing nothing unique there, stupidity as much as anything else demonstrated.

2) The big one: Rugby is a violent sport where we pit two warbands against eachother. There is a particular psychology associated with small groups in violent situations them vs us - you commit to the group and do things for the group you probably wouldn't left to yourself alone. The first George North incident (boot to the head) is exactly the sort of thing I'm talking about: A good man, the group, and a physical contact sport caused that incident.

It is why I think we DO need to protect the players from themselves at that point: The game is after all an artificial construct, not real warfare and we encourage and applaud the taking of risk for the team. When concussion ensues the player will want to continue for the sake of the team but is not making rational decisions largely because of the attitude of sacrificing yourself for the group that rugby encourages.

The consequences, too, are devastating.

No Wayne.

I believe he was KO'd the first time and therefore should have not been assessed by the Independent Medic with a view to returning to the pitch. I think there is enough evidence in the footage available for at least a "Suspected LOC" label to be attached to the incident ie. laying motionless face down on the pitch after a significant blow to the head.

The WRU medical team seem insure about what they were unsure about! I was suggesting a possible target for their uncertainty.

Yes, Cowshot - but the two issues are intertwined though.  

One game, differing driving points - from individual player ambitions to increasingly combatitive and physically demanding strategies from ambitious coaching teams.

In Ireland the last few years we had a running joke about Zebo (a player who loves a more mobile evasive game - a natural concussion avoider in a sense )  But the poor guy wasn't getting picked by Joe, (despite the pizazz characteristics) and we all had a lot of fun deducing why.

One possible cause was that he ignored Joe in a carpark (not a joke - a probable reality based story, we just never found out how true)
Another was because he failed to mentally turn up for a USA tour a few years back when he was waiting for a Lions call-up
And the reason that got most gametime amongst us fans was 'Ruck resourcing'.  Zebo wasn't being picked because he wasn't being honest enough in lending his head and neck to the cleaning out processes, he was considered to be evading the 'concussion' duties.

I just think more and more coaching isn't looking for personal fire from players, it's actually fine-tuning where players are expected to go and at what force they use, and when.

I know the heat of battle is a drug in itself and if you're a player then you are driven in the desire to bring about the victory with your team-mates - but more and more, the impact stuff is becoming training field directed and encouraged.  The constant worry/implied threat seems to be that if you don't do your hard hitting duty then there's a player there who will.

Jimpy wrote:

wayne wrote:

MrsP wrote:

BamBam wrote:North isn't playing on Sunday. Glad they've seen sense

+1

+2

However, it has been stated by the Welsh 'team' that his lay-off wasn't because he had his jaw knocked off its hinges on Fiday, it's because he was 'concussed in November' and they want to give him an extended rest.

What a load of rubbish. They havent selected him because he IS concussed and the ridiculous platitude about last November's injury is just a retrospective attempt to redeem the Welsh management in the eyes of the rugby world.

It probably wont work.

The lay offs come to prevent repeated concussions during a short period. That is whats truely dangerous.
he may have been sparked right out this weekend twice but actually not have suffered any significant concussion as a result of the impact. But combined with the previous incident even though he appears to be perfectly fit now is deemed too much of a risk to take another head blow in a short period.

The approach is based on scientific rigour and the latest understanding of how cumulative blows to the head present increasing risks.

The assumption that being knocked has a direct correlation to concussion and its severity is incorrect.



That said its pretty obvious someone with the authority to pull him off, be that doctors, coaches or the player himself must have known he had gone clean out twice and looked shaken when he returned the second time. It does beggar belief that he continued the game even if he wasn't actually concussed or presenting any symptoms.

If we wheel this back a year before Hape and others came out as punch drunk then the tests used and return to play protocols were even weaker than they are now. Give some credit, World Rugby are moving in the right direction with this and have some of the strongest regulations you'll find in any sport in this area.

And erring on the side of caution. Suspected loss of consciousness then they should be removed from play, completely, not for field-side assessment.

I agree with your last line fly. What makes that worse is that the current ruck clearing seems to have moved away from the laws, which require you to bind onto your teammate who is already there. Nowhere in the laws does it say run as fast as you can and dive into a stationary bloke who won't even be braced for impact.

Not entirely related to concussion, but it is seriously dangerous and that combined with the 'necklock and judo throw' which is also prevalent should be looked at by the authorities I think.

Bathman_in_London wrote:I agree with your last line fly. What makes that worse is that the current ruck clearing seems to have moved away from the laws, which require you to bind onto your teammate who is already there. Nowhere in the laws does it say run as fast as you can and dive into a stationary bloke who won't even be braced for impact.

Not entirely related to concussion, but it is seriously dangerous and that combined with the 'necklock and judo throw' which is also prevalent should be looked at by the authorities I think.

What struck me looking at the video of England's 2nd try after reading LT's excellent analysis was Burrell taking out Warburton who was attempting a jackel. Burrell basically just dived over the tackled player and smashed Warburton. It did mean the ball was clean and available, but it didnt look right somehow.

The necklock stuff was picked up by a ref in a game the other day (can't remember which one, possibly the England v Wales U20). Someone cleared out with a neckroll and got penalised. Not sure if it's the next thing to be focused on or not.

Oh and I thought that if concussion was confirmed you had a minimum of 2 weeks off. When did that change? [Regarding Lee being confirmed concussed but being considered if he meets the Return to Play requirements]

Agree they are intertwined, just wanted to make clear they are actually different things cos it makes it easier when talking about them. I'm concerned that the personal ambition element will affect England players in the Italy game with players looking to lay claim to the shirt and overdoing it.

Regarding coaches training for it. Um. Not sure you've provided convincing evidence so far. The wingers and OCs getting involved in the ruck has sensible game reasons that account for it (wasn't old BOD something of a pioneer in this regard?) and a player who wasn't doing his bit at that point is making it easy to drop him. The coaches might be considering the psychological effect on the group as well, if one player is seen as not doing the things he should.

But it is something that bears watching. Rugby is a great sport. I don't want to see it emasculated, but I don't want to see it turned into Rollerball either.

MrsP wrote:No Wayne.

I believe he was KO'd the first time and therefore should have not been assessed by the Independent Medic with a view to returning to the pitch. I think there is enough evidence in the footage available for at least a "Suspected LOC" label to be attached to the incident ie. laying motionless face down on the pitch after a significant blow to the head.

The WRU medical team seem insure about what they were unsure about! I was suggesting a possible target for their uncertainty.

And like I said we should be going by what they actually said instead of trying to put words in their mouths.

No 7&1/2 wrote:

MrsP wrote:No Wayne.

I believe he was KO'd the first time and therefore should have not been assessed by the Independent Medic with a view to returning to the pitch. I think there is enough evidence in the footage available for at least a "Suspected LOC" label to be attached to the incident ie. laying motionless face down on the pitch after a significant blow to the head.

The WRU medical team seem insure about what they were unsure about! I was suggesting a possible target for their uncertainty.

And like I said we should be going by what they actually said instead of trying to put words in their mouths.

Nah seven and a half, didn't you know he's a mind reader

HammerofThunor wrote:Oh and I thought that if concussion was confirmed you had a minimum of 2 weeks off. When did that change? [Regarding Lee being confirmed concussed but being considered if he meets the Return to Play requirements]

That changed quite at least 3 years ago Thunor.

Now they gradually increase activity in you remain symptom free for 24 hours after the increase.
So, rest for 24 hours, if no symptoms you are allowed to exercise gently. If you have no symptoms 24 hours after that you can increase again and so on until you are back playing in 7 days!

I should point out that this is only at Elite level and it must be supervised by a doctor.

At lower levels it is still 3 weeks I think.

I don't think I am alone in thinking it is far too short especially when it relies on the player reporting symptoms.

No 7&1/2 wrote:

Gwlad wrote:

MrsP wrote:

Gwlad wrote:

MrsP wrote:It is a bit difficult to accept that the only people in the country who did not see it are in the employ of the WRU.

The English player closest to the incident knew North was in trouble as he can be seen stopping to check on him.

So they must be lying right?

Jeebus you have blown this trumpet endlessly. The WRU and IRB are happy with what happened, so are the players, so is George.

What exactly do you want to happen regarding this incident and future ones?

Should the game come to a stop after every tackle to check everyone is ok?

Have you ever played the game yourself?

Not at all sure what this has to do with anything but, yes I have!

And nowhere have I suggested the measures you mention.

But the IRB being happy with the situation is not really very reassuring, is it?

Yes it is, it means the rules are being followed.

Over cautious people would ruin this game entirely if the health and Safety czars are allowed anywhere near it we will end up playing touch rugby.

North is fine, he says he is fine, the WRU say he is fine

Fine, he might be dribbling over his porridge in his 50s but, THAT IS HIS CHOICE.

If we TMO collisions the game is as good as dead

The rules weren't followed in the second instance. The TMO/video proposed use would be to see if there were clashes of heads. The second one was missed by everyone but Watson (?) but was clear on replays. The fact that you don't give a flying fig about player safety says a lot about you.

Oh dear, are you trying to give me forum guilt, to cast aspersions on my character because I don't think we should TMO collisions. That way lies the end of this game and if you are so naive you cannot see that then it says even more about you. The typical polarization of the argument by people like you who would destroy the game with their over zealous attitude to a contact sport sickens me.

Anyone playing the game isa fool if you believe that there is no effect later in life from playing rugby, you hit your head there are consequences and anyone who takes part knows that. We are all adults and we make those personal choices. That is life, otherwise stay in bed.

But that does not mean i would have the game policed this way which is what it will become. If we TMO the knocks then we introduce organizational liability and a litigious concept that the game as it stands can't possibly live with. Don't you get that?

George North was returned to play despite having had a huge knock to the head because he is considered one of Gatland's key players.

I believe it has little to do with a medical assessment or otherwise. The fact that he got a second knock and stayed on reinforces my belief I think.

MrsP wrote:

BamBam wrote:North isn't playing on Sunday. Glad they've seen sense

+1

(1) How much of this is down to the injury that North suffered?

(2) How much of the decision is down to pressure from the media?

I am Glad that North is not playing this week. And i do wish him well.

majesticimperialman wrote:

MrsP wrote:

BamBam wrote:North isn't playing on Sunday. Glad they've seen sense

+1

(1) How much of this is down to the injury that North suffered?

(2) How much of the decision is down to pressure from the media?

I am Glad that North is not playing this week. And i do wish him well.

It is down to liability. Now that the media and people like those on this forum have appointed themselves expert in deciding who should play and when, coaches now have to second guess selections to prevent being blamed if George gets hit in his head playing rugby. its a farce.

Do you understand that people have died from concussion? Especially the second hit concussions?

I for one am perfectly happy with coaches "having to second guess selections to prevent being blamed" if it means a 22 year old doesn't die because of a rugby match

BamBam wrote:Do you understand that people have died from concussion? Especially the second hit concussions?

I for one am perfectly happy with coaches "having to second guess selections to prevent being blamed" if it means a 22 year old doesn't die because of a rugby match

Utter farce.

Deleted

I find it difficult to listen to advice on head injury in rugby from someone who was saying a few pages ago that North was not KO'd in the second incident because he put his arm out.

I am very glad that North is to be rested. I am not sure the route they took to that decision was appropriate but the correct decision has been made. One out of three is not a very good strike right for correct management of head injury but ...

Bambam,

It is possible that your experiment has already been conducted?