World Cup - Does health matter?

Every four years we get a short window of International rugby that is the most intense our sport ever sees. We call it the Rugby World Cup. This is the pinnacle of our game, and players and coaching staff want to achieve the most they can. Players will try to deny injuries, knowing this stage may never beckon again. Coaches will be tempted to send their lads back out again when they are most needed.

Trouble is though can the short term gain of success in this competition ever outweigh a players long term health?

The retirement of Jonathan Thomas (http://www.bbc.co.uk/sport/0/rugby-union/34240574) should perhaps serve as a salutary lesson.

He was diagnosed with epilepsy last year which is thought to be from multiple head traumas and has led to a degree of brain injury.
"I've done everything in my power to keep playing," Thomas said.
"However, there comes a point when you realise you need to listen to medical experts and also do what's best for your wellbeing.

Effectively that seems to be saying that playing rugby has caused epilepsy and brain damage. It also suggests to me that for a while Thomas was not listening to the medical experts.

We need the team medics and physios to be looking out for the interests of the player. However in sport there is pressure on them to ignore that and concentrate on the interests of the club. Most recently we have seen it in Football with Chelsea's "Speshul One" effectively sacking the club Doctor and Physio. Rugby is unable to claim any moral high ground however. In the spring millions of people on TV could see George North had an issue - yet the medics did nothing. Rory Lamont was in the press when he retired castigating the SRU medical teams for their behaviour in permitting injured players to continue playing. We can add Shontayne Hape and many more to the list of people that have revealed major issues in the treatment of head injuries.

The build up in the UK has now started in earnest to the RWC, and overall this will be the most watched Rugby Tournament ever. Can we rely on the medics to do their job, or in fact be permitted to do their job?

I guess that just like in any highly competitive aspect of life the rules may be bent or broken to suit the aim of achieving success.
At least protocols are now in place so that incidents such as Florian Fritz being allowed to return to the field in a Top 14 quarter final in 2014 ( when he clearly was heavily concussed ) should no longer occur.
Player welfare is now a more prevalent issue but you are right to point out that it may still not be of paramount importance to the coaching staff of all the teams at the world cup.

http://www.medscape.com/viewarticle/553964_4

just an article i've been reading on after seeing your post. From a layman's perspective it does suggest that the evidence (as per 2006) is at best sketchy.

Although evidence does exist that head injury can cause epilepsy, this association only holds true for severe traumas. There is no consistent report of increased risk of subsequent epilepsy from a typical mild head injury in the general population. Typical sports-related head injuries are so mild that they are extremely unlikely to be associated with epilepsy.

here is another one from 2004

http://www.medscape.com/viewarticle/553964_5

The majority of sports are safe for epileptics to participate in with special attention to adequate seizure control, close monitoring of medications, and preparation of family, coaches, or trainers. Contact sports including football, hockey, and soccer have not been shown to induce seizures, and epileptics should not be precluded from participation.

again easy for me to miss something as I'm not a medical expert, these could have been heavily criticised and genuine links to have been discovered since. Haven't found any yet though.

Not to say there isn't a link between rugby and brain injuries.

http://www.worldrugby.org/news/81734

I think the way to go is for world rugby to have independent doctors on site to decide on players welfare... not team doctors at least.

Good question. I think the RFU and IRB are acutely aware that they will be under scrutiny and will be keen to ensure that things are done properly.

They've already made a big statement of intent with the announcement that video replays will be available to the medical staff as well as the refs - which presumably will be accompanied by a directive to get players off immediately if they see anything untoward.

In terms of rugby more widely, it seems clear to me that there are some big differences in how different teams handle things. We saw that in the difference between how England handled Brown's concussion and Wales handled North's.

Neither was perfect (should Brown really have played against France?) but England and Quins' handling of Brown was good once they realised it wasn't clearing up.

It was also interesting to watch how Quins handled their other England players - Robshaw was assessed for a stinger late in 2014 and was rested for a month to recover. Marler returned from the 6N with a shoulder injury and had an operation immediately so as to be rehabbed for the RWC. (Plus they somehow keep Nick Easter functioning, which I suspect involves either treatment regime used by Mr Burns in the Simpsons or a magic portrait that is now seriously decrepit.)

I'm not close enough to other clubs to know how they are handling player welfare, but it looks to me as if at least some of them are doing the best they can given the attritional nature of the sport.

The medics MUST be allowed to do their jobs- I imagine the pressure they would be under from GMC would trump any employer pressure anyway, gmc can stop you ever working again.

For the organisers and nations, looking at the payouts in the NFL at the moment, I imagine they will be cautious.

I don't know what to say other than to say that a few players are at the point that if a certain incident happens again, they really have to start questioning the wisdom of continuing in their professions altogether.

So it's a time for massive collisions and brutal breakdown work. Players will have bluffed to an extent up to now but this is the real deal and adrenalin won't hold them back now. I hope players come out okay.... but the clock truly is ticking loudly for a few of them.

I believe Refs will be strict - I believe they'll be told to be strict. I don't believe we'll now see obviously out-cold concussed players being allowed back onto the field. The eyes of the world will be on the sport and I believe they'll be sensitive to the natural concerns of a watching public.

You've got to promote the view that coaches and medics have a responsibility to their players that doesn't just span their careers, but also for the rest of their lives after they retire. I mean, its a culture shift thats needed. You've heard that line that "Footballers spend the whole game pretending they're hurt, rugby players spend the whole game pretending they're not' or variations on it and, you know... there is a very serious limit on how healthy that really is. There is a tipping point where playing through the pain is seriously counter-productive and unhealthy, and dangerous, and no amount of machismo can deflect from that. The onus has to be on the management to protect players from themselves and allow medics to do their job with zero interference.

LondonTiger wrote:Trouble is though can the short term gain of success in this competition ever outweigh a players long term health?

The answer to your question, for me, is no. Players long-term welfare being looked after is more important than winning games. Even games that mean a lot to a lot of people. The people who will be celebrating the World Cup win don't have to live with any medical consequences incurred by the players.

As a former competitor, I understand the desire to push through the pain barrier even at cost from your own body.
These days, there is so much more focus on player safety and wellbeing which is a massive massive improvement on days gone by.
As Notch said above, excellently I may add, the medical staff have a lot more responsibility for players and I feel its one they take very seriously.
On a side note, massive congrats to Nigel Own during the England Ireland match for firstly stopping the game and secondly telling the medics that Murray was out and asking for the concussion ruling. Excellent from him.

We all know the risks, are adults and make choices.

JT carried on for year with epilepsy ffs. These guys sit down with consultants after a knock and get told the potential of complications.

Fact is most want to play because they want to eat.

http://www.bbc.co.uk/news/uk-scotland-34249189