Concussion, early onset dementia and CTE

by king_carlos Tue 08 Dec 2020, 2:43 pm

First topic message reminder :

https://www.theguardian.com/sport/2020/dec/08/steve-thompson-former-rugby-union-players-dementia-landmark-legal-case?CMP=Share_AndroidApp_Other

That first link is an article in the Guardian about a potential legal case being brought against World Rugby, the RFU and WRU by 8 former players (all under the age of 45) with early onset dementia brought on by probable CTE. The players named publicly thus far are Steve Thompson, Michael Lipman and Alix Popham.

https://www.theguardian.com/sport/2020/dec/08/steve-thompson-interview-world-cup-rugby-union-dementia-special-report

That second link is a Guardian interview with Thompson, who's only 42, about his experiences with early onset dementia. Somber reading.

by No 7&1/2 Wed 30 Nov 2022, 2:16 pm

Got this from the BBC and sadly it's pretty much as I expected. The confirmation that White should have been removed immediately and permanently and the explanation that the medics didn't see the actual incident. As far as that goes yup get it, not everything will be seen. But it does not included any mention to the refs role here. Doesn't mention that he's told the medic / team official (?) who took White off that he was unstable and absolves him from any responsibility that he himself allowed White to come back on. Not good enough.

'World Rugby has said that Australia scrum-half Nic White should have been permanently withdrawn during the Wallabies' game with Ireland in Dublin.

White was brought back onto the field after he suffered two impacts to the head in quick succession during the game at Aviva Stadium on 19 November.

He went off, underwent a head injury assessment (HIA) and returned to the field and finished the game.

An independent review concluded the second impact had not been seen.

As a result, it was not reviewed by doctors while they were performing the HIA assessment but had they seen it, he would have been permanently withdrawn from the game.

Former Exeter player White, 32, was not in the Wallabies' matchday squad for their 39-34 win over Wales at Principality Stadium on Saturday, having been stood down for 12 days.

Ireland hold off Wallabies for 13-10 win
World Rugby said in a statement that the independent review indicated that it was "defensible for the medical team to remove White for an HIA after the first incident but the second incident resulted in Criteria 1 signs according to the World Rugby HIA process, which should have resulted in White's permanent removal from the field".

"Both the independent matchday doctor and team doctor were in the process of reviewing video footage for the first incident when the second occurred.

"The second incident was not communicated to either doctor and therefore, in performing White's HIA did not review any additional footage.

"Having been made aware of the second incident after the game, both doctors reviewed the footage and declared a Criteria 1 diagnosis.

"Discrepancies around process and communication, rather than interpretation of player signs, were therefore the key factors to affect this particular HIA process."'

by doctor_grey Wed 30 Nov 2022, 5:51 pm

Yeah, agree, kind of as expected. No harm, no foul, no punishment.
The blydi TMO chimes in about everything, but couldn't mention a player was on the pitch and was a danger to himself? The assistant refs? The player's ruddy teammates ffs.

by sensisball Wed 30 Nov 2022, 6:58 pm

Interesting HIA incident in last week's Toulouse, Lyon game. 19 year old replacement centre took a thigh to the face getting his tackle placement wrong
Went off for HIA looking really groggy. Commentator thought his game was over but he reappeared on to the pitch 10 minutes later still looking dazed.
At this point the match doctor was seen to be gesturing in animated fashion and shouting at the 4th official.
The player duly came off after only 2 or 3 minutes.
Not really sure what happened. Maybe miscommunication between the doc and Toulouse coaches?

by **Rugby Fan** Fri 16 Dec 2022, 12:00 am

NHL has just had an incident dividing fans. It seems this hit wasn't penalized:

https://twitter.com/SpokedZ/status/1603188906148728832

Some fans are arguing the player with the puck wasn't looking where he was going. Here's one reply to that line:

Floored by how many "perfect clean hit" replies are in here already

I know some people are desperate to protect a prior era of hockey but Reaves drives straight through Hronek's face here, if you can't admit that this isn't safe then you're watching for blood lust, not the game

https://twitter.com/JeffVeillette/status/1603191604529221633

by doctor_grey Sat 17 Dec 2022, 1:43 pm

If anyone thinks Rugby was tough in the past, the NHL makes Rugby look like handbags at a nunnery. The damn thing is Ice Hockey is such a great sport when played tough and played fast. The acceptance of violence is part of it's past. And always had a longer and harder road to navigate.

The vid you shared should clearly have been a major penalty. The NHL needs to get that out of its system once and for all.

by No 7&1/2 Mon 19 Dec 2022, 5:49 pm

“At the same time, because I’d had a similar thing before and he explained to me that your vestibular system is to do with your eyes, your eyes and the back of your neck – it’s not to do with brain damage … to be honest I was more worried about what it means for the future because you hear a lot of stories but I spoke to the specialist again and said: ‘What does it mean for the future?’ and he reassured me and said it can increase your chances but not by much.

“Generally it’s your genetics which will determine if you get things like dementia and stuff like how much you’re drinking, other recreational things, and how healthy you keep yourself in later life.

“Because I’m pretty good on that stuff anyway that reassured me.”

Slightly odd quotes from Lawes.

by Irish Londoner Tue 20 Dec 2022, 9:45 am

doctor_grey wrote:If anyone thinks Rugby was tough in the past, the NHL makes Rugby look like handbags at a nunnery. The damn thing is Ice Hockey is such a great sport when played tough and played fast. The acceptance of violence is part of it's past. And always had a longer and harder road to navigate.

The vid you shared should clearly have been a major penalty. The NHL needs to get that out of its system once and for all.

Old Finnish joke "I went to a fight and an ice hockey game started".

by dummy_half Tue 20 Dec 2022, 10:25 am

Irish Londoner wrote:
doctor_grey wrote:If anyone thinks Rugby was tough in the past, the NHL makes Rugby look like handbags at a nunnery. The damn thing is Ice Hockey is such a great sport when played tough and played fast. The acceptance of violence is part of it's past. And always had a longer and harder road to navigate.

The vid you shared should clearly have been a major penalty. The NHL needs to get that out of its system once and for all.

Old Finnish joke "I went to a fight and an ice hockey game started".

I'd heard it as a Canadian joke, but certainly a couple of decades ago there was more than a grain of truth in it. While the fighting has been (largely) cleaned up, there are still some huge hits, and players driven head-first into the boards. And that's the thing the crowd wants to see, like the big tackle in rugby, so it's difficult for the game' sadministrators to get on top of the problematic phases of play.

by doctor_grey Sat 07 Jan 2023, 11:52 am

Didn't want to create a new thread for this, but an NFL player for Buffalo suffered a heart attack during their game in Cincinnati on Monday night. Received CPR on the pitch, was taken to hospital where he was treated, put into a medically induced coma, then was slowly brought out with the proper treatment during the week. Just came off the ventilator yesterday. Will never play again.

https://www.nj.com/eagles/2023/01/bills-damar-hamlin-takes-next-remarkable-step-in-recovery-from-cardiac-arrest.html

This can happen to anyone, even NFL players who are monitored medically on a regular basis. It was also not contact related, as best we know now. And can happen across sport.

With Rugby, this happened at one of my club's games in October 2021. A player on the other team (Montclair) kicked the ball away and simpy collapsed with a heart attack. He lived only because my club has a lot of First Responders, Emergency Medical techs, Nurses, and a few docs, many of whom were at the game and are damn good at what they do. My job was to stay out of the way and handle the communications to/from the pitch, the ambulance, and local hospital. Despite St. Claires Hospital being only 1/4 mile away, the player couldn't be moved for almost 30 minutes. Heart stopped twice on the pitch, plus again in the OR.

https://www.dailyrecord.com/story/news/local/how-we-live/2021/10/27/morris-rugby-players-save-tevita-bryce-montclair-totowa/8556740002/

Such a shame.

by lostinwales Sat 07 Jan 2023, 12:27 pm

I don't know the full circumstances, and it was a long time ago (over 20 years? ) but a guy I played school rugby with died on a football pitch at age 30ish. It does happen.

by doctor_grey Sat 07 Jan 2023, 12:44 pm

Yeah, it's rare. It can hapen in sport. Especially, in my opinion, fast paced, stop start kinds of sports.

In both cases, my game and the NFL game, no one wanted to continue playing. I thnk it must be extremely difficult for people, whether players, staff, fans, whomever, to stand by helplessly, unable to assist, but just watching events unfold. And knowing the person being attended as a friend or teammate, or in our case the friendly opposition.

by **Rugby Fan** Sun 08 Jan 2023, 5:01 am

There's an interesting post by a man who became a sports reporter after one of his friends died on the track after a race.

https://davidepstein.substack.com/p/sudden-cardiac-death-in-athletes

Even with the knowledge we have, screening is hard. He does recommend people learn more about their family medical history.

by **BigGee** Sun 08 Jan 2023, 7:45 am

Slightly off topic but i remember Craig Chalmers, the retired Scotland FH, telling how his father collapsed and died whilst watching him play for Melrose.

That game was not stopped, and he played on, aware that something was going on, but not knowing the specifics.

I don't think that would have happened now and quite rightly. I imagine that would have been a pretty traumatic event for CC and everyone else playing that day.

Matches these days often get stopped even for an event in the crowd. In the past, when there may have been less medical cover at grounds and probably more docs playing rugby, players have gone jnto the crowd to help. I am oretty sure Rob Wainright did it once, even whilst playing professionally.

by doctor_grey Sun 08 Jan 2023, 12:23 pm

I think as more information and better technology is available, more people should be looking into family health history. Just kind of makes sense, especially for anyone involved with some physical activity (which should be all of us, ya know?). Knowing risk factors, if any, can be important. There is only so much which can be scanned or tested for.

That is a great point about docs playing Rugby. I think with the work needed to complete med school, residency, specialisation, and so on, makes it almost impossible for a doc to have time to stay in shape as well as playAnd work, of course. Some docs, especially surgeons, make the risk-reward decision as our hands and health are our livelihood.

by Unclear Mon 13 Feb 2023, 6:00 pm

Am I the only person who finds it ridiculous/dangerous/unsafe/choose your adjective that both Rob Herring and George North played on after significant head injuries at he weekend? The tackles were both sufficient to warrant sanction for contact with the head (let's not get into the rights and wrongs of the colours of the cards) after a reasonable number of minutes deliberations by the officials on the pitch. But this appeared insufficient for the medical staff (independent I think?) to say they should come off for an HIA.

Both players remained on the pitch as play resumed, only to be removed a couple of phases later. Surely there was enough evidence to warrant further investigation and this was visible to all as the discussions on foul play worked their way to a conclusion.

Herring was unable to play on, but North returned despite the confident assertion by one of the pundits (Barclay I think) that he couldn't as he had appeared to have lost consciousness briefly. As far as I could see this appeared correct and I rationalised this from the tackler's immediate response to raise his arm to signal a problem.

With such great focus on head impacts and player safety to me these incidents seem almost wilfully reckless on the part of the respective unions.

by Poorfour Mon 13 Feb 2023, 8:09 pm

It's very disturbing, especially for North who has had repeated issues with concussion. Wales have form in this area and it would be good to see WR take some action to make sure they are applying the HIA protocol effectively.

On a related note, I've bought Ms Poorfour Maj one of the N-Pro scrum caps that actually can reduce the risk of concussion, and I am now trying to work out which pro players are wearing them. Obviously the brand name is usually covered up but they have quite a distinctive piping pattern if you know what to look for, and the real giveaway is that they have a silver World Rugby Trial hologram on the rear that players don't have to cover up.

So far the only player I've seen who is definitely wearing one is Ireland's James Ryan (who has IIRC had concussion issues of his own). I hope to see a lot more of them as time goes on.

by TAFKA The Oracle Mon 13 Feb 2023, 9:06 pm

Not sure about North. Remember him lying there but it would be a stretch for anyone watching the game on TV to say he was definitely unconscious rather than just lying there thinking ‘you f*cker! Caught me with a swinging arm!’ Could have been milking it a bit to make sure the ref gave a card, a la Liam Williams, Sexton, et al who have been involved in some dubious comedy over acting after taking hits recently. But yes, if he was knocked out then heads should roll.

On another note, I really can’t see how the N-Pro scrum cap can reduce concussions compared to others? My understanding is that brain injuries such as concussion are caused by the brain ‘sloshing’ in the skull when there is impact. I.e. the brain has momentum and when the head snaps back or is stopped forcefully or immediately then the brain keeps going with momentum. Or something like that. Scrum caps might be good to stop soft tissue injuries, but concussion? What’s in the N-Pro on that is markedly different from others, concussion-wise?

I remember reading research in journals many years back when studying sport science that suggested the wearing of head gear across a number of sports, including rugby, actually increased injuries as players were more likely to put their head in harms way, lead with the head more, etc. as they felt more protected. I mean, look at the concussion rates in NFL and they’re wearing full on crash helmets! So I’m not sure a scrum cap will do much.

by mikey_dragon Mon 13 Feb 2023, 9:34 pm

How does a scrum cap reduce the risk of concussion?

by TAFKA The Oracle Mon 13 Feb 2023, 9:54 pm

mikey_dragon wrote:How does a scrum cap reduce the risk of concussion?

Exactly. Can’t see it myself.

by doctor_grey Mon 13 Feb 2023, 11:35 pm

It's very unfortunate that many discussions about head trauma lead back to George North, who in my mind should not be playing. In Rugby today, if a player appears to have had direct impact to the head, a whiplash reaction to a tackle, or head hit the ground, and they stay down a moment or two longer than normal, then they should, and are supposed to, come off for the HIA. It's better to come off for a few minutes and be negative than the opposite.

Concussion or head trauma is due to movement of, or damage to, the brain. The sloshing around. But it can also happen if there is direct impact to the skull, bruising forms, and causes significant pressure inside the skull. Both are bad, but bruising and pressure can take time to fully develop which can lead, in some cases, to a person feeling fine quickly, then having real symptoms develop later that day, or in some cases, days late (not the only reason for delayed symptoms).

I could be wrong, but I don't think many Rugby player these days really believe a scrum cap does anything more than helping the ears stay attached, but it certainly used to be different. At least, in Rugby it is illegal to lead with the head and we certainly don't see that very much regardless. Most cases I see are due to a shoulder charge or forearm to the chin.

I think the NFL problem with players feeling invincible leading with their helmets is going away, but absolutely not gone. Helmets today are form fitted to each player and there are choices of padding/filler material, all of which have to be approved by the league. And the teaching of better tackle techniques is changing. And that to a significant degree has its genesis in Rugby: Head to the side, cheek to cheek. Pete Carroll with the Seattle Seahawks started showing All Blacks tackling videos as part of pre-season training then throughout the season. And this was practiced over and over. Now it is normal.

by Poorfour Tue 14 Feb 2023, 11:12 am

TAFKA The Oracle wrote:
On another note, I really can’t see how the N-Pro scrum cap can reduce concussions compared to others? My understanding is that brain injuries such as concussion are caused by the brain ‘sloshing’ in the skull when there is impact. I.e. the brain has momentum and when the head snaps back or is stopped forcefully or immediately then the brain keeps going with momentum. Or something like that. Scrum caps might be good to stop soft tissue injuries, but concussion? What’s in the N-Pro on that is markedly different from others, concussion-wise?

I remember reading research in journals many years back when studying sport science that suggested the wearing of head gear across a number of sports, including rugby, actually increased injuries as players were more likely to put their head in harms way, lead with the head more, etc. as they felt more protected. I mean, look at the concussion rates in NFL and they’re wearing full on crash helmets! So I’m not sure a scrum cap will do much.

To tackle the second point first, NFL and rugby have different problems. In the NFL, helmets were effective at preventing concussions for a while but then for a long time players were taught to use the head in tackling and it was only after the concussion issues blew up that they outlawed it - the Seattle Seahawks even hired Martin Johnson for a time to teach their players how to tackle more like rugby players.

In rugby, the opposite was true. World Rugby explicitly banned any headguard that - with the technology at the time - was able to reduce the forces on the head in contact to a level where it would make any meaningful difference to the risk of concussion. The logic was that at the time the only way to reduce the impact effectively was to have a hard shell, so for the past 20 years or so the only permissible head guards have indded only been good for reducing scrapes and cauliflower ears.

N-Pro came up with a headguard around 5-6 years ago that is still soft but uses layers of hi-tech material that actually can significantly reduce the acceleration that the head undergoes. As far as I can tell, it behaves like a non-Newtonian fluid - it's initially soft and compressible but becomes less compressible the more pressure it's under, effectively braking the impact.

They had the evidence to show that it reduced the forces on heads, but because that was the metric that WR used to determine the legality of headguards, it was still illegal. They have now agreed a trial under which the headguard is allowed. You can read about it on their site, though for some reason all the videos seem to be locked: N-Pro

The NCBI tested the N-Pro and 5 other headgear examples by simulating head impacts and - NCBI study. The N-Pro offered a significant reduction compared to traditional headgear, though all the headgear did better than "no headgear" and the Gamebreaker Pro looks to be even better (and is cheaper - but is not yet approved for a trial). There were limitations - rear impact protection was limited, they didn't fully test rotational impacts and the benefit was reduced as impact height increased - but at the same time the test was dropping a sensor-packed head onto a hard surface so the real world impact may be different given players will generally be hitting softer surfaces.

tl;dr: yes, a headguard can reduce the risk of concussion, and newer headguards can do significantly better than older ones.

by TAFKA The Oracle Tue 14 Feb 2023, 12:40 pm

OK, sounds promising Poorfour. Hopefully will make some difference. I think the biggest difference that can be made is to stop a player's head from suddenly coming to a stop or snapping back from force, which I guess is why the talk of lowering the tackle height. But then that might just be transferring the risk to the tackler. Tackling low would increase the chance of hips and knees and thighs causing concussion to the tackle. It's a very difficult area of the game to govern.

by Poorfour Tue 14 Feb 2023, 1:18 pm

TAFKA The Oracle wrote:OK, sounds promising Poorfour. Hopefully will make some difference. I think the biggest difference that can be made is to stop a player's head from suddenly coming to a stop or snapping back from force, which I guess is why the talk of lowering the tackle height. But then that might just be transferring the risk to the tackler. Tackling low would increase the chance of hips and knees and thighs causing concussion to the tackle. It's a very difficult area of the game to govern.

There's a long but readable analysis of the incidence of injuries in tackles here: https://sportsscientists.com/2019/08/protecting-the-rugby-players-head-the-paradox-of-tackler-height-and-head-injury/. Basically, head to hip and head to knee injuries from lowert tackles happen much less per 1000 tackles than head to head / head to shoulder injuries from higher ones (but because the large majority of tackles are lower, we may see a higher absolute number).

If we leave that asisde, it struck me that there are two sides to the problem - heads and shoulders. If all players wore the new gen of headguards, then head on head contact would be much less dangerous, and head-on-other-bony-bit would be lessened too. But if we put the same tech into shoulder pads, it would also lessen the danger of an impact.

I could see a situation where in a couple of years wearing of next gen headguards and shoulder protection becomes mandatory at pro level - and I also expect that rugby will be dragged kicking and screaming into lowering the tackle height.

by lostinwales Tue 14 Feb 2023, 1:32 pm

I suppose the way we are (should be) going is that head contact is accidental. I wonder if that will have an impact on this kind of technology

by doctor_grey Fri 17 Feb 2023, 6:22 am

Another former NFL player who was symptomatic later in life dies early at 72. Per his wishes his body will be donated to science for study of CTE.
https://www.nj.com/giants/2023/02/family-of-recently-deceased-former-nfl-star-will-donate-his-brain-for-cte-study.html

The article mentions a study of former NFL players who were symptomatic in life and donated their bodies for research in which 92% had visible signs of CTE when examined. Which to me indicates that care must be immediately taken at the earliest signs of any symptoms.

by dummy_half Mon 20 Feb 2023, 11:38 am

doctor_grey wrote:Another former NFL player who was symptomatic later in life dies early at 72. Per his wishes his body will be donated to science for study of CTE.
https://www.nj.com/giants/2023/02/family-of-recently-deceased-former-nfl-star-will-donate-his-brain-for-cte-study.html

The article mentions a study of former NFL players who were symptomatic in life and donated their bodies for research in which 92% had visible signs of CTE when examined. Which to me indicates that care must be immediately taken at the earliest signs of any symptoms.

I take it that the 92% is from those who showed evidence of suspected CTE / head trauma-related issues later in life. Any idea what the rate is for former NFL players generally (noting of course that by the time they reach the NFL, they will have played at least a couple of years of very competitive football at High School and (typically) 4 years in college, so even those with a short NFL career have been banging their heads into other rather large gentlemen for a number of years.

Also, what is the rate of CTE found in post mortems from the general population (i.e. those not actively engaged in contact sport at high levels)?

by doctor_grey Wed 22 Feb 2023, 5:49 pm

Yes, the 92% is for players who were symptomatic and agreed to donate their bodies for study and evaluation. I have not seen any credible study on all NFL players so it is hard to put the 92% in the larger context (mostly because they have to be dead for the clinical exam). And I think that would be hard because many former players are not reporting, whether showing symptoms or clear. And almost no one is donating themselves for CTE study if they don't believe they were impacted. The 92% is real, but the rest are anecdotal studies and not sure what they truly mean.

I did see a study regarding CTE in the general population. In an American study approximately 6% of people had some form of CTE. For people who were athletes, though across all sports, the number goes up to approximately 9%, and down to 3% in the non-athlete population. This was based on people who donated their bodies for scientific research for whatever reason and not specific to head trauma or CTE.

As a final point, I would be sceptical of head trauma data for 10+ years ago in Rugby (and 20+ years ago in the NFL). It was vastly under-reported so improvements we have made to overall player health and safety appear much smaller than they actually are.

by **Rugby Fan** Wed 01 Mar 2023, 9:59 am

There's a Senate inquiry ongoing in Australia.

https://www.abc.net.au/news/2023-03-01/steve-folkes-cte-death-concussion-senate-inquiry/102041518

The daughter of the late rugby league great Steve Folkes has delivered an emotional plea to help players suffering from brain degeneration, addressing day three of a Senate inquiry into concussions and repeated head trauma in contact sports. Four of the nation's sporting codes — the National Rugby League, Rugby Australia, Boxing Australia and Football Australia — fronted the hearing in Canberra on Wednesday and acknowledged the link between head trauma and serious neurodegenerative disease.

The stand-out submission was from Hayley Shaw, Folkes's daughter, who detailed the difficulties the former premiership-winning player and coach endured in the final years before his death due to heart disease in 2018. Folkes later became the first NRL player to be diagnosed with chronic traumatic encephalopathy (CTE), a degenerative brain disease that is linked to repeated blows to the head.

As reported by The Guardian, Ms Shaw said the first symptoms she noticed of his illness was loss of memory, forcing him to introduce his family to people they'd met repeatedly. She added that he required a calendar of everything he had to do in his life because he knew he would forget things.

Ms Shaw praised the support the Folkes family received from the Australian Sports Brain Bank, but she said it there was little help from other parties after the CTE diagnosis was established. The Folkes family said they never wanted compensation or to harm the game, but that "they just want [former players who are struggling] to feel supported".

by dummy_half Wed 01 Mar 2023, 10:07 am

doctor_grey wrote:Yes, the 92% is for players who were symptomatic and agreed to donate their bodies for study and evaluation. I have not seen any credible study on all NFL players so it is hard to put the 92% in the larger context (mostly because they have to be dead for the clinical exam). And I think that would be hard because many former players are not reporting, whether showing symptoms or clear. And almost no one is donating themselves for CTE study if they don't believe they were impacted. The 92% is real, but the rest are anecdotal studies and not sure what they truly mean.

I did see a study regarding CTE in the general population. In an American study approximately 6% of people had some form of CTE. For people who were athletes, though across all sports, the number goes up to approximately 9%, and down to 3% in the non-athlete population. This was based on people who donated their bodies for scientific research for whatever reason and not specific to head trauma or CTE.

As a final point, I would be sceptical of head trauma data for 10+ years ago in Rugby (and 20+ years ago in the NFL). It was vastly under-reported so improvements we have made to overall player health and safety appear much smaller than they actually are.

Hi Doc

Thanks for the answers - looks like there is plenty of scope for further research, although bbviously this would requirequite a large group of volunteers from within the retied contact sports community, to undertake some form of cognitive testing during their later life and to allow assessment of CTE after their death.

If enough data could be gathered, it would be interesting to understand the differences through time as contact sports have got faster and more aggressive, but have also moved away from deliberate contact with the head / neck (think about some of the head-high tackles we used to see in the 70s - the difference was that a big player was about 85-90 kg then, and 125+ kg now.

by doctor_grey Sat 04 Mar 2023, 11:54 am

There is a lot of research going on now, mate. One of the real interesting avenues of research is looking for early indicators of brain trauma or bruising to identify if specific hormones or enzymes are secreted when there is bruising to the brain. The rationale is that we know the body reacts almost immediately to injuries or stress. The best example is the body turns on processes to secrete lymphocytes, a type of white blood cell to fight infection, almost immediately. We also know there are reactions in all tissues including the brain and surrounding tissues to injury. The research is looking for that specific thing which the body creates and - most importantly - can be tested for to ID brain bruising. This stuff is real high-end medical tech, and from what I understand, the results are promising.

I agree we need better assessments of pro athletes v. the general population. To me, there are really no meaningful, statistically reliable, baselines.

by Poorfour Sun 05 Mar 2023, 9:27 pm

For anyone who hasn’t seen it, the RFU’s tackle height survey is available and does a much better job of explaining what they are trying to do and why than they have previously managed (there are short introductory videos before you can answer the questions):
https://survey2.yougov.com/vkBXPxgKjyQmnq

The last few weeks, I have been supporting (and sometimes reffing) Girls’ U16 club and county games, and they have been brutal, with a far higher number of injuries than I have seen in boys’ matches (even up to Colts level); probably a reflection that girls playing at this level are really committed to the game and club rugby is their primary outlet for it. The more of it I see, the more I think the right step is for the tackle height to be lowered.

by doctor_grey Tue 07 Mar 2023, 1:31 am

Poorfour wrote:For anyone who hasn’t seen it, the RFU’s tackle height survey is available and does a much better job of explaining what they are trying to do and why than they have previously managed (there are short introductory videos before you can answer the questions):
https://survey2.yougov.com/vkBXPxgKjyQmnq

The last few weeks, I have been supporting (and sometimes reffing) Girls’ U16 club and county games, and they have been brutal, with a far higher number of injuries than I have seen in boys’ matches (even up to Colts level); probably a reflection that girls playing at this level are really committed to the game and club rugby is their primary outlet for it. The more of it I see, the more I think the right step is for the tackle height to be lowered.

Thanks for this. Unfortunately, the questions were designed to leads to their conclusion rather than a fair survey of what people would want to see. I agree the tackle height should be lowered, but to just below the arm pits. I wrote paragraphs in the boxes but answered the questions which I think they should have asked rather than the ones they did. Or. at least, answered based on my observations over the years, the experiences of other docs I respect, and reimagined the slanted questions. Hopefully, someone there can read not just put it through a vote counter and provide more data without context. Consequently my survey will likely not count.....

by bsando Mon 15 May 2023, 6:23 pm

https://www.nzherald.co.nz/sport/former-blues-and-tasman-rugby-player-billy-guyton-dies-aged-33/XFKZDGW2Q5A3HBECGOKFZQVUIM/

What a tragedy, RIP

by doctor_grey Tue 16 May 2023, 6:27 pm

bsando wrote:https://www.nzherald.co.nz/sport/former-blues-and-tasman-rugby-player-billy-guyton-dies-aged-33/XFKZDGW2Q5A3HBECGOKFZQVUIM/

What a tragedy, RIP

Did I miss if they said what happened? Hopefully not connected to his concussion symptoms....

by lostinwales Wed 17 May 2023, 9:27 am

doctor_grey wrote:
bsando wrote:https://www.nzherald.co.nz/sport/former-blues-and-tasman-rugby-player-billy-guyton-dies-aged-33/XFKZDGW2Q5A3HBECGOKFZQVUIM/

What a tragedy, RIP
Did I miss if they said what happened? Hopefully not connected to his concussion symptoms....

The article only said he had had to quit Rugby because of concussion.

by No 7&1/2 Wed 17 May 2023, 9:29 am

Not read anything on cause of death which is understandable. Could be anything.

by **Rugby Fan** Mon 26 Jun 2023, 12:18 am

There's a long piece in the Guardian about Norm Hadley, whch indicates he didn't die from a heart attack, as was widely thought at the time.

The article covers a lot of sensitive topics connected with depression, so be warned.

There's no way now to connect any of his troubles to concussion, though his family suspect a link.

https://www.theguardian.com/sport/2023/jun/25/every-single-blow-was-one-more-nail-in-his-coffin-the-life-and-death-of-stormin-norman-hadley

by **Rugby Fan** Fri 01 Dec 2023, 9:48 pm

Some new big names in the lawsuit

https://www.theguardian.com/sport/2023/dec/01/phil-vickery-and-gavin-henson-among-rugby-players-in-brain-injury-legal-claim

England’s 2003 Rugby World Cup winners Phil Vickery and Mark Regan, as well as former Wales star Gavin Henson, are among the 295 players that are taking legal action against World Rugby, the Rugby Football Union and the Wales Rugby Union after suffering symptoms from brain injury, it can now be revealed.

All three players were on a fresh batch of 226 names that was published on Friday evening after the players’ lawyers asked for reporting restrictions regarding their anonymity to be lifted at the high court in London.

It means that three of England’s victorious 2003 squad have now come forward to say they are taking legal action because of neurological issues which they blame on playing the sport. In 2020, the team’s hooker, Steve Thompson, told the Guardian that he had early onset dementia and could not remember his side’s World Cup win.

The former England scrum-half, Harry Ellis, and former Wales captain, Colin Charvis, are other prominent names on the list which includes a raft of international and club stalwarts from the early 2000s. All 295 players are seeking damages as they argue that World Rugby, the RFU and WRU were negligent and failed in their duty of care by not putting in place any reasonable measures to protect their health and safety.

That claim is strongly rejected by all three governing bodies, who in turn have criticised the players’ solicitors for withholding medical records and delaying the case.

The release of the majority of the 295 names followed a session at the high court on Friday when a request by the players’ lawyers to establish a group litigation order (GLO) to allow the legal action to come under one umbrella, was denied. While the senior master in the case, Jeremy David Cook, appeared sympathetic to granting such an order in the future, he said it was not possible without having detailed medical records of any of the 295 players involved.

Cook also expressed his frustration with the players’ legal team, telling them: “Unless the medical records are prepared properly, we’re going to have a lot of issues. The very least one needs in a case of this kind is medical records.”

Such records were a necessity, Cook explained, as it would allow both sides to fairly pick a smaller number of cases that would serve as a proxy for all 295 players when it was finally heard in full. He also dismissed a suggestion by the claimants’ KC, Susan Rodway, that thumbnail sketches should be sufficient.

“In an individual injury case, the first thing you ask for in order to verify someone’s history is a proper medical report,” Cook told the court. “There is a process and it must be fair. When one produces a condition and prognosis report, one must supply a medical history. It seems to me that it is absolutely basic. There is no liability without causability injury.”

Cook also urged the two sides to work together to remove any blockages before the next hearing, which he said would take place in late April or early May. “You are missing each other, you are passing like ships in the night,” he told them, before adding that unless there was progress “we will be going around and around the wheels of death on a computer, going nowhere”.

After the announcement of the 226 names, World Rugby, the RFU and WRU issued a statement where they expressed sympathy with the players but also made clear their exasperation with yet another delay in the case.

“Whilst today’s case management hearing was necessarily about legal process, we must not forget about the people and players at the heart of this case,” it read. “Legal action prevents us from reaching out to support the players involved, many of whom are named publicly for the first time today. But we want them to know that we care deeply about their struggles, that we are listening and that they are members of the rugby family.

“The court’s ruling for the second time that the claimants’ solicitors must provide information previously asked for is a positive step. The further delay to the case is regrettable and the players’ lawyers seemingly prioritising media coverage over meeting their legal obligations, is challenging for all concerned; not least the players themselves. The statement also insisted that the governing bodies’ put player welfare as the sport’s “top priority”. “Rugby is committed to leading the welfare agenda in sport, driven by evolving science and research to protect and support players at all levels,” it added.--

by Mcsweens Fri 01 Dec 2023, 11:51 pm

Some really big names there.
Sean Lamont stands out from a Scottish perspective. Presumably suing due to his time at Scarlets?

by king_carlos Sat 02 Dec 2023, 12:08 am

It's World Rugby as well as the RFU and WRU having action taken against them. The plaintiffs come from all over the world, I don't believe are exclusively players to have played in RFU or WRU run leagues. A majority are though which presumably why the RFU and WRU are named specifically. 76 of the named players are Welsh with 34 Wales internationals confirmed so far for instance. The lawsuit isn't exclusive to either board though, hence World Rugby being there.

It's going to get messy. I've mentioned it a few times but a reason I heard that it was suspected this might not get to court is that the first defence lawyers should make is raising anything other than rugby that might have caused these symptoms. In rugby that will be obviously partying, drinking and drugs. Both recreational and PED. Neither the boards nor the players will want the rampant drug use in rugby dragged out in court. That may well be about to happen though.

Whilst rampant coke and PED use might not be a surprise to many hardcore fans who may have seen that culture in lower national leagues themselves, it certainly will be to many of the more casual fans who will already be getting put off the sport by the concussion issues themselves.

by king_carlos Sat 02 Dec 2023, 12:40 am

Apologies, meant to add to the above that the RFU and WRU being named alongside World Rugby is likely largely due to the case being in English courts, under England and Wales law.

by mountain man Sat 02 Dec 2023, 9:06 am

I see Henson, Vickery are now among around 250? ex players suing WRU, RFU and World Rugby over concussion issues.

Whilst I have every sympathy for someone who has early onset dementia etc, unless those organisations were knowingly negligent then I'm not sure legal action is right.

If RFU etc knew the players would get dementia and still forced the players to continue to play, weren't assessed etc then fair enough but did anyone really know back then?

Yes give those affected compensation but then suing organisations seems wrong to me.

by **Rugby Fan** Sat 02 Dec 2023, 10:37 am

mountain man wrote:If RFU etc knew the players would get dementia and still forced the players to continue to play, weren't assessed etc then fair enough but did anyone really know back then?

Lawyers acting for the players asked rugby historian Tony Collins to give some background to who knew what, and when. Collins produced a couple of ten minute episodes for his Rugby Reloaded podcast, covering the matter. They are episodes 184 & 185. Soundcloud link below, also available on Spotfy etc.

The issue was first addressed formally in 1975, at a rugby union medical conference.

https://soundcloud.com/user-523674328

by TAFKA The Oracle Sat 02 Dec 2023, 8:43 pm

How is it that the unions themselves are being sued? Surely it should be World Rugby/IRB? WRU and RFU do not set any of the laws of the game, concussion protocols, tackle heights, etc. so what is it they’re being sued for?

by doctor_grey Sat 02 Dec 2023, 10:31 pm

All these players and former players involved in the legal action, what are they looking for?

by king_carlos Sun 03 Dec 2023, 12:06 am

TAFKA The Oracle wrote:How is it that the unions themselves are being sued? Surely it should be World Rugby/IRB? WRU and RFU do not set any of the laws of the game, concussion protocols, tackle heights, etc. so what is it they’re being sued for?

The boards are the regulators of the game in their respective jurisdictions.

In England for instance. Games are held under the authority of the RFU. Players are registered with the RFU. The RFU creates and enforces it's standards on brain injuries and treatment. It also runs the injury surveillance and research project. CRISP (community game), PRISP (Premiership and England men's side), WRISP (women's pro setup), BUCS ISP (uni).

World Rugby are the ultimately in charge of the laws of the game but local boards can even change these at the community level of course. Boards enforce WRs regulations. They can, and have, go beyond those minimum standards with regards to concussion protocols for instance.

The board are also employers of course. As such owe a duty of care to ensure players are reasonably safe at work. These duties will likely centre around whether players had necessary medical treatment and medical guidance was followed. This will include advice on return to play protocols. Hence move into arguments about whether these protocols were necessarily researched. For instance, a three week stand down after a concussion was introduced as early as 1977. Then at the start of professionalism that was tossed out. Was tossing that aside justified by research at the time? Indeed, was there any research done? Or did WR, boards, clubs, etc just want players back on the pitch sooner now they were being paid.

There is an overlap of their duties but given at the most basic level WR set the regulations and the boards enforce them I'd be very surprised if it isn't ruled that both have a duty of care.

by king_carlos Sun 03 Dec 2023, 12:20 am

doctor_grey wrote:All these players and former players involved in the legal action, what are they looking for?

In cases such as these usually some combination of compensation, funding for medical care and underwriting research to ensure that the same doesn't happen to future generations of players.

by mountain man Sun 03 Dec 2023, 8:30 am

doctor_grey wrote:All these players and former players involved in the legal action, what are they looking for?

Money.

I see a couple of dislikes but why else are they suing? I'm not saying players shouldn't if it's justified but I answered question asked which is correct. Money.

by doctor_grey Sun 03 Dec 2023, 2:45 pm

I haven't seen any demands or requests in writing outside of the most general. Hence, my question. There is not a lot of money in Rugby...

by mountain man Sun 03 Dec 2023, 2:55 pm

doctor_grey wrote:I haven't seen any demands or requests in writing outside of the most general. Hence, my question. There is not a lot of money in Rugby...

But whether people like it or not and not going by response to my first reply to you, it is about money. Players are after compensation = money.

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