Rugby heads in right direction

Progress being made to address critical issue of concussion, reports Marc Hinton.

New Zealand Rugby medical chief Dr Ian Murphy is by nature, and necessity, a cautious man. So when you ask him if he feels the sport is finally winning the battle against concussion his response is as optimistic as he dares to be.

He is more than eager to get a good news message out around significant inroads being made, both in New Zealand and globally, through greater awareness, stringency and monitoring in the area of head knocks in the game. But while there are cases still out there like high-profile, long-term sufferers James Broadhurst and Charlie Ngatai, both of whom continue to be plagued by lingering concussion symptoms that cloud their futures, Murphy is reluctant to talk in absolute terms.

In many ways NZR’s top doc considers Hurricanes lock Broadhurst, who hasn’t played since August, 2015, after suffering twin head knocks in the same game, and Chiefs midfielder Ngatai, out of action since an apparently minor head clash last May, the exceptions that prove the rule. Yes, their long-term absence is a concern, and, yes, two cases like that are two too many. But statistical and anecdotal evidence paints a much rosier picture of a sport making inroads in its No 1 medical issue.

‘‘Winning is a dangerous term to use in the medical game but I think we have made enormous progress that shouldn’t be understated or underestimated,’’ Murphy says in a wide-ranging state of the nation discussion on rugby’s battle against the ravages of concussions. ‘‘The moment you sit back and pat yourself on the back, that’s when you’re going to have a problem. But World Rugby should be congratulated, because they are leading the way and doing an exceptional job, which makes it much easier to start making some inroads into addressing it.

‘‘We are so far down the track from where we were, it’s incredible. The [just introduced] rule change with the tackle that starts high and goes higher resulting in penalties, yellow cards and red cards is vital . . . not surprisingly over 75 percent [of concussions] are happening in the tackle and typically in tackles that start high and go higher. That drives rule change, then the head injury assessment process will tell us whether that rule change has been effective in making the game safer. So we’re winning more, but the final whistle never blows.’’

Murphy has no doubt that dealing with concussion is the sport’s most important fight in terms of player safety, perception and longterm viability. Within concussions in rugby around 90 percent of players make a full recovery quickly (within seven to 10 days). But there are exceptions. The outliers. The Broadhursts and Ngatais — and that’s where medical experts are still a little puzzled.

‘‘They seem to come out of anywhere, we don’t have any way of Winning is a dangerous term to use in the medical game but I think we have made enormous progress. predicting them, and extraordinarily longer,’’

Sometimes when they look hard they find extenuating circumstances. Perhaps the initial knock was missed, there were multiple collisions, or maybe they were incorrectly managed. Evidence is emerging suggesting there could even be a familial disposition.

‘‘In almost all of them you can find something that, if identified, makes those exceptions seem less exceptional,’’ muses Murphy. ‘‘But it is notoriously difficult at the time to put our hands up and say that is going to be an exception if we’re not careful. So you’ve got to back they take says Murphy. up and say what could we do based on our learnings of all concussions, particularly these problematic long-term ones, that makes it safer?’’

To that end, rugby is reacting rapidly. Awareness is spreading fast through highly visible campaigns and firm messages sent. Systems are also widespread and robust. What was formerly the pitch-side concussion assessment is now the head injury assessment. More and more efficiently, it is removing those affected by head clashes immediately.

The numbers are encouraging. Previous to these rigid assessment procedures 56 percent of the time a player was concussed he was left on the field for a period of time. The PSCA reduced that to 12 percent almost overnight. At the last World Cup, with video review added to well-trained staff with teams and sideline, that figure plunged to 4 percent.

But the work, analysis emphasis must continue.

‘‘We can’t sit here and say we don’t have all the answers and then not try to find them,’’ adds Murphy. If he’d got a message to Broadhurst, Ngatai and their ilk, it’s ‘‘to not despair, that everyone is doing everything they can to see them right and we have their best long-term interests at heart’’. To that end, they and others in similar positions, will only return to rugby when they are absolutely, and unequivocally, ready.

Murphy cites the last Blacks captains as successes in this respect.

‘‘Richie McCaw was very clear at many times that he was not about to return to the game until he was absolutely right. If we had all our players, amateur and professional, understanding that they are part of the solution, we would be a lot better off. Kieran Read did that as well. There was no question of Kieran returning until Kieran was right in his own mind.’’ and two All glaring