Up­ping the ante in deal­ing with con­cus­sions

Rugby play­ers are gen­er­ally in good hands when it comes to treat­ment

The Star Early Edition - - HEALTH - JACK DE MENEZES

THE TREAT­MENT of con­cus­sion in rugby is taken more se­ri­ously than ever be­cause of a com­bi­na­tion of player wel­fare and a fear that a fail­ure to try to pre­vent head in­juries may come back to haunt the sport as it has done in Amer­i­can foot­ball.

But as the Bri­tish and Ir­ish Lions tour of New Zealand shows, is­sues can still “slip through the net”.

Both Leigh Half­penny and Joe Mar­ler have suf­fered from the af­ter-ef­fects of a con­cus­sion, yet failed to be taken off the field dur­ing matches for a head in­jury as­sess­ment (HIA).

The in­ci­dents raised con­cerns that de­spite the in­tro­duc­tion of the HIA process, con­cus­sions are still not be­ing picked up and dealt with prop­erly.

Dr Eanna Falvey, the team doc­tor for both Ire­land and the Lions, has stressed that while head in­juries are be­ing treated prop­erly, there is still room for im­prove­ment in iden­ti­fy­ing and re­spond­ing to con­cus­sions dur­ing matches, as the cases in­volv­ing Half­penny and Mar­ler show.

Yet he re­vealed the mea­sures that the Lions were tak­ing on the tour of New Zealand to do all they could to try and limit the prospect of an in­jured player con­tin­u­ing in a match.

“The whole HIA man­age­ment is a col­lab­o­ra­tive event now. I’m not there on my own mak­ing a de­ci­sion about that any more,” Falvey said.

“To fill you in on how that now works, we’ve raised the stakes on how we do this con­sid­er­ably. For all our games, one of our med­i­cal team sits in the coaches’ box as a spot­ter. He has a com­put­erised sys­tem where he has got the broad­cast feed and he can rewind that.

“So if there’s a bang, or some­body gets a bang, he can look at that for me.

“At the same time I also have ac­cess to a sys­tem on the side­line, an elec­tronic viewfinder sys­tem from New Zealand Rugby, where they have an op­er­a­tor work­ing the sys­tem, and I have 12 views where we can look at any im­pact and de­cide whether it meets the cri­te­ria for an HIA or per­ma­nent re­moval.

“Added to that, you have an in­de­pen­dent match-day doc­tors’ team, which is usu­ally three doc­tors, who ba­si­cally are on the side­line re­view­ing that and watch­ing the game them­selves.

“We made a con­scious de­ci­sion be­fore the tour that the in­de­pen­dent doc­tor would do all the HIAs, so ba­si­cally we re­moved any im­pli­ca­tion… that we might be favour­ing get­ting guys back on or not.” One in­ci­dent of note came in the 34-6 vic­tory over the Chiefs that in­volved both Mar­ler and the sec­ondrow Court­ney Lawes.

As they at­tempted to tackle Chiefs prop Siegfried Fisi­ihoi, the two clashed heads and Lawes was taken from the field for an HIA, his sec­ond in the space of a week af­ter be­ing knocked out in the de­feat by the High­landers, yet Mar­ler re­mained on the field.

Lawes re­turned to the field af­ter pass­ing the HIA, but Mar­ler would go on to show signs of con­cus­sion af­ter the match and was im­me­di­ately put into the re­turn-to-play pro­to­cols be­fore the first Test.

Falvey ad­mit­ted there had been a dif­fi­culty in as­sess­ing play­ers on that tour and in­form­ing them that they could con­tinue in the match, given how im­por­tant the warm-up games were to play­ing in the Test matches against the All Blacks.

“I’ve had a cou­ple of tough con­ver­sa­tions in this tour where play­ers couldn’t go back on and they were ex­traor­di­nar­ily dis­ap­pointed, par­tic­u­larly early in the tour, be­cause they’re miss­ing an op­por­tu­nity to make their case for a Test po­si­tion,” he added.

“We have to look af­ter them, we have got to pro­tect play­ers from them­selves. So we’ve used the in­de­pen­dent match-day doc­tor to do the HIA for us. It’s a truly in­de­pen­dent process, but even with that things get missed.

“In the Joe Mar­ler case, for ex­am­ple, he clashed heads with Court­ney Lawes, and we re­moved Court­ney for an HIA which he passed.

“Joe at the time was okay, and the video re­view doc­tor and the match-day doc­tor were quite happy with him stay­ing on.

“How­ever, that evening and the next day, when we re­viewed our own video, we could see that Joe had ac­tu­ally got up and fallen to the ground again, and that is a per­ma­nent re­moval cri­te­ria.

“There are 10 cri­te­ria on the HIA which, if you ful­fil any one of those, you aren’t sup­posed to do an HIA. You are re­moved with a sus­pi­cion of con­cus­sion and you go through the grad­u­ated re­turn to play.

“So then we moved Joe through a grad­u­ated re­turn to play.

“Ob­vi­ously, that’s not ideal, but you’re in a sit­u­a­tion there where, us­ing the best tools that you’ve got avail­able, some­thing slips through the net, but we still found it the next day and made sure we looked af­ter him prop­erly.

“He wasn’t in any con­tact sit­u­a­tion un­til it was in­di­cated by the grad­u­ated re­turn to play.” The prob­lem is that in a game with the phys­i­cal­ity lev­els of rugby, there will al­ways be the po­ten­tial for con­cus­sions no mat­ter how good the team is that is look­ing out for head in­juries.

While the in­ci­dent with Mar­ler is alarm­ing, more of­ten than not con­cus­sions do not slip through the net, and given how far treat­ment lev­els have come on since the last Lions tour, the play­ers are in good hands to re­ceive the best pro­tec­tion avail­able. – The In­de­pen­dent.

The whole HIA man­age­ment is a col­lo­bar­a­tive event now So if there’s a bang, or some­body gets a bang, he can look at that for me

PIC­TURE: DAVID FER­NAN­DEZ/EPA

PRE­CAU­TION: Lions play­ers in a match against the Jaguares in Buenos Aires, Ar­gentina, in March this year. Af­ter re­cent mishaps, the Lions are tak­ing mea­sures to do all they can to limit the prospect of an in­jured player con­tin­u­ing in a match.

PIC­TURE: EPA / NIC BOTHMA

Spring­bok fly­half Pat Lam­bie lies on the ground af­ter be­ing tack­led by Ire­land’s CJ Stander dur­ing the first Test match be­tween Ire­land and South Africa at New­lands Sta­dium in Cape Town. Lam­bie left the field with con­cus­sion.

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