Rugby is on a collision course with brain injury
BENNET OMALU is the pathologist who made the connection between head traumas suffered by NFL players and the catastrophic condition Chronic Traumatic Encephalopathy (CTE), and whose story was last year turned into a Hollywood film.
His battle against the medical consensus underpinning the care of American footballers lent his story the irresistible drama of the underdog. Judging by the reaction he received in Dublin this week, he is not the outsider any longer.
He was rapturously received at a discussion about concussion in sport at the Royal College of Surgeons. Omalu is clearly well practised and his presentation at times owes more to the flourishes of a showman than the sober reckoning of a scientist.
The doctor is deadly serious about his subject, though, and the decision of the NFL to settle a billiondollar action taken by thousands of former players has, so far, been the most public justification of his life’s work.
After his address in the College of Surgeons, Omalu was joined on stage by a panel to discuss the issue. It included Dr Rod McLoughlin, medical director of the IRFU, and Dr Pat O’Neill, the former Dublin All-Ireland-winning player and manager and a consultant in orthopaedic and sports medicine.
Another orthopaedic surgeon, John O’Byrne, who is also the team surgeon to the FAI, was present, as well as Bernard Jackman, whose rugby career was ended by concussions, and ex-MMA fighter Aisling Daly, who retired after a brain scan discovered an abnormality.
What became quickly apparent as the discussion evolved was that there were in fact two debates in play. Omalu argues that concerns surrounding brain injuries to sportspeople should not be confined to concussions.
Exposure to blunt force trauma of the head is the issue, he said, ‘with or without concussion’. This has enormous consequences for how head injuries are treated in sport and, if he is correct, it means concussion management protocols as pursued in sport are testing along too narrow a spectrum.
Just because a player passes rugby’s contentious Head Injury Assessment, for instance, it doesn’t mean they haven’t suffered a brain injury whose symptoms manifest themselves hours or days later.
Concussion is not the point; brain injury is. Dr McLoughlin declared that the IRFU is involved in eight concussion-specific studies, but Omalu’s argument centres on brain injuries, not specifically concussion.
Because of the damage he has seen done after years spent studying the brains of dead NFL players, his position is clear, and extreme: he wants the playing of what he calls high-impact sports (MMA, wrestling, ice hockey, American football and rugby among them) banned under the age of 18.
The logic of his argument, based on what he has studied in his career, is perfect, but it is also unworkable. Take a comment from Jackman during the discussion.
He said his eight-year-old son plays rugby and that it was a ‘risk I’m willing to take’ because he is convinced the benefits of the sport outweigh its risks.
Jackman has a connection to the game that has endured over 30 years and, even though brain injuries eventually ended his career, he is unwilling to countenance denying his child the pleasure he himself took from the game.
McLoughlin made the sour point that, a decade ago, those in the press seats were not seeing concussions but they were calling them out now. Greater awareness should not be bemoaned, and if the attention now paid to this subject has caused discomfort and anger in Irish rugby, that unhappiness is a price worth paying.
The IRFU and every other impact sport, including soccer, hurling and football, must also understand that brain injury is now a topic of which parents are aware, not just the media. It is the understanding and anxieties of mothers and fathers to which it must attend.
Even if there is a reluctance to accept Omalu’s arguments – and it was obvious there is – he is supported by decades of his own work. ‘No sports league has given me a dime to do research,’ he said, and that is no surprise, given what he might find next.
Arguing about the links between sport and concussion is fruitless, and that is what the sports in this country need to understand, rugby most urgently of all.
In the public sphere, there is now a connection between sporting collisions and brain injuries. The concerns will not disappear.
‘Do not be afraid of the changes that will come because whether you like it or not they are coming,’ said Dr Omalu.
He knows of what he speaks.