NZ Rugby on a learning curve
The game’s governing body insists it is taking head injuries seriously, writes Olivia Caldwell.
IT IS rugby’s biggest issue and concussion is something New Zealand Rugby wants to learn more about, if not be able to mitigate the risks altogether.
It isn’t just the short-term effect of players missing a game or two, it is the unknown future consequences on players’ health that is the biggest concern for the game and its management.
Through countless research, there is still no definitive answer on the long-term effects on the brain and a person’s wellbeing after they suffer one or more concussions during their career.
There have been some links found between traumatic brain injuries (TBIs) and eventual Chronic Traumatic Encephalopathy (brain damage) – such as signs of anxiety, depression, memory loss and general slowing in cognitive functions for former players.
New Zealand Rugby chief medical officer Ian Murphy wants to assure the rugby public that the organisation is taking concussion seriously.
‘‘It’s a tricky subject because the subject matter is a little uncertain as well,’’ he says. ‘‘Trying to get everything lined up and perfect is hard enough let alone the ground you are working on keeps moving a bit. It’s an evolving science.’’
It is no secret rugby posts the biggest number of concussions of any sport played in New Zealand. There were 2401 last year, according to ACC figures.
Murphy said the long-term effects on the brain from a head knock is something rugby should be looking at very closely.
‘‘It informs us that we need to be looking at this particular question pretty hard.’’
Murphy said it was important to look at substantial research rather than anecdotal evidence, which has often sparked public conversations in the past.
‘‘You have to be very cautious acting in a population way on the basis of anecdotal evidence,’’ he says.
‘‘It doesn’t point to us making wholesale changes to everything about the game on the basis of what are anecdotal informants. To have anyone suggest we have ignored them would be disappointing.
‘‘Rather than sit back and be passive and wait for the evidential base for the management of concussion to fall around us we need to make a contribution.’’
He is referring to NZ Rugby’s support for studies by Auckland University. A 2016 study by Auckland University’s Dr Patricia Hume found participants from two rugby groups had sustained more concussions than the non-contact sport group. An alarming 85 per cent of elite rugby players and 77 per cent of community rugby players reported having had at least one concussion, versus 23 per cent of non-contact sports.
The previously concussed rugby players performed worse on processing speed, flexibility and executive functioning as well as memory, compared to those playing other sports.
Associate professor in psychology at Auckland University, Alice Theadom, is in her sixth year of another study outlining the relationship between head injuries in sport (not just rugby) and longterm symptoms. She is adamant there needs to be further research in this space.
Her study found that four years after receiving a concussion, 17.3 per cent of participants had left their jobs for reasons other than retirement or study. One in five had also struggled to meet the demands of their employers and had to either leave work or reduce their hours.
The British Journal of General Practice study in 2016 showed there were persistent problems for New Zealanders for one year after receiving a mild traumatic brain injury, such as symptoms including fatigue, irritability and memory difficulties.
Murphy said one challenge with long-term studies is that it takes time and money to get conclusive evidence.
‘‘You need a large number of people because the issue you are chasing has a low prevalence, the number of people in the community with dementia, Parkinsons, is such a small amount of the population. So you need a large number of people for the research.
‘‘We rely on evidence to inform our decision making and we don’t have any evidence at the moment that is a clear yes or a clear no.’’ Murphy said while there are reports of former athletes going through depression post-career, NZ Rugby was not the best port of call for those people.
‘‘It’s important that people know they can reach out to New Zealand Rugby and that we provide a bit of direction. I think we would be loath to suggest that the best medical care you can get is from New Zealand Rugby rather than your own practitioner.
‘‘If they were to reach out to us, we certainly have mechanisms where we can arrange some support for that person. We certainly don’t close the door in their face but it is challenging where to get each individual because we don’t know each individuals circumstances.’’
Last year the fifth International Conference on Concussion in Sport was held in Berlin. It concluded ‘‘a cause-and-effect relationship has not yet been demonstrated between CTE and [concussions] or exposure to contact sports. As such, the notion that repeated concussion or subconcussive impacts cause CTE remains unknown. However, clinicians need to be mindful with their management of athletes as there is more to be determined about the cause and effect between the two.
‘‘The potential for developing chronic traumatic encephalopathy must be a consideration.’’ World Rugby has guidelines surrounding head injuries, which involves a three-step process of removing testing, re-testing, permanently removing and furthermore a recovery scheme to get the player back on the field.
Murphy said there was no issue of pressure on the match day doctors from team management to get the player back on the field and there was always a neutral game day doctor who made the call.
‘‘We were all concerned there would be pressure from team management. Quite the contrary, most of the team doctors, they’re actually handing the player over to them. It shows clear independence.’’
He said the issue of players returning to the field earlier than they should couldn’t be fully eradicated as some often hide symptoms. He said club rugby level was the hardest to police, as the mentality of the Kiwi male is to get out and play at all costs. Murphy said the studies, anecdotes and general public concern highlights how uncertain the concussion space is.
NZ Rugby has started an injury surveillance programme where it is collecting data for ongoing concussions and has hired a fulltime research officer to lead it.
Murphy said while concussion numbers are rising nationally in rugby, this has more to do with an increased awareness than the game becoming more dangerous.
‘‘Concussion is rising which is what happens when you increase awareness.
‘‘The challenge with that is talking about it creates awareness.
‘‘Do we we think the game is getting more dangerous? No, to the contrary. The new rules that are coming in around the maul the tackles and so forth. We don’t think it’s getting more dangerous, but we think if you can talk about something enough we are going to get people aware of it and we are going to hear about it a lot more. And that’s a good thing.’’ Sunday Star Times