Concussion: a headache that sometimes does not go away

HOLLYWOOD, for all its glitzy entertainment, on occasion meritoriously tackles a real-life subject that both highlights and educates.

The recent movie Concussion, starring Will Smith, is one such production and it had a ripple affect across the sporting world, even though it was focused on actual events in the NFL.

The movie illustrates the strides being made in the recognition of concussion, an all too prevalent problem in rugby, as most lately illustrated by the head knock taken by Sharks flyhalf Patrick Lambie last week against the Kings, which removed him from the game and has led to speculation he might not play again because of a history of similar problems.

In the movie, the NFL was sued a few years ago by 3 000 current and ex-players for $750 million (R9.8bn). The NFL settled out of court for a $1bn.

There had been evidence discovered by a forensic pathologist of an association between concussion and chronic brain damage a number of years down the line, and the NFL had tried to suppress him publishing his research. When he managed to get it published, the players then sued the NFL and were awarded a $1bn, some of which has gone into research in this field.

The good news for rugby is that World Rugby is ultra-serious in its treatment of the concussion issue. When we see a player being sent to the change room for a “concussion check”, it is the start of a very serious evaluation of the player’s condition.

One of the leading expert on concussion in South Africa, Dr Glen Hagemann, published papers on the issue and in an interview, not long after Lambie was pole-axed by Ireland flanker CJ Stander in June last year, said a professional rugby player undergoes the strictest of protocols before being allowed to play again.

Two years ago, a Falcons schoolboy player died from a concussion-related problem. Not long after, two other boys ended up in ICU after severe concussion-related injuries.

Those were extreme cases and most schoolboy players that are concussed are playing again in three weeks having followed the consensus guidelines that have been laid out by the leading experts in the field from all over the world.

Every four years concussion gurus meet to debate the latest research to update guidelines which are then adopted by most international sporting federations, including World Rugby.

The unfortunate problem is that not all schools follow the protocols that are so strictly observed at professional level, and which explain why it took Lambie six months to play again.

Research has shown that about 17% of schoolboy players are concussed in a season, or about one in six – close to three in a team on average. A risk study undertaken by the University of Nottingham in the UK analysed just about everything in life from playing rugby to driving a motor car and foundan “acceptable risk” is 0.1 to 2 catastrophic incidents per year per 100 000 participants in an activity.

Where does rugby fit in to that? “If you look at catastrophic incidents, like neck injuries, in England rugby is acceptable in that it comes in at 0.8 incidents per 100 000 players,” Hagemann said last year. “But Fiji is 13, which is out of the bounds of ‘acceptable’.”

Rugby in South Africa rates around two catastrophic incidents per 100 000 players, which places it on the margin of acceptability.

Last year, Lambie stringently followed the return-toplay guidelines, which evaluate how the player responds to walking, then jogging, then gym and so on until full contact, but if at any stage he suffers symptoms such as headaches, he goes back to the starting line in the recovery process.

A professional rugby player is so strictly monitored that it is impossible to take short cuts.

Sadly, this is not the case at amateur level, and one of Saru’s challenges is to somehow make a return-to-play protocols enforced all the way down from Lambie level to mini-rugby, because the biggest worry at amateur level is when a player gets back on the field not having fully recovered from a concussion and has a “concussion-on-a concussion”, with possibly deadly consequences.