Concussion: A matter of heart and head

To add to the pressure, Panorama provided an overview presented by John Beattie (a former Scotland and British Lions player) in which World Rugby's senior medical officer suggested the possibility of changing some of the rules.

Rugby has always been broadly acknowledged as a hard game for fit individuals, individuals who have an immense respect for the rules of the game and those who officiate, instilling a sense of camaraderie that lasts forever. Rugby takes discipline and the protection of its players seriously - the changes in respect of tip tackles and methodical engagement of scrums are two examples. Those changes do not lessen the contest.

Concussion, though, is present in many contact sports. Critics of rugby highlight the dramatic increase in notifications over the last two years. However, the increased awareness in the introduction and use of the head injury assessment (HIA) testing has also raised its profile. The Rugby Football Union’s website sets out in very clear terms the process players, from junior to club to professional, should undergo once concussion is confirmed, so as to allow as safe a return as possible to participation.

Neurological research in the US has linked repetitive head injuries from American Football to the development of post-concussion syndrome. Although research is in its early stages, there appears to be a connection between repetitive head injury and neurological symptoms, whether subtle or overt.

In layman’s terms, concussion is understood as being ‘knocked out’, perhaps ‘dizzy’, but medicine is rarely black and white or confined to narrow parameters. What we see developing, from the medical press, are changes to the brain which can occur irreversibly not only from the obvious – head clashes – but also the less obvious, such as a bodily collision. We have to remember that the brain is, in effect, a globe on a stork surrounded by fluid and within its own rigid cage, the skull.

Governing bodies have instigated and followed the HIA protocols by making players' decisions for them on whether to play on, regardless of their age (players, though, will always fudge the issue and want to play on). Coaches, officials, parents, and even spectators have been responsible for being the eyes and ears of the game. Hours are spent at a young age learning how to tackle safely; the definition of a tackle is using the arms. The referees and citing commissioners at the World Cup have been sharp to pick up on poor or illegal and neck tackles - and it is good to see new protocols being taken so seriously.

Rugby will not become a non-contact sport. But it will, through its governance, take
on board medical evidence, adapt its rules, and continue to provide the engagement and lasting friendships that it always has done. SJ

Dr Julian Morris is a partner at Plexus Law @Plexus_Law www.plexuslaw.co.uk