The Future of Concussion Assessment In Rugby

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The study of a concussion goes back to ancient Greek times and had been studied as an immediate injury, in other words, an injury that is treated within moments or hours of the initial event. It wasn’t clear whether there was a long term effect of these injuries until former players of the NFL began to question the rates at which veterans of the sport were dropping in their respective sociology-economic standings and suffered from symptoms normally found in dementia and Alzheimer patients.

The NFL initially tried to block and retract the paper published by Dr. Bennet Omalu and accused him of practicing voodoo. Dr. Omalu is the doctor who initiated examination on former player, Mike Webster’s brain in 2002 which brought the issue of post-concussion trauma to the forefront of the sport and led to a multi-billion dollar payout by the NFL.

Before Dr. Omalu conducted the autopsy on Webster, there was little documented evidence that concussions had a long-term effect on the brain. The papers and studies that came out of a British medical consensus was that brain injury and concussion was an occupational hazard in contact sport. This understanding stood as a guide since 1969, that is until Dr. Omalu discovered something very different.

CTE or chronic traumatic encephalopathy was coined by Dr. Omalu after he studied Webster’s brain along with other athletes that showed similar symptoms. In layman’s terms, CTE means traumatic brain injury sustained during repeated blows to the head. This type of injury can be found in any athlete that partakes in collision sports such as boxing, wrestling, football, rugby, MMA or any other sport where bodies collide.

With this discovery the NFL had to admit to the fact that there was a problem with concussion studies and treatment and after a decade of lawsuits and debates, the NFL eventually established a concussion protocol that now requires multiple assessments and uses technology to relay real time information to the sidelines concerning head trauma.

All teams now use a device developed by X2Biosystems called the xPatch and concussion management systems known as X2 ICE. This piece of equipment is tapped to the back of the ear of a player and can give readouts about the impacts on player’s head.

This technology has now been adopted into the realm of rugby, another sport that has taken concussion seriously and warrants serious investment. Saracens Rugby Football Club, the English club, recently had players wear this device when playing against London Irish. They have put up the initial investment of £350,000 for this program and will likely invest more in the future.

It is a new program that has the potential to re-write protocols and injury management, especially regarding head trauma. At the moment, rugby has a side line assessment program for players that have a suspected head knock. They are taken into the change rooms and given a series of questions to answer and some light physical testing. Once the doctor is satisfied that the player has passed these tests, they are able to return to the field.

Many have rightfully argued that this type of assessment is inadequate and we, as the the rugby community, do not fully understand the long-term effects of brain trauma sustained during a concussion. The technology available can help us better understand the impact suffered in contact with the X2 Biosystem device.

This system allows doctors to receive real time information and they can immediately pull the player from the field to minimise further damage. The xPatch is small enough to be attached behind the player’s ear but unfortunately, due to the nature of rugby, not all players can wear it, so some further development needs to be done so that all players can be monitored concerning brain trauma.

With the concern of catastrophic injuries becoming a main talking point in the rugby world, it won’t be long until some very inventive systems and protocols are introduced to limit injuries and prevent any long term damage. Rugby is a collision game and injuries will occur, no matter how much preparation is put in to prevent such things, that is just the nature of the game. We cannot stop every injury, but most injuries heal with no risk to long term trauma as they are normally ligament damage, broken bones or muscular tears. Most of these can be repaired through surgery, except the brain.

Brain trauma cannot be easily repaired and needs to be cautiously treated once a problem has been identified. The current tech can minimize the trauma and give the doctors a better understanding of the impact, but can never prevent it. This type of injury is normally treated through rest and controlled environments. Players are normally told to stay on the side lines and don’t get involved in any practices sessions.

In 2014 we saw at least two high profile players sidelined due to concussion concerns. Keiran Read was ruled out for a number of weeks during Super Rugby because of lingering concussion concerns and the Crusaders had to play without him. Recently Johnny Sexton has been ruled out until mid-February because of multiple on-field concussions.

These players have received the benefit of new concussion assessment knowledge and to prevent any long term problems, they were ruled out of the game for an extended period to allow their brains to normalise. By studying their cases, and many others, rugby is now in a position to go forward with new programs and technology.

Some ideas that have been proposed include building the xPatch device into scrum caps and having forwards wearing the caps, gum guards becoming a piece of technology that relay information to the sideline doctors and GPS trackers currently fitted to players, to relay other stats instead of just distance traveled.

The future of rugby is now reliant on proper assessment of injuries and the technology is there to help better protect and enhance players’ lives. It will be a sad day if we are to witness former greats in a state of depression and facing similar lives as dementia and Alzheimer patients. Clubs have taken steps to make sure that the future is brighter for the men and women who put their bodies on the line every weekend to play the game that we all love.