Symptom free: will the law strike a knockout blow on concussion in rugby?

As the Six Nations rugby tournament approaches its half way stage, the usual media chatter on who might win go on to win the championship has been substituted by concern over a number of high profile, concussion-related injuries.

Concussive injuries sustained by Wales’ George North in both halves of the opening game against England; the return of Ireland’s Jonathan Sexton against France after a 12-week layoff due to successive head injuries; and Mike Brown’s knock in England’s home game against Italy have been the dominant images¹ of Six Nations 2015.

Media comment has largely focused on whether existing medical protocols – suggesting minimum rest periods of 21 days for players – are not being fully enforced such that players are returning to the field of play within mere minutes of suffering an apparently concussive blow. More importantly, a number of sports physicians² have argued vehemently that even if extant, pitch side concussion protocols in international rugby are adhered to strictly, they are simply not of a standard that sufficiently protects the long term welfare of rugby players.

Risk prevention in elite rugby

The primary duty of care for rugby players’ welfare lies with the sport’s world governing body, World Rugby, and its various national unions. These organisations are, rightly, sensitive to criticism on the matter of head injuries, the incidence of which rose 59 per cent in English rugby in 2013-14³ compared to the previous season and thus making concussion the most common match injury for rugby players for the third straight year.

An example of that sensitivity can be seen in Ireland where, in light of what it called “disappointing and inaccurate commentary in the media by individuals with no medical expertise”, the Irish Rugby Football Union (IRFU) took the unprecedented step of issuing a press release on what it called the “medical management”⁴ of Jonathan Sexton. The IRFU noted that Sexton’s return to play had been sanctioned by independent neurologists in France and Ireland, his club doctors, as well as the Irish and French Rugby Federation’s medical teams.

Similarly, the RFU has highlighted that when Mike Brown was knocked out, following a collision with Italy’s Andrea Masi, he was attended to promptly by 13 England support staff⁵ and medics. In addition, the Welsh Rugby Union (WRU)⁶ was cleared of any wrongdoing⁷ by a World Rugby investigation into its the handling of George North’s injuries.

That World Rugby investigation, with input from a global expert independent Concussion Advisory Group, acknowledged that, although North should not have returned to play, WRU medics and the independent doctor acted within the “framework of information”⁸ they had at the time and would have taken a different course of action had they had direct pitch-side visibility or access to TV replay footage of the incident. Consequently, World Rugby is now considering both whether television match official technology can be expanded to identify head injuries as they happen on the field and giving medical staff access to pitch-side video footage.⁹