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It's time to act on concussion

By Niall Crozier

Concussion is a common-place injury in rugby football. That is hardly surprising; indeed, it is almost inevitable given the ultra-physical nature of the game, particularly the professional version thereof.

How could it be otherwise when you have strong, fit, fast boys and men crashing into one another at speed? We used to talk about tackles; increasingly, however, we talk about 'hits'.

Yet the 'C' word is avoided fastidiously, because it might mean a player being required to take time out.

Now, though, the game's authorities are being challenged to act. They stand accused of burying their heads in the sand in the hope that some of these difficult questions will go away. But they won't; they will continue to be asked.

In fact, the frequency at which they are asked is likely to increase with evidence now suggesting that concussion may lead to dementia in later life.

That has lobbed another grenade into the bunker in which some in rugby are accused of sheltering.

Some notable medical exponents have highlighted this in the recent past. And one of them – Toni Belli, a consultant neurosurgeon at Birmingham's Queen Elizabeth Hospital – said: "There is clear evidence of a link between concussion and dementia, but rugby is in denial about that."

And in response to the (English) Rugby Football Union's head of medicine Dr Simon Kemp's assertion: "It is going to take some time to definitely answer this question," Belli's put-down was blunt.

"That is the same argument used by the cigarette companies many years ago to deny that smoking causes cancer," Belli countered.

"We have a large body of evidence. Most of that has come from the United States, and if you are looking for clear evidence in rugby then it might not be there. But that's only because no-one has looked for it.

"The overall evidence for repeated concussion in sport (being linked to brain damage) is almost incontrovertible."

As for a statement released during the summer by the IRB which said 'Rugby is not American Football', Belli's answer was: "I can't really think of any logical explanation for that claim.

"I can't see how you can produce an argument that rugby players are not at risk of developing neurological conditions, because in any sports where you do get a concussion or repeated concussion the players are at risk."

Currently, the IRB is running trials on Pitch-side Suspected Concussion Assessment (PSCA). South of the equator, the Four Nations Championship participants and the Super 12 are on board for the ongoing PSCA trials. In the northern hemisphere, England's Aviva Premiership and France's Top 14 clubs are willing participants.

But neither the RaboDirect PRO 12 nor the Six Nations Championship has enlisted, though the willingness of the presence of PSCA trials in the English and French clubs' domestic competitions leaves the finger of non-participation blame pointing firmly in the direction of Irish, Scots, Welsh and Italians.

Research conducted by Belli in conjunction with Dr Michael J. Grey, reader in Motor Neuroscience at the University of Birmingham's School of Sport, Exercise and Rehabilitation Sciences has centred on the fact that, in a concussion, the brain is shaken inside the cranium.

Their finding was that the brain remains highly vulnerable after a concussion and that a secondary impact while it is in that state is very dangerous.

"Even a mild blow within that window means the victim is likely to have effects comparable to a severe head injury," Beli said.

In applying that knowledge to the reality of top-level rugby, he pointed out: "The players are professionals and they want to play. They learn how to manipulate those tests very quickly and deliberately under-perform in the baseline test so when they do have a concussion there's no significant difference."

Benjamin Robinson was not a top-level professional. He was 14 when he died on the pitch while playing for Carrickfergus Grammar School in January 2011 – from second impact syndrome, 25 minutes after suffering an initial concussion.

Coroner Suzanne Anderson told the inquest: "I accept the consensus opinion that the features of this death are typical of second impact syndrome which occurs when two concussive-type injuries are sustained in a short space of time."

That tragedy alone should see the IRFU doing all in its power in dealing with concussion.

Ben's father, Peter, said there is a policy in the United States "that can be put in place tomorrow if they wanted. I would love to fight for Ben's Law because why should children in the UK not have the rights like in America?"

Hard-hitting words which go right to the heart of the matter.

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