Concussion In Rugby: Poor Knowledge Or Bigger Hits?

Is there enough education about concussion in rugby?


Rugby is a very physical game, and this physicality has increased year on year since the game turned professional, with the guys getting bigger, stronger and fitter. The hits that occur in the game today are testament to how well conditioned and prepared the players at the top level are, otherwise they simply wouldn’t be able to get up from each knock.

I’m 6’8” and well built, but it’s clear that the intensity in contact has greatly increased even since I finished playing at Bristol in 2004. It’s not hard to understand why players are suffering more concussions and more injuries that result in surgery.

Previously if you were 6’6” and 17 stone you were playing in the back row. However, nowadays, those are the stats for wingers and centres in the professional game, and those guys move a fair bit faster than we ever did in the pack!

Concussion has always been in the game, it just seemed to be less prevalent when the guys were a bit lighter. The forces exerted on players as a result of the simple physics of moving a heavier person faster into a collision zone will obviously start to increase the frequency of more serious injuries such as concussion.

There has been some discussion recently in the press and on social media around whether the knowledge of concussion in rugby is poor. In healthcare generally, we are always striving to understand things better, and put policy in place to safeguard individuals, so I would never say that clinicians dealing with concussion regularly, such as myself, don’t need to evolve and update their understanding of it, but the knowledge of it by the Doctors and Physiotherapists working in rugby is not poor.

I had a great example of this just last week. I was looking after the 1st team at my local National League club, when I witnessed na fairly innocuous collision on the pitch next to us, where the Colts were training. With this collision, one player was left on the floor looking decidedly groggy, holding his left shoulder. After clearing his cervical spine for any nasty injuries I was able to investigate further, and my questioning went onto if the player had a headache, or if he felt sick.

He then reported to me that he had had a headache for 5 days since falling while skiing and this headache had gotten worse the day before when he tried to use the gym. He had not been to his GP as he had a helmet on while skiing, so his parents didn’t feel his headache was anything to worry about. I soon explained to them that not only should he have seen his GP, but he should also not have been at rugby training or even using the gym, as his headache, severity of pain from an innocuous challenge and the fact he had been struggling with bright lights meant he was certainly concussed, and should be having 3 weeks rest from all activity, to be followed by a staged return to activity after this, providing no further symptoms were experienced.

Luckily on this occasion, I was able to identify and manage things for the Colt; however, repeated knocks and performing to exertion while concussed could have had serious repercussions for him. So the poor knowledge of concussion in my opinion lies with the misconceptions of the public, and it should be our job as clinicians to educate the public on this, which is one of the major things does.

The misconception that a helmet while skiing will prevent concussion is the same misconception that a scrum cap will do the same. Scrum caps have been shown to purely limit the chance of head laceration, and will not prevent concussion from a head blow. Concussion occurs when the brain is shaken inside the skull, therefore scrum caps or ski helmets will not prevent this.

In rugby, concussion can be limited by being well conditioned for the level you are playing at, and working on tackling technique and body position at the collision zone. If you have your head in the ‘right place’ during these actions, you will reduce the risk of developing concussion, however, if you play a contact sport you are likely to take knocks which could “produce concussion despite having a good technique.


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