One step forward…another step back

By Sam Peters, founder of Concussed Media

Rugby’s ‘one step forward and another step back’ brain-injury two-step was illustrated again this weekend.

While both England’s splendid home win against France and Wales’ less splendid capitulation to Italy passed few concussion talking points, the final game of the weekend at Murrayfield, Ireland against Scotland, changed that.

Twenty-one minutes into what was a fairly prosaic win for the Irish, saw a sickening clash of heads between Scotland’s talismanic fly half Finn Russell and winger Darcy Graham.

It was, as the vast majority of head injuries are in rugby, entirely accident and without blame, but nevertheless one player (Graham) was left motionless for several minutes while the other (Russell) also lay on his back, arms splayed on the floor, after groggily extricating himself from the collision.

‘Oh, that’s a head on head from Russell and Darcy Graham so they’re both going to have to go off.’ Said ITV commentator Andrew Cotter, before referencing that ‘Graham usually plays in a scrum cap’, which do not protect against concussion.

After almost 10 minutes of on-field treatment for Graham, who was taken from the field on a stretcher, his neck in a brace, both players were removed. Graham was taken to hospital, Russell ushered to the dressing room for a Head Injury Assessment (HIA) as the clock ticked to 22 minutes.

Just over six minutes later, Russell, apparently ready and willing to return to the fray, appeared back at pitch side.

This despite World Rugby’s own rules stipulating:

‘The HIA off-field Assessment will now be a fixed 12 minutes – this means a player cannot return to play before 12 minutes, even if the assessment has been completed.’

Mercifully, at the insistence of Scotland’s medics, Russell was told ‘no’. And back on his tracksuit went. Graham was released from hospital on Sunday night with scans on his neck revealing no apparent signs of damage. The extent of the damage to his brain was less clear.

‘Finn is fine,’ said Scotland coach Gregor Townsend when asked about the incident in the post-match press conference.

‘He passed his HIA but our staff sensed he wasn’t totally aware of what was going on. There were a couple of things he wasn't remembering about plays. So we made the call not to put him back on.

‘He's obviously frustrated. It's a freak injury when you collide with your own player. I don't know the protocols of passing HIA and then being pulled out.

‘He will now be classed as a failure, delayed symptoms. I don't know whether that will be just seven days. It's based on his record and passing HIA too.

‘There's no game for Finn next week. We're hoping he'll make a full recovery in time for England.’

On Monday, the SRU confirmed both players had been ruled out of the Calcutta Cup encounter with England at Twickenham on February 22.

Leaving aside how quickly the HIA was completed – more in line with the old five-minute Pitch Side Concussion Assessment (PSCA) – let’s celebrate progress when we see it; both players diagnosed with concussion within 24 hours and ruled out for at least two weeks the following day.

One of those players, could easily have returned to play, had Scottish team medics not been alert to the signs of brain injury, as plenty have not been in the past.

So a big step forward there, along with Townsend’s post-match transparency and swift collective decision the next day.

But as always with concussion management, or indeed the commentary around it, nothing is perfect.

Firstly, the incident demonstrated yet again why, no matter how much goodwill there is within the game towards it, the Head Injury Assessment (HIA) is a horribly clumsy tool which routinely fails players who put their faith in it.

Despite the tsunami of World Rugby driven statistics which have flooded our inboxes since the PSCA was controversially introduced in 2013, it still cannot be relied upon to detect and/or diagnose brain damage in players.

Russell passed the protocols and would have been allowed to play on had it not been for the hawk-eyed Scottish medics.

Secondly, why did he undergo the test in the first place and how could it apparently be completed so quickly?

Was Russell, by lying motionless on his back with his arms splayed for a number of minutes, not demonstrating enough signs for immediate withdrawal?

Thirdly, the use of the term ‘freak injury’ by Townsend to describe the ‘blue on blue’ led to a flurry of misleading headlines implying the actual injury (concussion) was rare. Far from it.

Concussion is the most common injury suffered by professional rugby players and it has been for several years now.

Most concussions occur through head-to-head collisions (mostly opposition on opposition when tackling) so although the mechanism of injury was relatively unusual, although certainly not freak, the injury itself is entirely normal in the modern professional game.

So yes, applaud the fact that two brain damaged players did not return to play. That should be a bare minimum standard in any sport but for years in professional rugby it absolutely was not.

But, when it comes to concussion management as a whole and the HIA process itself, it’s far too early to start the backslapping just yet.

A better question we should all be asking ourselves is this: Why do so many concussions happen on a professional rugby field and what can be done to reduce them?

Join Sam Peters, the author of Concussed; Sport’s Uncomfortable Truth, at St Paul’s School on Wednesday Feb 12, alongside a host of brain injury and sports experts, as they explore safer participation in sport.

Tickets available here: https://www.tickettailor.com/events/concussedmedia/1468566

Your Brain Health launches global Concussion Officer campaign

By Sam Peters, Concussed Media Founder

Your Brain Health today launches a global campaign calling on all sports clubs, schools and other sporting organisations to appoint a Concussion Officer responsible for overseeing head injury protocols.

The initiative, which already has the backing of sports stars, coaches, medics, charities, concussion campaigners and grassroots organisations, including Datchworth RFC, calls on governing bodies to embrace an open conversation about concussion and facilitate the push for increased safeguards.

Become a Concussion Officer Today

Similar in principle to a club Fire Warden or Safeguarding Officer, which have been widely adopted by sports clubs and associations in recent years, a concussion officer would be nominated by each organisation and take responsibility for ensuring protocols and best practice are followed.

Speaking about the initiative, Your Brain Health (YBH) Chief Operating Officer and current Welsh Fire Lead Physiotherapist David Bartlett, said:

‘Sport is an incredible force for good—it builds physical fitness, mental resilience, and lifelong friendships. But to keep sport safe and accessible for everyone, we need to take concussions seriously. Appointing a Concussion Officer ensures that when head injuries happen, they’re managed properly, and allows participants to recover fully and return to enjoying the sports they love.’

Originally promoted by the Australian Institute of Sport, the Concussion Officer campaign is also fully supported by influential medical figures in the UK, including Mike Loosemore, Professor of Sport and Exercise medicine at the Institute of Sport, Exercise and Health (ISEH).

Professor Loosemore said: ‘I fully support this initiative being run by Your Brain Health. The concept of having a Concussion Officer in place is just simple common sense and I hope to see many clubs and schools embrace it over the coming months’

The campaign, which is being launched by Your Brain Health to coincide with the Six Nations Rugby tournament in Europe and the start of the Australian Football League (AFL) season in Australia, is aimed at all sports.

‘The Australian Institute of Sport has recommended in their 2024 Brain Health statement that every club and school should have a Concussion Officer. We already have safeguarding officers for child protection and fire wardens for emergencies. A concussion officer should be seen in the same way: a key role dedicated to ensuring safety and best practice in concussion management.

‘Early intervention is critical when managing concussions. Properly recognising and responding to a concussion can significantly reduce the risk of long-term complications, including persisting symptoms that in some instances can include mental health concerns. Having a Concussion Officer in place ensures that individuals get the right care from the start, improving recovery and protecting their future well-being.’

While the sports field would seem the most likely place for a child to sustain a concussion, or mild traumatic brain injury as it is also referred, school playgrounds see an estimated 27,000 diagnosed cases in Australia alone each year.

‘Schools have a duty of care to ensure these injuries are managed appropriately. Without clear protocols, concussions can be missed, leading to long-term health consequences. A Concussion Officer ensures that no child falls through the cracks and that brain health is treated with the seriousness it deserves.’

YBH, with the backing of Concussed Media and other concussion awareness groups, believe the campaign will help clubs and sports organisations achieve:

• Better protection for clubs / schools

• Better health outcomes

• Better performance

• Peace of mind of players / parents

• Increase participation

• Improve reputation of organisation

Datchworth Rugby Football Club, who play in Herts/Middlesex League One, this week became the first UK rugby club to embrace the campaign.

Sports Club Chairman Andrew ‘Woody’ Wood, believes the onset of professional rugby, which sees some aspiring amateurs players training five or six times a week while others can only manage one or two training sessions between work commitments, has created a serious disconnect at grassroots level.

He would also welcome the introduction of weight banded categories, similar to those used by the New Zealand Rugby Football Union, to avoid potentially dangerous mismatches between youngsters at different developmental stages.

He said: ‘I’ve taken my eldest son and youngest son through all the age groups as a coach, and sometimes you get it where it’s effectively a man against somebody who hasn’t even been through puberty. And there’s a massive size difference there.’

The RFU was criticised for attempting to reduce the tackle height in the amateur game in 2023, but former Datchworth First XV captain Stu Young believes the reluctance of referees to penalise head high tackles, which have always been illegal under the game’s laws, is the biggest stumbling block to progress.

‘Massive hits to the head are either just given as a penalty or 10 minutes in the sin bin and then they come back on,’ Young said. ‘It’s not really achieving what I assume the RFU want to do which is to lower the height of tackles and therefore lower the amount of head knocks.

‘If the referees were a bit more on it (prepared to give red cards) that might have more of an impact than just saying ‘we’re going to lower the contact area from shoulder height to sternum’.’

Another Datchworth stalwart, Warren Sullivan, who coaches the junior section and is current Chairman, is concerned the mounting threat of legal action has caused some parents to become overcautious. He wants a renewed focus on coaching the tackle, where most concussions occur.

‘People have got scared,’ Sullivan said. ‘they’re more or less throwing the baby out of the bathwater.  A lot of parents don’t want their kids to play rugby anymore but I think a lot of it’s unfounded.

‘We need to improve tackle technique across the game. It doesn’t help seeing the professionals tackling so upright.’

Fergal O’Brien goes the extra yard for Brain Health

(

By Sam Peters, Concussed Media Founder

It is often purported that the growing band of brothers and sisters championing the need for improved athlete welfare through a more caring culture in professional sport are blind to its number one imperative: winning.

Those of us in rugby who have spent decades calling for greater protections for players as the sport’s risk profile has sky-rocketed have been labelled ‘soft’ or ‘not rugby people’ while the mere mention of ‘player welfare’ is snarled at in certain quarters as evidence of an invidious woke culture creeping into the game.

It is, of course, utter tosh. But that does not stop those whose interests are best served by ignoring the long-term health and wellbeing of those we cheer on from the stands parroting the same old tired lines.

Call for change and be prepared to be shot down by some uneducated but very loud voices. Such is life today, I suppose.

Professional sport is a tough world. Anyone who has been within a cricket ball’s throw of a sports dressing room or training ground knows that. No quarter is ever asked, let alone given.

In the wrong hands, it can be a world where machismo reigns, bullying can fester and being honest about emotions or personal health can be sacrificed on the altar of protecting a contract or your place in the starting line up. Short-termism reigns. The future? It can wait.

Meanwhile, in schools sports, players and parents themselves can be their own worst enemies when pushing for faster return to play times.

Medics can also be pressured into burying their morals by coaches and owners more interested in today than tomorrow while those calling for improved workplace culture are dismissed as romantics who don’t understand the cold, hard reality.

Brain health inevitably suffers as concussions are denied and mental-health problems hidden.

And there are few sports where the participants have traditionally been expected to ‘suck it up’, ‘grin and bear it’ or ‘take one on the chin’ more than in professional horseracing where the owner is king and young, vulnerable jockeys compete for rides.

In a sport where concussion is an everyday risk for jockeys and stable staff tasked with moving the horses around their yard and the country, the temptation to hide symptoms of concussion or mental health concerns is ever present.

“There’s times in my career and I think every jockey has had times where they know and you go into the instant mode where you’ve always got to beat the doctor,” explains Max Kendrick, a seasoned jump jockey with almost 500 rides in the past five years.

“Yeah I think you have to break it down and understand the sport if you think about like every single lad in that change well most lads in that change room are self-employed so I mean if you’re stood down, it’s not like you’re playing for Arsenal or Chelsea if you’re injured.

“There is insurance so you’re getting paid for but you know you miss rides you might not get back on the horse the next day. So automatically the mentality is straight away no matter what the injury is not just head – whatever it is – can I get away with riding. Yeah, so in that sense like I think the power has got to be kind of taken out of the jockey’s hands because like I don’t think I can see a world where you’re ever gonna shift that mentality.”

Kendrick is speaking with me on a crisp December day outside the office of the Grade One National Hunt trainer Fergal O’Brien’s yard in the stunning surrounds of his Ravenswell Farm in the heart of the Cotswolds.

We are in racing country, where tradition and hierarchy are prized. But here, at one of the most successful and well-known yards in the land, there is a real sense of change in the air. Progress even.

I’m here at the invitation of Your Brain Health, an Australian owned company on a mission to improve the education of medics and physiotherapists around the world about the importance of better concussion management,  brain health awareness and improved brain function.

Critically, they are seeking to take the guesswork out of return to play protocols following a concussion, where historically decisions have been made either by the subsistence of demonstrable symptoms, or even worse, on the athletes word.

“When we’re treating an athlete with a hamstring injury there are tests we perform so we know precisely when it has returned to full function,’ YBH’s chief operations officer and current Welsh Fire physio David Bartlett tells me.

“Just because the patient is symptom free does not necessarily mean that hamstring has recovered. The same is true of brain injuries but historically we haven’t treated them with the same levels of objectivity and reasoning as other parts of the body.”

Bartlett and his YBH team, include experienced physiotherapists Simon Shepard and Emma Edwards, a chartered physiotherapist and member of the jockey injury management team which looks after professional jockeys on the racecourse, have been invited to the yard by Dr Simon Gillson, a close confident of O’Brien’s founded Concierge Medical and has worked at the yard for nine and a half years.

Gillson describes the concussion risk in racing as ‘an occupational hazard’.

“It would basically be impossible for a jockey to go through their career without sustaining a concussion,” Dr Gillson explains.

“I think the stats on fallers have changed over the years. It used to be one in 10 races you expected to fall off as a race rider. I think that might be down to one in 20. They’ve (authorities) have improved jumps safety and other things which is great and there’s improved equipment but you are still having rotational injuries, you’re falling at speed, horses are rolling on top of you, being kicked in the head, the neck, the chest.

“So your chances of getting through any lengthy career without having a significant head injury and concussion are, I would say, a zero. I mean, absolutely zero.”

Edwards nods in agreement.

“When it comes to testing for concussion so much has been based on some fairly basic orientation questions. As a physiotherapist something I’ve looked at is eye movements, as being something that even when someone’s denying having a concussion, you can pick up on eye movements. It provides an objective measure to tell a jockey, ‘this is what I’ve seen, do you think you’d be safe, seeing the stride to the fence, and making the right decision in that split second?

“More often than not they’ll put their hand up and go, ‘actually, now you’ve said that, I’m not really feeling 100%’.

“They’re not stupid. They know their every move is being scrutinised. They just want to perform well.”

The plan, with O’Brien’s blessing, is for all 37 of his yard staff to undergo a ‘multimodal’ baseline screening of their brains by the Your Brain Health team, with tests ranging from balance, and reaction times to a digital evaluation of the vestibular ocular motor system.

From force plates to measure balance, to a reaction mouse, to the use of a VR headset, the key thing seems to be the use of technology to provide better quality data.

“With multiple functions the brain is a complex organ and what we are doing is not going to cover everything.’ said Shepard. ‘However, put this data alongside other tests and clinical examination, and it may well lead to better understanding, better decision making and a personalised approach to care.”

The tests are carried out in a highly professional but light-hearted manner, which puts the jockeys and yard staff at ease and encourages them to take a full part in the testing. The participants seemed genuinely interested in both the testing and the reasons that sit behind it.

I undergo the tests myself and am pleasantly surprised to read the graph afterwards which shows my eye tracking to be in pretty decent order.

Much more importantly, the presence of the YBH team indicates a shift in mindset which is looking to place the brain health of staff far higher up the priority list than it has been historically in horse racing. It is forward thinking in every sense.

It also has the added benefit of potentially improving the performance of jockeys who after all, need great balance, great eyes and great decision making, if they are to optimise their performance and that of their prized equine assets.

“It’s been shown in cricket there is a correlation between certain helmet strikes and a drop in batting averages,” Bartlett explains.

“By generating more objective data, and adding a ‘gamification’ element, not only do we see better compliance than with historic testing, but we are also being able to identify individuals function, and as such ensure a return to performance, rather than trying to ‘beat’ the system and return before they are ready.”

Improved athlete welfare and improved performance. Now that really is something worth going the extra yard for.

Ends

For more information visit Your Brain Health www.yourbrainhealth.io

Curry selection leaves RFU in a pickle

By Sam Peters

It’s 17 years since I sat in the press box at the Parc des Princes in Paris and watched England captain Lewis Moody knocked out twice in the same match but allowed to play on.

Afterwards, those of us who questioned the decision were swatted away with the usual platitudes that ‘player welfare was a priority’ and the players were ‘receiving the best medical care available’.

The fact that even back then in 2007,16 years after Michael Watson had almost died in the ring fighting Chris Eubank, Moody would have been counted out if he was a boxer seemed lost on most of us. The incident drew next to no public comment in the media.

It’s 11 years since I sat in the press box in the Olympic Stadium, Sydney, and watched Wallaby flanker George Smith suffer a brain injury in an accidental clash of heads with British & Irish Lions hooker Richard Hibbard, before being allowed to play on, having apparently passed the newly implemented five-minute Pitch Side Concussion Assessment.

At the time, the incident drew next to no comment from rugby’s travelling press pack. Despite my mounting concerns around player welfare at that time, even I did not include a line on it in my 1,000-word match report for the Mail on Sunday.

Because these incidents had become completely run of the mill. Such had been the rapid increase in size, power and commitment of professional rugby players in 18 years since it had turned professional in 1995, and the ensuing ferocity of the collisions, we had almost become immune to witnessing brain damaged players returning to the field. Playing on with brain damage had become rugby’s new normal.

And who were we, rugby hacks, to say it shouldn’t be so?

In August 2013, with evidence mounting about the connection between repetitive head trauma and a condition called Chronic Traumatic Encephalopathy (CTE) in deceased American Footballers, I wrote my first article on the subject in the Mail on Sunday headlined ‘Rugby’s Ticking Timebomb’.

In it, I quoted the RFU’s head of medicine Simon Kemp, the England team doctor when Moody played on against Tonga in 2007, stating:

‘We understand that there is no proven causal relationship between head injuries sustained while playing rugby union and the reported cases of CTE and early onset dementia.’

My strong sense, even then, as I assessed the mounting evidence around the world, was that this line would be a difficult one to hold.

Naively, I expected the article, which challenged the RFU’s position and highlighted the groundbreaking work of neuroscientists including Bob Cantu and Anne McKee in Boston, and Willie Stewart in Glasgow, to cause a major stir.

But at the time, very few picked up on the article. In rugby circles, several of my friends in the media thought I was crackers.

One friend, a highly respected rugby writer who remains a friend to this day, told me their sports desk editor at the time, a man I knew and respected, had told him; ‘Don’t touch concussion. It’s dull. A non story.’ So my friend did as they were told.

To be fair, almost everyone did. But times change.

Last week Tom Curry, a young man with a long history of concussions, including flying back from England’s 2022 tour to Australia because he was suffering such severe side effects, was picked to play in a meaningless friendly against Japan at Twickenham.

Nothing surprising there, but when you consider Curry had also been knocked unconscious twice inside two months, once just two weeks previously against Australia, then understandably questions were asked.

Including by me; ‘If he were a boxer, Curry would not be allowed near a ring.’ I tweeted.

‘I cannot understand why England have picked him. There is so little to gain (by his selection) but so much to lose.’

To be clear, there is no suggestion England flouted the rules, and I have no doubt Curry passed all the required tests he was required to take, but something felt very different about the reaction to his needless selection by head coach Steve Borthwick.

Eleven years ago since I wrote my first article to the sound of silence from my friends and colleagues, this time the voices in support of my position were bold, informed and unflinching.

Daniel Schofield, who as a young freelancer shared a byline with me on that original ‘Ticking Timebomb’ piece in 2013, but is now a senior rugby writer at the Telegraph, wrote ‘There is no justification for Steve Borthwick’s short-sighted and potentially damaging decision to select forward for Japan game’.

While the Times rugby correspondent Alex Lowe wrote described the ‘tone deaf’ selection decision which illustrated how ‘out of touch’ the RFU is with the grassroots game in England.

Meanwhile, social media was awash with criticism of the decision, with expert after expert lining up to denounce Curry’s selection and the Telegraph subsequently running a story suggested the RFU had sought to tone down the criticism through the use of AI software.

So, although I was aghast to see the 26-year-old Curry picked for a Test match which he so easily could have been rested for, I believe there are reasons to be positive about the resulting outcry.

Because it is abundantly clear to me that public opinion, and the view of the heartland of rugby union, has shifted profoundly when it comes to addressing concussion in the game we all love. We know the sport, at a professional level, is more dangerous now than it was 30 years ago. We know players suffer more concussions now than ever before, because the data tells us.

And finally, despite the odd knuckle dragger, the sport is waking up to the idea our players need looking after across the sport if it is to have a viable future.

All we need now is for the RFU to catch up. Fast.

Ends