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