BIGGER, FASTER, STRONGER…BUT SAFER?

Now backs need to be similar in body mass to forwards. Interestingly, rugby strength and conditioning coaches often spend time studying what their counterparts in the NFL are doing. The gaps in power and size between the two sports is growing ever narrower, and a concussion epidemic is putting players in both at risk.

More organised and aggressive defences is another trend that has become entrenched in rugby over the last decade. Defence coaches are tasked with teaching players how to hit opposition players to gain possession. Turnovers produce some of the best attacking ball to play off – so there is a huge premium on hitting hard enough to force the ball from the opposition. This, coupled with attack coaches putting a big emphasis on the need for their players to “dominate collisions” when carrying the ball, culminate in more regular and larger impacts in games. Unsurprisingly, there has been a concomitant increase in concussion, although it must be noted that some part of this increase could be due to the improved awareness about concussion amongst players and coaches.

What is concussion?

Concussions are accepted as brain injuries, involving complex functional responses to biomechanical forces. It is worth clarifying that concussions can occur due to a kinematic response after impact (i.e.there does not necessarily need to be a direct trauma to the head). Concussion is now something that most players are concerned about, and player honesty is imperative if damage is to be limited. This creates a natural conflict of interests – no player wants to spend time out of the game. Considering the substantial risks presented to players’ long-term health and the damage that is being done to the game’s reputation, action is undoubtedly required. So what could help combat the impact of concussion on the game?

1: Objective diagnosis

Research has recently been published on the history and reporting of concussion in elite Irish rugby union players. Interestingly, 45 percent of players reported at least one concussion during the 2010-2011 season, but only 46.6 percent these players presented to medical staff. The reasons for not reporting their concussion included not thinking the injury was serious enough, and not wanting to be removed from the game. Furthermore, subjective tests are can be cheated easily, resulting in players providing false baseline data to ensure clearance following concussion assessment on the pitch. Accordingly, objective concussion assessments require consideration; a new study conducted by Leinster Rugby has very positive implications for real time objective diagnosis of brain injury and suitable return to play protocols.

2: Improved preventative measures.

An interesting approach in prevention of concussion is the increase of blood volume in the brain. According to NASA, “The oscillation of a fluid caused by an external force, called sloshing, occurs in moving vehicles containing liquid masses.” This oscillation (slosh) occurs when a vessel is only partially filled. The brain experiences slosh when impact forces are sustained. Slosh permits external energies to be absorbed by partially filled vessels. Myers and colleagues (2013-15) are in the process of developing a compression collar that gently decreases blood flow out of the brain, increases brain-blood volume and limits sloshing. Interestingly the concept originated from animals who appear to be naturals at withstanding head trauma, like woodpeckers and ramming sheep. The ability to withstand head trauma in these animals is attributed to a strong omohyoid muscle. Myers’ compression collar replicates the omohyoid action and applies mild jugular compression. Although there has been promising research to date, further research is required to fully understand the effects of collar usage in sport.

Greater neck strength and bracing for impact are both thought to reduce an athlete’s risk of concussion during a collision by attenuating the head’s kinematic response after impact (American Journal of Sports Medicine 2014).

Similarly, visuomotor system training to promote peripheral vision could reduce concussion risk. Players are at risk of detraining essential peripheral vision (with increased phone/tablet usage) that enables them to perceive and react to incoming impacts. Importantly, more prospective research studies are needed to determine if neck strengthening (or other interventions) will reduce concussion risk and severity.

3: Rule changes

In the NFL, rule changes have been used to great effect over the past 3 years. For example, since outlawing helmet to helmet hits (that have reduced by greater than 46 percent) there has been a corresponding 36 percent fall in concussion, according to Jeff Lewis, Senior VP of Health and Safety in the NFL. In very recent times, Dr Martin Rafferty, World Rugby Chief Medical Officer has stated that rule changes around tackles are being considered. It is difficult to foresee effectiveness of rule changes but penalizing players for leading into contact with their heads could help reduce concussion incidence. It is also worth remembering that big collisions are a large part of the appeal of rugby. Thus, the challenge is to create rule changes that can both increase player safety without diminishing the appeal of the professional game.

Conclusion

Increased impact frequency and intensity present increased risk of concussion for rugby players. Similar to the NFL, provisions for reducing risk and improving methods for monitoring, treating and possibly preventing concussion in rugby are required if the game is to continue on a successful trajectory and preserve the health of players in both the short and long term.