9 Jan 2013

Concussion: Should there be rules regarding recommendation to retire?

The IRB decided to introduce the Concussion Bin for the current 2012-13 Aviva Premiership season, which will see players temporarily removed from the field of play for cognitive testing.

This will mean that the testing that takes place following a knock to the head will be far more thorough to ensure that any suspected concussion can be identified to prevent the risk of any short-term damage but, perhaps more importantly, everlasting long-term neurophysiological and psychological concerns caused by a second impact on an already concussed brain (Second Impact Syndrome).

In 2010, we saw the much-regretted retirement of John Fogarty on the premise of medical grounds due to consecutive concussions. The repeated concussions are thought to have been the cause of symptoms that were affecting his personal life, as well as his professional career.

Whilst this is a step in the right direction to managing and minimizing the risks associated with concussions and head-related injuries, should the IRB and national governing bodies be taking a much more firm stance on this?

Firstly by implementing more frequent medical examinations to assess cognitive actions on a more regular, scheduled basis and secondly, should retirement be encouraged as a serious option if there is a noticeable difference in the cognitive and mental performance of a player?

The Case for Yes
The simple case for monitoring and educating players better is that players may not be necessarily aware of the long-term impacts that they may be causing both physically and mentally. In many contact sports, players will undergo cognitive testing to record a baseline score that can be used as a benchmark for the year ahead if they need to be assessed for a concussion following an impact. This is used and taken into account when deciding whether a player is fit enough to play.
Is this really frequent enough for Rugby? And does it take into account, players not reporting symptoms or hiding them. Instead, maybe the introduction of frequent head-tests will enable clubs and governing bodies to readily identify when a player may not be performing to their mental capabilities. This will allow coaching staff to effectively ‘stand-down’ players to give them a further period of rest to ensure the brain has time to recover before the chance of another concussion.

Understandably, the governing bodies and coaching staff have a responsibility to the players and families to ensure their well-being during training and competition. If there is such a visible decline, and there is reason to believe that rugby is a contributory factor in that, a plausible solution could be for a recommendation to retire. With regards to player wellbeing and safety, a decline in cognitive results could be the indicator that the next big hit could result in permanent damage or even death; the staff have the responsibility to the play to recommend the best course of action particularly if the test results are clear.

The Flaws
However, there are flaws in the plan. Players may naturally see depreciation in their cognitive scores as they get older and not necessarily as a result of concussive injuries. There can often be a mental pressure on players and it is often spoken about when someone is mulling over whether to retire or not.
The idea of suggested retirement could lead to players hiding cases of concussion to avoid testing in between the scheduled tests. In addition to this, it may also mean that a player forces themselves to play in games, despite knowing that they are not physically ready. This was highlighted by former Ireland forward, Bernard Jackman, who is quoted in the press as saying that he did not report mild concussions throughout his career.

The Unquestionable Psychological Impact
If a player could visibly see their cognitive scores reducing, there is a chance this could have a negative effect on his mental state. The knowledge of a decline in cognitive scores could lead to the fear of the game being taken away and in turn result in depression and anxiety. Imagine being told that playing the sport you love was having a negative impact on your well-being, along with a recommendation to retire. This is something that John Fogarty has discussed in detail following his early retirement from the game.
It is for this reason the ‘State of Mind’ campaign was introduced in rugby league. During the recovery time from any injury, it can become frustrating and mentally draining. The State of Mind campaign provides players with an outlet in which to talk about the impacts the injury is having on their life. The campaign has received backing from club officials, players and MPs alike. Rugby Union could implement a similar campaign to ensure that players across both sports are given the support they require during and following an injury that could result in retirement from the sport they love.

This guest post was written on behalf of Pannone.
Pannone specialise in Personal Injury cases resulting from head injuries.