New Concussion report

[Danno]

Good

[32nd Man]

Could do with them reinforcing and re-iterating the head contact protocols for referees and disciplinary panels.

The weekend saw two more pretty big head shots result in only yellow cards, and the super rugby refs have been undermined by a few cases of clear reds being downgraded in the post match process this season.

[fivepointer]

https://www.theguardian.com/sport/blog/ ... ot-working

This is a good read. Cards dont seem to have deterred high tackles and maybe they will never be eliminated. Plus, there are many other legal collisions during a game that can cause just as much damage.

"to send innocent players from the field for incidents they have no hope of avoiding" There is something in this, though i'm blowed if i know what the game can do about it.

[Mellsblue]

Very good read. Can’t see the laws changing on this any time soon, though. It’s as much about perception as science.

[32nd Man]

Fairly grim article on Hayman in today's Grauniad. There's a whole raft of front rowers who had their career during the hit era, who have the impact of that on top of the "normal" impact of just playing against guys the size of full time professionals.

[Which Tyler]

[Galfon]

Sad news - still a young man with young family.
many more to follow from the era just passed one suspects, with the CTE form.
https://www.bbc.co.uk/sport/rugby-union/62194385

[twitchy]

Really grim reading.

[Which Tyler]

https://www.thetimes.co.uk/article/rfu- ... -p95b890cb

[Which Tyler]

https://www.bbc.co.uk/sport/rugby-union/62225228

Well fuck.

"England prop Joe Marler says he once he forgot he was a father as a result of a head injury he sustained during a game."

[Which Tyler]

https://bjsm.bmj.com/content/early/2022 ... 021-105045

Abstract

Objective We aimed to quantify the female athlete composition of the research data informing the most influential consensus and position statements in treating sports-related concussions.

Design We identified the most influential concussion consensus and position statements through citation and documented clinician use; then, we analysed the percentage of male and female athletes from each statement’s cited research.

...

Results A total of 171 distinct studies with human participants were cited by these three consensus and position papers and included in the female athlete analyses (93 NATA; 13 ICCS; 65 AMSSM). All three statements documented a significant under-representation of female athletes in their cited literature, relying on samples that were overall 80.1% male (NATA: 79.9%, ICCS: 87.8 %, AMSSM: 79.4%). Moreover, 40.4% of these studies include no female participants at all.

Conclusion Female athletes are significantly under-represented in the studies guiding clinical care for sport-related concussion for a broad array of sports and exercise medicine clinicians. We recommend intentional recruitment and funding of gender diverse participants in concussion studies, suggest authorship teams reflect diverse perspectives, and encourage consensus statements note when cited data under-represent non-male athletes.

[morepork]

These are indeed useful metrics but one cannot help feeling they are designed to triage individuals at prior risk rather than addressing possible increased incidence of dementia as a result of trauma from your day job in pro rugby. Repeat trauma to individuals that have existing risk markers is going to result in a pretty predictable outcome. What we want to know is how increased is the risk for dementia in ostensibly healthy individuals within an age demographic. I'd like to add that any clinical study worth its salt needs to factor in gender, and if the generation of these metrics are not being applied to women also then the results will have an unintentional bias. Women are disproportionately represented in Alzheimer's, for example (women do live longer than men on average, but there is evidence for fundamental sex-specific metabolic factors at play). Most of the real time shear forces that those vids propose to collect data on are known quantities in neurology. Animal studies have absolutely validated this. There needs to be a treatment option for players that get their bell rung, and there needs to be longitudinal data on outcomes following that treatment. I don't have an answer to that but the cataloguing of exposure to risk in the absence of data quantifying the impact of treatment/mitigation of risk is going to become quickly redundant. Rugby needs effective treatment protocols to be coupled with the data collection process. Resveratrol, N-acetyl carnitine...whatever, but on the face of it, getting smashed in the head is bad is all this is going to state.

*SMUG*

https://bjsm.bmj.com/content/early/2022 ... 021-105045

Abstract

Objective We aimed to quantify the female athlete composition of the research data informing the most influential consensus and position statements in treating sports-related concussions.

Design We identified the most influential concussion consensus and position statements through citation and documented clinician use; then, we analysed the percentage of male and female athletes from each statement’s cited research.

...

Results A total of 171 distinct studies with human participants were cited by these three consensus and position papers and included in the female athlete analyses (93 NATA; 13 ICCS; 65 AMSSM). All three statements documented a significant under-representation of female athletes in their cited literature, relying on samples that were overall 80.1% male (NATA: 79.9%, ICCS: 87.8 %, AMSSM: 79.4%). Moreover, 40.4% of these studies include no female participants at all.

Conclusion Female athletes are significantly under-represented in the studies guiding clinical care for sport-related concussion for a broad array of sports and exercise medicine clinicians. We recommend intentional recruitment and funding of gender diverse participants in concussion studies, suggest authorship teams reflect diverse perspectives, and encourage consensus statements note when cited data under-represent non-male athletes.

[Which Tyler]

I remember his last year at Bath was absolutely blighted by concussion, and failure to recover

[Which Tyler]

https://www.irishtimes.com/sport/rugby/ ... by-ulster/

[Danno]

Crumbs

https://www.theguardian.com/sport/2022/ ... mes-higher

[Which Tyler]

https://www.theguardian.com/sport/2022/ ... mes-higher

https://pubmed.ncbi.nlm.nih.gov/36195436/

[Banquo]

https://www.theguardian.com/sport/2022/ ... mes-higher

https://pubmed.ncbi.nlm.nih.gov/36195436/

seems like the sport is facing an existential crisis to me? Kids are already being prevented from playing by worried parents. What's the plan, do we think?

[Which Tyler]

The plan can only be to follow where the evidence leads; and to take as many reasonable measures as possible - but ultimately, it (should) come down to informed consent.
If every player, every coach, and every patient, knows the risks, then it's their choice whether to take that risk or not. Which probably spells the end of the sport as a professional game; and is certainly playing a large part in my falling out of love with the (professional) game.



The other problem is, the critics always have instinct on their side (and I say that as someone who criticised based on instinct rather than evidence 10-15 years ago) - and can often use hindsight to say that things that weren't known at the time should have been known earlier - which just isn't how the world works, but it how human brains are wired. Which all means that rugby is fighting a rearguard action and just waiting for a PR disaster to happen.



Elsewhere I summed up my feelings in response to this:
https://www.stuff.co.nz/sport/rugby/129 ... s-lukewarm

To my understanding - it kinda sums up the whole "debate"

Instinctively, it would seem like a good idea, and therefore everyone joins the bandwagon.
However, without actual evidence of efficacy, it can do more harm than good, and would open up the Unions to accusations / legal suits, for not being evidence based.
Evidence takes time to acquire, and then it takes time to draft workable responses to the new knowledge, and acquire evidence as to whether the suggested solutions actually help or not.

I say this as someone who was calling for fMRI scans every season for professional players about 10 years ago. I'm not anymore though, as we've learned more about the harms associated with routine/regular imaging - I currently suspect they'd be useful, but can no longer claim that it would be harm-free, therefore, we need actual evidence that it would show what we need it to show, before having a conversation about the risks vs rewards of the process, and making a decision.

As someone who was long critical of rugby's response to concussion, I'm far more forgiving these days than I was 10-15 years ago. Back then, we weren't really doing anything about it, and the macho "man up" culture persisted, players were applauded for refusing to admit the injury, and would actively block physio.s from reaching a concussed player. Equally, CTE wasn't a known thing, and the link between repeat concussion and early onset dementia was barely understood (known, but not understood), the link between sub-concussive mTBIs and dementia not even made yet.
The only options we had to deal with things were based on instinct, not evidence - and I called for those options (mostly due to the known risk of second impact syndrome).
Since then, rugby has been very open about the risks as they became more clear, massive headway has been made on educating players, coaches, medical staff and parents, at all levels of the game, further research has been funded, and a never-ending program of regulations and innovations attempting to address the issue has been followed.

For me, World Rugby, and the Unions, have done pretty-much everything they could, and in a timely fashion. The problem has been when the regulations haven't been followed (eg the only people not seeing that G North was unconscious being the Welsh medical and coaching teams).



Going forward, I hope the massed class-action suit against WR and RFU fails - not because those players don't deserve compensation, but because it sends the message that you are responsible for knowing things that nobody knew at the time - medically speaking - that's a hell of a dangerous precedent to set.
Action absolutely can be taken against those who ignored, or bypassed the regulations, and should have known better.
Going forwards, and IMO, rugby's authorities should make the game as safe as it reasonably can be made, with regulations aimed at addressing the issue, but ultimately, it comes down to informed consent. If they players know the risks, and are happy to take the field in full knowledge, then that's on them.

[Banquo]

Worth watching the Steve Thompson doc, if on i-player. Very moving -poor guy.

[Peej]

It was engrossing but also terrifying. Particularly the point he made about care homes not taking men below a certain age, which is an additional layer of shit.

His comment was also revealing about those sessions after a poor defensive performance in a game; 'You were rubbish in defence at the weekend, so we're just going to smash into each other.'

[Banquo]

It was engrossing but also terrifying. Particularly the point he made about care homes not taking men below a certain age, which is an additional layer of shit.

His comment was also revealing about those sessions after a poor defensive performance in a game; 'You were rubbish in defence at the weekend, so we're just going to smash into each other.'

Think we've all been there,whatever level you played at. But the consequences of bigger heavier players doing it ad infinitum are much worse.

[Gloskarlos]

Played rugby all my life, which my wife fully understands, its my not so guilty pleasure. Without watching, coaching and reffing there is a void in my life. Mrs K came home whilst I was watching this half way through, and despite us being a fully committed rugby family, and constantly being mindful of my son’s head and future (something we have often discussed), she asked me genuinely if our lad should still be playing - and was visibly concerned. For any families not ‘bought in’ quite as heavily to rugby, having seen the same documentary I can only imagine the vast majority coming down on the side of walking away (regardless of the headcase courses we ask parents to do, demonstrating stringently followed protocols and giving the best coaching possible etc.) I think it’s a tough thing to watch and come out of with any confidence that non elite rugby is any better. Especially any parent if a player who has been concussed once or more recently.

[padprop]

Crumbs

https://www.theguardian.com/sport/2022/ ... mes-higher

Did a bit of a deep dive into the paper itself. As you can imagine the title is a bit sensationalised.

Essentially they had 412 of former Scottish International rugby players and a control group of 1200 people matched for year of birth and socieconomic status.

No one in the control group developed MND, which is rare as lifetime prevalence is approx 1 in 350. They added 1 case to the control for the sake of the paper so stated 1/1200 cases in the control group.

They did not state the amount of individual players who developed mnd but gave a hazard ratio of x15.0 (The stat making the rounds on the news), which likely means there was around 4-5 cases in the elite rugby group.

We already have studies that show elite sportsmen are more likely to develop mnd, both in contact and non-contact sports, although admittedly higher in contact sports.

So yes another bad trend in rugby news, but nothing particularly new imo

[Adam_P]

It was engrossing but also terrifying. Particularly the point he made about care homes not taking men below a certain age, which is an additional layer of shit.

Agree, a really uncomfortable but captivating programme. Made me kind of appreciate my knee putting an early end to my playing days about 5 years ago - I certainly fit a fair number of head injuries into my time playing rugby and outside of rugby (still can't smell after a fall and TBI in Feb 2020!).

I can understand where the care homes are coming from. I've got family who work in a dementia care home and it sounds like hard work controlling/restraining the old ladies when they get worked up - certainly wouldn't want to be doing the same to someone like Steve Thompson in a few years time.

[Banquo]

Crumbs

https://www.theguardian.com/sport/2022/ ... mes-higher

Did a bit of a deep dive into the paper itself. As you can imagine the title is a bit sensationalised.

Essentially they had 412 of former Scottish International rugby players and a control group of 1200 people matched for year of birth and socieconomic status.

No one in the control group developed MND, which is rare as lifetime prevalence is approx 1 in 350. They added 1 case to the control for the sake of the paper so stated 1/1200 cases in the control group.

They did not state the amount of individual players who developed mnd but gave a hazard ratio of x15.0 (The stat making the rounds on the news), which likely means there was around 4-5 cases in the elite rugby group.

We already have studies that show elite sportsmen are more likely to develop mnd, both in contact and non-contact sports, although admittedly higher in contact sports.

So yes another bad trend in rugby news, but nothing particularly new imo

Yep, I had a quick look and concluded the 15x headline was at best sensationalised.