Rugby brain injuries: Top medic urges radical change in name of safety

In response to rugby's "huge wake-up call", as the Rugby Players' Association CEO Damian Hopley described it, Dr Willie Stewart, the world's foremost expert on the link between football and brain injury-related deaths, has called for the game to make radical changes immediately.

Speaking to The Irish Times, Dr Stewart, a consultant neuropathologist based in Glasgow, has called on rugby to cease contact training, impose a zero tolerance approach to high tackles and excessive clear-outs at the breakdown and, ala boxing, have all players undergo brain scans at the start of each season in order to obtain a licence to play.

He also believes that a la American Football, this has to be a defining moment for rugby.

“American Football was faced with the same challenge a decade or so ago. The contact area was the problem so they just changed the rules and removed as much of the contact as possible. You look at rugby and I’m not sure that same approach has been adopted,” said Stewart, citing the examples of clear-outs last weekend in the Autumn Nations Cup, which were not penalised and which “no sport should accept”.

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Otherwise, he adds, the game will have to ape Rugby League and do away with the breakdown.

Dr Stewart worked with World Rugby as one of their independent advisors on concussion before they “parted company”.

“Moves to reduce the number of concussions as opposed to counting them weren’t taking shape and secondly, when a player with concussion appeared to be left on the pitch there wasn’t a proper, rigorous breakdown of why the process failed a player there. It was clear that our independence wasn’t valued so much as our name.”

Identification of concussion does not address the problems caused by cumulative exposure to head impacts over a career.

“Concussion represents the tip of the iceberg,” he admits, but adds that if those levels dropped it would be reasonable to assume head impacts had dropped.

“The big gain is to get rid of this in training, because this is just not necessary. American Football did that. They just said: ‘Contact training, not necessary.’ And there was a massive reduction in the number of impacts.”

The Professional Rugby Injury Surveillance Project (PRISP), an annual study which dates back to 2002 and is commissioned by the RFU and Premiership Rugby, found that 38 per cent of all injuries in the 2017-18 season were sustained during training. For the third consecutive year, concussion was in the top five training injuries, ranked third.

Dr Cliff Beirne was one of those who conducted a pilot study into concussion at schools level in 2016 along with Dr Éanna Falvey, who became World Rugby's Chief Medical Officer this year, Dr Ciarán Cosgrave (the Irish team doctor), Colm Fuller, Head of Physiotherapy at the Sports Surgery Clinic in Santry, who funded the study.

They monitored players from St Michael’s, St Andrew’s, Blackrock, Gonzaga and St Mary’s for a year. “This research informed the creation of a clinical framework for the safe management of concussions in schoolboy rugby players. That was published in the British Journal of Sports and Exercise Medicine in 2018,” says Beirne.

Law suits

Beirne adds: “There’s ongoing research in Santry where Colm Fuller is doing a PhD thesis on concussions and I think that will inform an awful lot. There’s another study on training loads at schools level with the RCSI and it’s getting technical support from World Rugby.”

A Consultant Maxillofacial Surgeon based at the Sports Surgery Clinic in Santry, and actively involved in rugby since 1982, Beirne adds: “As a medical professional hearing those testimonials is awful but we must continue to strive for improvement in the game and make it as safe as we can. If legislative changes are made in the way the game is played at varying levels, the interests of player welfare has to be the priority. The impact of these legislative changes will need to be re audited to see if there is evidence that they are in fact making a difference to injury rates.”

Rugby is in a bad place. Multimillion pound losses and the cessation of under-age and schools rugby has now been compounded by the possibility of a law suits and the damaging accounts of Steve Thompson, Michael Lipman and Alix Popham.

The effects will be lasting, both financially and in turning kids and their parents away from the game.

Rugby thought it had encountered its biggest problem when the pandemic struck but it now has a bigger one

“That’s the saddest thing,” says Stewart who says that their studies on ex-Scottish rugby internationals “also found that their heart health was really good, their cardiovascular levels were lower. Our football studies showed that, although there were very high levels of dementia, cardiovascular disease was lower, cancer was lower, mental health was better. So there’s always benefits from participation in physical activity. It’s just this real problem with the head knocks and complications after that.

“I think that’s where rugby and football may be missing the point, that by putting their fingers in their ears and thinking this will go away and it won’t be such a big problem.

“If rugby changed, if football changed and with the knowledge in 2020, and said: ‘we see this problem and we’re changing immediately’, parents would say ‘that’s great’,” adds Stewart.

As a response to his study ion dementia in football, the Scottish Youth Football Association outlawed heading of the ball.

“There wasn’t a backlash. Players, parents, coaches welcomed that and are delighted that change was made. If rugby were to do the same thing I think parents would believe their kids were being looked after. American Football has had that problem, resisted change and kids went off to play soccer.”

Rugby thought it had encountered its biggest problem when the pandemic struck but it now has a bigger one.