Concussion takes centre stage again


Words: Nick Tatham | Photo: Dave Macleod

A spate of serious injuries to rugby players, and the ongoing experimentation with the rules of the game has focussed the spotlight on the serious dangers associated with primary and secondary concussion injuries in rugby.

This month a report released in Ireland confirmed that the 2011 death of schoolboy Benjamin Robinson in a rugby match in Northern Ireland was the result of concussion sustained from two head knocks, leading to a conditions known as 'Second Impact Syndrome'.

The boy remained on the field after coaches and the referee were not made aware of his complaints after the initial concussion and he picked up a subsequent head injury. Robinson then collapsed in the final minutes of the match and was taken to hospital where he passed away as a result of his head injuries.

The report underscores advice from the Discovery SharkSmart programme, which offers guidelines to numerous top sporting schools in KwaZulu-Natal, to take concussion injuries seriously, as children and teenagers are more susceptible to injuries of this nature because the brain does not recover as quickly as adults.

The family of the Irish player who died from the secondary concussion injury is positive that if they had taken their son off the pitch after he sustained his first concussion he would still be alive today and they feel that it is important to revisit the guidelines and laws behind the management of concussion in school sports.

With the introduction of the Pitch Side Concussion Assessment (PSCA) at Super 15 and international levels the idea was that it would mean that medical staff would have a longer period to assess a player as opposed to the few minutes that they used to have on the field and now with certain tests they are able to determine whether a player is fit enough to return to the field of play. This five minute “brain bin” is not allowed to be implemented at games played at lower levels, especially schools.

There have been a number of high profile concussion injuries in recent weeks with the Wallaby debut of Christian Lealiifano ending within the first 30 seconds of the match after he was knocked out when he collided with Jamie Roberts’ hip, George Smith’s controversial readmission into the final Test match against the British and Irish Lions when he and Lions hooker Richard Hibbard clashed heads and then most recently, Toby Flood’s concussion during the Leicester Tigers warm-up fixture against Ulster.

Lealiifano was cleared to play in the second Test match after he passed the necessary concussion tests that had been given to him.

In the case of George Smith it seemed at the time as if there was little chance he could continue. He was unable to walk properly and was assisted when he was walking off the field. He managed to return five minutes later to continue the match in what was his last Test for Australia.

Flood was recently knocked unconscious during a match against Ulster and was taken to hospital after being taken off the field on a stretcher with an oxygen mask. He will miss the opening game of Leicester’s season due to medical advice in order to recover from the knock.

Stuart Berry, who is one of the top globally emerging referees, feels that with respect to the PSCA it is important for people to realise that the medical personnel are responsible for making the decision on the player’s wellbeing.

“Ultimately it is the medical personnel who are responsible for making the decision about whether a player is able to continue or not,” Berry said. “What we can do is send a player to the side of the field if we feel that the medical personnel are not acting in the player’s best interest.”

This comes with its own challenges considering that most referees are not medical professionals but with the option of the potential return to the field of the injured player the pressure on referee could be lifted slightly with players having the opportunity to return to the game if they are deemed to be healthy to play.

“You can see when a player has taken a knock they are now less reluctant to leave the field, knowing that they could possibly return if cleared.

“Being able to come back on has meant that there is less pressure to stay on the field,” Berry mentioned.

Former England doctor Simon Kemp recently came out with the PSCA statistics after the first round of experimenting with the Pitch Side Concussion Assessment that was used during the Guinness Premiership.

In total there were 33 players that were taken off the field with suspected concussions. Of those 33, 23 were allowed to return to the field of play. That means that the other 10 were permanently removed from the match and it was discovered that of those 10, nine were concussed following further testing. Of the 23 players that were allowed to return to the field only two of them were concussed.

The Discovery Sharksmart programme advocates the management of concussion according to the globally accepted concussion consensus statement adopted by most international sporting bodies including the IRB.

“Every individual case of concussion is treated on its own merits using as many objective criteria as possible; the return to play of a concussed player is dependent on that individual’s ongoing symptom status and following a defined return to play protocol” said Discovery SharkSmart director Dr Glen Hagemann.

The Sharksmart program encourages the use of Impact testing, a computerised program that is taken before the beginning of the season in order to gauge a player’s neurocognitive ability and sets that as a benchmark. When a player is concussed they take the test again to indicate the severity of the injury in terms of its effect on the neurocognitive abilities of the player. This information supplements the doctor’s clinical assessment in determining whether or not it is safe for a player to return to play.

For more information on SharkSmart’s concussion protocol visit