In professional sport head injuries are commonplace, but life-changing injuries are thankfully rare. However, in 2020 we learned that a number of former ex-professional rugby players, led by former England hooker Steve Thompson, are shaping up for legal action against the games’ global governing body, World Rugby. Essentially they claim that historically, World Rugby has not taken sufficient action/steps to protect players against accumulative head injuries.

Thompson is one of seven players who have all tragically been diagnosed with brain damage. They plan to sue the unions of England and Wales as well as World Rugby for negligence. It has been reported that the claim could open the door to a wide-ranging, multi-million-pound class action. It is the first claim of its type and if successful, commentators are predicting that it could change the game forever. Sadly, I also suspect that there are possibly hundreds of retired rugby players who, unknowingly, have sustained injuries similar to those experienced by Steve Thompson, but have yet to uncover these hidden traumas; only time will tell.

The issue of head injuries in sport is nothing new; the NFL was the first professional sport to acknowledge the link between accumulative head trauma and early-onset dementia after several former players lost their lives due to, in some cases, suicide and erratic/irrational behaviour. Post-mortems of these players revealed that in several cases, they had suffered irreparable brain damage that had undoubtedly contributed to their premature death. The NFL responded by a reduction of the number of games in a regular-season (16) and removing all physical contact during in-season training sessions. The NFL also dedicated significant funds into a foundation for injured players – they recognised that they had a responsibility to the players upon whose efforts the game had been built. I suspect that World Rugby will need to look at a similar strategy because it is sadly inevitable that more players will be diagnosed with long-term concussion-related injuries.

There is no doubt that the research conducted by the NFL into head injuries prompted a number of other contact sports, including Rugby Union, to take concussion awareness more seriously. Although inherently different, rugby chiefs recognized that both sports focus on intense physical bodily contact. Rugby authorities came to the conclusion that they would need to take steps to protect players who suffered a head injury and also minimise the likelihood and severity of head injuries without compromising the game. Tragically, it appears that for some, this action came too late.

To understand the case presented by Steve Thompson and co, we need to look at the development of the game. In historical terms, Rugby Union is a fledgeling professional sport (1995) and in the last 25 years the development of the ‘rugby athlete’ has been remarkable. Thanks to advances in training techniques and nutrition the participants are now bigger, faster and stronger than ever before. Rugby of both codes is littered with giants who can move ‘freakishly’ fast and hit incredibly hard. To give you two practical examples, the average scrum (Rugby Union) generates approximately 16,000 Newtons of pressure; this is equivalent to a car crash at 30mph. Furthermore, on average, a one on one tackle generates 2,000 Newtons of force, and it is commonplace for the modern loose forward, even in the amateur game, to complete more than twenty tackles in a game.

Fortunately, Rugby Union has, over the course of the last three years, put safeguarding procedures in place to manage the welfare of players. For example, in mini and youth rugby, every coach is asked to complete the RFU bespoke concussion awareness course entitled ‘Headcase’ – online training designed to help coaches, teachers and parents identify the signs and symptoms of a concussion. The course also set out very precise procedures which ensure that young rugby players are given the time and support to recover from a concussion/head injury and eventually return to physical activity, but only when they are fully recovered.

As the rugby player matures (13 years and older), physiotherapists and health practitioners follow a strict procedure known as SCAT (Sport Concussion Assessment Tool). The SCAT procedure assesses the extent and nature of the head injury and helps the physician/ healthcare practitioner formulate a graduated return to play plan for the injured player. Exeter Chiefs Head Coach Rob Baxter explains: “It is not easy now for a player with concussion to get back on to the field. Rugby is probably now a leader in monitoring return-to-play safety practices around head injuries. The system has been in place for a number of seasons and is looked at in greater detail each year.”

On the pitch, Rugby Union has also looked very carefully at the way in which players manage contact during the game. At the pinnacle of our domestic and international game, the TMO (Television Match Official), will scrutinise every ruck, tackle and collision in order to enforce player safety standards. Contact with an opponent's head (deliberate and accidental) with a shoulder or a swinging arm will invariably result in either a 10-minute spell on the sidelines or a red card. Players now readily accept that a poorly executed tackle, even without intent, is likely to attract some form of penalty. There is no doubt that this zero-tolerance approach is making the game safer.

The reality is that anyone who was playing any form of rugby prior to 2000 will have been playing a very different game to the one we watch and play today. It’s a sad indictment, but I suspect that most retired players, at all levels, will be unable to accurately recall the number of probable concussions they sustained during their career. In the not so distant past, a head collision was treated with a wet sponge and your concussion test consisted of a question such as “where are you and what day is it?”

In closing, the injuries sustained by the likes of Steve Thompson are devastating. It is absolutely without doubt that many, many players will have accumulated some life-changing injuries. Only time and a lengthy legal battle will establish whether the games’ authorities were culpable and negligent. Fortunately, however, the modern game (at all ages and levels) places a greater emphasis on the health and welfare of its participants.

Thank you so much Jon.

Do take care everyone.

Maggie

President CRFC