Falvey calls for measured and scientific approach to rugby injuries
For Dr Éanna Falvey, tomorrow will be an unfamiliar experience as he enjoys a Test match at a remove from the action for the first time since Ireland won the Grand Slam in 2009.
The World Cup quarter-final defeat to Argentina was the Corkman's last involvement as national team doctor. He has taken the sideways step into a research role with the IRFU, having taken up a lecturing position at University College Cork to go with his work at the Santry Sports Surgery Clinic.
His research role with the union and his position on a World Rugby multi-disciplinary panel on injury prevention will keep him involved with the game, but the high-pressure work at the coal-face has been handed over to Dr Jim McShane.
Over the course of his time in charge, issues around injury and concussion in particular have grown in significance in rugby and the debate around those issues has grown more heated.
There are fears about the effect the size, pace and power of players is having on their safety, with Ireland's World Cup defeat of France a prime example and, while Falvey accepts that there are issues that need to be dealt with, he wants everything to be evidence-based.
"If you don't buy into the major drama and say 'we need to act on it quickly' it sounds like you're a denier. Of course there are issues that need to be looked at," he said.
"You see the traumatic injuries we suffered against France; Paul (O'Connell)'s injury. . . you could physically see his hamstring go with the contact.
"That was in the poach position. Paul's been in that exact position thousands of times and you talk about colliding variables, we talk about whether he was fatigued, whether or not he was a bit sore in that area, whether or not he got hit by two guys from different positions at one time, whether or not his foot stuck in the ground. All different scenarios for the same injury.
"In the same match, you had Peter O'Mahony tearing his ACL (anterior cruciate ligament). I was amused to read an article from so-called "expert" in the UK who said that Peter's knee couldn't take the contact. Peter's cruciate was gone before he went into contact. That's an injury that happens all the time, in many sports.
"The third injury was Johnny (Sexton) who hurt his adductor kicking the ball. . . I was as shattered after that as anyone was, it was one of the worst games I've ever been involved in - a brilliant match, crowd and a fantastic win but it felt somewhat hollow after the game when we looked at the price we had paid.
"I'm not trying to say that injuries don't happen. Of course they do, I've been dealing with them for the last six years, but you need to contextualise the problems and look at them from a scientific viewpoint and not from an emotional one."
When it comes to head injuries, set to be a huge issue again this Six Nations, Falvey says the widely criticised pitch-side assessment has helped in convincing injured players to come off the field.
"My first experience with concussion, I would have had a fairly robust discussion with the coach because at the time it was a mandatory 21 days out and it was 'was he really concussed?' kind of thing," he said.
"As a doctor, you had to stand your ground, but over the last few years I've never had a word from a coach. Everybody's accepting of it now.
"The hardest guys are the players. From my perspective, professionally, the pitchside concussion assessment was a Godsend.
"Lots of people were critical of the process when it came out, saying five minutes wasn't enough. But, the research out there from the 2011 World Cup showed that you had 56 seconds from the player going down to play starting again to get it right. You didn't have long enough and then getting the player off the pitch was virtually impossible.
"With the HIA, if you're absolutely certain the guy is not coming back on, you can say, 'come off and we'll have a look. If everything's okay you can come back on again'. It's much easier to keep somebody off than get them off.
"Players become more educated, they know the risks. I've had guys who wouldn't talk to me for a few days after it because they were so disappointed and upset - but as a doctor your first responsibility is to look after the person."
With the IRFU, Falvey's research to date has largely focused on preventing illness in players, but he says the union's capacity to gather data on injuries has improved in the last two years and will inform their decisions in the future.
With World Rugby, there is a broader discussion on how to bring down injury rates and he believes that there is an appetite within rugby to change.
"It's everything. It's scheduling, it's to do with seasons, in and around the tackle and the ruck; there's a real appetite for discourse on ways to improve player safety," he said.
"To a large extent, it's wide open for looking at the right thing and the right stuff to do.
"When you talk about games missed, it includes illness and training-ground injuries; it includes modifiable factors.
"Training injuries and medical illness - those things when you add them up far outweigh what happens in the tackle, and you can probably impact on those ones more than you can on the contact injuries which, because of the nature of the game, are going to happen."
That is his field now. The pressurised on-field decisions are no longer his to make.
"As a doctor you can't be a fan," he said. "You can't let what you want as a fan to cloud what you do, you have to do your job first and foremost, to ensure the player's not in any danger from what you're doing. You go into professional autopilot. I find that after the game that you're emotionally shattered and physically very tired."