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Monday 22 September 2014

Sporting authorities in a daze over concussion protocols

Published 05/09/2014 | 10:45

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Germany's Christoph Kramer admitted that he doesn't remember the World Cup Final. Kramer took an accidental blow to the head, but continued to play for 14 minutes before he was eventually substituted.
Germany's Christoph Kramer admitted that he doesn't remember the World Cup Final. Kramer took an accidental blow to the head, but continued to play for 14 minutes before he was eventually substituted.

It doesn't matter the sport, the area of concussion is now one of the burning issues globally yet many sporting bodies appear as confused and dazed as any player on the receiving end of a blow to the head.

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The World Cup gave us more high profile examples of players who clearly were not in a fit state to continue, but defied medical advice to stay on the pitch. All contact sports are coming under scrutiny, particularly in light of last year's $765m NFL settlement after more than 4,500 former players sued the league for concealing the risks of long-term brain damage.

The players' representatives accused the NFL of hiding research that had shown the harmful effects of concussions, while glorifying and promoting violent play.

Irish parent Karen Walton hasn’t accused rugby authorities of “promoting violent play”, but has criticised the IRFU and the IRB over the prevailing attitudes towards concussion and has called for more stringent measures to be introduced.

Her 14 year-old son Benjamin Robson died on a rugby pitch in Carrickfergus, Co Antrim three years ago.

“Concussion is a brain injury," she insisted in a recent interview.

"There's still that old schoolboy mentality of 'suck it up; get on with it. After a hit you're in a daze anyway.' And that is wrong. If you suspect concussion, get that child off and don't return him to the match.”

Read more: Parents of rugby death schoolboy (14) critical of IRFU concussion campaign  

Rugby has had its fair share of concussion controversies. In recent seasons, the sight of Brian O’Driscoll and Luke Marshall visibly struggling after receiving blows to the head made for difficult viewing. The fact they were ushered back in action so soon afterwards even more harrowing.

In 2012 the IRB introduced the '5 minute rule' where players who suffer suspected concussion are temporarily removed from the field of play and assessed to see if they can be brought back on.

In theory it was going to improve player welfare, in practice it has divided opinion. So much so that Dr. Barry O’Driscoll, the uncle of Irish rugby hero Brian, quit his role as an IRB medical advisor over his opposition to the new measures.

"As a result of a 4-year concussion in sport conference with the wise men of the world on concussion in sport, we got it down to 7 days - that it was safe and rational and we could see that a player showing signs of concussion could return in 7 days if you went through a graded return,” he said.

“Suddenly, out of the blue, the international board decided to make it 5 minutes.”

O’Driscoll is adamant that the rule is nonsensical because the very fact you’re performing the test means that you suspect the player has concussion and that, alone, should be enough to take a player out of the game.

Many medical practitioners in the GAA are in agreement.

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Mayo team-mates Aidan O'Shea and Cillian O'Connor clashed heads during the first half of last weekend’s All-Ireland semi-final defeat to Kerry. Their bloody faces and apparent grogginess meant they were kept on the sideline until team doctor Sean Moffatt gave the pair the all-clear after a period of observation, confident that there were no signs of concussion.

The pair were treated for facial lacerations and resumed play in the second half after passing a number of tests.

"In my experience, players often do no exhibit full signs or symptoms of concussion until much later,” Dr. Moffatt said, backing up the opinions of O’Driscoll.

He insists that any player that gives any indication he is concussed following a qualified examination should not return to the field of play, regardless of the time period.

“Secondary concussion can be worse than the original blow and players often don’t display symptoms until hours later.”

Read more: Mayo GAA stars suffered facial injuries and not concussion, says team doctor

The Medical, Scientific and Welfare Committee devised their concussion management guidelines in conjunction with the GAA and states that any player suspected of having sustained a concussion, should be removed immediately from the field and should not return to play on the same day. It is advised, not mandatory.

Last season Tottenham goalkeeper Hugo Lloris was widely praised for his bravery for refusing to leave the pitch while concussed, admitting afterwards he couldn’t recall the remainder of the Premier League match against Everton, even pulling off a number of saves. The praise for the player was followed by condemnation for the club's negligence toward the French international.

The FA has since stated that players who are even suspected of losing consciousness during a match will have to be removed from the game and not allowed to return.

German midfielder Christoph Kramer admitted he couldn’t remember the World Cup Final after he was replaced in the first half with a suspected concussion, 14 minutes after a clash with Argentina defender Ezequiel Garay.

Read more: I can’t remember the first half of the World Cup Final, says injured Kramer 

"I can't remember very much but it doesn't matter now," he said afterwards. Few would agree with the latter part of the statement, while critics have suggested that FIFA themselves don’t seem as concerned as perhaps they should be.

“FIFA can regulate many things but when it comes to health we cannot make strict regulations we can only make recommendations . . . we can manage and educate but we cannot overrule the team physician,” Jiri Dvorak, FIFA’s chief medical officer told the media during the World Cup.

Read more: World Cup incidents propel concussion back into the spotlight 

Non-collision sports too are beginning to appreciate the serious implications of concussion. Last year the first case of chronic traumatic encephalopathy (CTE) in a baseball player was announced. Ryan Freel, who committed suicide in 2012 and known for his fearless, physical style of play, turned out to have significant amounts of abnormal protein in his brain.

Unquestionably there is huge progress that needs to be made, but slowly attitudes are changing.

Hopefully some of the worrying images seen recently will be consigned to history.

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