Hollywood film that's tackling the head-injury debate
Renewed concerns about Johnny Sexton's welfare have put concussion centre stage. But it's a Will Smith film that has kick-started debate in US.
'If he was my son I would be extremely worried" - Donal Lenihan didn't mince his words when discussing the plight of Johnny Sexton this week. One former Ireland rugby legend trying to warn a star of the present.
The Leinster fly-half (pictured) and darling of Irish rugby left the field with a possible head injury last weekend. His coach Leo Cullen later insisted that Sexton did not suffer concussion and only remained off the field as a precaution.
But when he hit the ground, Irish rugby feared the worst.
Sexton (30) suffered four separate concussions in 2014 and took a 12-week break from playing on medical advice.
Like so many top-class sportspeople, involved in intense contact sports, the fear of head injury is great for Sexton. Some say his tackling style doesn't help and Dr Barry O'Driscoll, one of the most foremost authorities on health in rugby and uncle of former Ireland captain Brian, is concerned for the player.
"Players such as Johnny will be targeted in games, we know this. He's a brave and great player and I would really be concerned for his safety. And the position of his head and upper body when going into some tackles is also concerning," says Dr O'Driscoll.
In 2012 O'Driscoll resigned in protest from the world rugby body IRB after it introduced a five-minute rule or 'Pitchside Concussion Assessment' (PSCA) as it is better known, where any player who is suspected of having concussion has to be removed from the pitch for a five-minute assessment by the medical staff, who decide if he is fit to continue.
"I couldn't abide by that ruling. To me it made no sense and was dangerous as the impacts of concussion are not always immediate," says Dr O'Driscoll.
Each year more data is emerging which clearly underlines the dangers of concussions.
In his radio interview to 2fm sports show Game On this week, Donal Lenihan added: "We're all more educated on concussion than we were three or four years ago. The days are gone when you were forced to go out and play if there were issues like that surrounding you."
And while much of that new research is coming from the United States, the Hollywood blockbuster Concussion certainly touched a nerve with the NFL when released in the USA last month.
The film, which stars Will Smith as Nigerian-born former Pittsburgh coroner Dr Bennet Omalu, details how, in 2002, he became the first person to diagnose CTE (Chronic Traumatic Encephalopathy - a degenerative brain disease) in deceased NFL player Pittsburgh Steelers centre Mike Webster and, later, in several other Steelers players who had died.
It was Omalu's conclusion that the thousands of blows to the head he estimated that Webster absorbed in his career were the cause of his CTE.
When Dr Omalu confronts the NFL with his research findings, the league denies the charges and aims to discredit him. The movie, recounting real-life events, shows Omalu being stonewalled by the NFL as he tries to raise the alarm on the effects of repeated head trauma on players' health.
Indeed, the very mention of 'brain injury' in American football has been taboo up to recent years.
But now as many as 87 deceased players who competed in the NFL have been diagnosed as having CTE.
Already the league has agreed to pay out €700m ($765m) to settle a lawsuit brought by 4,500 players alleging that the NFL concealed the dangers of head trauma.
Rugby union chiefs are keeping a close eye on unfolding events across the Atlantic.
And now the NFL is investing up to €18m ($20m) in new technologies that may be able to better diagnose or prevent traumatic brain injuries.
Gestures and public relations exercises or genuine attempts to make the game safer - the jury Stateside is still out.
But now unable to disregard the threats posed by concussion and brain-related injuries the NFL are finally sending out the right messages.
George Atallah, the executive director of the NFL Players Association, says of the movie: "We are encouraging players to see it, as a teaching tool for them about the not-so-ancient history of how the league mismanaged a serious health and safety issue."
He added: "I think that's where the film has a really strong message. Not that (American) football is dangerous, because we all know playing football comes with risks, but the only way football is going to end is if we continue to deny some of the dangers and don't try to fix them."
And the same message must now be true of sporting codes closer to home.
Dr Billy O'Driscoll believes that, when it comes to rugby union, honesty is now paramount.
He tells Review: "One of the arguments you hear from time to time in rugby is that there are no more cases of concussion now than there would have been in the past as the impacts are not considerably heavier. This of course makes no sense. In top-tier rugby, the weight of the players are now more and the speed of the game quicker - a simple equation tells us that the impact must be so much greater now and such impacts can lead to more severe head injuries."
And he says sense must prevail and that the governing bodies may need to step in to protect players - and perhaps even the sport's future.
"Top-tier rugby is big business. There's a lot riding on victory but as a sport, rugby union could be terribly liable down the line.
"We're still finding out what the long-term impact of recurrent concussions are, such as dementia and cognitive defects later in life.
"It's very alarming and preventative action must be taken," adds Dr O'Driscoll.
In other codes, the issue of concussion has gradually come to the fore in recent years. Sean Potts of the Gaelic Players Association, which represents over 2,000 inter-county GAA players, believes the GAA is making strides in this area but that continual assessment is required.
"New guidelines and protocols were introduced last year which state that any player who gets a blow to the head in a game must come off the field of play immediately and not return. The player's management team and medic must make the player leave the field - not the referee. While that rule may work at high-end games, there would be concerns that it will not be followed through to the letter at lower levels," says Potts.
"The GPA will assess how the new guidelines are working in practice before deciding if this is the best way to deal with concussion. We're all searching for the right model that protects players, but also doesn't allow loopholes which could be used to a team's advantage," he adds.
Players, such as Dublin football star Rory O'Carroll, have expressed concerns regarding the amount of undocumented cases of concussion in the game.
In an sample survey carried out by the GPA in 2014, to which 416 players contributed, 48pc said they had experienced concussion in their playing careers; 65pc said that had not been assessed by a medic and 51pc of players said they had returned to the field of play immediately or within the next 24 hours.
Dr Andrew Franklyn-Miller, head of Biomechanics and Sports Medicine Research at the Sports Surgery Clinic (SSC) and Research Foundation in Dublin, tells Review that for years concussion has been deliberately hidden from view.
"For too long, little in the way of rehabilitation has been offered for concussion. In part, I think, this is the reason why (players) think if they are concussed, then they're out of sport with little to do until the rules give them the opportunity to return. We know already that athletes tend to hide the symptoms of concussion," says Dr Franklyn-Miller.
And away from the field of play, the impact of concussion can have life-changing consequences too.
"We know one of the biggest bars to recovery is the impact on concentration - this makes going back to school a real challenge for younger athletes - but rest alone is not the answer. Some studies have looked at sleep disturbance and heart-rate variability but these are not yet established as reliable markers."
It's alarming that as long as man has played sport, concussion has existed - yet we still know relatively little about the brain injury, the name of which comes from the Latin for 'to shake violently'.
Boxers and wrestlers down through the ages grew accustomed to the injury. Soccer players who made names for themselves as great headers of the ball, such as West Brom's legendary striker Jeff Astle, went on to suffer dementia. And one study claims that a jump jockey is 125 times more likely to sustain concussion than an American football player.
But the parallel stories of Sexton and Concussion have added weight to the calls for more to be done across all sports to protect participants from harm and possible long-term brain injury.
Let's just hope those running our sporting organisations are truly listening.
Three sports stars who retired due to concussion
Kevin McLaughlin (Rugby Union):
The 31-year-old Leinster and Ireland back-row's decision was based on medical grounds after a neurologist raised concerns about his increasing susceptibility to concussion and the length of recovery. Other Irish rugby players to have taken a similar decision include Bernard Jackman, Declan Fitzpatrick, John Fogarty and David Quinlan.
Gwen Jocson (Horse-racing):
In a hugely successful career, American jockey Gwen Jocson won 763 major races but in 1999 she took the decision to retire after having one too many falls. She has constant trouble with her balance.
Briana Scurry (Soccer):
The US ladies' goalkeeper who played in four World Cups and two Olympic games for her country suffered a career-ending concussion early in the 2010 season after she dived to save a shot on goal.