Against the head
Why concussion is giving rugby a major problem
Modern rugby union is a ferocious game. Players are heavier, faster and more muscular. Collisions exert car-crash level forces on to the body. For many, this is part of the attraction; but for administrators, it's causing a serious headache.
Concussions are now the most prevalent injury on a rugby pitch. In 2010, an IRFU survey of Irish elite players found that 44.9pc had sustained at least one concussion in the previous season.
But head trauma doesn't only impact those who are well rewarded for playing. At school and youth level, sophisticated nutrition and gym programmes are designed to pack bulk on to already powerful frames. Add in the increased susceptibility for young, undeveloped brains to suffer greater damage from head injury and there's an obvious risk factor for thousands of amateur young players.
Almost simultaneously, it's also becoming clear that the longer-term cost of this 'physicality' could be more than we previously thought.
In the US, a recent $765m (€568m) settlement by the NFL with former players over the handling of brain trauma has catapulted the topic into national consciousness.
The league was heavily criticised in a recent documentary for allegedly attempting to cover links between on-field concussion and long-term brain injuries. Rugby is taking notice.
For former Ireland and Leinster hooker Bernard Jackman, being concussed on a rugby field was normal.
"If I go back over my whole career, I would estimate I had 35-40 concussions. The worst I had was playing for Connacht. I had to buy blackout blinds and I remember laying in bed for weeks." Ironically, Jackman now works as a 'collision coach' in France after he retired in 2010 on medical advice after suffering repeated concussions.
Research into the danger of sports-related head injury is evolving. The world hub, based at Boston University, is devoted to research of chronic traumatic encephalopathy (CTE). Prevalent in boxers, and known as dementia pugilistica, CTE is a progressive degenerative disease of the brain found in those with a history of repetitive trauma.
Former NFL and WWE star Christopher Nowinski is a co-director of the institute. A Harvard graduate, Nowinski was diagnosed with post-concussion syndrome after his career ended.
Since then he's been driven to educate himself and others on the subject. "Research I did proved to me that we were handling concussions incorrectly in sports, and it was killing athletes or costing neurological health.
"People like me were willingly and needlessly damaging our brains out of ignorance. I want to accelerate a treatment for CTE while reforming sports so athletes can play smarter and more safely," he said.
At present, CTE can only be diagnosed posthumously by examining brains of retired athletes who suffered concussions and later from conditions like memory loss, depression and dementia. Sadly, there is no shortage of such specimens as the suicide rate for NFL players is said to be multiple times the national average, a fact linked by some to CTE.
And 90pc of the 170-plus brains examined by the centre found signs of the disease.
In an eerily similar stance to the NFL's position earlier this century, the International Rugby Board (IRB) has contested the link between repeated head injury and CTE despite evidence to the contrary. Holding their medical conference in Dublin this week, the IRB view seems to be shifting – with chief medical officer Dr Martin Raftery admitting that "there might be a potential link".
Former IRFU and IRB medical chief Dr Barry O'Driscoll (uncle of Brian) is concrete in his views, saying: "Almost certainly there's going to turn out to be some kind of connection, despite the fact that we haven't fully found it yet."
Nowinski agrees. "I anticipate that members of the rugby community will be diagnosed with CTE just like athletes in NFL and boxing," he said.
Intriguingly, he also states that the centre is "close to finding a way to diagnose CTE in living individuals", a development that would have major ramifications.
So what are rugby's authorities doing? So far the IRB has attempted to be proactive, but has been criticised for not going far enough. Under new guidelines, yet to come to the northern hemisphere, a pitch-side assessment, or 'five-minute rule', allows a medic to give players a series of tests for signs of concussion.
This hasn't stopped numerous jelly-legged players returning to the field. During the Lions tour this summer, Australia's George Smith was involved in a clash of heads and left the field in a state of obvious distress.
He returned within minutes, still visibly feeling the impact.
But Jackman is sceptical of rules. "I don't agree with them. In some ways, it's worse than having no protocols. It trivialises the injury when players come back out after five minutes and it's counterproductive in some ways. It doesn't send a red flag to people," he said.
Dr O'Driscoll also has major concerns, saying: "I resigned from the IRB over the pitch-side assessment. There is no scientific or clinical basis to suggest that it has any standing. It's an experiment that hasn't been done by any other sport, yet we choose to use it on young players who are being sent back in to have further head trauma." Even IRFU head medic Dr Rod McLoughlin has reservations. "I think it's potentially a move in the right direction, but yes, I have concerns about it," he said.
"You are sending a message, potentially, that blood is more serious than a head injury."
Known for bursting runs on the pitch, Jackman is one of the only players to speak out publicly on the subject. "I was really naive of concussion. It's very easy to hide, but you're certainly leaving yourself open to more problems down the road. Players at all levels need to understand this."
For the IRFU's part, this is certainly being seen as a very serious issue. Recently, IRFU director of rugby Eddie Wigglesworth has been clear about the union's stance.
Despite admitting that rugby was perhaps late to the party, Wigglesworth stated that "there's no degree of reluctance on our behalf to make sure that players are safe". He added: "To imply that we're not doing enough, or should be doing a lot more is not a real recognition."
Irish rugby's governing body is focusing on the areas of education, research and mandatory knowledge for coaches and referees.
"The biggest challenge is in the educational area. That's fundamental. There's only one side in this debate and what's most important is the welfare of those who play the game," said Wigglesworth.
Jackman is singing from the same hymn sheet. "It's important that there's support in our academies and increased education. I love rugby, I'm not anti big collisions. But I just want to raise awareness that with those collisions can cause injuries to the brain that we don't see."
Research into the area is an imperfect science for now, but ignoring the lessons learned in America, and the resulting consequences, should be enough reason enough to heed the warnings. Rugby must continue acting decisively to prevent a potential dark cloud forming on the horizon.