Sunday 20 January 2019

Neil Francis: What do we consider an acceptable price to be paid in later life for traumas we put our bodies through?

Compared to 30 years ago, today's players put their bodies under a huge amount of stress

‘The area of the game that had to be sanitised and de-powered by World Rugby (IRB) was the scrum’
‘The area of the game that had to be sanitised and de-powered by World Rugby (IRB) was the scrum’
Neil Francis MRI
Neil Francis

Neil Francis

Three former Irish rugby internationals - a 60, 70 and 80-year-old - meet up for a chat one day. On balance things are good but life isn't as easy as it used to be.

The 60-year-old pipes up saying that his bones are weary and his prostate is at him. "I wake up at 7.0am and it takes me 20 minutes to have a pee and all day long I feel like I need to go even though I don't need to go. It's agony to get even a dribble out. I can't even have a few beers anymore, otherwise I spend the day on the jacks. It's terrible."

The 70-year-old starts up: "My bones are weary too, I wake at 8.0 each morning but the bowel is goosed and the whole day revolves around trying to get a motion going. I have prune surprise and lentils during the day and a tablespoon of blackstrap molasses at night but nothing ever really works and I'm pushing and squeezing all day long and not so much as a Malteser. It's agony."

Now the 80-year-old looks at them and says: "At 7.0 I piss like a stallion and at 8.0 I shite for Ireland." The two boys look at him wide-eyed and say, "Well, what problems do you have?" The ould fella replies, "I don't wake up until 9.0."

If you go to bed at night and you wake up in the morning, well that's a good start to the day. Physical and mental well being and a good life balance is what we all crave. As rugby players we take our health and corporeal being for granted, so it's always interesting to get a perspective 30 years from the last time you threw a ball around the place.

And so a 30-year reunion of the 1987 Rugby World Cup squad took place in Portrush on the beautiful Antrim coast right at the tippy top of this island. Good organisation, a good turnout and everybody in rude health. It is remarkable to observe that this is the case a full 30 years later.

This is not a scientific analysis of what state a group of former players' bodies are in at the moment, a lot of it is anecdotal, but the key criteria here is that while we played the game of rugby union, the game we played involved nothing like the force, stresses and torsions of the professional game. The inertia of the amateur game was brought alive by money and the consequences are predictable but are as yet still unknown. All we can talk about is what we know now.

What, as players who represented our country, do we consider an acceptable price to be paid in later life for the traumas that we put our bodies through?

Out of a squad of just 26 players, obsolescence and wear and tear came with a pretty strong tariff. Three players had two hip replacements and one knee replacement. One player had two hip replacements and another player had a knee replacement. That is 20 per cent of the squad that had to have major surgery and artificial joints inserted. If we had all been actuaries and played lawn bowls would we have the same collateral damage?

The balance of the squad were in remarkably good shape. Since 1987 there were repetitive strain injuries and joint and ligament issues that never really healed and then got progressively worse as they got older. Yet nearly everyone could walk on a long hike, play 18 holes or ride a bike for 30 or 40 kilometres. A goodly portion could even jog 10 kilometres. Let's see what the RWC 2011 crew can do in 2041 - it's a long way away.

Whatever about our muscelo-skeletal system, most were more concerned about the top four inches. Every member of the squad was mentally agile, there are no signs of cognitive dysfunction or neuro-degenerative diseases beginning to manifest. There was a lot of very smart, university educated guys in that squad who are still smart and mentally nimble.

What about concussion? Or the long term fallout from concussion? At one edge of the spectrum you can only diagnose CTE from a post-mortem. The fact is that as amateur rugby players we rarely got concussed. That is not to say that we did not get concussed, or we did get concussed but it was not recognised or diagnosed on the pitch or at a later stage.

What you have to recognise is that 20 or 30 years ago there were no team tackles or gang tackling. Players in every position were two to three stone lighter. BMIs and body fat ratios were radically different. I have said it before: I think an international forward today is probably twice as strong as one who played in the 1980s and '90s at the end of the amateur era.

There would be very few forwards in that 1987 squad who could squat 150kg comfortably. Some of the brutes in the provincial squads can do 300kgs - incredible power! We acknowledge what our eyes are telling us that the game has become so fast and so explosive that it is a wonder there are not more catastrophic injuries and a higher concussion count.

The reason why the 1987 squad picked up few, if any, concussions is because we were operating at 50 per cent of the levels that they go at now. I had three concussions, one serious one in my career, and I don't think there would be too many in the 1987 squad to go above that.

All things considered I am in pretty good nick physically. The only thing I would not or could not do is play rugby at any level now. Pictured here is an MRI image of my neck and brain - scientific proof that I do have one.

Neil Francis MRI

The cervical spine MRI is interesting. The clinical report states that there is "Reduced signal in the cervical discs due to desiccation with moderate loss of height . . . osteophytic encroachment . . . annular bulging posteriorly . . . surrounding degenerative change . . . etc."

My neck, in other words, is not in great nick. At this moment in time there is no pain travelling down my arms, no pins and needles and no loss of power, but a lot of my peers who played the game at all levels do.

The area of the game that had to be sanitised and de-powered by World Rugby (IRB) was the scrum. In the good old days, particularly at Test level, both packs waiting to scrum down stood off and took a running jump at each other. Quite often it ended up in a heap and we would have to re-set. It was unedifying and boring for the paying customer so we changed it to crouch, touch, pause, engage and eventually crouch, touch and set.

Effectively they now fold in and power up when they are almost locked up together. The days when a metric tonne was set a metre and a half away ready to charge into another metric tonne are over - the hits were incredible at times. Where does all that power and torque get absorbed? It would be in every member of the tight five's cervical spine discs and shoulders. Every prop and to a lesser extent their second row at Test level would have moderate to extreme degeneration of their discs and cervical spine.

There won't be a class action coming any time soon, but something had to be done and mercifully it was and tight five forwards now won't be as bad as some of their forebears. All you have to do is ask the older guys to look left or right or how they slept the previous night.

An MRI of the brain can be instructive and sometimes used as a preventative tool. So far in my case I have nothing serious to report, but for the pros who were forced out of the game through concussion would, I suspect, have to have regular MRIs from their late 30s onwards.

These former players will be hoping and praying that there are no signs of the onset of a myriad syndromes or diseases that come about from repetitive trauma or concussion. The three concussions I suffered are small potatoes to the count for some of the pros. It is important to remind ourselves that all over the world I have not once heard of a professional rugby organisation saying that a player got concussed in training. Rolled an ankle, tweaked a hamstring or picked up a stinger - but no concussions. You train five or six times for every match you play. Amazing that.

I may have been injury prone in my career, but I had ten seasons with Ireland and 13 with Leinster. I am reasonably happy with my body. Not all of the 1987 crew are but that is the price we pay for the game we loved and played. What I do know is that the professionals falling off the conveyor belt now will be praying that they will enjoy even 50 per cent of the pain-free environment of those who played 30 years ago.

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