Crunch game: The increasing toughness of rugby
Rugby has never been more popular and all eyes are on Ireland today as it opens its Six Nations defence with a gladiatorial battle in Rome. They'll be eagerly watched by the thousands of children and teenagers who tog out every week to play a sport that has become increasingly tough and physical. Kim Bielenberg reports
Like an audience gazing at gladiators in mortal combat in the Colosseum, rugby fans will be thrilled by the spectacle of the Six Nations championship over the coming weeks.
The TV trailers invariably show bone-crunching tackles and high velocity collisions, but for many true fans of the oval ball game, the inevitable toll of injuries has become sickening.
As a spectator sport, rugby has never been so popular. The Sports Sentiment survey showed that the Rugby World Cup is the event Irish sports fans look forward to the most this year. The Six Nations is not far behind.
Our national success gives the sport added lustre, but the close-contact physicality comes at a severe cost in terms of injuries, and there is mounting concern about the damage, particularly to teenagers and young players.
Barry O'Driscoll, former medical adviser to the International Rugby Board and an uncle of former Ireland golden boy Brian O'Driscoll, says the style of the game has changed drastically since he himself played for Ireland.
"The young players are coached to run at other players. When I played we ran for the spaces. There are many more impacts and they are much bigger clashes than there used to be."
A player not only smashes into one player, but then follows it up with another crash-ball collision and another, and by the end he might as well have has done a few rounds with Mike Tyson.
Professor Allyson Pollock, a professor of public health, started looking at rugby injuries in Britain and Ireland after her own son smashed his cheekbone, broke his nose and fractured his leg playing rugby.
She says rugby-playing schools collectively experience the equivalent of a multiple pile-up of traumatic injury each weekend of play.
It was her concern for her teenage son that led the professor to study this toll of carnage and write a book, Tackling Rugby.
"When my son was injured a couple of times, I was concerned about it and actually felt guilty that I had not found out what the risks were," she tells Weekend Review. "He broke his leg in a tackle, and less than a year later he had a broken cheek bone, which is the equivalent of smashing through a car windscreen, or having your face smashed in a street brawl. That was pretty nasty."
This kind of injury list would be a mere saunter in the park for our most famous rugby luminary, Brian O'Driscoll, who was almost crushed from head to toe as his long career became a litany of casualties. The most notorious incident came on a Lions tour when he was thrown head first from a height in a spear tackle.
His shoulder had to be reconstructed with 16 staples. O'Driscoll said afterwards: "It looked like a shark had tried to rip my arm off."
No wonder the overwhelming feeling of his family when he came off after his last international last year was one of relief that he had not suffered a crippling condition.
"I was pleased that he finished then," says his uncle Barry. "He took some hard knocks."
Professionals are now built for hard knocks, but it is the casualty list in youth rugby that is causing the most concern.
Prof Pollock came across an Irish accident and emergency study showing that 43pc of sport-related injuries in secondary-school children are linked to rugby - three times more than any other sport.
Her own research suggests that children playing rugby have at least a one-in-six chance of being seriously injured during a season.
"Since professionalisation, the game is getting more violent and rates of injuries have doubled," says Prof Pollock.
Concussion is one of the main reasons for concern, and the rugby authorities have taken measures to ensure that players showing signs of it are not allowed to continue playing.
There are acute dangers if a concussed player stays on the pitch (and until quite recently that was an all too common gruesome sight).
Prof Mick Molloy, former medical officer of the Irish rugby team, says when a player continues, they can be in danger of Second Impact Syndrome. This is when the brain swells rapidly after a player suffers from a second concussion before symptoms from an earlier one have subsided
Prof Molloy says: "Young people are at particular risk of this because their brains swell rapidly."
The savage effect of Second Impact Syndrome killed 14-year-old Ben Robinson during a schools match in Northern Ireland four years ago.
An inquest into the boy's death showed that the pupil from Carrickfergus Grammar School had suffered three separate brain injuries, probably all inflicted in the same game.
This case, and the relentless campaigning of Ben's parents, Peter and Karen, have helped to raise awareness of concussion.
Smashes to the head have also brought about the long lay-off of the Irish outhalf Johnny Sexton, who was recently chosen as the most marketable Irish personality.
Sexton was forced to take 12 weeks out of the game after he was found to have suffered four concussion incidents in a year. As a result, he misses Ireland's match against Italy in the Six Nations today.
Nobody has been a more passionate advocate of the schools game than the former Irish outhalf and Irish Independent rugby writer Tony Ward.
He loves the free-flowing tradition of schools rugby, but also frankly admits that he is disturbed by the modern style of play at the top.
"I hate the way the game is going in terms of power and strength. In my day you tried to attack space to get around players, but that is now gone.
"Now it is about bulldozing your way through the opposition through physical power."
When Ward played, players tended to tackle low and this meant there were fewer knocks to the head.
"Now the players tackle high and try to push their opponent back when he may be coming in at a rate of knots. It's scary to watch."
The average international player is 10pc heavier than they were when O'Driscoll started his career, and this means the hits take a much heavier toll.
The players are now starting to bulk up as soon as they are playing at Junior under-16 level in school, and even in this age group they are becoming much bigger, according to Ward.
Dr Barry O'Driscoll says: "They are developing the physique of youngsters very early now. It's possibly too early.
"Nature takes a long time to develop the bodies of these teenagers, and there is a right time to put on muscle bulk. If that is done too early, will they have the right proportions?"
The Irish Rugby Football Union recently warned that teenagers using substances such as creatine and protein supplements to bulk up were putting their health at risk, and could even fail a doping test. But the muscle-building products are widely available in shops and on the internet.
"If you look in the rooms of many boys who play rugby, you will find they are using these supplements," says Prof Pollock. "These can cause a hormonal imbalance. They affect testosterone levels and the kidneys. I have also talked to renal physicians who have reported kidney failure in some of these boys."
In one of its surveys, the World Anti-Doping Agency (WADA) bought food supplements from all over Europe to test purity, and found that a high number were contaminated with banned substances.
While the rugby authorities have moved to ensure that players with head injuries are properly managed and taken off, Prof Pollock says there needs to be a greater focus on prevention.
"There is a new emphasis on managing concussion, but there should be an emphasis on ensuring that it does not happen.
"It mostly happens when boys are being hit in a tackle. So perhaps the tackle needs to change."
Prof Molloy, the former Irish team doctor, is among those who has called for a change of the rules to stop high tackles that are more likely to cause head injuries.
"I believe there should be a line across the shirt at nipple level, and nobody should be allowed to tackle above that."
There are few sporting events that match the high-octane excitement of the Six Nations. But unless more is done to stop the mounting injury tolls in every age group, parents could be forgiven for losing faith in the great game.