Expert warns of child injuries playing rugby

Action from this season's Scottish Schools Cup final. Picture: SNS
Action from this season's Scottish Schools Cup final. Picture: SNS
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MIDDLE-aged and middle class, Professor Allyson Pollock does not look like Edinburgh’s answer to Che Guevara. Nevertheless this revolutionary has lobbed a grenade into the heart of Scottish rugby and the shock waves will be felt for a long time to come. The pyrotechnics followed the publication of her book Tackling Rugby a couple of months back.

Pollock is Professor of Public Health at Queen Mary, University of London where she currently works although, for much of the decade it took her to research and write this book, Prof Pollock was employed by Edinburgh University which is why she has the Scottish Rugby Union and the Scottish Government firmly in her sights.

The book is in two parts, the first dealing with the lack of data collection on youth injuries in the sport, the second part outlining what parents need to know before their offspring sign up. If you are a rugby parent I urge you to read it.

Her book covers many issues but the claim at its core is this: As adults we have a duty of care towards children. The game of rugby union does not collect comprehensive data of children’s injuries so no one knows how dangerous it really is and, without that knowledge, no one can give their informed consent to play the game.

Her own son suffered three serious injuries in his school rugby career, including a broken cheek bone which can be psychologically devastating; little wonder mum was horrified.

“It [the book] was written from the point of view that there is a lot of information that parents needed to have and were not being given,” she says when we meet in Edinburgh. “If there is any annoyance it is really that the [Scottish] government has failed to respond to repeated calls for collecting and monitoring data, not just in rugby but in all sports.

“I was pretty appalled by the number of injuries I was seeing routinely and hearing about and feeling that no one was paying any attention to what was happening.

“You can’t carry out your duty of care if you are not measuring the injuries and monitoring them and that is all I want to see.

“I want injury collection on all children. We need a school reporting system and a good Accident & Emergency reporting system. Both if those things are feasible and doable. It is no less than children deserve.”

When talking to people in the game about Prof Pollock’s work, it is surprising how many insist that she wants to ban children’s rugby outright, a charge she firmly denies.

“Where do I say that in the book?” She doesn’t. “I don’t want to ban things, I want to make them safer.”

I ask her if rugby union’s old guard has closed ranks on her in an attempt to repel this upstart and all her troublesome questions?

“No, no, no, no, no,” she says for emphasis. “Some of the most informed, wise and thoughtful interventions have come from the old boys. They understand the game and they see far too much collision. I have had four or five sets of comments from older professionals who understand the game. Rugby doctors who speak out about the neglect of some injuries. I don’t feel like that at all. In some ways I think that some people within the game have found it difficult to speak out.”

Tackling Rugby does just what the title says and harder than some appreciate. Prof Pollock talks about the disconnect between what children want from the game (camaraderie) and what adults want children to get from the game (competition). She also points out that the millions of children playing the game globally have no representation. The odd false note, “every injury is a failure of care in the game”, should not detract from her core message that we must do better. I found myself nodding in agreement with almost everything until I reached the following on page 79: “The SRU finds protection in ignorance. The axiom is: ‘if we don’t collect the data we don’t need to know the risks, and if we don’t know the risks we don’t need to act.’ Lack of risk data is a handy tool in the contest with public health advocates.”

Rather than blaming the usual human frailties of inertia or a lack of resources Prof Pollock is accusing the SRU of wilfully failing to collect data on children’s injuries because it knows the results would horrify parents. It is an astonishing accusation to make but she doesn’t disown it.

“The question, if you want to say they are not wilful, is for ten years why have they chosen not to collect data?” Prof Pollock argues. “I have been writing and talking about this for ten years! Why has the SRU not taken more steps and made greater strides in data collection? They could have done it. They could have been going to the Scottish Government, they could have done it through Sport Scotland… Why did nobody ever say we need to have the data?”

It is a question I put to Dr James Robson, head of medical services at the SRU and the national team doctor. I must confess an interest here because Dr Robson has been around Murrayfield so long that he patched me up on more than one occasion in my own playing days.

Outside Scotland, Dr Robson is best known as the doctor who has overseen the past six Lions tours. He has probably saved the life of two players, Thom Evans in Cardiff in 2010 and Will Greenwood in South Africa back in 1997. Dr Robson is not used to defending his own integrity and this most rational of men becomes noticeably emotional when I put Prof Pollock’s charges to him.

“I am not sure how to counter that,” he says. “We do collect [injury] data and I have just finished writing a report for the board with my recommendations after collating the information from last season.”

But hospital visits only catch a small percentage of all rugby injuries?

“You have to draw the line somewhere,” counters Dr Robson, right, “and we decided on a hospital visit was a reasonable cut off point but I agree that the system is flawed.”

But the system is voluntary, relying upon parents/coaches filling out the requisite form.

“From my point of view that is an education thing and we made a big push two years ago, saying to people, this is the form, please fill it in. We got an external person to come in and we changed the form to make the data collection easier. We changed it from being a paper form to being an online form.”

Dr Robson concedes that there is no separate harvesting of injury data at youth level but he argues that the online form collects age information so youth data can be separated from adult when necessary.

“Potentially it [the online form] is still missing things but what do we do?” argues Dr Robson. “Do we make it totalitarian? This is an argument that is outwith just the SRU. Are the NHS not beholden to capture that data, for all sports not just rugby? How many other sports capture their data?”

Should the SRU be doing more to quantify the risk in youth rugby even if it takes more resources?

“That may well come from one report I have done for the board,” comes his response. “My next port of call is my discussions with the independent SCOT Group, so where do we take it from there? I can’t solve it overnight. I have been here ten years now and in that time we have managed to effect some good change and we still have lots of change to make. But life evolves. I am more than happy to look where we are going and say we’re not there yet.”

The SCOT Group is the Scottish College of Orthopaedic and Trauma Surgeons, who are as reputable as they sound and who have been working closely with the SRU for the last six or so years. An SRU spokesman was keen to underline that Murrayfield works in concert with outside bodies even if Prof Pollock is not one of them. It was the SCOT Group who helped structure the SRU’s Are You Ready To Play Rugby, following three catastrophic injuries in three years.

Prof Pollock’s response to that is that we don’t know how effective the initiative has been because the SRU doesn’t have the data to judge. She also mentions the late Prof Garraway who had his research funding cut by the SRU in the mid-1990s “because they could see where that was going”. One Murrayfield insider from that era concedes “we were leading the way and then we lost our way” but insists that those cuts were due the financial constraints of a newly professional game.

Both Prof Pollock and Dr Robson are intimately concerned with player welfare. I suggest to both parties that they should be on the same page; they almost certainly started there. Where they differ is on the pace of change required. In short, Prof Pollock wants it yesterday, while Dr Robson is happy to make a start today on the understanding that the fight continues tomorrow.

This conflicting approach is perfectly illustrated by their respective views on concussion and both parties independently suggest that I speak to Dr Barry O’Driscoll, the Irish doctor who resigned from the International Rugby Board’s (IRB) medical panel in protest at the five minute protocol that was introduced in 2013.

Prof Pollock suggests that the revised, ten minute pitch-side test is not enough and insists that Dr O’Driscoll will agree. Dr Robson thinks it a step in the right direction and claims Dr O’Driscoll’s support. The Irishman knows Prof Pollock’s work having spoken at one of her conferences and he knows Dr Robson of old… so who does he back? The answer, of course, is both.

“Ironically the IRB have brought it back to exactly the position it was before I resigned,” says Dr O’Driscoll, pictured below top. “A suspected concussion now is off the field with no assessment, the player must stay off and is out of the game for six days. Is ten minutes enough? No, for the same reasons five minutes was not enough. Symptoms can come later, that night, the next day, when you try and exercise again. Too many things can go wrong.

“But the IRB have added another level, a ‘potential concussion’ which muddies the waters because almost every collision is a potentially concussive. A lot of suspected concussions will come off and be deemed potential [once they pass the ten minute test]. I am delighted that a suspected concussion comes off and must go through a six-day return. I am just worried about the confusion caused by the ten minute protocol.”

O’Driscoll emphasises that he knows nothing whatsoever about the specifics of the SRU’s data collection, or lack thereof, and while he is sceptical about big corporations – “the IRB put out misinformation about me” – he has this to say about his friend and colleague Dr Robson:
“I know James [Robson] very, very well and James wouldn’t give out misinformation, he’s as straight as a die. I can’t see James doing that, I really can’t. His care of a player is as good as any I’ve seen. He is a top clinical doctor and he would never threaten the welfare of a player.”

At the end of our conversation in Edinburgh, Prof Pollock asks me what she should do next? I suggest she has a coffee with Dr James Robson. If the pair of them pooled their talents this issue would be put to bed by tea time.