Rugby looks to saliva test for concussion

DUNEDIN, NEW ZEALAND - AUGUST 26:  Sonny Bill Williams of the All Blacks looks on during The Rugby Championship Bledisloe Cup match between the New Zealand All Blacks and the Australia Wallabies at Forsyth Barr Stadium on August 26, 2017 in Dunedin, New Zealand.  (Photo by Dianne Manson/Getty Images)
DUNEDIN, NEW ZEALAND - AUGUST 26: Sonny Bill Williams of the All Blacks looks on during The Rugby Championship Bledisloe Cup match between the New Zealand All Blacks and the Australia Wallabies at Forsyth Barr Stadium on August 26, 2017 in Dunedin, New Zealand. (Photo by Dianne Manson/Getty Images)
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It was somewhat overshadowed by the brilliance of the rugby, but last weekend’s Bledisloe Cup was marred by yet another controversial concussion debate.

As early as the second minute of the match, Sonny Bill Williams tackled Aussie skipper Michael Hooper and appeared to collide with team-mate Joe Moody. Williams is clearly groggy after the event, getting to his feet only after supporting himself for several seconds on his hands like a new-born Bambi.

To anyone watching he was obviously struggling, but it appears that no-one amongst the All Blacks camp noticed because the centre was allowed to play on without the mandatory head injury assessment (HIA).

Sanzar did what authorities do in these circumstances, start an inquiry that quickly concluded the NZRFU was guilty of “no deliberate failure” … so we can assume that the NZRFU was still guilty of failing to observe what fans in the back row of the bleachers could clearly see.

“I think everyone missed it to be honest,” said All Blacks’ coach Steve Hansen of the incident, “otherwise the HIA doc would have taken him off.”

The problem of missing head injuries that are bleeding obvious remains with us for now but at least the problem of whether someone has or has not suffered a concussion may soon be a thing of the past, because the University of Birmingham’s Professor Tony Belli has discovered biomarkers in saliva that are linked to concussions. These biomarkers take the form of microRNAs, which are released when the brain starts to heal itself.

A separate study by Penn State University managed to predict the severity of a child’s concussion using the same method.

Now a season-long rugby trial will take place. The study will take and test urine and saliva samples before and after head injuries in the hope of nailing a cast-iron connection between head injuries and these biomarkers that appear to be caused by them. Where there are no suspected or actual head injuries, there will be no samples taken.

“Early and accurate diagnosis of concussion is one of the biggest challenges we face clinically and is particularly a major concern in the sporting world,” said Professor Belli.

“The University of Birmingham recently made a significant breakthrough after identifying molecules, which can be found in saliva and act as biomarkers to indicate whether the brain has suffered injury.

“In this exciting next study with the RFU, Premiership Rugby and the Rugby Players’ Association, we will collect players’ saliva and urine pre- and post-injury, which we will then test in the laboratory in order to assess the reliability of these biomarkers.

“If these biomarkers are found reliable, we can continue our work with industrial partners with the hope to have a device available within the next two years that will instantaneously diagnose concussion on the pitch-side with the same accuracy as in the laboratory; a major step forward for both sport and medicine.”

This study extends to the Championship, England’s second division which hosts London Scottish. If Professor Belli is to be believed, we could be just two years away from a reliable and accurate device that will determine whether a player has been concussed and it is long overdue, because the current system, which relies upon cognitive processing compared to a base level, is open to abuse.

Some years back an Irish journalist revealed that several players at the time had deliberately under-performed when setting up their base cognitive standard. By doing so they had given themselves wriggle room when it came to a real head injury. Provided the blow was not too severe they could be expected to match, or near enough, the lowly base line that they had established as their “norm”.

In addition to making professional rugby safer, the hand-held device could be utilised pitch-side in every youth game, where head injuries are more serious given the developing nature of the teenage brain.

The downside to this potentially useful device is that it still won’t guarantee that Sonny Bill Williams and his ilk is taken from the field to have his concussion confirmed, especially if the player himself is simply too stubborn, too stupid, or perhaps just too concussed to ask for the test.