Tom English: Rugby needs to use its head

Published on Sunday 13 November 2011 01:06

American football has woken up to the devastating long-term effects repeated brain injuries can have on its players. So why isn’t the IRB doing more about it?

ROBERT CANTU is sitting in his office at the Boston University School of Medicine explaining in layman’s terms what it is he does. Cantu is a clinical professor of neurosurgery, a world expert on concussion and co-director of an organisation that goes by the cheery moniker of the Boston Brain Bank. He has vast experience in analysing head trauma in sports.

All around him in this place are the brains of deceased athletes, mostly American footballers. One hundred have been analysed and 75 per cent of them have one thing in common, he says. They all show signs of Chronic Traumatic Encephalopathy. Let’s call it CTE for short.

Or better still, let’s think of it as punch-drunk syndrome – repeated punishment to the brain. It is a progressive degenerative disease found in athletes (and others) with a history of repetitive brain trauma. Time was when the world thought that only boxers suffered from it, but there’s a new reality now.

It was to the Boston Brain Bank that the brain of Dave Duerson, the celebrated Chicago Bear, was donated when he committed suicide earlier in the year. Duerson had advanced CTE. It was to Boston that the brain of Cookie Gilchrist, the legendary Buffalo Bills running back, was donated after he had a troubled life after retiring in the 1960s. Gilchrist had severe CTE.

Now, up to 500 athletes in America have committed to donate their brain upon death in an attempt to advance the research of the dangers of this condition to sportsmen competing in attritional competition. Many of the deceased National Football League (NFL) players lived out their post-professional years suffering memory loss, impaired judgment, severe headaches, aggression, depression and, in some cases, dementia – the classic symptoms of CTE. Up until last year the NFL was in denial about the relevance of CTE to its game. Now? It is convinced of its dangers and is a huge, if belated, campaigning force to raise the awareness.

Cantu is wondering about rugby. He knows the sport, has played an active part in the International Rugby Board’s (IRB) medical conferences, has seen some games where the hits have been immense and is suspicious of what might lurk beneath the surface. Sure, American football is an entirely different game to rugby. Until recently the NFL allowed players to effectively use their helmeted head as a weapon against another player. Head-on-head collisions were commonplace in that sport whereas they never have been in rugby.

And, yes, the research is at a very early stage, too early to extrapolate too much from what they’ve discovered. Also, rugby woke up to the dangers of concussion a while back. Or it likes to think it has anyway. The avoidance of head injuries is the number-one priority, says the IRB. “Is it relevant to our game at the moment? I’d question that, but we want to make the game as safe as possible,” says Martin Raftery, the recently appointed chief medical officer of rugby’s governing body. “There has been no recorded case of CTE in rugby and we’re always looking at this area.”

Always looking, but where are the stats? Nobody can say how many concussions there are in the game. No recorded case of CTE, but Cantu reckons there might be if only somebody took a look. “We haven’t had the opportunity to study the brains of any rugby players but I would assure you that if we did there would be some, that if they had played long enough, would have CTE, because there is a fair amount of head trauma in rugby,” he says.

“CTE effects the entire brain, but it’s the medial temporal lobe that is mostly involved and the medial temporal lobe controls memory; it’s where our emotions are. Things like depression, panic and anxiety are common symptoms.

“Rugby as a sport should encourage its athletes who have had emotional impulse issues later in life to donate their brains upon death for study and be assessed to see if they have the clinical symptoms that go along with CTE. The diagnosis cannot be made 100 per cent unless you study somebody’s brain, but you can have a very high index of suspicion.”

James Robson, the respected and experienced doctor to the Scottish team as well as a veteran of many Lions tours, is well aware of the Brain Bank in Boston.

“We’re paying attention to it,” he says. “We’re watching with great interest. Anything that can help us get a greater understanding of any aspect of the game that can result in injury and particularly long-term disability has to be supported.

“Concussion has been a concern of mine and has been a hobby horse of mine. I endeavour to treat head injuries and concussion with great respect, having learned from a very public mistake with Simon Webster [failing to diagnose that the player was concussed during a game a few years back]. Ever since, I’ve been like the guy who gives up smoking, I’m a zealot as far as concussion goes. We have to keep an open mind on what is coming out of Boston.”

In the world of professional rugby, injury is bad for business. If a player damages a shoulder or hurts a knee then it’s diagnosed and they’re out of the game for a period of time and there is nothing they can do about it. If they are concussed it’s more of a grey area. They can cheat concussion in a way they can’t with other injuries. They can hide the truth.

There is the culture of the dressing room to contend with. One player, speaking on the understanding of anonymity, said last week that “you’d feel like a dick if you announced that you felt a bit dizzy and you didn’t want to play at the weekend. It wouldn’t go down well.”

Players need to be protected from themselves, from their own desperation to stay in a team or get in a team. Players are not comfortable talking about concussion. Thankfully, though, there are some case studies to look at. You have to wonder, though, how closely the authorities are looking. A year ago, John Fogarty retired from rugby in his early 30s after playing for Connacht, Munster and Leinster, where he was in the 2009 Heineken Cup-winning squad. In June 2010 he played for Ireland against the All Blacks. After retiring he told his story – see panel above.

Willie Stewart is a consultant neuropathologist at the Southern General Hospital in Glasgow and a leading expert in the UK in the area of CTE. He supports Cantu in his call for brain donation in rugby. Without it, he says, there is no way of telling whether this disease is a danger in the game or not.

“You wouldn’t want to overplay the risk, but it’s something that needs to be looked at,” he said. “If these things can happen in American football then why not in rugby? Especially the way the game has gone in terms of physicality. Do we know if it happens? No. Have we ever looked? No. I’m keen to bring rugby into this discussion rather than just say that it’s an American football issue, but it’s early days and we have to be careful because it’s an emotive subject.”

The International Brain Injury Association’s Congress will be held in Edinburgh in March. At the Congress there will be a session entitled “Chronic Traumatic Encephalopathy and Sports Concussion”. Stewart will make a presentation as will Bernard Jackman, the former Irish and Leinster hooker who, by coincidence, was Fogarty’s team-mate at the province until his retirement through concussion in May last year. It’s a second compelling case study – see above.

Last November, Jackman wrote his autobiography, Blue Blood. It was short-listed for the Rugby Book of the Year award. And yet he has never had a single call from anybody in the IRB asking about his experiences and the lessons the game might learn from his story.

“We have a medical conference this month,” said Raftery, “and I’ll be proposing some procedures to help us reduce head injury rates. It’s the number one thing for us. We’re taking it seriously. Are we perfect? No. But everything that Bob Cantu wants us to do we are already doing. We’re really mindful of this. What we need to do is reduce head injuries in our sport so we don’t get even close to CTE.”

It might be a good idea, though, if somebody picked up the phone to Jackman and Fogarty and invited them along to the conference. It seems bizarre that nobody in the IRB has thought to explore their cases. This is a governing body committed to reducing head trauma and concussion in its sport. Why would they not want to know more about what happened to these guys?

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RDC7

Sunday, November 27, 2011 at 01:09 PM

Is there any way to contact Tom English about this article? I am an ex-player in Scotland who suffered many concussions during my career and am concerned about CTE myself- I suffer from some of the symptoms outlined in the article. Does he have an email address?

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Jimson

Sunday, November 13, 2011 at 11:27 AM

Brain injuries also arise from large deceleration forces applied to the body. Just like some of the really hard crash tackles I've seen in recent weeks. Perhaps the players involved were not only winded when they were hit but concussed as well.

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