Six Nations: Is Rugby Union Safe?

Francesco Celot, 40, a sales manager working in construction, has recently recovered from a head injury after playing in his team’s first match of the season. 

He got hit side-on behind his ear accidentally in the first game of his year by somebody from his team as the player came in from behind.

The loosehead or hooker by trade felt a bit strange afterwards because he felt that it wasn’t a definite concussion.

Later though, he began to feel confused, so he came off at half-time. He realised that he had issues with his eyesight, lights, and his balance after the incident.

Celot said that the concussion took four weeks to recover from. He was forced to take time off work because a simple task would take ten times longer than usual.

Celot’s concussion story is increasingly common in both amateur and professional rugby union.

What is concussion?

Concussion “is a traumatic brain injury typically resulting from a blow to the head or body, which results in forces being transmitted to the brain. The symptoms can present immediately and be short-lived, or the onset of symptoms may be delayed and start to occur some time after the initial injury,” according to England Rugby.  

Hamish Bain, 29, a neurologist at University College Hospital, said: “Within seconds, direct trauma to the skull can cause bleeding at the site of contusion (essentially a brain bruise) and is often accompanied by damage to the opposite side of the brain. 

“Bleeding disrupts the delivery of oxygen to this area and releases neurotoxic chemicals that can cause damage locally.

“In hours to days, the lack of blood flow and consumption of resources can cause your brain function to be impaired for several days while the damage is repaired.

“In this period, your brain is highly vulnerable to a second impact that will make total recovery time significantly longer.”

The statistics on concussion are stark, even in England Rugby’s own studies. There has been an increase in the incidence of concussions in the professional game documented by the England Professional Rugby Injury Surveillance Project season report 2020/2021, which found that the most common injury was a concussion for the tenth season in a row. Concussion accounted for 28% of all injuries in the professional game in that season.

Players spent an average of 17 days off with a concussion in 2020/21 compared to the average of 13 days per concussion between 2002 and 2020, showing the severity of concussions has increased as players are spending more time on the sidelines needing to recover.

Independent studies conducted by academics back the upsurge in concussion in the professional game. In the British Journal of Sports Medicine, a study collected data from the four Welsh professional teams – Cardiff Blues, Dragons, Ospreys, and Scarlets- as well as the Welsh men’s international team.

Rafferty et al found that between the seasons of 2012/13 and 2015/16, concussions grew across the four seasons that they researched.

Alongside the fact that concussion was increasing, the study documented that there is a 38% higher injury risk after having a concussion.

 Rules and Legislation

In order to protect players from the dangers of concussion, the authority in charge of governing rugby, World Rugby, introduced the Head Injury Assessment (HIA) back in August 2015, otherwise known as HIAs in common rugby slang.

The HIA allows for the team of the player who may have been concussed to make a substitution so that the player can take tests to determine whether he or she has a concussion.

The HIA is a three-part process where the player is seen by either a match official, the doctor for the team and the independent doctor for the match. There is then an off-field review using an assessment tool, a pitch-side video review, and a review by a doctor.

This is followed by another assessment inside three hours of the game being completed. It is used to decide whether there has been any improvement in the player’s condition using the test used in the previous part.

Finally, the last stage, three happens in the next two or three days. A doctor assesses the player and the same test as before to see if the player’s cognitive ability has improved.

However, the HIA is not a foolproof system to protect players from concussion, as seen in the recent case of Nic White, the Australian scrum-half, during an Autumn Nations Series game against Ireland.

White, 32, played on despite having a head injury in the game because of “discrepancies around process and communication,” according to an independent review.

The review found that he should have been substituted, even though he had already passed an HIA.

If players get concussed and cannot play on, they have to undergo the return-to-play protocol, which involves 14 days of rest and recovery followed by a slow return to full-contact rugby spread over time.

The return-to-play protocol is a process that involves the player increasing his workload from light exercise to full contact training over a period of five days if it is quick, but it can be much slower if the symptoms of concussion continue to appear during the process.

Sometimes professional rugby players do not ever come back from the return-to-play protocols, such as George Taylor, an Edinburgh Rugby player, who was forced to retire due to concussion at the start of this year.