GAA must be conscious of the concussion crisis facing rugby

Head injuries in sports built on collisions are a serious threat
GAA must be conscious of the concussion crisis facing rugby

Rugby is dealing with some huge issues regarding head injuries in what is an extremely physical sport built on collisions.

WHEN David Walsh wrote an excellent column in the Sunday Times in November exposing rugby’s blithe attitude to head injuries, his argument was framed around three former rugby union players and their partners telling him what it’s like when the man of the house has been diagnosed with brain disease.

One of those former players, Michael Lipman, reckoned he was either concussed or knocked out 30 or more times in his playing days.

Lipman, like the former England World Cup winning hooker Steve Thompson, were among a group of former players below the age of 45 who have been diagnosed with early-onset dementia.

That group of players are launching a legal action against World Rugby, the English RFU and Wales Rugby Union over their alleged failure to protect players from risks that cause concussions.

The inevitable counter-argument and defence from those organisations will be that those players were playing a collision sport and knew the risks.

However, Walsh argued that this isn’t true; the players did not know all the risks.

“We knew our bodies would be broken,” Alix Popham told Walsh. “But not that the same would happen to our brains.”

Legal experts believe that the players’ case will not be easy to prove.

Whatever happens, there won’t be any winners. If the players are successful with their case, the game may have to pay out hundreds of millions to the players and their families. But the players will still have to live with brain disease, especially dementia.

The players’ real focus is to drive change in the game. Rugby is certainly at a crossroads, but sport-related concussion has become a huge public health concern in recent years.

England World Cup winner Steve Thompson. Picture: David Davies/PA Wire.
England World Cup winner Steve Thompson. Picture: David Davies/PA Wire.

Only last week, England football manager Gareth Southgate said that football remains “in the dark” about the long-term risks of heading the ball and concussions sustained on the pitch.

There is far more education on concussion now, especially in protocol procedures post-concussion, but it still remains a highly charged area of concern even in the GAA, and particularly with the hits getting harder at inter-county level every year.

A recent study by researchers at University College Cork’s School of Medicine, Mario Pasquale Rotundo and Darek Sokol-Randell, was revealing around concussion practises in the GAA.

Reviewing 111 matches during the 2018 and 2019 inter-county Gaelic football seasons, the researchers used a video-analysis methodology previously applied to professional soccer to investigate the incidence and assessment of potential concussive events.

The study found that although most players were assessed following a potential concussive event, 88.6% of assessments were under two minutes in duration and only 5% of players were removed from play. The standardised concussion assessment tool (Scat-5) recommended for use by the GAA and international bodies takes at least 10 minutes to perform.

Yet the findings by Rotundo and Sokol-Randell “suggest that this assessment is rarely being completed, if at all,” wrote the authors.

Their most important finding though, was the proportion of players who returned to play following a potential concussive event that resulted in visible signs of concussion. Rotundo and Sokol-Randell highlighted an international consensus study published in 2019, which indicated that there are six observable signs on video analysis that indicate a high probability of concussion.

The authors of that study recommended that if a player displays even one sign, they should be immediately removed from play and professionally assessed for concussion.

Yet the study by Rotundo and Sokol-Randel determined that 61 (25.2%) potential concussive events resulted in a player with one or more signs. However, only nine (14.8%) of those players were removed from play.

“This suggests that assessment of potential concussive events in elite men’s Gaelic football may not always be in accordance with best practice, and is placing players at risk,” wrote the authors.

The same methods have been applied to elite inter-county hurling, and a paper detailing this research is currently under review at the Irish Journal of Medical Science.

“The assessment and RTP findings were almost identical to those in Gaelic football, suggesting this is a widespread issue that exists across the entirety of the Gaelic Games,” wrote Rotundo and Sokol-Randell.

The GAA has done a lot of work in trying to educate players, managers and coaches on concussion.

Their concussion management guidelines recommend that all players suspected of concussion be removed from play pending a standardised medical assessment. Yet very little research exists on whether this is actually occurring on the pitch.

Rotundo and Sokol-Randell have recommended the GAA take action to improve the identification and management of head injury, through strategies such as sideline video analysis, external concussion spotters, and concussion substitution rules.

They are also advocating to standardise concussion assessment and RTP protocol across all levels of play.

In 2019, an anonymous survey of U14 and U16 GAA players showed around three in five male and female players had suffered a concussion in the past. Yet many were never medically diagnosed.

Teenagers admitted an impending important game discouraged them from getting help for a concussion. Some also stated that they didn’t want to let down family, team-mates or friends.

Author of the report, Siobhan O’Connor, assistant professor in DCU’s School of Health and Human Performance, subsequently highlighted those concerns attached to not reporting concussions.

“They may be at future risk of another concussion,” said Dr O’Connor. “Second-impact syndrome is a small but serious risk if they sustain another blow.”

The study by Rotundo and Sokol-Randell is the first of its kind in Gaelic games and their findings certainly underline the importance of concussion awareness, education and adherence to guidelines.

The dangers may not be as apparent as in rugby.

But the key message from the study is that there needs to be more of a collective effort between the GAA and the community to make the game safer for everyone.

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