Against the Head- Knockouts and Concussion in Rugby

by darraghmccauley

“Concussion producing forces are common in Rugby; fortunately most of these do not result in concussion. There is widespread variation in the initial effects of concussion. Recovery is spontaneous often with rapid resolution of signs, symptoms and changes in cognition (minutes to days). This could increase the potential for Players to ignore concussion symptoms at the time of injury or return to play prior to the full recovery from a diagnosed concussion. This may result in a more serious brain injury or a prolonged recovery period. The potential for serious and prolonged injury emphasizes the need for comprehensive medical assessment and follow-up until the concussion has fully resolved. Returning to play before complete resolution of the concussion exposes the Player to recurrent concussions that might take place with ever decreasing forces. We have concerns that repeat concussion could shorten a Player’s career and may have some potential to result in permanent neurological impairment. Players must be honest with themselves and medical staff for their own protection.” – IRB Player Welfare


Considering the fallout injuries-wise following the first Lions VS. Australia Test match in Suncorp Stadium, I personally was surprised (and a little relieved) to see Adam Ashley-Cooper and Christian Lealiifano make a speedy return to the starting XV for the second test in Melbourne. Not only did both players sustain what looked like serious injuries on the pitch, which required them to be stretchered from the field, they both looked like they would both miss the second test given the initial reaction of the physios. (On a side note, AAC was knocked out last season as well)

Although I am glad both players returned, and were essential in defeating the Lions in the Second match thriller, I do feel like it is important to discuss something that has been a bit of a grey area in the IRB for 4 years now: Is being knocked out a serious enough prerequisite for players to miss matches the following week?

Guidelines surrounding concussions in rugby are sound, as far as a man with zero medical background as myself can discern. Any player suspected of having a concussion is asked the following questions:

At what venue are we today?

Which half is it now?

Who scored last in this game?

Which team did you play last week/game?

Did your team win the last game?

Naturally an inconclusive answer to these questions, or any of the ‘red flags’ for concussion (Nausea, Dizziness, Disorientation, Headache) means that a player is more than likely concussed. They can’t return to full on training until they have been symptom free for a period of 24 hours, and even then it is recommended that they only get the heart rate up to about 70% (IRB Guidelines).

Now this is completely subjective, but there I was concerned for Lealiifano  the whole time during the second test, every time he got the hands on the ball I was expecting the worst if he were to be tackled (it didn’t happen, he ended up nearly single-handedly beating the Lions). But if something DID happen, does a week seem like an adequate recovery time for someone who has been knocked unconscious?

Simply put, there are no guidelines for when a player who has been knocked unconscious in a match to return to training/play, mainly because a concussion is the most highly rated head injury in the IRB’s and ARU guidelines. The fact of the matter is that most knock-out hits don’t lead to a concussion. Christian Lealiifano went on to watch the rest of the match on the sideline, as did Beau Robinson in the Reds game.

Beau gave the crowd a thumbs up from the stands later

It might just be me having a case of over-sympathy in terms of watching players getting injured or knocked out (I sat in the front row for Ireland VS. England once, couldn’t pay me enough to have been on that pitch) but I do feel that there is a worrying trend amongst international players to get back to the field as soon as possible. Obviously, this is understandable- who would want to risk losing their place on the team following a concussion or a knockout? But are younger players more inclined to shrug it off and continue playing if they can pass the initial evaluations? Should a player who has been knocked out face tougher guidelines like those in the NFL (now that they are being sued over it)?

There is very little information available towards what happens to a player following a knockout in a test match (if you have any please forward it onto me), but one has to wonder do players have the sense, or (for want of a better word) the maturity to decide if continuing to play, regardless of medical advice given to them?

I will leave you with this bit of info in regards to All Blacks centre Conrad Smith:

“The 31-year-old Hurricanes centre was knocked out cold during yesterday morning’s 48-14 loss to the Bulls in Pretoria. Although scans cleared him of a neck injury, the effect of being unconscious for at least 45 seconds will take its toll. This is not the first serious head knock the All Black has suffered. He blacked out during a match in 2010 and only six weeks ago failed a pitch-side concussion test after an onfield collision. Though Smith later said he did not think he’d been concussed, he confirmed he’d been “stunned” twice during the match. He also said he would have major concerns if they became regular. n the latest knock, Smith was unconscious before he hit the ground after putting his head on the wrong side in a tackle. He regained consciousness after being taken to the sideline and rejoined his team at their hotel after being discharged from hospital. The team doctor was assessing him last night to establish whether he should return to New Zealand a week before the rest of his Hurricanes team-mates.” –