Concussion on the political agenda

Concussion visited Leinster House yesterday. In many ways that in itself was a triumph. That legislators wanted to know about the newest, perhaps most mysterious condition on the block seemed timely and appropriate.

The injury that terrifies parents and which is only beginning to be understood is now on the political agenda. As a gallery of experts informed the House as much about what they didn’t know about concussion as what they did, the message that landed was that while there are gaping holes in the bank of knowledge, it is being treated as one of the most serious issues to visit sport.

Fact: In 2012-2013 there was a 41 per cent increase in the number of adolescents presenting to St Vincent’s Hospital in Dublin with sports-related head injuries. The reason for the significant jump is the recognition of the condition and not a greater incidence.

Prof Michael Molloy, consultant rheumatologist and former international player alongside Willie John McBride, is not a man to overstate facts.

An Irish rugby team doctor for years, Prof Molloy nodded his head and calmly agreed with Dr Michael Farrell, consultant neuropathologist, Beaumont Hospital, that "there is no scientific data" and that much of the knowledge "is anecdotal".

Prof Molloy also agreed that with regard to the professional game of rugby, “yes, the bulking problem is a worry.”

A study carried out by Prof Peter Millburn in Australia’s Griffith University and posted on the website The Conversation showed that over the past 25 years, the weight of rugby union players grew three to four times faster than young men in the wider community.

He analysed 700 All Blacks from the New Zealand Rugby Museum website dating back to 1884 and found the height and weight of the players increased by 2.35cm and 4.9kg every generation (25 years).

Risk areas

Dr Eanna Falvey

, the current doctor with the Irish rugby and boxing teams, is satisfied bulk is a risk factor and knows that players from the age of 15 are on structured weight programmes.

Furthermore, rugby may have to look at its own laws to try to find where the major risk areas occur and possibly even change some rules to protect players. The balancing act comes in maintaining the integrity of the game while making it more secure.

“Momentum equals mass by velocity squared,” said Dr Falvey. Simple, a train crash is worse than two toddlers hitting each other on their bikes.

“If you are bigger you are going to tackle harder. Look at the statistics in professional rugby. Players are much bigger than they were 10 years ago. So if you have got a bigger man moving into a collision a kilometre an hour faster, you have much more momentum and bigger impacts . . .”

Changing the laws of the game to reduce concussion may not be a toxic notion to the International Rugby Board (IRB). It may take time for medical observations to be turned into rugby decisions but strong efforts are now being made to evaluate risk factors for injury.

“That’s the 60 million dollar question, isn’t it,” said Dr Falvey. “If you are going to take it that people are going to train they will get bigger. Then looking at what they are legislated to be allowed to do, that I think is where there is some ground to be made, and I think it’s something that needs to be persistently evaluated. Contacts are bigger and, yes, that is a concern.

“Just one small thing within the concussion,” he adds. “If you get a trend where say, cleaning out a ruck is where a lot of this is happening. Okay, now we have bigger guys. They are hitting the ruck and here’s how they are hitting that ruck. If we change how they are hitting the ruck, it may make that a safer process.”

One of the ironies that emerged was that while the professional game is fraught with risk, it is the amateur players and children who don’t have at-hand medical back-up that may be most in danger.

Prof Molloy told the committee that it can take between seven and 10 days to recover from a concussion, and longer than that for children and adolescents, adding that children with concussion have to be treated different to adults because they may bleed from the injury. Prof Molloy effectively brought the sports injury into the classroom.

Mistaken belief

“They have to be kept out of school, they shouldn’t be allowed use their iPhones or play games on their phones. They have to be evaluated slowly and they take longer to recover,” he said.

Helmets and scrum caps are not a solution. In fact, studies show that while they protect the scalp, they allow some children to lead with their head in the mistaken belief that they are more protected and there is less risk attached.

The issue of concussion is an “emotive head concern”, added Dr Falvey.

There is poor science. Impact biomechanics are not well understood and there are no longitudinal studies on which to draw. All that while bigger players run into each other at faster speeds. It’s only just beginning.