How should we tackle concussion in schools rugby?

‘Tackle him, Winter!” bellowed my schoolmaster from the touchline. A pupil at Belfast Royal Academy, where obedience was prized and rugby demanded a stiff upper lip, I complied – upper lip stiffening, lower one trembling – and got flattened. Hence my advice to players in this weekend’s clash between Ireland and Scotland: take up cross-country running.

But what do I know? Cross-country gave me sore tendons and a lacerated kneecap from hurdling a barbed-wire fence. So ban it, recruiting the suspect logic that informed an open letter from academics and health professionals urging UK and Irish governments to ban tackling in school rugby.

Seventy medical doctors, academics and healthcare professionals – the "Sport Collision Injury Collective" – signed the letter earlier this month, calling for a ban on tackling in rugby union at schools level.

It cannot be overstated that all sports, including rugby, confer more benefit than risk, but it's instructive to measure risk if it's to be managed successfully. For example, the Rugby Injury Surveillance in Ulster Schools (Risus) studied 825 adolescents at 28 schools over the 2014-2015 season. Writing in the British Journal of Sports Medicine, the researchers reported 426 injuries, including sprains (31.2 per cent), concussion (19 per cent) and muscle injuries (15.3 per cent). Significantly, the level of concussion revealed was higher than most previous reports in youth rugby.

In a survey of 79 adult male and female rugby players in Ireland, reported last year in the Irish Journal of Medical Science, 75 per cent said they would continue playing an important game even if they suspected they were concussed.

However, the controversy is not over facts adduced by these and other studies, but the opinions distilled from their evaluation. The signatories consider the risks of injury are so “high and often serious” among under-18s that tackling should be banned. But, according to Peter Robinson and Dr Andrew Murray, this view is not tempered by perspective about the nature of the risk and how it could be managed.

In January 2011, Peter’s son, Benjamin Robinson (14), died following concussion while playing rugby for Carrickfergus Grammar School. “Banning tackling is not the way forward,” Robinson told me.

“Kids will always want to play contact sport; developing schoolboy players need contact to learn proper tackling technique; and banning it would only cause problems later on in their game. It’s down to us adults to make the playing field as safe as possible. Education of everyone . . . is crucial.”

Murray, a GP and consultant in sports and exercise medicine at Edinburgh University, agrees.

He and Robinson collaborated with Edinburgh University, Glasgow University, the Scottish government, and all sports in Scotland to produce the Scottish concussion guidelines, and he argues we risk putting our children off sport: “Turning our children into couch potatoes is not a cure for sports injuries, including sports concussions.”

Murray suggests measures such as banning tackling in school rugby may deprive many of the opportunity to enjoy the sport and reduce participation. “An outright ban on the tackle is also difficult to justify scientifically,” he says.

“One of the open letter signatories suggested that allowing my daughter to play rugby would be like allowing her to be hit by a bus. This is scientifically absurd; I know of no schoolgirls who weigh 9,000kg and travel at 30 miles per hour.”

Robinson explains the Risus survey not only found that larger physical stature and higher competition levels were important risk factors for injury, but that head guards and shoulder pads failed to protect against injury.

“Rugby has evolved with the introduction of nutrition advice allied to strength and conditioning, but . . . you can’t condition the brain. With stronger and faster players, there are bigger collisions, and the Risus survey found that one in five players suffered a brain injury. Yes, concussion is a brain injury.”

So, how should we address the problem of concussion in school rugby? Firstly, says Robinson, it’s a public health issue. “Concussion training is a life skill and has to be compulsory for all involved before a kid goes onto a pitch. Don’t get me wrong, rugby is now leading the way with ‘concussion and graduated return to play’ protocols, but that has not always been the case,” he says. He notes that during Benjamin’s inquest, it was highlighted that concussion awareness on and off the pitch was more or less non-existent.

Today, the school rugby landscape shows signs of a growing awareness of the importance of concussion management. For example, before the 2014/2015 season, the Irish Rugby Football Union and Ulster Rugby undertook roadshows targeting young rugby players. Prominent messages included “If in doubt, sit them out,” and “Stop, inform, rest, return,” in combination with refined “graduated return to play guidelines”.

Both men insist the benefits of sport outweigh the risks.

Laya Healthcare’s “Head On” Concussion Management Programme, in association with Leinster Rugby, will deliver 1,350 baseline screenings to amateur players aged over 16 from Leinster clubs, free of charge. A 20 per cent discount is available to other clubs. For more, call 1800 844 864 or visit layahealthcare.ie/HeadOn