USARugger
John Thornett (49)
Kane Douglas
All of you who watched the Waratahs v. Brumbies Round 14 clash witnessed this shortly after kickoff:
All of you who watched the Waratahs v. Rebels Round 15 match saw the same man named in the starting lineup less than six days later. Through this piece I would like to explore how it is possible for this to happen and why this is not alright. Are we protecting our footballers or our win/loss records?
The IRB Concussion Guidelines
Before we get started it's probably important to go over the concussion guidelines set forth by the IRB. From the IRB website here is a table of possible concussion symptoms:
It doesn't take a doctor to see that Kane very, very clearly exhibited all three of the primary symptoms listed above. The man was so much 'in a fog' that it looked like he was trying to navigate early morning London traffic while drunk and blindfolded. It's also clear that by his attempt to return to play that Kane almost definitely did not remember what happened only a few moments prior. While there are over a dozen concussion charts used depending on which part of the world you find yourself in any level of amnesia almost universally bumps a concussion from Grade I to Grade II. This also means that Douglas would be looking at an absolute minimum of two weeks of time off. Another angle of the incident reveals that this may have even been a Grade III concussion, which implies that the player was unconscious for less than one minute:
While I don't believe Kane was out for more than a few moments at most this would automatically rule him out of play for several weeks at an absolute minimum by the standard of nearly any medical professional on Earth.
The IRB's Graduated Return to Play (GTRP) protocols also reveal another aspect to Douglas playing again so soon:
By the IRB's own chart Kane was put back into play in the absolute minimum time window of 6 days. This would imply that Douglas' concussion was a mild one. I am no medical professional but I beg to differ. I have had mild concussions myself and I have seen others on the receiving end of a mild concussion. I have also had a severe concussion and have seem them happen to others as well. What happened to Kane Douglas was, in my eyes, absolutely not a mild concussion.
How Did This Happen?
So how did this happen, exactly? How does a man who has clearly forgotten where he was and had to be helped off the field return to play less than a week later and barely within the established guidelines of the IRB? There seem to be two major factors playing a role here.
A conflict of interest brought on by team medical staff doing the concussion tests is one potential issue. The other is the fact that players will misrepresent or deny symptoms. It is also no secret that some players will intentionally 'flunk' their preseason concussion testing. These preseason tests are used to establish a baseline for each player from which they will be judged when a concussion occurs. By bombing this baseline test these players are able to 'pass' even with a concussion.
First of all there is no excuse for the fact that independent medical professionals are not brought in to deal with instances such as this independently. As it stands the team doctors have a say in the concussion assessment process, this creates a conflict of interest. I am aware that this would cost money but if we are not spending money on player welfare then what is worth spending money on? There is a direct conflict of interest in the fact that medical staff which are paid by the club are involved in assessing the severity of concussions afflicting players of the franchise. This decision and assessment should be entirely in the hands of an independent professional paid by either SANZAR or the IRB.
Secondly the notion that players will intentionally give false reports about their symptoms or even cheat on their baseline concussion tests should not be a surprise to most of the readers here. Many of us who have played the game know what it is like and how hard it can be to leave the field and know you won't be returning for some time. None of this makes this okay. The notion of players misrepresenting symptoms is supported by this article on neuropsychological test and concussions: "the authors recommend relying on symptom checklists but fail to mention that, in some cases, athletes minimize or intentionally deny symptoms when they are, in fact, symptomatic".
The NFL has been attempting to deal with the issue of players cheating their baseline tests for years now. NFL legend Peyton Manning had this to say about his own preseason baseline tests: “Before the season, you have to look at 20 pictures and turn the paper over and then try to draw those 20 pictures. And they do it with words, too. Twenty words, you flip it over, and try to write those 20 words. Then, after a concussion, you take the same test and if you do worse than you did on the first test, you can’t play. So I just try to do badly on the first test”.
On the brighter side of things this article about the intentional sandbagging of these tests indicates that while it is not impossible to do this, it is somewhat difficult: "Seventy-five undergraduate athletes were re-administered the ImPACT neurocognitive battery, which they had previously taken to establish baseline functioning, but were instructed to perform more poorly than their baseline without reaching threshold on the test validity indicators. Eight participants were able to successfully fake significantly lower scores without detection by validity indicators".
The use of independent medical professionals for preseason baseline testing as well would also work towards eliminating any kind of conflict on interest. What worries me the most about these athletes which choose to cheat the tests is that they are eliminating any hope of legal recourse should they become the victim of a debilitating injury related to their history of concussions. These injuries can have devastating long-term impact and very recently have jeopardized or tragically ended the careers of rugby-playing athletes across the world.
Berrick Barnes and Rowan Stringer: A Case in Point
I'm sure that most of our readers here are familiar with Barnes' history of concussions and the footballer's migraine which nearly ended his career. You may be less familiar with the tragic story of a young girl from Canada named Rowan Stringer.
Rowan was a young woman from Ottawa, Canada who loved rugby and was the captain of her Grade 12 side. Ms. Stringer passed away tragically only a few weeks ago after a mid-air tackle went wrong and ended with Rowan absorbing much of the blow through her head and neck. She lost consciousness and never regained it. A week before the fatal incident Ms. Stringer had reported copping a head knock to her parents as well as the fact that she was taking medication to deal with the ensuing headaches. Two days before the accident she took another blow to the head but did not tell her parents, only her friends.
My heart goes out to the Stringer family.
Barnes is another case of a young person being severely adversely affected by a history of head trauma. In 2012 Barnes nearly ended his rugby career because of the development of what is known as footballer's migraine. Some may argue that footballer's migraine is not directly linked to concussion history. This paper says otherwise. A quote from Barnes in an interview with The Rugby Club details the effects of this condition: "I didn't suffer a migraine or a headache, I just lost all memory...especially for an hour after the game, I couldn't remember what I’d done, where I’d been, who I was playing for or what was going on".
As stakeholders in the game of rugby we must push for the issues surrounding concussions to be handled more seriously. The recent steps made by the IRB have been encouraging but are not enough. The implementation of independent medical professionals as well as stricter oversight on the return of players would be positive steps in the right direction. I am not saying we need to bubble wrap every player who hits his head during a game but more care must be taken in ensuring the welfare of these athletes. If there is anything the IRB should be spending money on it is the welfare of the players.
The fact that I could make a highlight reel out of Tatafu Polata-Nau knocking himself out and then getting back up to continue play does not sit well with me. It should not sit well with you either.
All of you who watched the Waratahs v. Brumbies Round 14 clash witnessed this shortly after kickoff:
All of you who watched the Waratahs v. Rebels Round 15 match saw the same man named in the starting lineup less than six days later. Through this piece I would like to explore how it is possible for this to happen and why this is not alright. Are we protecting our footballers or our win/loss records?
The IRB Concussion Guidelines
Before we get started it's probably important to go over the concussion guidelines set forth by the IRB. From the IRB website here is a table of possible concussion symptoms:
While I don't believe Kane was out for more than a few moments at most this would automatically rule him out of play for several weeks at an absolute minimum by the standard of nearly any medical professional on Earth.
The IRB's Graduated Return to Play (GTRP) protocols also reveal another aspect to Douglas playing again so soon:
By the IRB's own chart Kane was put back into play in the absolute minimum time window of 6 days. This would imply that Douglas' concussion was a mild one. I am no medical professional but I beg to differ. I have had mild concussions myself and I have seen others on the receiving end of a mild concussion. I have also had a severe concussion and have seem them happen to others as well. What happened to Kane Douglas was, in my eyes, absolutely not a mild concussion.
How Did This Happen?
So how did this happen, exactly? How does a man who has clearly forgotten where he was and had to be helped off the field return to play less than a week later and barely within the established guidelines of the IRB? There seem to be two major factors playing a role here.
A conflict of interest brought on by team medical staff doing the concussion tests is one potential issue. The other is the fact that players will misrepresent or deny symptoms. It is also no secret that some players will intentionally 'flunk' their preseason concussion testing. These preseason tests are used to establish a baseline for each player from which they will be judged when a concussion occurs. By bombing this baseline test these players are able to 'pass' even with a concussion.
First of all there is no excuse for the fact that independent medical professionals are not brought in to deal with instances such as this independently. As it stands the team doctors have a say in the concussion assessment process, this creates a conflict of interest. I am aware that this would cost money but if we are not spending money on player welfare then what is worth spending money on? There is a direct conflict of interest in the fact that medical staff which are paid by the club are involved in assessing the severity of concussions afflicting players of the franchise. This decision and assessment should be entirely in the hands of an independent professional paid by either SANZAR or the IRB.
Secondly the notion that players will intentionally give false reports about their symptoms or even cheat on their baseline concussion tests should not be a surprise to most of the readers here. Many of us who have played the game know what it is like and how hard it can be to leave the field and know you won't be returning for some time. None of this makes this okay. The notion of players misrepresenting symptoms is supported by this article on neuropsychological test and concussions: "the authors recommend relying on symptom checklists but fail to mention that, in some cases, athletes minimize or intentionally deny symptoms when they are, in fact, symptomatic".
The NFL has been attempting to deal with the issue of players cheating their baseline tests for years now. NFL legend Peyton Manning had this to say about his own preseason baseline tests: “Before the season, you have to look at 20 pictures and turn the paper over and then try to draw those 20 pictures. And they do it with words, too. Twenty words, you flip it over, and try to write those 20 words. Then, after a concussion, you take the same test and if you do worse than you did on the first test, you can’t play. So I just try to do badly on the first test”.
On the brighter side of things this article about the intentional sandbagging of these tests indicates that while it is not impossible to do this, it is somewhat difficult: "Seventy-five undergraduate athletes were re-administered the ImPACT neurocognitive battery, which they had previously taken to establish baseline functioning, but were instructed to perform more poorly than their baseline without reaching threshold on the test validity indicators. Eight participants were able to successfully fake significantly lower scores without detection by validity indicators".
The use of independent medical professionals for preseason baseline testing as well would also work towards eliminating any kind of conflict on interest. What worries me the most about these athletes which choose to cheat the tests is that they are eliminating any hope of legal recourse should they become the victim of a debilitating injury related to their history of concussions. These injuries can have devastating long-term impact and very recently have jeopardized or tragically ended the careers of rugby-playing athletes across the world.
Berrick Barnes and Rowan Stringer: A Case in Point
I'm sure that most of our readers here are familiar with Barnes' history of concussions and the footballer's migraine which nearly ended his career. You may be less familiar with the tragic story of a young girl from Canada named Rowan Stringer.
Rowan was a young woman from Ottawa, Canada who loved rugby and was the captain of her Grade 12 side. Ms. Stringer passed away tragically only a few weeks ago after a mid-air tackle went wrong and ended with Rowan absorbing much of the blow through her head and neck. She lost consciousness and never regained it. A week before the fatal incident Ms. Stringer had reported copping a head knock to her parents as well as the fact that she was taking medication to deal with the ensuing headaches. Two days before the accident she took another blow to the head but did not tell her parents, only her friends.
My heart goes out to the Stringer family.
Barnes is another case of a young person being severely adversely affected by a history of head trauma. In 2012 Barnes nearly ended his rugby career because of the development of what is known as footballer's migraine. Some may argue that footballer's migraine is not directly linked to concussion history. This paper says otherwise. A quote from Barnes in an interview with The Rugby Club details the effects of this condition: "I didn't suffer a migraine or a headache, I just lost all memory...especially for an hour after the game, I couldn't remember what I’d done, where I’d been, who I was playing for or what was going on".
As stakeholders in the game of rugby we must push for the issues surrounding concussions to be handled more seriously. The recent steps made by the IRB have been encouraging but are not enough. The implementation of independent medical professionals as well as stricter oversight on the return of players would be positive steps in the right direction. I am not saying we need to bubble wrap every player who hits his head during a game but more care must be taken in ensuring the welfare of these athletes. If there is anything the IRB should be spending money on it is the welfare of the players.
The fact that I could make a highlight reel out of Tatafu Polata-Nau knocking himself out and then getting back up to continue play does not sit well with me. It should not sit well with you either.
