Crumbling credibility of rugby union’s elite concussion protocols hanging by a thread
This article is written by Progressive Rugby
Progressive Rugby believe that the crumbling credibility of rugby union’s elite graduated return to play (GRTP) concussion protocol has been irreversibly damaged by further scientific evidence.
The player welfare lobby group say that additional evidence lends further weight to their assertation that current GRTP are gambling with the long-term health of elite players.
They point to a sports related concussion study into men and women that, through the use of diffusion weighted MRI brain scans, demonstrated evidence of damage to the brain was still present two weeks after a head injury in athletes who were considered full recovered having passed conventional concussion tests and stating they were symptom-free.
The authors of the paper say it has important implications for the differing management of concussion for both men and women, including guiding return-to-play decisions.
A week later, The Age newspaper in Australia, referenced a study by Monash University of amateur Australian football players, which also found that players’ brains were still recovering 12 days after a concussion and backed those calling for longer recovery periods.
“Even though these athletes are cleared to return to play, they feel that they are ok, are functioning ok and are good to play - what it is showing is that the disruption hasn’t resolved as yet,” Associate Professor David Wright said.
The paper demonstrated that, using a multimodal MRI, evidence was found of persisting white and grey matter damage in young-adult Australian footballers with a history of concussion in comparison with control athletes with no history of concussion.
In Australian Rules Football (AFL) and rugby league players have to spend a minimum of 12 days on the side lines following a concussion. In rugby union, World Rugby’s six-stage protocol means players can and do return to play just six days after a concussion.
In contrast, the amateur game senior players are stood down for a minimum of 19 days (23 days for U19). The group argue that, despite increased medical care, there is no firm evidence that elite athlete’s brains can recover any faster, and that elite players are subject to larger impacts.
Progressive Rugby have been lobbying World Rugby since February 2021 for the elite game’s protocol to be extended to ensure an athlete’s brain has had sufficient time to recover.
The group have highlighted World Rugby’s own brain health consultant, Professor Willie Stewart, publicly stating it was now accepted that two weeks was needed for the brain to recover and that the evidence to reduce the three-week stand down in 2011 was “never really there.”
World Rugby say that 70 per cent of players don’t return until at least 10 days, and those that do must be passed to play by an independent concussion consultant.
A spokesperson for Progressive Rugby said: “These latest findings further damage the already crumbling credibility of the current six-stage graduated return to play protocol in rugby union.
“Despite players returning from concussion reporting being symptom-free, brain scans show that they still have concerning changes to their brains that has not sufficiently recovered 14 days on.
“It has been a fundamental concern of Progressive Rugby that return to play following concussion must be at a point when the brain is recovered and not at risk.
“The graduated return to play protocol was developed without any specific evidence the brain had recovered but reduced the time of playing absence from three weeks to six days.
“The simple fact that elite rugby union players can and do still return in just six days in the face of such mounting evidence is a stain on this great game.
“This, coupled with growing concerns around the effectiveness of the head injury assessment protocol, is eroding the public’s confidence that the game looks after its own.”