World Rugby’s recently launched global campaign called ‘The Brain Health Initiative’, is aimed at educating people within rugby on the importance of brain health.
A statement made at a World Rugby Medical Commission conference in London, said that the purpose of the initiative was to “make rugby safer, and to make it the most progressive sport on public welfare.”
Its centrepiece was the release of a video, highlighting the work of “leading experts” who identified 12 modifiable risks of dementia so as to optimise brain health, and inform players about what to do if they suspect they have a brain injury.
University of Edinburgh professor, Craig Ritchie, explained how, “dementia isn’t necessarily a consequence of one factor”, and how rugby players can maintain good health by actions such as “tackling stress, anxiety and depression to reduce certain risk factors.”
World Rugby Chairman Bill Beaumont chimed in, saying that, “good brain health is much wider than what happens on the field, and we have more control over it than what we think.”
“It’s about creating community, starting conversations and building an understanding of how we all can make lifestyle changes that can positively impact our long-term wellbeing.”
Perhaps the Pimms had been too liberally splashed across World Rugby’s board table that day, but Beaumont presents as the New York news reporter pointing to a fire in a sidewalk trash can, while the Twin Towers burn and collapse over his shoulder.
Welsh player Adam Hughes is one of a group of players – now numbering in the vicinity of 175 – who are taking legal action against rugby’s governing body, as a result of brain injuries suffered as a result of playing the game. He spoke for many when he said that the video was “disappointing” and felt “just a bit patronising.”
Hughes qualified his comments by praising an initiative to allow ex-players access to specialised brain clinics, so as to monitor their health more regularly. But there is no getting past the fact that, by incorporating a range of lifestyle behaviours into the discussion, emphasis on concussion and its main causes and effects, has been substantially watered down.
“The video basically says, ‘look, there’s 12 reasons why any current or former player can be suffering from brain health, only one of which is getting your head knocked around playing rugby’,” said Hughes.
Even if the video is strictly medically correct, in the context of rugby’s concussion problem, it is misleading and dangerous. By identifying and grouping together all possible causes of early onset dementia, World Rugby has effectively picked out eleven pieces of small, low-hanging fruit, while the watermelon in the room – repetitive head injury – has merely been afforded equal standing.
Further, dementia is just one of many debilitating conditions potentially in play. By being so narrow in its focus, World Rugby’s announcement does not fully account for all of the medical considerations and concerns faced by concussed players.
A concussion advert during the Guinness Six Nations Rugby Championship match between Scotland and Ireland at the BT Murrayfield Stadium in Edinburgh, Scotland. (Photo By Ramsey Cardy/Sportsfile via Getty Images)
As respected neuroscientist, Associate Professor Michael Buckland, from the University of Sydney, noted about the misplaced emphasis on Twitter; “not the sole cause of dementia, but repetitive head injury is the only known risk factor for CTE”.
What is clear is that, while rugby players suffering the after effects of repeated concussions may have some lifestyle factors in common, and others not, what they indisputably all have in common, over the course of their playing careers, is being hit repeatedly in the head.
So, what are we to make of this development? Is it conspiracy or stuff-up? Convention usually points to the latter, but there is no escaping the feeling of an uncomfortable shimmy to the former.
To its credit, World Rugby can point to a body of work on concussion management, adopting an evidence-based approach to incorporating a number of adjustments to laws and refereeing guidelines, designed to make the game safer.
Under World Rugby’s guidance, national unions administer programs which ensure that concussion protocols are enforced at all levels of the sport, and which carry extra protections for junior players. For professionals, a guideline to limit the number of contact minutes in training to 15 per week was introduced in September.
By contrast, in adhering to 2017’s global Consensus Statement on Concussion in Sport, World Rugby still employs return to play protocols that allow, in some cases, concussed players to return to play within a week of suffering a concussion. This despite research from neuroscientists, including Melbourne-based Associate Professor Alan Pearce, indicating that the brain can take 28-30 days to recover from the impact of trauma.
Not only is the Consensus Statement dated, it was discredited when a 2020 expose by Jeremy Allingham of the Canadian Broadcasting Corporation found that of the 36 expert panellists who compiled the statement, 32 happened to have connections to organisations and sports where concussion is a major issue.
There are numerous examples of global corporations failing to adequately address matters of health and safety. Tactics employed typically include inadequate response to failures and breakdowns, obfuscation, the creation of confusion in calling for more evidence, the commissioning of lengthy, irrelevant research or studies with pre-determined outcomes, abnormally high legal and public relations costs.
There is now widespread awareness of concerns around concussion in rugby, due to the advocacy of affected players like Alix Popham, Jamie Cudmore, and Steve Thompson; publicity around recent player retirements such as Carl Hayman, Dane Haylett-Petty and Dillon Hunt; the formation of new advocacy groups like ‘Progressive Rugby’; and the work of journalists such as Andy Bull (UK) and Dylan Cleaver (NZ).
Anybody who plays or who has played rugby, who has a child playing rugby, who watches rugby, will have first-hand experience of concussion. Accordingly, there is not a person in the game unaware of the extent of the problem and who doesn’t understand the link between repeated head injury and brain damage.
As technology continues to deliver more diagnostic certainty, links between head injuries suffered in the playing of rugby and the range of medical conditions suffered by players will be confirmed beyond doubt.
The existence of CTE can only be confirmed in the brain post-mortem, however Magnetoencephalography (MEG) scanning is now being used to determine probable CTE diagnoses in affected players.
In such informed times, it seems inconceivable that World Rugby would choose to follow in the footsteps of discredited corporations like Philip Morris, Volkswagen and the NFL, to deflect, or to ignore its responsibilities.
But for that concern to be countered, they will need to be far more convincing and to the point than their Brain Health Initiative purports to be.
(Photo by Cameron Spencer/Getty Images)
This is not the time to be hiding behind calls for wider research. More education. Better management. Focus should be squarely on two things; how to adequately look after past and future sufferers, and how to minimise instances of concussion, as urgently as is reasonably possible.
Whatever the eventual outcome of the legal action launched by players in the UK, through Ryland Lawyers, it is not unreasonable to expect a financial settlement to be either awarded or negotiated, on behalf of players party to the action.
Ongoing, to take matters out of the court system, a mechanism to establish and maintain a ‘concussion fund’ for affected players will need to be established. Indeed, this is one of the key objectives of the fast-growing lobby group ‘Progressive Rugby’, which met with World Rugby in June this year.
As to where the money comes from, it is surely not unreasonable for a sport that generates revenue in excess of A$500m in a World Cup year, and which is awash with private equity investors looking to cash in on its global potential, to be able to fund a sizeable player fund.
Long-time AFL player advocate Peter Jess has pointed to the vast sums of money generated from AFL by sports betting agencies, and recommended that the AFL (and other sports) look to a levy or similar, as a funding mechanism.
It’s fair to assume that private equity investors and gambling companies are not drawn to rugby for the opportunity to have their profits shaved by contributions to a player fund. But as Jess explains, “why should businesses profit from a sport where players are endangering their health, without there being an obligation to appropriately recognise the risks that are overwhelmingly borne by the players?”
No matter the work done to date to lower tackle heights, it is evident that a viable solution – one which improves player safety outcomes without losing the essence of rugby – remains elusive.
In the recent autumn international season, numerous players were injured and/or unavailable for Test selection as a result of concussions suffered. On one hand, this can be construed as evidence that player management is robust and effective. Regardless, the fact that head injuries are so prevalent, is a huge and growing concern.
An illustration of the extent of the problem comes via a random sample of different ways head injuries were sustained.
Australia’s Taniela Tupou, the tackler, got himself into an awful position, against Scotland. Ditto Beauden Barrett against Ireland.
Welsh lock Adam Beard suffered a head clash as a result of Australia’s Rob Valetini entering the tackling zone far too upright. Teammate Ross Moriarty carried the ball leading with his head low, and was heavily concussed as a result of contact made by the shoulder of New Zealand’s Nepo Laulala in a double tackle.
South African superstar Eben Etzebeth, also slipping to the ground after initial contact, was hit in the head by England’s Tom Curry. Having suffered three concussions this year, Etzebeth, on medical advice, now faces a three-month stand down from the game.
Australia’s Andrew Kellaway misjudged a jumping attempt at catching a high ball, and hit his head on the Principality Stadium turf.
James Parsons of the Blues walks off with concussion (Photo by Hannah Peters/Getty Images)
An array of accidents, half-accidents and non-accidents. Unsurprisingly, player management, adjudications and sanctions were all over the place.
Despite obvious forceful contact being made to his head, Etzebeth wasn’t required to submit to a head injury assessment (HIA), and was allowed to play on. His physio is never far from the action. How does rugby ensure slip-ups like this do not occur?
Curry was judged to be a victim of circumstance and not sanctioned, unlike Laulala, who received a yellow card. How does rugby deal with situations where ball runners stoop low into contact and lead with their head?
Tupou, Barrett and Valetini all went high into contact because the modern game demands and rewards offensive tackling. How will World Rugby encourage or compel rugby coaches to accept a depowering of the contest at the gain line? Is such a thing even realistically possible?
Valetini received a red card, was suspended for six weeks, reduced to three for ‘good behaviour’, reduced to two for Valetini ‘attending counselling’, with both to apply to two Brumbies trial matches that, in all probability, Valetini would not have played in anyway.
How does this outcome – effectively no suspension at all – provide confidence that World Rugby is providing effective deterrents to high tackling, and treating the issue with clarity and purpose?
These are just some of the high-profile cases, visible to television viewers all around the world, across three weekends. There were others. But what wasn’t visible to viewers were any sub-concussive hits; head knocks that don’t exhibit obvious symptoms, but which concern neurologists due to their deleterious cumulative effects.
Further, what isn’t known is the number of those hits suffered by those players in their junior and senior careers. A particular challenge is to reconcile action taken to reduce or minimise concussions with the probability that many of these players will already have suffered damage before they even became professional rugby players.
The autumn season also featured a series of Test matches between international women’s teams. How does World Rugby reconcile the growing popularity of women’s rugby with the evidence that females suffer disproportionately from the effects of brain injury?
And what of the player’s associations, at the moment hopelessly conflicted by financial ties to national administrations, and the desire of players to maximise their earnings while they are in the prime of their careers?
How comfortably does the obligation to advance their member’s financial interests sit alongside them sending their members into battle, to suffer head injuries in increasing numbers?
This is a devilishly difficult and complex problem to solve. It must be solved with haste. World Rugby’s Brain Health Initiative might sound warm and fuzzy, but it is no solution.
Derek Murray
Roar Rookie
Say it quietly but we’ve got tickets for the Bees in the new year. Great ground to watch sport and less than 10 minutes walk from my house
gatesy
Roar Guru
Definitely on my bucket list!
Derek Murray
Roar Rookie
That'll make it tricky. We went on Saturday. Very polished performance. Never looked like losing. The match was over as a contest after 15 minutes. The scrum was a problem but there were very few of them
gatesy
Roar Guru
Mate, I am in Brisbane!!
gatesy
Roar Guru
mate, at 210:1, why not only $5? Mind you they have firmed in to 101, but there are still 17 rounds to go. Two straignt wins on the trot and they hammered the Newcastle Falcons last week. Every week you can see them gelling more and more as a team, too. Plus there is a raft of Aussies playing - Phipps, Coleman, Simmons, Hoskins and Rona -all going well. To be honest, I am a shy gambler, but it is just that much better to have a little bit of skin in the game.
Cole
Guest
Where does this stop though? Do army vets now claim against the impact from their profession? What about the stress and sleep deprivation of business men and women that has been PROVEN to result in health issues. Do they claim against their employers? Surprise!, a contact sport results in injuries from contact…. Btw I’ve played rugby professionally for 14years and suffered numerous concussions. I’m more than qualified. I do believe that help should be made available after however. Say an assessment every eg 3-5 years
Muglair
Roar Rookie
:laughing: I was predicting 100% support from referees. It is a serious issue though, I posted elsewhere on the absurdity of international teams with tens of millions invested into their performance, where the outcome and quality of the game is significantly influenced by a team that has had as little as possible invested into them.
Paulo
Roar Rookie
"So easy for nobodies on blogs to heap criticism" Again, you have a great nugget of truth in your post. I agree that it is a very complex issue to solve, and its exacerbated by a great paucity in research to what is actually happening to a human brain through the whole 'rugby' process. Highlighting the fact that this program misrepresents the causes of brain injuries' sustained, but leveling equal importance on all 12 causes, is important to show the potential issues with an unfocused approach. WR need to focus on the main cause of injury, not trying to deal with 12 at a time. We both agree this is very challenging task while trying to maintain the integrity and essence of what Rugby is and why we as fans love it. I don't have an answer, that's not my job, that's not what I am paid for. That doesn't disqualify me from saying they need to do more. I don't know how to fly a helicopter but if I see someone fly it into a tree, I can definitely say "you're doing that wrong". These people in WR are paid very good money to come up with solutions. I am happy to except I am wrong if they are doing something I am not aware of, so if you know more actions and/or programs they have in place, please let me know. As for your own situation, even though we have almost never agreed on here, I do hope the 30yrs of playing has not had any negative impacts to you and when you do see a doctor he affirms that. This criticism Geoff and I have for WR stems from the desire to have the same outcome as what you want, which is to protect the players and the game we all obviously love.
SM
Guest
Ruck laws allready exist to improve the ruck contest, they just need to be enforced 15.3 Players involved in all stages of the ruck must have head and shoulder no lower than hips , sanction : free kick How often have you seen that penalty ? watch rucks and players have heads down, below hips, hands on ground or player -> not supporting weight in ruck and prevent players rolling away, closing off ruck Ref just need to blow whistle if you grab a shirt of player on ground, have hands on ground The ruck was always like a maul , a moving living mobile scrum where you pushed to win the ruck, not shoulder charge into it taking off heads. If the ruck rule was changed so you had to bin to player before the hit similar to scrum the ruck might go back to the original intent, and be a lot safer I have watched my son go through from under 10's to U16's and coaches still cant teach a tackle right, I sill see bending at the waist , head looking at ground , hitting with top of shoulder and not a hint of hip drop , so i am constantly showing kids , chest and back should be at 45 degree angle, hips down , hitting with front of shoulder, head up and looking at opponent and very few super rugby players seem to apply this technique which shows it comes from junior coaches through the ranks So who is to blame? WR? only if you apply a chain or responsibility logic
jcmasher
Roar Rookie
as a practicing referee I fully support this initiative
James584
Roar Rookie
How do you address this risk in a collision sport? It is a very difficult, if not an impossible task. Unless you are willing to change the whole concept of the game. So easy for nobodies on blogs to heap criticism on WR. Come up with a solution that will work. Nobody else has. We see constant arguments over the existing rules. Geoff himself argued against an on-field sanction against a Kiwi player for head contact not that long ago. They will have to completely outlaw any contact above the armpits to protect the ball carrier. I can’t see how you can protect the tackler from hip and knee collisions. This step by WR is very good. It will help get better outcomes for at least some of the ticking time bombs out there. I may be one of them, having played prop for 30 years from age 7 to age 37. I intend to see my doctor to discuss what I can do, along the suggested WR lines. Thank you WR, for making me at least realise that I may be in danger. It is much easy for ex-players like me to ignore this and pretend the risk doesn’t exist. No thanks to those heaping criticism on this campaign. You are defecting attention from the very important messages it contains.
Carlos the Argie
Roar Guru
Hi Ross, Thanks for the thorough explanation. However, I think these explanations create more problems than they resolve. You should have NOT signed in to do the study. If you felt that the study was not designed correctly, you have to say no. Now, it is published with your signature and you are then claiming that the new tackle laws generate a higher concussion rate. In court, you would be in trouble by the opposing counsel. My work is primarily helping companies design, analyze and interpret clinical trials. For the last 25 years this has been in virology and immunology. But I have worked in Neurology and Psychiatry in the past. Most of the issues relate to people wanting to do things that are not "controlled" correctly. The wrong population, the wrong timing, the wrong outcome measures, etc. Even after you tell them what is going to happen, internal exuberance or hubris usually results in doing what they wanted anyway. Then the results come back poorly and they call me again to help them "resolve" them. It is amazing! Basically, you say that you have the wrong "population" in the study as it is not the same one from the original work. You also say that this "population" has not been trained on the method to achieve the outcome you were measuring. I recall in cognitive function studies, the investigators spent a lot of time training the subjects on the test so that they could test the actual impact on cognition instead of the training aspect. I think it becomes really important to you and WR to conduct proper studies now to show they impact of the laws. In the meantime, you have this problem study to deal with. I am still surprised how many times this happens, people with good intentions still sign for improper work instead of putting their foot down. Thank you immensely for your transparency and honesty. You are a good guy!
Muglair
Roar Rookie
They need to fix the issue of the height of the carrier but apart from that, it is the responsibility of the tackler to keep it down. If you ride up into the head then the initial point of contact was too high, or your technique out.
Muglair
Roar Rookie
More of the rugby gold river needs to be diverted from administrators, players, coaching staff etc and into refereeing. There is no game without them, and the impact on the game of refereeing is profound. At all levels. The most necessary investment in the game.
Muglair
Roar Rookie
Very interesting GJ. Backs seem to be coming into elite rugby without complete skills in passing and kicking as well as often only developing skills in defensive positioning. Tackling techniques are often not much to write home about either so a non-contact alternative is not as silly as it sounds. Forwards can probably learn a lot of the specialist skills at a later age so I do not necessarily see it as a problem. However I see the increasing quality of forward stocks as a result of the players not being so suitable for other sports. Therefore a fast non-contact alternative might leave many potential rugby forwards not being attracted to rugby.
Muglair
Roar Rookie
The referees need autonomy to referee the game in front of them in line with the rules which do need a bit of tidying up, especially around time issues, but are a lot simpler if you ignore interpretations, fashion and the TMO. There is millions in player salaries, support staff, travel accommodation and a zillion other costs invested in the two test teams lining up for a game. A fair result and the quality of the spectacle depends on the referee. How much does WR invest in referees? SFA would be close I guess.
Muglair
Roar Rookie
A lot of the problems are caused by indecisive refereeing of the laws, in turn caused by unions not investing in refereeing of the game. Head issues arising from cleanouts would be less if the tackled player released the ball "Immediately" to the jackal. They also need to get rid of the NZ BS around the breakdown, which admittedly was pretty useful for us in the SH tests but seemingly less tolerated in the NH games.
Ankle-tapped Waterboy
Roar Rookie
Hi Mick - when I raised this point earlier this week on The Roar, the (wise) reply was that the value of sacrificing technique is a gain in power in the tackle. In other words, Valentini's godawful technique might have been a coached and tactical thing, so as to rock the opponent back behind the gain line. Valentini may well know how to tackle properly, but power is more important. What does this mean for the HIA protocols? Maybe it would help the protocols to have a bit more distance between the sides, such as would arise with a clearer approach to the offside line?
Ankle-tapped Waterboy
Roar Rookie
Hi Ross - thank you and well worth cut-and-paste into a separate article. If only to help with bookmarking for future reference! In response, we introduced the HTSF to try to give referees a systematic tool to guide the process. That too was met with major resistance, especially at the World Cup. I'm a mug spectator and I learned of the HTSF in early May 2019 before the World Cup, from a clear article on Planet Rugby which linked to the protocols. Timeframes were tight before the World Cup - you've explained why, and with a public health initiative like this it would have been imperative to have the HTSF included in the World Cup, to maximise the communications otherwise you'd lose a couple of years. Seems to me that the complaints and protests at the World Cup weren't so much as "didn't get the memo" but more along the lines of "couldn't be bothered with the memo/ didn't believe the memo/ didn't believe it would happen until it happened." (More recently we still have International coaches who haven't integrated the 50-22 into their game plans). given our basic premise that sanction carries the message to change behaviour, offering technical education to players after sanction would amplify the message, and force the coach to really think about what the original error was. how can that player’s technique be addressed, and thus, by extension, can we ‘percolate’ that message to the rest of the squad? I think it’s actually quite a good way to make sure that the red card, applied to one player, creates a message that then reaches more than one player by going THROUGH the coach. This is standard practice in health interventions, to the best of my knowledge. I did the same when co-ordinating state-wide public health interventions. You have limited resources, you rely on the prior buy-in, and maximising the yield from your cases (red carded players). Consistency by the people issuing the sanctions is vital, otherwise the coaches end up with more questions than answers when trying to apply the prevention lessons learned. My impression is that World Rugby has a referees variability problem on the HCP. I am hoping that whoever is counting the cards-issued statistics is also reporting and providing feedback on the incidents where faulty or diluted application of the HCP occurs. ("Should have been a red, ref said "play on", this is why we are not happy with that"). You omitted "experienced change manager" from your declaration. "Research scientist and consultant" tells just part of the story. From a reply below: As for the Brain Initiative, it’s a really difficult one because as I said elsewhere in a comment, I don’t think it is fair to characterise it as a marketing play in the same vein that tobacco used, It may not be fair, but it is the change landscape that World Rugby is operating in. It is naive to have failed to recognise this. Unfortunately if it looks like a duck and quacks like one, it might not be a duck, but may easily be mistaken for one. (Patagonian killer whales are often mistaken for a type of shark, but are actually dolphins.) With some referees, crowds, players, and coaches still not fully on board, and risk managers, actuaries, insurers, defense lawyers, and financial controllers scared witless, all are looking for excuses to minimise, evade, avoid, condemn, or delay. By failing to call that out, and by providing a tool (the video) for those laggards and saboteurs to point elsewhere and indeed point anywhere but in the mirror, World Rugby looks complicit. Whoever approved the video's storyboard and messaging got it wrong, and as it stands, seriously wrong, even though it would not take much to fix. It has set back your campaign, and I'm very disappointed, because your campaign is essential, necessary, does have wide support, and is twenty years overdue.
Geoff Parkes
Expert
Cheers Ross, all the best with this.