The World Cup has had an exciting and controversial start,  the spotlight has been on the height of tackles in the competition. With penalties, citings and Red Cards being dished out for offending players. Cries of phrases such as ‘ the game’s gone soft’ and ‘ Rugby is a contact game’ have been seen online, I watched an episode of the Wales Online ‘breakdown’ question and answer session. During this episode Sports Journalist Andy Howell berated the attempts to protect players as he noted that players are aware of the dangers of playing Rugby and therefore they capacitously decide to play, thus removing a duty of care from World Rugby. Now many will agree with Howell, but this struck a chord with me, firstly, Howell does not look like a man who has ever played the game and if he did he does not look like he would have played in an era where players are getting bigger, faster and stronger week on week. Secondly, the macho attitude towards concussion is wrong in my opinion. Yes players decide to play the game and make good livings while they are playing but there still needs to be a duty of care to protect players to ensure they are left with all their faculties post retirement. People also opt to drive cars and cross roads knowing the risks involved but we still need the Police to keep people safe.

I have had the misfortune of experiencing a few concussions, each one was different, but one sticks out as being particularly bad. I can’t remember the week of my 20^th birthday, not due to alcohol induced memory loss, but due to a concussion I sustained in a game for my University team. I had played on for the duration of the first half with no knowledge of at what point in the game I sustained the head knock. My last memory was going into a tackle on my opposition Hooker. I came off with a thumb injury, my team mates only became aware that I was concussed when I asked a friend the score five times in a row and did not even know where we were. This was at a level where there were no physio’s on the sideline, no coach present and no availability for any concussion assessment’s. I have a vague memory of the bus journey home, where another team mate offered me a bottle of wine as per the Birthday tradition on the way home which was intercepted by other members of the team.

The next day I woke up feeling sick and dizzy, I felt incredibly tired, exhausted even. I had no memory of the day before and I feel now my only memories are ones I have generated having been filled in on details by my friends. This sick feeling lasted for the next 48 hours, the dizziness even longer than I care to admit. I was out of action and feeling pretty rough. 72 hours later, I was tasked with driving home to Swansea from Stoke. I had driven this journey home enough times to make it feel like a short trip home. But this drive was different, I still had not seen a medical professional, had no supervision or guidance on what to avoid doing… I was 20 years old but had no clue on how to deal with a concussion. An hour into my drive, the feeling of fatigue hit me like a ton of bricks. I was miles away from a service station and almost fell asleep at the wheel near Worcester, this was frightening and really hit home how significant a concussion can be.

On my return home I was filled in on more memories I had forgotten, entire conversations with family members the day before my birthday, even a few days before which I still cannot recall. The drive home had scared me, I did not tell anyone and merely thought I was OK and just tired…. By the next Monday,five days post concussion I felt slightly more back to normal, I still felt off balance and considered sitting out my next game on the Wednesday. I was persuaded to start on the bench, but was soon on at half time. This,I now know was possibly the worst thing I could have done, second impact syndrome is a killer and there have been several high profile deaths relating to people who had been concussed, returning to activity too soon and then getting another head trauma. I was lucky but the impact this had on me was profound. Imagine having the added pressure of Rugby being my livelihood ( Dr Barry O’Driscoll’s views) ? Or having prolonged symptoms. George North had a myriad of prolonged symptoms and at one point could not even do the dishes without experiencing symptoms of Concussion. I also feel that I became more susceptible to Concussion following my first, with me having several more in my career, but none were as severe as my first.

I was perturbed when I saw a physio four years after my final game, my balance which had usually been good, and flexibility which for a 5ft 8 ( at a push) and 15 stone (On a good day) former Hooker had been excellent were way off what they once were. Now some years of inactivity can do that as well as post Rugby weight gain, but the Physio also noted that it could be related to my most recent concussion, which I had sustained four years previously as the effects of concussion on balance and flexibility can last for a long time. Now…. Surely that is brain damage more associated with Boxing rather than a concussion seen by many as an occupational hazard of Rugby and a badge of honour for some.

The most sobering aspect of it for me was something I still think of frequently, I am now a mental health nurse.In my first year of training I had a placement with a community team specialising with people who have a diagnosis of Dementia. My mentor asked me what I felt it would be like to have Dementia, My response? ‘ I imagine it is like being permanently concussed’, that is where the penny dropped for me and I was able to recognise the impact concussions can have on someone’s long term cognitive function. I had been aware of the research and figures associating Concussion and Dementia but like most players I had been ignorant and thought it would never impact on me. Just like every smoker does not get lung cancer, I am not trying to suggest that everyone who has ever had a concussion will get Dementia, but would I want a governing body to reduce the risk of player’s being exposed to concussion in an already high risk area? In a heartbeat I would.

With the National Football League in America facing a multi billion dollar lawsuit from former players and their families (Further reading here), due to players experiencing Chronic Traumatic Encephalopathy (CTE) which leads to a change in an individual’s behaviour and demeanour and can cause cognitive problems, which can then lead to Dementia. World Rugby has had to take steps to protect players from concussion as they recognise their duty of care for players, at the top level at least.  A similar lawsuit would sink World Rugby, and the ultimate health of players is paramount whether they make £500,000 a year or pay £5 a week to play for their local 3^rd XV. So keeping tackles down, preventing players leading into contact with a leading forearm and improving tackle technique are just a start.  Damage limitation is different to risk free Rugby.