Rugby-Ten-minute cooler is key concussion advance

By Mitch Phillips LONDON, March 27 (Reuters) - For all the scientific advances and extensive research projects it seems the greatest development in the recognition and treatment of concussion in rugby has been the ability to spend 10 minutes with a dazed player in a quiet room. "Creating the opportunity for players to be taken off to an appropriate quiet environment for assessment has been one of the major changes," Simon Kemp, the Rugby Football Union's head of sport's medicine, told Reuters in an interview. "When I started as a team doctor you were making assessments in a break in play on the pitch with a player who wasn't concentrating on the assessment because he wanted to get back to playing. "Ten years ago when a player said he was dazed for a few seconds he probably wouldn't have been viewed as having a concussion. "You don't usually feel any pain with a concussion so it has to be taken out of the player's hands. "He has to be honest in that assessment process but it's much easier to persuade a player not to return in that cool 10 minutes in a medical room than on the pitch halfway through a game -- and it is the medical professional involved, not the coach." Recent high-profile Six Nations knockouts such as those sustained by England's Mike Brown and George North of Wales gave the subject another nudge of publicity. The unions and the sport's governing body World Rugby have committed a huge amount of time and money to better educate everybody involved about how to deal with concussion. World Rugby announced last week the start of a review of the sport's laws with specific reference to how they should work to deal with concussion while the RFU recently released an online concussion education course, backed by brain injury charity Headway, which drums home the "Four Rs" message of "Recognise, Remove, Recover and Return". STEEP INCREASE Kemp, heavily involved in concussion research for more than a decade, suggests it is the sport's clearer understanding of the issue and a willingness of players and coaches to 'buy in' that is behind a steep increase in reported recent incidents. "Contact injuries across the game have been very constant over the last few years so I think the rise in reported concussions is partly a result of that increased awareness and an expansion of what concussion actually is," he said. "And what we've seen is fewer concussed players remaining on the field. The message is very simple -- 'recognise and remove'. If you have any suspicion you remove the player, and it's the same message for the professional game as the community game." While most concussions are caused when the head is hit by a boot, knee, another head or the ground, they can also result from whiplash. Last Saturday 82,000 people at Twickenham and almost 10 million TV viewers collectively winced at the replay of England lock Courtney Lawes's devastating hit on Jules Plisson that flipped the France flyhalf's head back as if attached to a length of elastic. BIG IMPACT Remarkably, Plisson escaped injury but Kemp said every precaution was taken. "We had 20 camera angles on that incident that were made available to the doctor to review," he said. "They were offered to the French medical team and we reviewed it subsequently and it didn't appear that the player showed any evidence of concussion. "It certainly looked a big impact but the challenge is that the force needed to cause a concussion is not constant." That means that video or, as some clubs are using impact sensors, tells only half the story and checks by a fully qualified medical professional remain an essential part of the process. "The science around concussion and head injury is changing very rapidly across all sports," Kemp said. "FIFA, the IOC, the NFL, the International Hockey League and World Rugby are all signatories to the Zurich Concussion Consensus and we will continue to research and contribute to that Consensus every three or four years." One issue causing concern across the sporting boundary is what seems to be an increased likelihood of concussed players sustaining other, non-head, injuries once they return to action. Research by UEFA has shown that footballers have a substantially increased risk of suffering other injuries on their return and rugby has conducted similar research within the English Premiership, the results of which will be published in the next few months and are likely to show a similar pattern. Kemp, however, is keen to stress that concussion, and all other injuries, should be seen in context. "These issues need to be viewed alongside the recognition of all the positive aspects and health benefits of playing rugby and all sport," he said. "Rugby asks the difficult questions and is a good environment to look after players. "From a medical perspective, rugby puts player welfare at the heart of what it does -- which is why many of us are here." (Editing by Toby Davis)