Knock out

First topic message reminder :

Despite some great performances and a very welcome win what will stick in my mind is George North. He d already had 1 concussion check and took another hefty blow to the noggin and stayed on. How and why it was allowed is beyond me. Its too serious a pointtobe ignored. Does the tmo need to be involved more here?

concussions are a far far more serious problem now than in the amateur era. the weight, impact and speed of players and collisions is significantly greater, and our chins and heads are no stronger.

And the money is largely in the club game now so it is much much harder for players to not do what the coaches ask them to do. there are only 11 england matches per annum. it's understandable if players risk more for the national team in crunch matches. top tier club sides combined play about a thousand matches per annum in europe alone. and thats where most of the injuries happen.

Hard to fake a concussion too

death happens yes........................... despite all the airbags!!!!!!!! (looking at you car manufacturers! )

Anyway, yes, death happens all around us - but there are still rules that make murder illegal (despite the killer wanting to kill and it being nobody else's business but his and the person he intends to kill) - and you are forced to wear seatbelts whether you want to or not, and you're commanded to keep to the pavements when walking and cross at traffic lights, and if you work on a building site, you're required to wear your protective gear, whether or not you want to.

There are lots of rules and regulations protecting individuals from their own choices.  And I go back to the truth that much of it is because of legal concerns as much as genuine human concern.

If a player dies on a field and proper concussion procedures are found not to have worked, or had been inappropriately acted upon, then who comes looking for the people who didn't allegedly do their job?
Well, that player's family might be one group.  Are they going to sit back and say; "well he knew the risks, we don't blame anyone.  He died doing what he wanted to do and nobody is to blame."

Somebody is to blame if that player had already been off for a concussion investigation and was put back out only to fall unconscious again and still remain on the field.  That's going beyond the idea that a player is responsible for the risks he takes.
If that player had been assessed, sent back out, concussed again and seriously injured or died - that's no longer just fate and a simple accident that could happen at anytime. It has become an issue that family members (amongst others) would seriously consider criminal.

North getting concussed once is not the issue - the issue is that he was reintroduced, got concussed again and was left on.

Gwlad wrote:Hard to fake a concussion too

quinsforever wrote:concussions are a far far more serious problem now than in the amateur era. the weight, impact and speed of players and collisions is significantly greater, and our chins and heads are no stronger.

And the money is largely in the club game now so it is much much harder for players to not do what the coaches ask them to do. there are only 11 england matches per annum. it's understandable if players risk more for the national team in crunch matches. top tier club sides combined play about a thousand matches per annum in europe alone. and thats where most of the injuries happen.

Most injuries in terms of numbers yes - and naturally so given, as you say, the number of club games.

Interms of percentages though, I wonder how it pans out there? I don't know but it would be interesting to find out. The way I look at it, club maybe be starting to mimic the intensity of International but I'd still say players play with more 'lack of concern' for selves at International level (particularly at the top level) than for club.

So it would be interesting to see what percentage of players are injured in the number of International games that take place in a year and compare that number to club injury percentage.

dont know why anyone doubts that North got left on because cuthbert already had a yellow card.

utter pants from their medics about them not noticing because they were treating someone else. in international rugby, you hardly have to blink to see first-aiders piling onto the pitch before the ball is 5 metres away from the fallen player.

quinsforever wrote:dont know why anyone doubts that North got left on because cuthbert already had a yellow card.

utter pants from their medics about them not noticing because they were treating someone else. in international rugby, you hardly have to blink to see first-aiders piling onto the pitch before the ball is 5 metres away from the fallen player.

oh this gets better and better…..a critique of the rights and wrongs of on field medic protocol by you is like waking up and finding your wife has been replaced by Scarlett Johannson



please, continue…..

quins fans are uniquely qualified to talk about these kinds of issues. everyone else is just guessing

quinsforever wrote:quins fans are uniquely qualified to talk about these kinds of issues. everyone else is just guessing

bravo!!

Independent doctors at games may help. More doctors the better. I'm not sure of the protocol but even if both doctors from both teams were present during the sideline check that may reduce any doubt or aspersions cast.

"North, who plays his club rugby in the English Premiership with Northampton, is a member of the RPA, which intends to intensify its campaign for independent doctors to attend all major professional matches. The association will wait for things to unfold fully between World Rugby and the Welsh Rugby Union before deciding on any intervention of its own"

http://m.nzherald.co.nz/sport/news/article.cfm?c_id=4&objectid=11398936

No doubt in my mind that North should have been taken off and stayed off after his second blow to the head. Real failing by WRU (no surprise there) not to manage this situation better. I am though astonished that Atwood's kick was not punished, he appeared to be trying to kick the ball from out of North's grasp, but missed and kicked him in the face!

I expect the IRB (whatever they are now called) to push Wales into resting North for a significant period. That's assuming he does not get cited and banned for head-butting Atwood's boot!

quinsforever wrote:quins fans are uniquely qualified to talk about these kinds of issues. everyone else is just guessing

Since my guys were almost the victims of it, I think I'm qualified too

NOrth should have been off for the rest of the game after the first KO. Thats what the protocols say is it not?- knocked out - off the rest of the game.

TJ wrote:NOrth should have been off for the rest of the game after the first KO.  Thats what the protocols say is it not?- knocked out - off the rest of the game.

Yes. No more 'macho knocked out twice in the game and played on' crap.

At least it sounds like he's been cleared for the next game. Phew, it means he's fine.

So question.

Would that then become a gameplan - to spin an important player or two into the fuzzy head department and have them removed for good from the game?

There are a good few side issues that drop into the lap of this concussion one.

Afterall, it's been said openly and without any guilt in the past, by many teams, that their goal would be to 'target' the 10 for rough treatment.  And it's still seen as a legitimate tactic.  So it's not exactly an exact science - this roughing up gig.  Teams can't decide how much roughing up they do.  They just send players down the channel with the intention of steamrolling the player as much as possible.

So................... when does all that stuff and chat become willful intention to get a player taken off the field of play for good with concussion?

Grey area?

HammerofThunor wrote:At least it sounds like he's been cleared for the next game. Phew, it means he's fine.

I sincerely hope so and that being cleared is not a fudge. I know its a million miles away from the Hape situation but when you read about how any knock could knock him out, and then see how the collision with Hibbard led to North just falling limp on the ground, you can't help but worry.

Rugby has many collisions in it, and they can be a wonderful thing for us spectators, but you want the guys to get up again afterwards, even if only slowly.

SecretFly wrote:So question.

Would that then become a gameplan - to spin an important player or two into the fuzzy head department and have them removed for good from the game?

There are a good few side issues that drop into the lap of this concussion one.

Afterall, it's been said openly and without any guilt in the past, by many teams, that their goal would be to 'target' the 10 for rough treatment.  And it's still seen as a legitimate tactic.  So it's not exactly an exact science - this roughing up gig.  Teams can't decide how much roughing up they do.  They just send players down the channel with the intention of steamrolling the player as much as possible.

So................... when does all that stuff and chat become willful intention to get a player taken off the field of play for good with concussion?

Grey area?

I think its hard to target the head without doing something illegal and obvious

HammerofThunor wrote:At least it sounds like he's been cleared for the next game. Phew, it means he's fine.

If he plays next week its an outrage. he should be rested for a while for his own sake. His brain will not have recovered from the KOs.

I'd like to thing the targeting the 10 is in relation to making him tackle a lot to tire him out (which is what J Davies was talking about before the game). Some it can be to hit them with big (legal) tackles to make them what to ship the ball on quickly or simply give them less time to think. But I'm sure some of it, at all levels, is about hurting them.

TJ wrote:NOrth should have been off for the rest of the game after the first KO.  Thats what the protocols say is it not?- knocked out - off the rest of the game.

As I understand it the protocol is to assess the player off the field to check whether they are concussed (not the same as being knocked out). This was done after North was kicked in the head by Atwood but not after his clash of heads with Hibbard.

He is now undertaking further tests to see if he was concussed, if there are no signs of concussion the he is clear to play.

My reading of it is he should have been removed from the field, not come back on and should be undergoing graduated return. this is even if concussion is suspected.

http://www.rugbywa.com.au/sites/default/files/uploads/IRB%20CONCUSSION%20GUIDELINES%20-%202014.pdf

http://www.irbplayerwelfare.com/concussion

Big (legal) tackles don't have to target the head (and never would I say a player would willingly go along with such a tactic or be directed to attempt such a tactic) - but hitting a player when he least expects it at speed and from some of the bulkiest players IS part of the game yes and is legitimate - yes - but it can also produce that dangerous 'kick-back' of the head perched on a neck that leads to lights out.
The target doesn't have to be a head but specific rough-treatment, coming from tactics - and it becomes a very real possibility (with new concussion laws) that the player will succumb to a fuzzy feeling in time - and if sent off, that's his contribution over - on comes the less skilled alternative and the game becomes easier for the opposition in theory.

I'm only using the 10 as example.  There could be other central players that could theoretically be targetted too when the idea becomes settled that only one episode of grogginess gets you sent off.

I'm just pointing out that ambitious coaches are out there and some of them don't value the seriousness of concussion as much as others.  When does that concussion policy become a strategy for some 'careless' coaches looking for an edge?

There's a danger there is all I'm saying.  Not everyone in the game is a saint.

SecretFly wrote:So question.

Would that then become a gameplan - to spin an important player or two into the fuzzy head department and have them removed for good from the game?

There are a good few side issues that drop into the lap of this concussion one.

Afterall, it's been said openly and without any guilt in the past, by many teams, that their goal would be to 'target' the 10 for rough treatment.  And it's still seen as a legitimate tactic.  So it's not exactly an exact science - this roughing up gig.  Teams can't decide how much roughing up they do.  They just send players down the channel with the intention of steamrolling the player as much as possible.

So................... when does all that stuff and chat become willful intention to get a player taken off the field of play for good with concussion?

Grey area?

There's a certain amount of that sort of thing already happens - people targeted in some tours in the past - so yeah, you have to fear that attempts might be made in that direction. However, dangerous play is kept fairly well under control and the concussion issue is serious these days with players at the top level being so much bigger, quicker and fitter than they were even 10 years ago, which makes the impacts greater. So the negatives are certainly no worse than they were and the issue has become more prominent. There is more urgency now in relation to this issue.

At the same time, the courage of the players is one of the things we admire about them, and something the game gives us a chance to admire: George North being a perfect example with the boot to the head. He was completely aware of the risk as he did it. Brave lad. Roughing up the fly half is entirely legit. Roughing him up by smacking him in the head is not. There is a line that can be drawn and thankfully, the head being where it is on the body, it's usually fairly clear if someone takes a whack at it.

So I don't think the risks you mention, though real, are sufficient to mean no action should be taken for rear of making the situation worse in other ways.

In the North case, as I said above, the WRU need to look at their procedures because no way North should have played on after the second headbash (with Hibbard) and yes at that point I do think players need protecting from themselves. No game, not even a World Cup final, is worth the sort of life serious brain damage can leave you with.

It has only been relatively recently (last 10 years or so) that we have started to understand concussion and the affects it can have. I think boxing and of all sports football brought it to the attention of the medics. Boxers you can understand, but football.

Apparently heading a football, especially the old leather ones is akin to taking a solid punch. Think how many times centre halves do that in a game, never mind in training.

An example of how little was known about it in the 70’s:

At my first club (I was still a colt then) we had an opposition player die on the pitch due to what we later found out was a brain haemorrhage. He had been concussed the week before, told not to play again for at least 2 weeks by his GP. They were short so he decided to turn out for their third team for a run around.

First contact and he was out cold and never came around. They had the St. Johns Ambulance medics in attendance with an ambulance, the hospital was less than a mile away but they still couldn't save him.

It traumatised the whole club for weeks

There you go. Stories like that kinda stop you dead in your tracks and perhaps silence is all that's needed as a response.

Well, to try to be constructive about this, there is one thing that could be done that might help: scrum caps. They won't help much with rotation and only a little with whiplash, but they might just take a little off the edge of the straight impacts. Maybe it is something that should be considered in addition to the procedures and existing medical systems? Helmets in the American football style I know bring their own problems, but a little padding and no hard shell might be well worth it.

Scrum caps protect your ears and may reduce scalp lacerations.

I have seen no evidence that they have any effect on concussion or brain injury.

I think its more like amateur boxing where they are trying to get rid of head guards because they lead to more head injuries, but they do offer protection from cuts.

Cowshot wrote:Well, to try to be constructive about this, there is one thing that could be done that might help: scrum caps. They won't help much with rotation and only a little with whiplash, but they might just take a little off the edge of the straight impacts. Maybe it is something that should be considered in addition to the procedures and existing medical systems? Helmets in the American football style I know bring their own problems, but a little padding and no hard shell might be well worth it.

There have been a number of studies into protective clothing and equipment in sport and some of the findings were the opposite of expected - that padding and protection lead to more injuries and bigger impact. The theory being that those wearing head guards/chest plates/shoulder pads, etc. felt a bit invincible/more protected and therefore less at risk (logical I suppose) and were therefore more likely to go into contact harder than if they were not wearing it. The protection was therefore negated somewhat. The other theory was that people wearing them actually saw it as an opportunity to strike with the padding, i.e. using the protection as a striking weapon, lead with the head more, attack with the should extended, etc. and therefore impact and injury risk was greater.

So protective gear logically makes sense. But in reality, and with us stoopid humans, it may not actually be the case. I'll see if I can dig up the journal articles online.

Here's one in junior rugby. Just Googled it and haven't read it properly. It's not the study I was on about.

Not a massive sample size in terms of those with concussion though so maybe take with a pinch of salt:
http://bjsm.bmj.com/content/35/3/167.full

Oh well Not so good then.

If only it were that simple Moomoo.

What we need are new sensory suits. Padded up but with pain sensors all over to give players a jolt of HURT if they try to use suits as weapons.................

................ em I think we're back to Submarine's Borg from another thread

Serious question.

I heard the Welsh doc didn't see the knock out and North passed the test so he was good to go.

My question is, how come some host broadcasters can trawl through footage at the speed of light and find opponent team indiscretions to replay over and over and over on the big screen until there is a reaction but can't seem to find footage of a local lad being knocked out to replay over and over and over on the big screen? It would have helped the local docs out to make the correct decision.

ebop wrote:Serious question.

I heard the Welsh doc didn't see the knock out and North passed the test so he was good to go.

My question is, how come some host broadcasters can trawl through footage at the speed of light and find opponent team indiscretions to replay over and over and over on the big screen until there is a reaction but can't seem to find footage of a local lad being knocked out to replay over and over and over on the big screen? It would have helped the local docs out to make the correct decision.

subtly loaded question ebop...

ebop wrote:Serious question.

I heard the Welsh doc didn't see the knock out and North passed the test so he was good to go.

My question is, how come some host broadcasters can trawl through footage at the speed of light and find opponent team indiscretions to replay over and over and over on the big screen until there is a reaction but can't seem to find footage of a local lad being knocked out to replay over and over and over on the big screen? It would have helped the local docs out to make the correct decision.

The footage of North colliding with Hibbard was played on the big screen. It didn't appear instantly, because there was a TMO referral over Haskell's non-try, so that footage was shown first. It was located and shown soon afterwards, though.

It may be true that none of the Welsh medical team thought to look up when over 80,000 in the stadium winced as they saw the video of North hitting the deck. It's much harder to believe that not a single member of the rest of the Welsh back-up team was paying attention. Anyone who saw it should have alerted the medical staff. Charitably, we might say that they might have assumed the medics already knew about the collision, and didn't think to mention it. Less charitably, they all ducked responsibility.

Sorry, couldn't resist Tman Serious issue though.

http://www.bbc.co.uk/sport/0/rugby-union/31320811

And what about the first time?

Yeah I think you summed it up there Rugby Fan. It's good that there has been a big blow up over this as it puts further spotlight on the issue but unfortunately it came at North's potential future health. Seems he's good to go for next weekend after reading MrsP's article. Hope he doesn't get another head knock in the next game, it's a bit risky ain't it?

See this is where these protocols need to be over-ridden by good clinical judgement.

North should not be playing this weekend no matter what the RTP guidelines say.

The man suffered 2 serious blows to the head in one match, at least one of which the medical team acknowledge lead to LOC. (In my opinion he was KO'd both times). How can it be a good idea for him to play again 8 days later? The RTP protocol relies on accurate reporting of symptoms by the player. There is no empirical evidence used in making the decision.

Someone needs to get their head out of the tick sheet and look at the bigger picture.

WRU the IRB & rugby have not come out of this situation very well.

Even to the layman North was out cold & everyone saw that, to hide behind the comment 'North was totally lucid' after on field examination is embarrassing & does no one any good.

It is unbelievable that the coaches & analysts were not aware at the time. Even the beer sodden crowd were aware for goodness sake.
For the medics to say in hindsight having viewed the footage...... Who do they think they are kidding?


Oh I know the toothless IRB

I just remembered getting knee'd in the head in a schoolboy match. I did probably come across as lucid but still played like an idiot for the rest of the game.

When a player 'appears' lucid after being on the floor and out cold...a lot of it probably has to do with adrenalin trying to compensate and drag up as much 'lucidity' and 'alertness' as possible in a classic "fight or flight" situation.

I think I've said this before when this topic was been discussed a few years ago - we all know about or have heard about people who have been in accidents (traffic or otherwise) - we've heard the stories of them carrying out conversations with medics or helpers, of being calm and collected and articulate............. and then just dying moments later.

A body in the early stages of shock can mimic perfect health pretty damn good unfortunately.

I hope North simply gets through this season of games and there is no residual fuzziness or other serious knocks - cumulative is my biggest worry for players - a close sequence of blows when recovery hasn't time to happen fully between them - so fingers crossed that we won't be even thinking about North by the end of the 6N - unless the bastareaud is holding up another damn Cup!

what a shambles.

even the pink hat cowboys saw the incident replayed on the big screen.

IRB showing how toothless they are once again. Lip-service to player safety is decided to be sufficient.

[quote="MrsP"]See this is where these protocols need to be over-ridden by good clinical judgement.

North should not be playing this weekend no matter what the RTP guidelines say.

The man suffered 2 serious blows to the head in one match, at least one of which the medical team acknowledge lead to LOC. (In my opinion he was KO'd both times). How can it be a good idea for him to play again 8 days later? T.[/quote]
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Or even training .............IMHO

George is a big boy, he doesn't need some overbearing hysterics telling him what to do.

Hammersmith harrier wrote:George is a big boy, he doesn't need some overbearing hysterics telling him what to do.

He wasnt in a condition to decide what was best for him to do, but then he probably didnt know that at the time. Someone needs to take responsibility for head injuries and that someone should not be the injured player.

Hammersmith harrier wrote:George is a big boy, he doesn't need some overbearing hysterics telling him what to do.

and i'm sure he'll say the same thing 30 years down the line when he doesn't even recognize who his grandchildren are....

Martin Brundle, the Sky F1 commentator and former driver tells a story of him having a big crash in practice at Monaco (iirc), where he rolled the car and his head banged on the track. He ran back to the pits and was talking to his mechanic about setting up the spare car then asked which track he was at...

Of course the other reason there is such a big focus on concussion is the current class action suit in the US between former players and the NFL - huge compensation is on the way because of a lack of aftercare for concussed players. Of course, the NFL players are all big guys with strong necks and thick heads.

I'm not sure GN was knocked out in the first incident (maybe, but the video is inconclusive). No doubt about the second one though - only unconscious or dead drunk people fall like that, and I'm sure George wasn't downing the contents of his hip flask during the game. Now, how someone who was knocked out at least once and possibly twice during the game can be judged within 48 hours as having no signs of concussion is very dubious to me.