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Concussion, early onset dementia and CTE

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Post by king_carlos Tue 08 Dec 2020, 2:43 pm

https://www.theguardian.com/sport/2020/dec/08/steve-thompson-former-rugby-union-players-dementia-landmark-legal-case?CMP=Share_AndroidApp_Other

That first link is an article in the Guardian about a potential legal case being brought against World Rugby, the RFU and WRU by 8 former players (all under the age of 45) with early onset dementia brought on by probable CTE. The players named publicly thus far are Steve Thompson, Michael Lipman and Alix Popham.

https://www.theguardian.com/sport/2020/dec/08/steve-thompson-interview-world-cup-rugby-union-dementia-special-report

That second link is a Guardian interview with Thompson, who's only 42, about his experiences with early onset dementia. Somber reading.

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Post by king_carlos Tue 08 Dec 2020, 2:47 pm

https://www.bbc.co.uk/sport/rugby-union/55208227

A Beeb interview with Alix Popham, only 40-years old, about his experiences there as well.

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Post by lostinwales Tue 08 Dec 2020, 3:58 pm

Devastating stuff. Thanks for posting this.

I just hope all the efforts over the last few years are helping. I also think Thompson's idea about yearly scans is a good one, though no doubt there would be resistance.

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Post by Duty281 Tue 08 Dec 2020, 4:10 pm

Awful story to read about.

Rugby Union needs serious reform. It's something that's been apparent for many years now, but little has been done.

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Post by lostinwales Tue 08 Dec 2020, 4:21 pm

Duty281 wrote:Awful story to read about.

Rugby Union needs serious reform. It's something that's been apparent for many years now, but little has been done.

I am not sure. At what point do we think enough has been done? We are not there yet but things are better than they were. The two key issues for Thompson seems to be lack of recognition of concussions occurring in the first place and the 'beasting' in training that lead to most of the damage. There is much greater awareness of concussion and its symptoms, and training is more scientific.

I suspect his generation will be the worst affected.

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Post by king_carlos Tue 08 Dec 2020, 4:28 pm

The landmark case against the NFL by about 4,000 former players resulted in a class action lawsuit, $765 million settlement which is reported in many sources to have risen to over $1bn now. So these lawsuits aren't without precedent.

It's been widely rumoured that the NFL had research pointing to the long term effects of concussion which they hid from players and the public though. Whilst never confirmed the NFL settled on the terms that it wouldn't have to disclose what it knew, or when they knew it, about the effects of concussions which seems pretty telling.

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Post by king_carlos Tue 08 Dec 2020, 4:36 pm

lostinwales wrote:
Duty281 wrote:Awful story to read about.

Rugby Union needs serious reform. It's something that's been apparent for many years now, but little has been done.

I am not sure. At what point do we think enough has been done? We are not there yet but things are better than they were. The two key issues for Thompson seems to be lack of recognition of concussions occurring in the first place and the 'beasting' in training that lead to most of the damage. There is much greater awareness of concussion and its symptoms, and training is more scientific.

I suspect his generation will be the worst affected.
Understanding of concussion is undoubtedly improved as are training protocols.

Players are still getting bigger and more powerful though, hence collisions getting bigger which wont help. The frequency of collisions during games is also through the roof compared to Thompson's generation with fitness improving massively.

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Post by Duty281 Tue 08 Dec 2020, 4:44 pm

lostinwales wrote:
Duty281 wrote:Awful story to read about.

Rugby Union needs serious reform. It's something that's been apparent for many years now, but little has been done.

I am not sure. At what point do we think enough has been done? We are not there yet but things are better than they were. The two key issues for Thompson seems to be lack of recognition of concussions occurring in the first place and the 'beasting' in training that lead to most of the damage. There is much greater awareness of concussion and its symptoms, and training is more scientific.

I suspect his generation will be the worst affected.

I agree that those two key issues have been remedied to a large extent; also high tackles and off-the-ball incidents are punished with greater magnitude now, which is good.

But the size of the players themselves being on the increase, as well as a congested fixture calendar which demands far too much from elite-level players, is partially the reason that I don't think Thompson's generation will be the worst affected. I read Dylan Hartley's autobiography recently, which paints a similarly grim picture:

"The costs are equally apparent. Hartley, a front row forward, suffered more than the usual cauliflower ears. He suffered broken bones, torn ligaments, snapped tendons, punctured lungs, popped ribs, nerve damage and bulging discs in his spine. He missed 1,320 days through injury (plus another 60 weeks through suspensions for foul play). At 34 he is still a young man, but his body is broken.

He limps out to meet me in shorts, T-shirt and a baseball cap. He has problems with his back, hips, knees, wrists and ankles, he tells me. He tried jogging gently down his drive during the lockdown and could not walk for a week. He put his hip out mowing the lawn. He struggles to complete a family stroll. He has to descend stairs sideways. He sits with his right leg crossed over his left one to stretch his damaged 
hip flexor muscles. He cannot bend or straighten his left thumb. He cannot jump on a trampoline with his four-year-old daughter, Thea, or even play ‘Heads, Shoulders, Knees and Toes’ with her.

And then there is the damage that cannot yet be gauged – the brain damage from three serious concussions in recent years and others suffered before concussion became a recognised injury a decade or so ago. Right now the manifestations are minor. Hartley occasionally drops things or muddles words, and gets dizzy easily. He tries not to think what he might be like in 10 or 15 years. ‘I try to enjoy what’s happening now, but it’s always a concern,’ he says."


https://www.telegraph.co.uk/rugby-union/2020/08/14/players-chewed-spat-dylan-hartley-life-england-rugby-team/

I think there needs to be upper size limits on players to limit the impact of fearsome collisions. Far fewer substitutions need to be allowed. The rugby calendar needs a drastic reduction, and should model itself closer to the NFL than the English Premier League. Limits on contact training should also be imperative. The breakdown should also be reformed so you don't have players flying in on other players who are stationary.

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Post by TightHEAD Tue 08 Dec 2020, 6:25 pm

I don't remember anything either.

Ban players from going to the gym and stop subs.
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Post by Guest Tue 08 Dec 2020, 11:46 pm

This will be the move that turns rugby in to the highly technical, far less high contact/aggressive contact sport it is at the moment. Akin to what football went though in the 90s and 00s.

The men are just far too big now to get away with this sort of style of rugby. Particularly in the NH where it's as much about the slow, grinding, heavy carry that looks unspectacular yet includes heavy hits to the heads. The SH players seem, firstly, more durable as men and as players than the NH, but they also play in an more 'open', harder manner: the Kiwis in particular play fast and loose rugby, but hit harder than most in the NH. They don't seem to have nearly as many head injuries, stoppages etc over there than we do in the NH. I think it's as much about carrying style and the desire in the NH to lead with the head, bodies low, in this trench warfare game of inching forwards ruck by ruck that does more damage than anything else. Yes, big hits are terrible, but brain damage like this is about the repetitions.

I watched the Fiji-Georgia and England-France games at the weeend and was amazed at the amount of contact with the heads that is 'legal', particularly through this form of carring (and the Fijians have zero respect for the head area when clearing out). Eventually, the rugby we saw at the weekend will go. It will have to. It'll have to go back to a 'purer' interpretation of the rules where we have instant release on the floor again and also far less leniency for poaching the ball. Rucking will become an 'instant' thing - you either win/lose the ball at contact, no poaching it or wrestling for 5-10 seconds so multiple players suffer mutiple contacts when in vulnerable positions. It'll become even more of a game of technique and not just raw strength. I guarantee it.

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Post by No 7&1/2 Wed 09 Dec 2020, 8:06 am

Horrible news for the guys involved. I just hope world rugby the unions etc dont put up too much of a fight to this as it seems pretyybobvious they were slow to react. We've got a lot better around concussions the new law interpretations etc for hugh tackles. Still some way to go though and rugby won't be the last sport to be affected.

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Post by GeordieFalcon Wed 09 Dec 2020, 9:16 am

Is rugby League suffering the same levels of these issues? Or has it not been studied yet?
(Aside from the obvious case of Rob Burrows.)

If there are less cases does that suggest theres a particular aspect of union which is causing it. Its curious all 3 who are named are forwards? Or is that pure coincidence....

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Post by BamBam Wed 09 Dec 2020, 9:37 am

Forwards generally are more involved in the brutish collisions we've seen over the past 20 years than backs, so I don't think its a big surprise if forwards are those mainly affected. When the NFL story broke a few years ago, it was mostly offensive/defensive linemen, running backs and other defensive players who made up the original basis of the lawsuit.

Hopefully this link works, its worth a read - https://www.nytimes.com/interactive/2017/07/25/sports/football/nfl-cte.html#:~:text=Of%20the%20202%20players%2C%20111,%2C%20confusion%2C%20depression%20and%20dementia.

In rugby's case, I hope it is resolved without a prolonged legal battle. We have seen improvements in how head injuries are treated, and increased punishments for offenders, but for the players named in the case its probably too late. Reading Steve Thompson and Dylan Hartley's accounts of their current lives is very difficult, and I hope they can live as normal lives as possible going forwards.


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Post by lostinwales Wed 09 Dec 2020, 9:40 am

GeordieFalcon wrote:Is rugby League suffering the same levels of these issues? Or has it not been studied yet?
(Aside from the obvious case of Rob Burrows.)

If there are less cases does that suggest theres a particular aspect of union which is causing it. Its curious all 3 who are named are forwards? Or is that pure coincidence....

Re: rugby league - if you think about the issues that Sam Burgess has been rumored as presenting I suspect it is more a question of lack of reporting. For want of a better word there are few more 'macho' sports than league and that tends to lead to a lack of acknowledgement for such problems.

It does of course depend on where the concussions are occurring. It may be that the lack of set piece work and breakdowns helps, although the head on tackling probably does not.

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Post by Irish Londoner Wed 09 Dec 2020, 9:46 am

GeordieFalcon wrote:Is rugby League suffering the same levels of these issues? Or has it not been studied yet?
(Aside from the obvious case of Rob Burrows.)

If there are less cases does that suggest theres a particular aspect of union which is causing it. Its curious all 3 who are named are forwards? Or is that pure coincidence....

I don't think it's as big a problem in league because they don't have contested scrums or rucking so the only big impacts are in the tackle. Also the amount of running every player has to do in a league game mitigates against the players putting on too much weight/muscle as they have to be fast as well.

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Post by mikey_dragon Wed 09 Dec 2020, 9:58 am

Quite horrifying to hear some of the stories, Hartley’s was particularly worrying. Are there less guys in the SH suffering the long-term effects of repeated concussion, or do we just not hear of it? You would think the collisions there are bigger with the amount of islanders scattered around.

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Post by Soul Requiem Wed 09 Dec 2020, 10:24 am

I think genetics plays a fairly significant part in this, if you look at the England forwards for instance you have a few players to use boxing parlance I would consider cruiserweights who have bulked up into heavyweights like Tom Curry, Kyle Sinckler or Sam Underhill. These are the players I would imagine are more at risk of concussion than your genuine big guys like Kruis, Launchbury or the Vunipolas.

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Post by lostinwales Wed 09 Dec 2020, 11:05 am

Another one. Michael Lipman.

https://www.theguardian.com/sport/2020/dec/09/michael-lipman-if-i-knew-then-what-i-know-now-id-have-been-a-lot-more-careful

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Post by dummy_half Wed 09 Dec 2020, 11:24 am

Soul Requiem wrote:I think genetics plays a fairly significant part in this, if you look at the England forwards for instance you have a few players to use boxing parlance I would consider cruiserweights who have bulked up into heavyweights like Tom Curry, Kyle Sinckler or Sam Underhill. These are the players I would imagine are more at risk of concussion than your genuine big guys like Kruis, Launchbury or the Vunipolas.

I don't think the science particularly backs this up. Concussion and sub-concussion injuries are a result of the skull moving relative to the brain and an impact between the two- some people are more prone because there is less space between the brain and skull, but simple physical size doesn't appear to be a significant factor in this. One thing that does seem to have a significant effect, known from boxing, is that dehydration is detrimental, but otherwise it doesn't seem to matter much whether it is guys that have bulked up or those who are naturally larger.

Of course, much of the knowledge comes from the NFL, where it is the big guys on the offensive and defensive lines who take the brunt of the impacts and especially historically head to head or arm to head impacts, so perhaps give something of a skewed sample.

I also wonder about what it is that has caused the cluster of MND cases in rugby players (and other sportsmen) - Some suggestion that trauma to the head and spinal region could be a contributor, although evidence is weak.

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Post by MichaelT Wed 09 Dec 2020, 12:06 pm

As someone has mentioned Underhill, who had issues with concussion a couple of seasons ago, it is fantastic to see his technique in tackling has changed. Now its usually from the waist down he makes contact with the opposition, you regularly see him flat down with his arms around the ankles/ legs of the player to stop them.

No worrying about offloads or any of those excuses as to why players go high. Stop the person with the ball. A team-mate can stop the next player. A much safer approach to all I think.

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Post by Gooseberry Wed 09 Dec 2020, 1:49 pm

dummy_half wrote:
Soul Requiem wrote:I think genetics plays a fairly significant part in this, if you look at the England forwards for instance you have a few players to use boxing parlance I would consider cruiserweights who have bulked up into heavyweights like Tom Curry, Kyle Sinckler or Sam Underhill. These are the players I would imagine are more at risk of concussion than your genuine big guys like Kruis, Launchbury or the Vunipolas.

I don't think the science particularly backs this up. Concussion and sub-concussion injuries are a result of the skull moving relative to the brain and an impact between the two- some people are more prone because there is less space between the brain and skull, but simple physical size doesn't appear to be a significant factor in this. One thing that does seem to have a significant effect, known from boxing, is that dehydration is detrimental, but otherwise it doesn't seem to matter much whether it is guys that have bulked up or those who are naturally larger.

Of course, much of the knowledge comes from the NFL, where it is the big guys on the offensive and defensive lines who take the brunt of the impacts and especially historically head to head or arm to head impacts, so perhaps give something of a skewed sample.

I also wonder about what it is that has caused the cluster of MND cases in rugby players (and other sportsmen) - Some suggestion that trauma to the head and spinal region could be a contributor, although evidence is weak.

I think the issue with player size is that the weight plus speed they generate from their increased power, the forces in impacts are greater because players are heavier and stronger. Thats one thing that is nigh on impossible to legislate out of the game without putting in even more dangerous things like extreme weight cutting (which is where the boxing issues come in).


One thing thats really struck me watching rugby recently is for all the focus on ensuring players tackle safely it seems players with the ball in hand are perfectly entitled to put their shoulder into the oncoming tacklers noggin.

Anyway Id assume/hope that any changes are data driven, as the previous ones were. I hope a few of the pundits who declared rugby was ruined when Sam Warbuton got carded will be wishing his mate Popham well. It has been good to see the game adapt quickly after a few months of fury to latest changes, its going to have to be an iterative thing looking at more than just tackles.


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Post by Soul Requiem Wed 09 Dec 2020, 2:05 pm

dummy_half wrote:
Soul Requiem wrote:I think genetics plays a fairly significant part in this, if you look at the England forwards for instance you have a few players to use boxing parlance I would consider cruiserweights who have bulked up into heavyweights like Tom Curry, Kyle Sinckler or Sam Underhill. These are the players I would imagine are more at risk of concussion than your genuine big guys like Kruis, Launchbury or the Vunipolas.

I don't think the science particularly backs this up. Concussion and sub-concussion injuries are a result of the skull moving relative to the brain and an impact between the two- some people are more prone because there is less space between the brain and skull, but simple physical size doesn't appear to be a significant factor in this. One thing that does seem to have a significant effect, known from boxing, is that dehydration is detrimental, but otherwise it doesn't seem to matter much whether it is guys that have bulked up or those who are naturally larger.


Size obviously makes a difference as does an individuals physiology. It's a reason why George North has suffered so badly with concussion. Studies have shown that neck strength plays a direct role in the likelihood of concussion if and this is the kicker someone is expecting impact and braces. It's where the links with boxing are admittedly tenuous, in one you are constantly awaiting strikes to the head and in the other you are not.

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Post by miltonkeynesengland Wed 09 Dec 2020, 2:10 pm

I'd be interested to hear from Doctor Grey on this.
Although I read yesterday that the various rugby authorities used to mandate a 3 week break from playing after a concussion since 1977. It seems that in the 2000s that went down to 6 days. I think it needs to more like 3 weeks again and players independently assessed about head injuries

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Post by lostinwales Wed 09 Dec 2020, 2:11 pm

Another problem is that the headlines are very reactionary but the process causing the damage is a long one. We are seeing the results of damage done 15 years ago. There have been changes since then.

I suspect the only way we can have a better knowledge of damage now is to have annual brain scans of pro players.


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Post by king_carlos Wed 09 Dec 2020, 2:48 pm

CTE isn't solely a discussion about concussion. It's the cumulative effect of mild traumatic brain injuries (mTBI). Judging by the research in the NFL these mTBIs could realistically be caused by run of the mill rugby collisions, rather than exclusively through high tackles and illegal clearouts.

Diffuse axonal injuries (DAI) are at the heart of CTE research. I.e. injuries from the brain moving inside the skull. Axons are a part of the neuron that conducts the electrical impulses away from the neuron cell body, allowing the brain and nervous system to work. When someone running at 15-20mph is then stopped dead, the brain keeps moving inside of the skull this can cause those axons to shear. Scary stuff.

You then have direct impacts (not necessarily concussions) that are more frequently discussed that can cause bruising and microbleeds.  They can also cause swelling of the brain which can lead to it crushing itself within the skull.

If that's the case for rugby then reducing the number of collisions players go through by limiting contact training and games played is likely the only means to reduce these effects.

The cluster of MND cases that others have noted is obviously worrying. 3 players from the 1999 RWC have publicly announced their MND diagnosis. Jarrod Cunningham sadly passed away in 2007 at 38-years old due to ALS. Rob Burrows more recently in rugby league.

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Post by king_carlos Wed 09 Dec 2020, 2:52 pm

https://twitter.com/rugbyandthelaw/status/1336240293553827840

That's a good link that someone posted on another forum. It's a thread breaking down the potential legal case.

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Post by doctor_grey Wed 09 Dec 2020, 7:52 pm

Sad.  Always tough to read when someone like Steve Thompson or anyone, really, suffers like this.  And knowing it will be with them to some degree for the rest of their lives.  

As the Guardian report mentioned, Thompson played in that era after formal professionalism started and before significant protection for players were added to the laws and/or properly enforced.  A lot of progress has been made and won't stop.  There were a number of good quality studies across many sports which I have seen which were due to finish and publish results in 2020, but Covid became the obvious priority and access to athletes in their sports virtually eliminated.  So likely sometime in the new year.  
Just a few thoughts, if you don't mind.........

Bruising to the brain happens any time the body or head is disturbed in a way which causes the brain to shift position suddenly or impact against the skull with undue force.  And when players are bigger, stronger, and faster, the potential for injury increases.  Muscle does not protect the head.  Smaller guys who bulk up too much are more likely to have injuries due to load, force, torque on their frame, but I don't think added risk for head injury (my opinion only).  

I truly believe we do not have a unique problem in Rugby at this point.  We do have a problem in sport, however.  There are many sports with some contact which could cause head injury and I think only a few have seriously embraced head injury protection.  American football, soccer football, Aussie Rules football, Rugby Union, League, basketball, ice hockey, lacrosse, boxing, MMA, and more. Just pick your sport.  And each manages - or not - in it's own way.  

I believe part of the problem is people in each sport thought - or think - their sport will/would be neutered or pushed to be banned.  When that subsided with the NFL after their USD 1 billion settlement (which I thought was low), it opened the door to aggressive efforts and much more funding and transparency.  Many of the NFL and other American football studies are now state of the art medical investigations which many other sports as well as the auto industry, for example, are using.  Regarding League, I have not seen any significant studies attached to League players.  Not that they don't exist, but I haven't seen one.  These are tough guys and to me there is in general more force in their tackles, and certainly there are more tackles of consequence in League than in Union.  More to come from there, I presume.  

Looking at Rugby, I still cringe when i see a replay of the vicious Tana Umaga dump tackle on Brian O'Driscoll.  That, I think, along with Graham Henry minimizing it, was the tipping point which started the real focus on player safety.  Certainly when that poor lad died about 9-10 years ago due to poor supervision and care from his coaches, the urgency increased.  We now have laws across all levels of Rugby which eliminate dump and spear tackles, contact with the head, taking a player out in the air, the engage/drive impact in the scrum, no-arm tackles, and more.  There is significantly more training for coaches and support personnel.  We have instituted strict HIA protocols including baseline testing required almost everywhere, and players are regularly withdrawn simply out of caution, just as in the NFL/American Football.  

I think we all now accept we are on a journey not at an end point, which is good.  And there are still things we can do.  Unfortunately, this comes too late for Steve Thompson, Alix Popham, Michael Lipman, Steve Devine, or the many others.  I do think we owe them something.

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Post by Guest Wed 09 Dec 2020, 9:13 pm

Does anyone have the full list of players who are behind the litigation?

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Post by king_carlos Thu 10 Dec 2020, 5:48 pm

There isn't a full list of players involved published anywhere that I know of.

Steve Thompson, Alix Popham and Michael Lipman have been widely named. They've also given interviews about their advanced symptoms.

Mouritz Botha and Carl Hayman may also be involved from some other reports.

It seems from most reports that around 8 players (thus far) who have engaged legal action already have advanced symptoms.

Lawyers from the group have claimed there are around 70 more players aged between 25 and 55 showing less advanced symptoms who have serious concerns.

Now it has gone public I expect the number of reported cases will rise over the coming months as other players seek medical advice and contact those who are considering legal action.

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Post by lostinwales Thu 10 Dec 2020, 5:55 pm

I wonder if Shontayne Hape is on the list? He has had widely reported issues.

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Post by lostinwales Thu 10 Dec 2020, 5:59 pm

List on Ruck.co.uk of 10 players who retired with concussion from 2018 (may not overlap with the above group who may not have shown symptoms at the time of their retirement).
Shontayne Hape
Andy Hazell
Jared Payne
Mouritz Botha
Kat Merchant
Declan Fitzpatrick
Dominic Ryan
Nic Berry
Pete Brown
David Denton

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Post by Guest Thu 10 Dec 2020, 7:29 pm

king_carlos wrote:There isn't a full list of players involved published anywhere that I know of.

Steve Thompson, Alix Popham and Michael Lipman have been widely named. They've also given interviews about their advanced symptoms.

Mouritz Botha and Carl Hayman may also be involved from some other reports.

It seems from most reports that around 8 players (thus far) who have engaged legal action already have advanced symptoms.

Lawyers from the group have claimed there are around 70 more players aged between 25 and 55 showing less advanced symptoms who have serious concerns.

Now it has gone public I expect the number of reported cases will rise over the coming months as other players seek medical advice and contact those who are considering legal action.

Thanks.

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Post by doctor_grey Thu 10 Dec 2020, 10:42 pm

Rob Baxter on the current concussion protocols in Rugby Union. I agree with a lot of it. Some I don't agree with. But his opinion is important, I believe.

https://www.planetrugby.com/exeter-chiefs-director-of-rugby-rob-baxter-defends-rugbys-concussion-protocols/

And this is truly impressive:
https://www.skysports.com/watch/video/12156217/quins-using-gum-shield-to-track-head-injuries


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Post by No 7&1/2 Fri 11 Dec 2020, 8:22 am

Have to say the media coverage is very prominent which is great. World Rugby and other authorities surely have to be seen to be doing something else above what's already planned purely from a pr perspective. I wouldnt be surprised if refs went a bit more hardline for any remotely high tackles again either.

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Post by Rugby Fan Fri 11 Dec 2020, 2:29 pm

One thing this case will hopefully do is stop the "game gone soft" line, which too often seems to challenge attempts to make the game safer.

It has been striking, watching the Rugby Championship, how often Australia and New Zealand commentary teams have sought to excuse direct shots to the head, when anyone watching a similar incident in the north would expect a red card.

I don't really like the fact that the red card now covers accidental dangerous play, when it used to only be for deliberate violence, but that's a distinction for which we can legislate afterwards.

We've had a few years of some pundits bemoaning the fact that law changes have partly been an attempt to pre-empt legal action of the kind we are seeing. I wonder, now the legal action is real, quite what they would have had World Rugby do instead.

It does look like we had a period, in the early days of professionalism, when old school, full-contact training methods overlapped with bigger and better faster bodies, that real damage was done.

For me, bigger bodies became a thing when I saw Va'aiga Tuigamala and Jonah Lomu both playing rugby union as wingers in 1995. The idea that rugby might be getting concussion wrong didn't really sink in for me until 2010, when Chris Ashton was knocked out cold early in the game against South Africa in Twickenham but was kept on for almost the whole match. That looked reckless at the time, so I use that as my arbitrary line for when we all should have already known better.

I reckon we need to keep an eye on the condition of top players who were active in that fifteen year window. We might still be getting it very wrong but, if we are, then the whole game will need need an overhaul, probably turning it into a very different proposition.

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Post by doctor_grey Fri 11 Dec 2020, 3:22 pm

Great comments.  
We probably watched some of the same NZ commentary where John Kirwan went off about red cards, saying he believed they were, in general, bad for the game.  And it seemed to me, that some head shots were excusable.  

It is an important issue, for sure.  But we don't see many head shot red cards right now which tells me the current laws are working.  Most above the shoulders contact that I see are accidental.  That said, we have to penalise even the accidental ones in some way, if only to keep contact points in the forefront of players thinking.  I don't think it is hurting the game in any way.  You see it the same way?

You know, when this hit the NFL some people were saying it would be the end of American football.  But they took the lessons and are still working on it more which they should.  It still looks like the same game to me.  This is my New year's wish for our sport.

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Post by king_carlos Fri 11 Dec 2020, 7:43 pm

doctor_grey wrote:And this is truly impressive:
https://www.skysports.com/watch/video/12156217/quins-using-gum-shield-to-track-head-injuries
Those gum shields are potentially brilliant. The BBC did a report on I think the Osprey's trialing them around a year ago after a Swansea University study. Good to see they are catching on.

Given the growing research showing that CTE is caused by sub-concussive blows and the brain moving inside skull, which realistically could be caused by ordinary rugby collisions, those gum shields could be a brilliant tool for tracking those impacts.

A part of me worries that too much of the discussion we are seeing still revolves mainly around concussion though. The understanding and education of concussion, HIA protocols, etc have undoubtedly improved out of sight from Thompson's days. It feels like many are still trying to ignore the elephant in the room of the effect that cumulative sub-concussive blows can have with regards to CTE.

One area of the potential court case that could get interesting is defences that World Rugby, the RFU, etc could make about causation. The argument could be made that whilst a lot was known about concussion prior to HIAs being introduced there was very little known about CTE and the accumulative mild traumatic brain injuries. It's easier to argue that sub-concussive blows are inherent in the sport than concussion. If that defence is made it should open up a big debate about CTE rather than specifically concussion though.

The only way to reduce mTBIs is to reduce the number of collisions players are involved in. Which should lead to limiting contact training and the amount of games players can be involved in a season.

The breakdown by the Guardian of the increase in average tackles a game in RWCs is telling. In the 1995 RWC there were an average of 113 tackles per game, by 2003 it was 189, in 2019 it was 257. That's before considering the likewise increase in number of breakdowns.

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Post by Rugby Fan Sun 13 Dec 2020, 1:15 pm

doctor_grey wrote:...I don't think it is hurting the game in any way.  You see it the same way?...

I do. It's only relatively recently that rugby union has taken to yellow and red-carding actions it wants out of the game. The spear tackle was low-hanging fruit, as it was premeditated, rather than instinctive. Tougher penalties for tip tackles, and challenges in the air proved more controversial, because often they were the result of clumsiness rather than malice. Neverthless, players have certainly changed their behaviour, which is what the law changes were designed to do.

High tackles, and no-arm tackles in particular, are going through the same process of being outlawed, while tackling technique has not fully adjusted. A number of pundits seem(ed) to think this is such an intrinsic part of rugby's DNA, that you can't stop people tackling that way, and it spoils the game if you send someone off for something they don't intend.

I'm older than most pundits and podcasters, and played the game when tackles were usually missed, or low. If someone went high with arms, it looked like a clothes-line tackle, which was outlawed even in the amateur game. I do know the game changed radically, and anyone under 40 will have grown up tackling the upper body as a regular part of the game. As Tony Underwood showed, you couldn't reliably put down someone like Lomu by trying to take his legs. Instead, you went high to try and check his momentum, in the hope that would buy time for a teammate to join you.

It's not an eternal part of rugby's DNA to tackle high, or shoulder charge. It developed as the best answer to a new problem of big lumps in the backline running at pace. The pacific islanders always had players that size but their national teams could be ground down in the set piece, and we didn't see them much, anyway. With the advent of professionalism, suddenly their players were popping up in club games all over the world.

In some respects, the 2009 Lions tour was peak old school rugby meeting professional conditioning. BOD's tackle on Rossouw is interesting to watch. A clear red card today, it looks like it is being penalized but the referee is just signalling a knock-on. Stuart Barnes in commentary knows enough about the laws then to realize it was illegal but also acknowledges how much BOD inspired his team.



That's the same match Botha shoulder-charged a prone Adam Jones out of a ruck, ending his tour. When he was cited and banned, the Springboks were outraged, and wore "Justice for Bakkies" armbands.

I loved that tour but rugby was at a turning point, and is only now dealing with the consequences. I can't remember worrying in the slightest about Roussow's concussion in 2009 but I was concerned about Ashton in 2010, so I must have started reading something about CTE in the intervening period.

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Post by doctor_grey Tue 15 Dec 2020, 10:55 am

It's good attitudes are changing, overdue, but mostly people understand the situation and the need to change.

I am not in favour of reducing substitutions.  Frankly I am not sure how low we can reasonably go.  Tired athletes have slightly slower reactions which is how accidents/injuries of all kinds can occur.  And we still have a minimum of 7 players going for the full match.  Part of the rationale for the current 8 subs is to have a full front row, because rightfully, we want to prevent spinal injuries and not go to uncontested scrums.  Beyond that, I am not sure where we can reduce the subs by more than one person.  Not sure that's worth it.  

Ultimately, I think the answer lies in too much Rugby for our players.  Not many people want to go there because of the financial impact (gross revenue plus screen-time visibility which grows the sport) and because the rest of us like turning on the television and watching Rugby.  But, in my opinion, that will be the ultimate solution and will potentially give our players longer careers and a healthier retirement.  I still remember when the NFL Player's Association turned down an offer to increase the regular season from 16 to 18 games (with the attendant two game increase in salaries).  The players thought the increased risk of injury was not worth it.  That should resonate with Rugby.

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Post by No 7&1/2 Tue 15 Dec 2020, 6:36 pm

Rugby getting a lot of stick but read this and shudder.

https://www.mirror.co.uk/sport/football/news/jan-vertonghen-played-concussion-symptoms-23173125

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Post by doctor_grey Wed 16 Dec 2020, 1:41 am

Thanks for sharing that article. It's absolutely unbelievable in 2020 that anyone in top level sport anywhere would hide head trauma symptoms. And that clearly shows the philosophy in football and that could put them in legal jeopardy. And deservedly so.

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Post by miltonkeynesengland Wed 16 Dec 2020, 10:40 am

Interesting to read Kearnan Myall in the Guardian today. Not very happy about what's he's hearing.

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Post by king_carlos Wed 16 Dec 2020, 7:42 pm

https://www.theguardian.com/sport/2020/dec/16/kearnan-myall-rugby-union-dementia-understand

That's a link to the article that milton is referring to. Myall is a bright guy and speaks a lot of sense.

His worries are similar to mine that I voiced earlier in this thread. The response from most current players, coaches and administrators has revolved around concussion and HIA protocols improving whilst completely (some might argue willfully) ignoring the elephant in the room that is CTE caused by the accumulation of sub-concussive blows.

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Post by king_carlos Thu 17 Dec 2020, 3:14 pm

The law firm representing the players has reportedly issued World Rugby, the RFU and WRU with a letter of claim setting out their intentions to sue.

Former Wales U20 centre Adam Hughes and former England U21 back row Neil Spence have joined the claim.

I'm very interested to find out whether the claim will be centering around concussion or CTE. At the minute the desire from many in rugby seems to be to discuss concussion (where protocols have improved a lot from these players time) but completely ignore CTE (which has been given very little thought in rugby).

The rugby union section of the BBC website is currently leading with two articles titled "Concussion in sport: More former rugby union players prepare to take action" and "Rugby and Concussion: Key questions the sport faces" respectively. At the bottom of the first article there are three paragraphs under the subtitle "What is CTE & how can it be diagnosed" that read almost like a footnote.

Each player to have come forward so far has been diagnosed by neurologists at King's College, London, with early onset dementia and probable Chronic Traumatic Encephalopathy (CTE).

CTE is the disease discovered by Dr Bennet Omalu in American football player Mike Webster, and the subject of the film Concussion starring Will Smith. In 2011, a group of former American football players started a class action against the NFL and won a settlement worth about $1bn (£700m).

CTE can develop when the brain is subjected to numerous small blows or rapid movements - sometimes known as sub-concussions - and is associated with symptoms such as memory loss, depression and progressive dementia.

Given that states that each player so far has been diagnosed with early onset dementia with CTE as a probable cause I'm beginning to be at a loss as to why so much focus is on discussing concussion whilst still ignoring the elephant in the room.

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Post by doctor_grey Fri 18 Dec 2020, 1:05 am

I think when referring to concussion many people are lumping many/most forms of head trauma under that term. Not technically accurate, but that's how I read it though I could easily be wrong. I generally use the term 'head trauma' because the docs and researchers I know who are more expert tend to use that term and there is no other single term which seems to capture all aspects of bruising to the brain from any sudden movement.

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Post by king_carlos Fri 18 Dec 2020, 8:50 am

doctor_grey wrote:I think when referring to concussion many people are lumping many/most forms of head trauma under that term.  Not technically accurate, but that's how I read it though I could easily be wrong.  I generally use the term 'head trauma' because the docs and researchers I know who are more expert tend to use that term and there is no other single term which seems to capture all aspects of bruising to the brain from any sudden movement.    

That I can accept in many circumstances doc * but the quote from Bill Sweeney, "There is no scientific proof of the causal link between concussion and CTE, that is not a proven thing, and research is ongoing into that", just drives me crazy though. It's one of those statements that is at best ignorant and at worst willfully misleading.

If he is using concussion as a blanket term for head trauma then it's plain incorrect. Whilst if he's referring to concussion specifically as concussion it's very disingenuous given CTE is caused more by the accumulative effect of sub-concussive, usually asymptomatic, mTBIs. 

I'm not doubting that more research into CTE is needed, but the consensus of the research completed thus far is clear and statements like that really don't help the discussion.

*Thought I'd just add how great it is to have your perspective back on the boards for topics like this as well as general rugby and Saints chat of course!

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Post by No 7&1/2 Tue 22 Dec 2020, 11:17 am

Some gruesome stories on this. A fifth of elite players in england suffered a concussion in 2018 19,though you can say it's a postive it's being caught as much and hopefully appropriate treatment put in place.
And the jamie Roberts article on walesonline. He fractured his skull in 2008 and played for 15 mins. Drs waved him back on. He diagnosed himself when he tasted his brain fluid and feeling slow.

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Post by lostinwales Tue 22 Dec 2020, 1:42 pm

Who is going to be happy with their kids playing rugby after this?

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Post by doctor_grey Tue 22 Dec 2020, 2:10 pm

king_carlos wrote:
doctor_grey wrote:I think when referring to concussion many people are lumping many/most forms of head trauma under that term.  Not technically accurate, but that's how I read it though I could easily be wrong.  I generally use the term 'head trauma' because the docs and researchers I know who are more expert tend to use that term and there is no other single term which seems to capture all aspects of bruising to the brain from any sudden movement.    

That I can accept in many circumstances doc * but the quote from Bill Sweeney, "There is no scientific proof of the causal link between concussion and CTE, that is not a proven thing, and research is ongoing into that", just drives me crazy though. It's one of those statements that is at best ignorant and at worst willfully misleading.

If he is using concussion as a blanket term for head trauma then it's plain incorrect. Whilst if he's referring to concussion specifically as concussion it's very disingenuous given CTE is caused more by the accumulative effect of sub-concussive, usually asymptomatic, mTBIs. 

I'm not doubting that more research into CTE is needed, but the consensus of the research completed thus far is clear and statements like that really don't help the discussion.

*Thought I'd just add how great it is to have your perspective back on the boards for topics like this as well as general rugby and Saints chat of course!
Thanks for the thoughts - really appreciated.  

I completely disagree there is no causal relationship between concussion/head trauma and CTE or other forms of bruising and possible mental impairment.  This is just logical.
To be fair, the data which is missing, and extremely hard to obtain, is if a single individual concussion will result in future CTE or any form of bruising to the brain for any particular person in a specific incident.  Or if it may take multiple incidents.  As I said, it's likely incident and person dependent.  

For the sake of anyone playing sport, we need to take the conservative approach, and in many cases we are, though we can and should do more, following the science, as it were.  Most likely each incident is different as people are different.  Which adds to the variability and eliminates the certainty we need.  That said, however, to me, if a player fails an HIA, the rest period must be longer than 6 days without symptoms.  

On the other hand, we know with a high degree of certainty (though nothing is ever 100% with this) that repeated head trauma without time off for proper healing, which we call SIS, Second Impact Syndrome, is extremely dangerous and carries with it a high probability of severe injury to the brain.   This second impact is something we absolutely need to prevent.  

I think you make a great point:  We should refer to head trauma as what it is.  And not limit it simply to a head knock.  I absolutely believe we can do this and still retain Rugby and many other sports similar to how they are played today.  It is sports like boxing, and especially MMA, which I can't understand.  

I think the good news coming out of this is that head trauma/mTBI is not always due to impact to the head.  This is good science and I'm glad you mention it.

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Post by nlpnlp Mon 04 Jan 2021, 12:05 am

I posted 5 years ago after George North was knocked unconscious in the England v Wales 6 Nations game but allowed to play on, that the 'Powers that be' would only take the matter seriously when they were being sued for multi millions. Very sadly this now seems to be the case. I understand that concussions/knockouts are a small part of the CTE issue, but they should have been a red flag to those running the game how serious an issue this was.

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