Returning to play from concussion – a Q&A with Dr Eanna Falvey, Chief Medical Officer at World Rugby
Could you set out the changes in the rules around how a player in elite rugby will return to the game after a concussion?
In the simplest terms, we’re focusing on each player’s medical history when it comes to concussion and what their symptoms are at diagnosis. Players with a history of concussion or who have suffered obvious symptoms will now have to sit out for at least 12 days, most players will miss their next match.
If a player suffers a muscle injury we treat that injury on its own merits and based on their history of similar issues in the past. Using scientific evidence and expert opinion we’re applying those same principles of focusing on the rehab of the individual plater to treating brain injury in elite rugby.
What was wrong with the old protocols?
There wasn’t anything wrong with them, they have always been advanced using the latest evidence and expert opinion. We continue to follow external independent advice and to improve our knowledge with rugby-based research.
Why have you decided to make these changes now?
World Rugby has an independent Concussion Working Group who advise us on the latest scientific evidence and opinion. They reached a consensus that things would be better for elite players if we took this new approach based around every individual player and case.
As soon as the independent group took that decision, we put these new protocols on the agenda of the next Executive Committee meeting. The whole approval process from recommendation to implementation has been a matter of weeks and I would like to thank everyone involved for acting so quickly.
Do these changes impact community rugby?
No. For the community game players with suspected concussion should seek medical advice. If they are diagnosed they should sit out for at least two weeks with longer periods applying to youth players. None of that advice has changed.
Why haven’t you forced elite players to stand down for the game in the same way as they do in the community game?
People often ask why the rules are different for the community and the elite game and the answer is that elite players are surrounded by elite sports medical care, working with specialists who know their medical history, on a daily basis. That type of all around care just isn’t possible in the community game. It’s not the injury that is different, it is the level of treatment which leads to the differing approaches in return to play.
How important are the players themselves in this system?
Players are essential. International Rugby Players, the elite players association, support the new protocols and have said that these changes are about a change in the culture of players and coaches. Both in reporting symptoms and in recognition that brain injuries are serious injuries. World Rugby wholeheartedly endorses that point, nobody should be taking chances with their health, especially when it comes to the brain.
International Rugby Players are member of the independent Concussion Working Group who have helped bring about these changes and World Rugby is grateful for the support they have shown in this process.
If a player is concussed how likely is it that they will miss the next game?
Under this new system it is far more likely than not that a player who is diagnoses with concussion will miss the next game, assuming that match is the following week. We can’t put an exact number on that at this point as we haven’t seen how the protocols will work in practice but World Rugby keeps a record of every head injury that takes place at the elite level under our protocols and we’ll be keeping the impact of these changes under constant review.
You’ve spoken about World Rugby’s six point plan on player welfare where do these changes fit in?
A key pillar of World Rugby’s six-point plan is to cement rugby as the most progressive sport on player welfare and as part of that we keep the laws of the game and our protocols under review at all times. These changes, alongside some of the more recent law adaptations such as 50:22, Goal Line Drop Out and trials such as the scrum brakefoot are proof of the plan in action. It is a plan that we put into action every day and it won’t stop at these protocols, there is still a lot more work to be done.
World Rugby often says you will never stand still on player welfare, so what next from here?
That’s right, we are always looking at the evidence and consensus opinion to make sure that the advice we are giving players at all levels of the game is as up to date as possible.
If that evidence doesn’t exist yet then we’ll look to invest our research budgets to uncover what we need to know. This year alone we have invested £500,000 in better understanding welfare in the women’s game and later this year we’ll be announcing more research with a specific focus on returning to play after concussion in the men’s and women’s elite game.
What about the women’s game? How do these changes impact there?
These changes apply equally to the men’s and women’s elite game. World Rugby is very conscious of increasing evidence which shows men and women present concussion symptoms differently and that women can be more susceptible to certain incidents than men. We commissioned the University of Otago and University of Ulster to undertake the biggest study of its kind on head impact in rugby. The study looks at roughly equal numbers of male and female players and the results there will tell us a lot more and we’ll make further changes if that is what our independent experts tell us that is what is needed.
