George North’s concussion damaged him and the image of rugby union

Wales dealt with North’s head injury poorly both during the game against England and afterwards, but this problem extends way beyond a single team
• George North left out of Wales team for Scotland match

- Paul Rees
- theguardian.com, Thursday 12 February 2015 08.27 EST

George North during Wales's defeat to England. Photograph: Kieran McManus/BPI/Rex

The opening round of the Six Nations contained half as many tries as last year’s and none of the three defeated sides scored a point in the second half of their matches. But the debating point was George North remaining on the field for the entire match between Wales and England despite taking two knocks to the head and appearing to be momentarily knocked out in the second incident.

World Rugby’s reaction was swift, as it had to be after the howls of protest that quickly blew up on social media. Concussion is a live and emotive topic and there was incredulity that a player was not taken off despite the two clear impacts he took to the head, never mind that he was rested for a week last November having been concussed.

World Rugby’s investigation revealed that systematic, rather than human, error had been responsible: Wales’s medical team had missed the second incident, a clash of heads, and did not have access to a video replay. Wales’s coaches, who watched the match from a hospitality box, had analysts with them armed with laptops, but they were used to review previous passages of play rather than what happened to North.

Wales’s response was disappointing throughout, culminating in Robin McBryde, a coach with responsibility for the forwards, being made available for their first media conference after the England match, rather than anyone from the medical team. The emphasis seemed to be on absolving from blame the coaches and the medics (not that anyone had officially done so) rather than focusing on the welfare of a player who had already suffered one concussion this season.

The safety of players is paramount is World Rugby’s mantra which is why the WRU’s national medical director, Prav Mathema, should have been answering questions about North, not McBryde, who was unreasonably having to stray beyond his field of expertise. Mathema was interviewed on the WRU’s website on Monday, but the feed was put out at a time in the evening after the deadline of most media outlets.

The questions that needed to be put had nothing to do with blame: the whys and wherefores of what happened on Friday night, and what did not happen, had been established and action taken to ensure that there is minimal prospect of a repeat. After McBryde had read out a statement about North and answered a couple of questions, the subject was declared off-limits and three further questions, none of which was accusatory or provocative, were blocked. Even for a union that does not have a reputation for public relations expertise, it showed an insensitivity to public feeling on the issue.

The preoccupation should have been the health and welfare of North, not the absolution of others. The question that needed to be put to Mathema was, never mind protocols and symptom-free tests, would it not be sensible for a player who had suffered one concussion this season and taken two clear knocks to the head on Friday night to be given a week off from all physical contact, never mind play against Scotland?

Less then 24 hours after North was being examined in the Wales dressing room, another 22-year old, Kariym Irving, was playing in a football match in Surrey. An all-round sportsman who also plays rugby, he was involved in a clash of heads and carried on playing. He was this week in hospital in an induced coma after collapsing when he returned home, though he has since regained consciousness.

The Wales head coach, Warren Gatland, sensibly decided that North should not play against Scotland, regardless of whether he was symptom-free for the requisite number of days before the match. Rugby union has to put the welfare of players above everything, which means countries following the guidelines laid down by World Rugby. Otherwise it is risking lives.

Wales’s medical team will be armed with video replay facilities for the rest of the Six Nations, something the WRU should have ensured was in place anyway. The systems that will be in place for the World Cup later this year are rigorous, including video relays for medical teams and an independent doctor at every match who has the final say on whether a player should be removed from the pitch. But they are not obligatory for other tournaments, only recommended.

Systems cost, just as concussion can cost health and lives. But this is an era when the game is awash with more money than ever, even if it is a fraction of the amounts television companies irresponsibly lavish on Premier League football in England. The Six Nations aways boasts about how much the tournament is worth; the Top 14 clubs in France recently announced a television deal to rival the gross national product of a developing country; the Aviva Premiership is enjoying a lucrative tie-up with BT that has extended into Europe; and if the Rugby Championship has yet to reach its real commercial value, New Zealand have tapped into the Asian market in an unapologetic dash to sell the All Black brand.

There were more than 70,000 spectators at the Millennium Stadium. The BBC’s viewing figure peaked at 8.8m. The WRU banked a large seven-figure sum through an interest that was generated by the players. One of the reasons that World Rugby often seems unable to act decisively is that it is made up of the unions it rules over: its executives do not have executive powers, something that needs to change.

What happened on Friday night was damaging to North and, in consequence, the image of the game. Errors, whether systematic or human, will never be eliminated, but they can be minimised. Concussion safeguards cost, so why not have a ticket levy for Test matches of one or 1.5%, extending to the European Cup at least at club level, with the proceeds used to ensure that World Rugby’s recommendations are implemented in full at international and elite club level?

Action is needed, not words. Rugby union may have a macho culture, but there is nothing soft about taking concussion seriously. The future of players and the sport itself depends on it.

‘THE OLD MACHO DAYS ARE GONE’

Concussion was the theme of a conference on sport that was held in York last week. Organised by Minster Law, the personal injury solicitors, The speakers included a consultant neuropsychologist, a sports injury management lecturer, a barrister and a former rugby union player who retired from playing after suffering a serious head injury.

David Jackson, who played for Nottingham, told the conference: “I was knocked out. My team-mate said he was about to laugh at the way I went down, but I then had a seizure. The depression I suffered after my retirement led me to questioning when things would ever return to normal.”

Jackson found his way back by campaigning to raise awareness of concussion in sport and helping younger players. He is an ambassador for Headway, the brain injury association, and argues that better understanding of the subject comes from greater information. He suggested that physical contact sports should bring their rules in line with boxing, where a fighter’s professional career is over if anything suspicious is detected on an MRI scan.

A message from the conference was that better awareness and tighter rules at professional level would flow down to the grassroots. North’s injuries were seen by a television audience of nearly nine million with many more made aware of what had happened through social media. The game’s response will be noted and the Wales head coach Warren Gatland put North’s health above the desire to bounce back from the opening round defeat to England.

Jackson retired from rugby in August 2013 after the last in a series of head injuries. He had been with the club for 14 years and, after a series of concussions that included three overnight stays in hospital, an accidental collision in pre-season training left him with the symptoms of concussion for the next nine months.

He is still involved in the game as a coach and raises funds for charities, including Headway UK and Headway Nottingham. On 17 April he is taking part in a 100-mile bike ride to raise funds for Fountaindale SEN school in Mansfield, having helped raise £8,500 last year. The link for donations iswww.justgiving.com/NRCCC2.

“My message is that the sport has moved a long way in terms of dealing with concussion,” he said. “If I was 18 again, I would have no hesitation in trying to make a career as a rugby player. Ever since lawsuits were taken out against the NFL in the United States a few years ago, concussion has been a hot topic.

“Measures have been put in place in the professional game to protect players, and while what happened to George North was unfortunate, it is important to remember that there was no breach of medical protocol. He was properly assessed after his first blow to the head and he would have been taken off the field the second time had Wales’s medics seen the clash of heads. The approach now is totally different to when I picked up my first head injury.

“The return to play protocols are strict. You start off by running with a physio for 50 or 100 metres and if you have symptoms such as a headache, you stop and repeat it the following day, doing so until you are symptom-free. Then you go through cognitive tests, with your answers compared to those you gave in one at the start of the season when you had not suffered a blow to the head. The process is thorough.

“Where awareness needs to grow is at the grassroots and school levels because there the message can be blurred. Brain injuries are complicated: they are not like a broken bone when a player instantly knows what has happened and an X-ray confirms it. Each one is individual. We are at the limit of what we know and we have learned a lot in the last few years.

“I openly talk to players and children about what happened to me because I want them to understand concussion. It took me nine months to get over my final head injury when I was knocked out completely. I kept getting headaches, I suffered from blurred vision, I was fatigued, sensitive to light and depressed. I still have difficult days and I wonder about what I will be like when I am 40, 50 or 60 and if I will suffer from a degenerative disease, although a neurologist has told me that there are no signs that I will. I still struggle with the mental side at times.

“In another decade, understanding will have moved on a long way again. The North incident generated a huge amount of publicity and that will increase awareness. What happens at the top of the game impacts on what goes on below and every time something like that happens what is important is that procedures are examined and tightened up, which happened in this case.

“Rugby union is a tremendous sport and my regret is not playing it but that I am no longer able to do so. The conference in York, which was very well attended, was important because different sports took part and one can learn from another. The message was that everyone is taking concussion seriously: when a player has suffered it, the return to play is not determined by him or her or a coach or manager, but by medical officers acting on evidence. The old macho days have gone: player welfare now comes first.”