The Ticking Time Bomb, Part Three

During the last two years I have written a number of articles about rugby’s injury problems, both from the short-term perspective, and with huge concern about the longer term impact of rugby’s constant knocks.

The entire issue of rugby injuries falls into three distinct categories.

« The short-term injuries – the bumps and bruises, the muscle strains and stretched ligaments. All those minor aches and pains that go with a hugely physical game where muscle and bone confront muscle and bone. These are the injuries that every player expects during his career. Some may result in a game or two off, or perhaps a practice missed, others are simply taken on the chin.
« The more serious injuries – broken bones, torn ligaments, joints wrenched out of sockets, contusions and concussions. The injuries that require a period of rehabilitation and time out of the game to recover. Sometimes a player’s season is cut short; sometimes he misses a full year of rugby. Sometimes these injuries might be career ending; at other times they are a god-sent opportunity for a player’s entire body to recover from the intensity of the game.

« And then we have the long term injuries and effects, those that manifest themselves in later life. The cumulative effect of too many bone-jarring tackles, the accumulation of minor knocks to the head. The long-term effects of concussive event after concussive event. The unwanted, and mostly unacknowledged legacy of a contact sport.

As the 2016 Super Rugby season looms we are again confronted by the issue of injuries in all three the categories I mention above. The season has not kicked off yet, and media headlines buzz with news of more and more pre-season injuries to top-level players.

The following, all culled from rugby focussed media, are illustrative of the problem:

NEWS: the Lions suffered a pre-season blow with the news that stalwart Ross Cronjé faces surgery.

NEWS: Sharks captain Patrick Lambie will miss the first half of the Super Sugby season with a shoulder injury.

NEWS: The Sharks have confirmed that Pat Lambie, Ruan Botha and Francois Kleinhans will all be out for 12 weeks as the result of various injuries.

 NEWS: The Stormers have lost the services of Jean Kleyn (4 months) Rynhardt Elstadt (6 Weeks) Wilco Louw (6 months) and Rikus Botha (12 Weeks) through injury ahead of this year’s super rugby tournament.

NEWS: Chiefs openside flank Mitchell Karpik will not play any part in this year’s Super Rugby tournament after picking up a serious knee injury in last Friday’s pre-season trial against the Waratahs at Rotorua.

NEWS: Bulls loose forward Pieter Labuschagne has been ruled out of Super rugby action for eight weeks due to an ankle injury.

NEWS: Kings coach Deon Davids has been forced into making a number of changes to his team to face the Cheetahs in a super rugby pre-season match on Friday. Davids has replaced hooker Edgar Marutlulle, who is out with an injury to his ear, while Jacobie Adriaanse is out because of concussion.

NEWS: Springbok winger Cornal Hendricks is suffering from a serious heart condition that threatens to jeopardise his rugby career.

NEWS: Akira Ioane has been ruled out of the Blues’ pre-season match against the Chiefs at Pukekohe on Friday due to a hamstring strain.

NEWS: Matt Proctor, Ben May and Motu Matu’u sidelined for Hurricanes

NEWS: Highlanders back Richard Buckman ruled out for Super Rugby season

NEWS: Dane Coles Still Out For Canes

NEWS: The Bulls, and South Africa, are without the services of stalwart Handre Pollard, who is sidelined for the whole season with a knee injury.

NEWS: Bulls loose forwards Deon Stegmann and Lappies Labuschagne are both out of action for two months with ankle injuries.

NEWS: The Chiefs will kick-off their Super Rugby campaign without scrum-half Augustine Pulu after he broke his arm on Sunday.

NEWS: The Stormers’ centre stocks suffered another blow ahead of the Super Rugby season, with Jaco Taute ruled out through injury. This on top of Damian de Allende’s injury woes that will keep him out of most if not all of Super Rugby.

NEWS: The Bulls will be without Springbok hooker Bandise Maku for the start of the Super Rugby season, as he is the latest addition to the side’s injury list.

NEWS: Chiefs lose All Blacks prop for the year. Nepo Laulala has been dealt a crushing blow on the verge of the Super Rugby season after the Chiefs tighthead prop was ruled out for 2016. Laulala, who has four Test caps, tore his ACL, PCL and MCL ligaments in his right knee during training on Friday.

NEWS: Faulkner blow hits Force. Western Force have suffered a setback to their front-row after prop Tetera Faulkner was ruled out for the first six weeks of Super Rugby. News of the injury comes on the back of fellow prop Francois van Wyk having dislocated his wrist, ruling him out for six weeks of action.

NEWS: Crusaders hit by Crotty, Fruean blows. Crusaders boss Todd Blackadder has revealed that Robbie Fruean and Ryan Crotty will miss the start of the season.

You cannot make this stuff up! These are all news headlines culled from mainstream rugby media in January and February 2016, including Rugby365, The New Zealand Herald, PlanetRugby, Stuff.co.nz, SuperSport, SA Rugby, and the like.

Again: Remember the rugby season has not started yet!

Prior to the commencement last year’s Rugby Championship I wrote an article entitled “Previews, Injuries and Changes” in which I spoke about the number of potential Wallabies, All Blacks, and Springboks who were plagued by injury after the Super 15 Rugby series. They included: Quade Cooper, Wycliff Palu, Sam Carter, Matt Toomua, Tatafi Polota-Nau for Australia. Aaron Cruden, Beuden Barrett, Jerome Kaino, Liam Messum, Brodie Retallick, Charles Piutau, Richie McCaw, Izzy Dagg.

South Africa had problems too:-  Duane Vermeulen, Jan Serfontein, Scarra Ntumbeni, Faf de Klerk, Cobus Reinach, Pat Lambie, Lionel Mapoe, Lood de Jager, Pieter-Steph du Toit, Willem Alberts, Fourie du Preez, Heinrich Brussouw, Steven Kitshoff and Jean de Villiers were all on the injury list.

Every one of the players mentioned above was in their national team training squad! These are just the top-level players we are talking about. The injury list amongst non-contenders for national call-up was even longer.

Let’s go and look at some other facts:

After the finalization of the 31-man squads for the 2015 tournament and prior to the commencement of the 2015 Rugby World Cup the number of players who had to withdraw from their national squads through injury had more than doubled compared with the 2011 tournament at the same stage.

Before the start of the tournament 34 players had been replaced in their national squads. At the same stage in the 2011 Rugby World Cup, there had been 16 withdrawals.

Surely, surely there must be some very serious cause for concern amongst the administrators of World Rugby??

I do not have any answers to the scourge of injuries that plague our sport. I do not know whether we should be considering limiting the number of games a player is allowed to play, or whether we need to look at changes to the protective clothing a player wears? Do we legislate the amount of contact allowed at practices? Do we require regular MRI scans? Must a player undergo a physical examination after every game and let a medical team decide whether he needs time off despite not having any visible discomfort from injuries? I am not sure how the problem of injuries can be addressed.

I am sure there will be those that say the players accept the risks in exchange for the money they are paid. This is rugby and it is a tough game. This is a “man’s game” and the players must simply “man up” and take the punishment. It comes with the territory.

This is a nonsense argument and extremely shortsighted too. This argument is most usually offered by retired rugby players from a previous era, or by those fans of the game that never actually donned a pair of boots and a gum-guard in anger. In both instances neither the player from a bygone era nor the sideline fan have any idea of the intensity and physical demands of the modern game.  If we allow our top players to be constantly crocked and out of the game, we are effectively reducing the quality of the rugby on offer.

Couple this to the very real fact that we simply have no idea what the longer term impact of rugby is on the health and longevity of retired players.

What really really concerns me is that all the warning bells are ringing, and rugby is not taking any notice whatsoever.

We also know that younger men think they are invincible and assume that the injuries will happen to someone else. The modern era rugby player who makes it to the top of the game is a media celebrity of sorts and is usually earning very large amounts of money too. He is not thinking about the longer-term effects of the game he is playing. He will play as much rugby as he can manage.

We need to change this mindset.

If I may mention two high qualified individuals who have voiced their concerns.

Professors John Fairclough and Gordon Mackay are both renowned orthopaedic surgeons in the United Kingdom. Fairclough has a 30-year association with the Welsh Rugby Union and Cardiff RFC while Mackay has also worked extensively with the Scottish Rugby Union. Both are rugby men to the core, but are deeply concerned by both the scale and severity of the injury rate in the sport.

Professor Fairclough is on record as saying:

“It is not my job as a surgeon to alter the game of rugby union but any sport that produces that level of injury is akin to Rollerball,”

 “That is not sustainable in the long term. From a medical point of view, the most important thing is that no sport should be so dangerous that it is going to be not just career threatening but affect people for the rest of their lives.

 “When you have injury rates of that nature then somebody needs to be brought to investigate. It needs to be led by people without vested interests in rugby union, but looking at it purely from a point of view of personal injury.”

He hits the nail squarely on the head: Any investigation must be led by people without vested interests in rugby!

Professor MacKay tells us that there are two components to the problem –

Firstly the increasing size of players. Since the 1987 RWC tournament the average size of a forward has increased by 8,9 kilograms, while backs have increased in size by an average of 8,5kg. Add the increase in size to the overall reduction in body-fat count amongst forwards, especially tight forwards, and the increasing size of players becomes even more marked.

Modern era players are bigger, stronger, fitter, faster and in vastly better physical condition than those of the bad old days of rugby.

MacKay goes on to say that the game has evolved to a point where players actively seek contact, rather than seeking to avoid contact. In addition the nature of the contact has changed beyond all recognition.

He says: “The big hit was never a feature of the game 20 years ago. The big hit aims to stop the ball-carrier on the gain-line, and if possible, knock him backwards. You also have the chop tackle which is effective at stopping big men, but it is a recipe for a rapid rise in the number of knee injuries in particular.”

 “Apart from the fact that these big collisions can lead to whiplash or skeletal or muscular trauma, they also place huge stress on the joints,” Mackay said.

If I may come back to Professor Fairclough’s suggestion that the scourge of injuries be investigated by someone or a body who has no vested interest in the game of rugby itself. We have seen World Rugby sweep the problem under the carpet before.

Here is World Rugby’s response to the two learned professors:

World Rugby chief executive Brett Gosper has confirmed the organisation is prepared to amend certain laws in the interests of safety, but says he is unconcerned by the injury rates at the (2015) World Cup, which this organization measures by loss of playing and training time per 1000 hours.

“Visually it is looking more serious because of the size of two of the games where injuries have been happening, but our monitoring is not showing the number to be extraordinary in any particular way,” Gosper said.

“Let’s wait until the tournament is over before doing a full analysis. We want to make sure it’s evidence based rather than emotionally based because player welfare is our number one priority.”

This line is parroted time and time again by rugby administrators. Player Welfare is “paramount,” while the playing calendar is being filled with additional games by both unions and clubs. Southern Hemisphere players are expected to participate in a season that stretches for anything from 9 to 11 months. Players then sign short-term contracts to go and earn some extra pocket money in the “off season” playing for clubs in the northern hemisphere, most usually Japan.

I come back to the ticking time bomb mentioned in my previous articles about this subject.

We have absolutely no idea what the longer-term effects of top-level rugby are or will be on the future health and welfare of retired rugby players.

Last year World Rugby did their utmost to, again, sweep the issue out of sight. I quote:

“World Rugby and New Zealand Rugby have welcomed the results of a wide-ranging independent study, researching the long-term physical and psychological health effects of playing elite rugby, community rugby and non-contact sports. 

 The three-year study, conducted by the Auckland University of Technology (AUT), funded by World Rugby and AUT and supported by New Zealand Rugby, does not provide definitive links between rugby and long-term cognitive health issues and further research is required in this priority player welfare area.”

 This was a little bit of Smoke and Mirrors stuff, as the AUT report did make some very definitive recommendations:

The key recommendations made by AUT were:

  1. Further targeted research is needed to assess the impact of concussion on long-term balance and cognitive brain function. Arthritis and cardiovascular health in retired athletes also requires further investigation.
  2. Sports should focus on improving concussion awareness, management (immediate and follow-up) and prevention programmes.
  3. Injury prevention and injury management programmes should target not only acute injuries during participation but also long-term injuries associated with the greatest morbidity such as arthritis.
  4. Education on the harmful effects of excessive alcohol ingestion should be a core inclusion in all sports education programmes.
  5. Sports should identify and highlight not only the injury risk associated with sport but also the potential benefits to general and neuropsychological health that are associated with sports participation.

Once World Rugby had accepted the AUT report they publically stated that rugby has no serious long term effects on the health and welfare of players.

They disown the problem at their peril!

Let me take you outside the world of rugby union.

I am not the greatest moviegoer on the planet. My tastes are tilted towards documentaries and factual offerings rather than fantasy. (Although I do admit to enjoying the special effects of Star Wars and the Lord Of the Rings type movies.)

As I type this a movie staring Will Smith is making some waves in the movie world and in certain segments of the world of sport.

The movie is called “Concussion” and is a true life (yet somewhat contrived) story about a medical pathologist, Dr Bennet Omalu, of Alleghey County, Pennsylvania’s Coroner’s Office. Dr Omalu handles the autopsy of a retired NFL player, Mike Webster, of the Pittsburgh Steelers, who was found dead in his vehicle. There was no visible cause of his death.

Dr Omalu discovers that Webster had suffered severe brain damage during his life and that he had died as a result of the long-term effects of repeated blows to the head suffered as a top-flight American football player in the NFL. Dr Omalu calls it Chronic Traumatic Encephalopathy, or just CTE for short.

With the help of former Steelers team doctor Julian Bailes, another medical doctor, neurologist Steven T DeKosky, and the County Coroner Cyril Wecht , Dr Omalu published a paper on his findings, which is initially dismissed by the NFL.

Dr Omalu continues his research and finds more and more evidence of long term brain problems, CTE, amongst former NFL players. Still the NFL will not listen. In the movie Dr Omalu is subjected to considerable pressure to back down from his efforts.

To cut a long story short, Dr Omalu’s contention that American Football can and does cause serious long term effects to players is vindicated when former NFL Players Association executive Dave Duerson commits suicide due to growing cognitive problems; in his suicide note, Duerson admits that Omalu was right.

Dr Omalu is allowed to address an NFLPA conference on concussions and CTE. Amid growing scrutiny from Congress, the NFL is forced to take the concussion issue more seriously.

The movie ends here and all is well that ends well.

Some of the science in the movie has been questioned by concussion experts, they contend that CTE is not an automatic after-effect of concussion, and that CTE can and does have other causes.

Yes, CTE is connected to concussions. But scientists don’t yet know the exact nature of the relationship between the two.

Scientists have known about this pattern of abnormal brain cells since the 1920s, when it was discovered in boxers, according to Dr. William Barr, director of neuropsychology at NYU Langone Medical Center.

The term CTE has also been used for decades.

Even experts don’t know what turns concussion into CTE.

“Years of exposure to trauma to the head do appear to correlate with a CTE diagnosis,” said Dr. Jamshid Ghajar, a neurosurgery professor at Stanford School of Medicine and president of the Brain Trauma Foundation. “But there is no apparent causal relationship between the severity of a concussion or number of concussions and CTE,” he said.

And there is even more concussion experts don’t know.

“No one talks in the medical community about how much we don’t know,” said Jessica Schwartz, a spokeswoman for the American Physical Therapy Association. “Getting a concussion is hardly good for your brain, of course. But having a concussion doesn’t lead straight to Omalu’s autopsy table.”

So, concussion and CTE are not quite as easily related as the movie contends. We must allow the movie some poetic licence, it is meant to entertain and is not a purely scientific discourse presented to the scientific and medical communities.

However, we cannot ignore the facts:

There is absolutely no doubt that concussions and other types of repetitive play-related head blows in American football have been shown to be the cause of Chronic Traumatic Encephalopathy which has led to player suicides and other debilitating symptoms after retirement, including memory loss, depression, and dementia.

On September 30, 2014, researchers with Boston University announced that in autopsies of 79 brains of former NFL players, 76 had tested positive for CTE.

In September 2015, researchers with Boston University and the US Department of Veterans Affairs announced that they had identified CTE in 96 percent of NFL players that they had examined and in 79 percent of all football players.

In April 2011, the Philadelphia law firm of Anapol Weiss filed a federal lawsuit on behalf of seven retired NFL players. Thousands of former NFL players have since filed lawsuits against the League after suffering repeated concussions throughout their careers. The multidistrict litigation (MDL) titled In re: National Football League Players’ Concussion Injury Litigation (MDL 2323) was filed on January 31, 2012.

The lawsuit alleges the League “… was aware of the evidence and the risks associated with repetitive traumatic brain injuries virtually at the inception, but deliberately ignored and actively concealed the information from the Plaintiffs and all others who participated in organized football at all levels.” The master complaint argues the NFL knew or should have known players who sustain repetitive head injuries are at risk of suffering “… early-onset of Alzheimer’s Disease, dementia, depression, deficits in cognitive functioning, reduced processing speed, attention, and reasoning, loss of memory, sleeplessness, moods swings, personality changes, and the debilitating and latent disease known as Chronic Traumatic Encephalopathy (CTE).”

A proposed settlement was reached in the litigation on August 29, 2013. Under the agreement, the NFL will contribute $765 million to provide medical help to more than 18,000 former players. Retired players who suffer severe neurological conditions such as Alzheimer’s and amyotrophic lateral sclerosis (ALS) diseases in the future will also be eligible to apply for medical help. In addition, $10 million will fund brain injury research as well as safety and education programs.

The settlement says it should not be interpreted as a statement of legal liability on the part of the NFL.

The settlement, which is projected to protect retired players for nearly 65 years, will compensate injured former players who need immediate help and will provide baseline assessments and medical benefits to those who are symptom-free or beginning to show signs of neurological problems.

Now that is the state of play in that other high impact contact sport. American Football as acknowledged and accepted that their sport has a problem.

Rugby, a more fiercely contested game, with far more physicality, longer playing hours, a much longer playing season, and vastly more of the high impact physical contact during a playing career, denies that there is a problem!

Examine the facts:

In America’s National Football League there are only 16 regular season games in a season. Just the Super Rugby Series exceeds that quota before we even reach the play-offs and finals.

Add in the Rugby Championships, local competitions like South Africa’s Currie Cup and the provincial championships in New Zealand and Australia. Add in the incoming mid-year international tours. Add in the meaningless end of year tours to the north, and a southern hemisphere rugby player has a season that can include as many as 45 top-level rugby matches.

That is a season lasting up to eleven months.

Back to the US and the NFL – the NFL strictly limits the amount of contact training each and every player may be exposed to. Some teams ban tackling and blocking practice at most sessions. Rugby loves it’s full contact training sessions.

And when the season is over and a very short rest period looms, the players head off for short period playing contracts in Japan, France, England, Italy and elsewhere.

This is simply rugby suicide! Or, if I may be so morbid to suggest it: Suicide by rugby.

I will end this discourse with that distressing roll call:

« Joost vd Westhuizen’s battle with amyotrophic lateral sclerosis, also known as Motor Neuron Disease is well documented.

« 1995 RWC hero and stalwart flanker Reuben Kruger has passed away after a battle with brain cancer.

« Wium Basson, another Bok lock forward died of cancer in 2001 at the age of just 25.

« Andre Venter, a Bok in the ’99 RWC squad has transverse myelitis, yet another neurological condition that has confined him to a wheelchair for the rest of his life.

« Tinus Linee, another Bok has just passed away as a result of Motor Neuron Disease.

« Former Natal and Rhodesia player Danny Delport, now living in Perth, has been diagnosed with Motor Neuron Disease (MND).

« Another ex-Natal player, Ryan Walker, who played scrumhalf for the Sharks in 2002 and 2003, has also been diagnosed with MND.

« Derek Hougaard, another ex-Bok recently admitted to cognitive and vision problems and is seeking help.

Those are the high profile players. There are many others.

I am a rugby fan. I follow the game, I think about the game, and I write about the game. I love the game.

I am very very concerned about the constant flow of injuries in our game, and I am especially concerned about the long terms effects of too much rugby and too many high-impact hits on the rugby payers of today.

World Rugby needs to take a long hard look at itself and take serious steps to address the issues I have highlighted in this article.

The Time Bomb is ticking louder and louder.