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20th Jan 2017

Munster coach makes fair comment on concussion before overstepping the mark

Patrick McCarry

Leave rugby to the rugby teams and go Google search on some other stuff.

That was, in a kernel, the advice from Munster’s director of rugby Rassie Erasmus about the latest concussion furore.

Over the course of 20 hours, Ireland’s half-back pairing of Conor Murray and Johnny Sexton both sustained big hits above chest hit. Video footage showed Murray and Sexton take heavy blows just below the chin and both looked in a bad way after it.

Sexton and Murray, after an eventual video review, both went off for Head Injury Assessments. Those assessments are supposed to work like this.

  • Player gets asked five ‘Maddox’ questions based on the game they are playing in.
  • Medical team make a judgement based on what they have initially seen, the players’ responses and demeanour and tell-tale visual signs.
  • The player is brought back to a medical room and is asked to perform a number of number and memory [cognitive] and balance tests. More replays of the incident in question – with possible, additional angles – are viewed.
  • There is a symptom checklist (headache, dizziness, blurred vision etc.)

During a 2014 educational talk about concussion, with members of the Irish media, Dr Eanna Falvey [team doctor for the 2017 Lions Tour] discussed why H.I.A was better than the old Pitch-Side Concussion Assessment [PSCA]. He said:

“Studies from World Cups show that, from a player going down to play starting again, the average time is about 56 seconds. As fit as I am, it takes me about 15 seconds to get out to the injury, so you have a very limited time to get through that.

“There is a lot of noise. You are in this situation. You are trying to, over the noise, communicate with your colleagues and with the player.

“We have gone from having 56 seconds from them hitting the ground, to getting up, to make a decision. You now have 10 minutes to help you out with that. While I wouldn’t argue that this is the perfect solution, it is better than what we have had in the past. I think anyone who has been involved in the game is happier to have that time to do something than not.”

Between the Murray and Sexton H.I.As, the players were off the pitch for a combined 11 minutes. That includes leaving the pitch, making it to the medical room going under the stands, footage reviews, tests being carried out, players removing their boots for a balance test, a decision to play on or not being made and the player returning to the pitch.

Murray’s H.I.A was 7 minutes. Sexton’s was 4 minutes. Leo Cullen said Sexton’flew through’ his test and the greater concern in both cases was for potential neck injuries.

In Murray’s case, in my opinion and in the opinion of Dr Barry O’Driscoll [formerly of World Rugby], he should not have returned to the pitch judging by video replays of his collision.

Passing a H.I.A may tick a box but former players, including Brian O’Driscoll, will tell you about passing such, and similar, tests only for concussive symptoms to be discovered at a later date.

Speaking about the protocols that saw Murray and Munster captain Peter O’Mahony removed from the fray, Erasmus gave a measured take on the idea of independent assessors making concussion calls. He told The Irish Examiner:

“I am so satisfied with all the things we put in place over and above the normal protocol and regulations. Medical doctors, they have got an oath and they look after player welfare.

“You will lose a player’s commitment towards the club, and the coaches and the medical team if you put them back on the park or risk them and you will suffer later in your coaching career if players don’t trust you. Our doctors and our medical staff will never ever jeopardise a player’s welfare so I don’t think it [an assessor] is needed.”

While Erasmus is entitled to his opinion on this matter, he overstepped the mark by stating pundits, writers and fans were not helping at all by offering their opinions on concussion incidents. He continued:

“Even myself, as a coach, it’s a very dangerous thing to sit there and make a judgement like a medical doctor on medical conditions. It’s almost like googling an illness on the internet and making a diagnosis.

“It’s me sitting there and I totally trust the medical team. If a guy gets injured I will wait for the info from them and while I’m sitting there and while I played the game and have seen injuries a lot of times, I am not qualified to make calls like that.

“It might be very irresponsible to make assumptions watching the game when you weren’t part of the action on the ground. I think it’s a big responsibility and that we all adhere to that.”

Erasmus is suggesting that next time one witnesses a player taking a shuddering hit to the head, to say nothing and leave it to the professionals.

It must be noted, rugby left Rob Kearney on the pitch against France [2009] for over an hour after he was bashed in a Sebastien Chabal tackle and twice slipped while trying to regain his feet.

Rugby left Brian O’Driscoll on the pitch in 2013 after he was clearly rattled by charging, 19-stone prop Vincent Debaty:

Rugby allowed George North to play on for Wales, in 2015, after he took two concussive blows, including one that knocked him out, during a Six Nations game. Rugby then allowed North to play on for Northampton Saints, late last year, after more video replays were missed.

Now rugby is telling us that rugby will look after the flawed H.I.A system.

Forgive us if we don’t hold our tongues on the matter.

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