New Concussion report

[jimKRFC]

A new study has been done showing a decline in brain function after one season of professional rugby: https://www.theguardian.com/sport/2021/ ... y-suggests

With the mouting evidence I think World Rugby is going to have to look into further changes to reduce risk to players.

[Gloskarlos]

More study required - but this could be the start of the end of rugby. Any school age player with parents cuspy about their children's involvement with the game will start to disappear, there are already signs this is happening at local clubs to me.

I think the players at most risk here are those who play at a good club standard, but not high enough to benefit from the best dedicated medical attention and facilities. There must be many that fall through the cracks there.

[Mellsblue]

….. this could be the start of the end of rugby.

This was my initial reaction, as much as I chided myself for thinking it. We are becoming a more risk averse society by the year.
Dreading when the long suffering Mrs Mellsblue reads this - there will be a battle to be had over the kids continuing to play. She has already raised concerns at various points.
I find it horribly ironic the rugby union has done more than almost all to research this issue and now risks being hoisted by it’s own petard.

[Puja]

….. this could be the start of the end of rugby.

This was my initial reaction, as much as I chided myself for thinking it. We are becoming a more risk averse society by the year.
Dreading when the long suffering Mrs Mellsblue reads this - there will be a battle to be had over the kids continuing to play. She has already raised concerns at various points.
I find it horribly ironic the rugby union has done more than almost all to research this issue and now risks being hoisted by it’s own petard.

Mine too.

I believe I've mentioned on here that my memory is utterly banjaxed. Medical investigations haven't shown conclusive physical damage, but the brain is so poorly understood that it's nigh impossible to rule it out. I have problems with mental illness, mood swings, difficulty concentrating, and I don't remember any of my childhood. All of those things could and might be the fault of the mental illness, but I do wonder whether the number of games I played through concussion have not been at least partly the cause.

It is worth noting that I still play. My brain's already fucked and I have experienced nothing in this world quite like a game of rugby so I don't want to give it up.

However, if I were to acquire a time machine and meet my 18 year old self, I'd probably tell him not to play. Even with the friends and the fitness and the drive that rugby has brought to my life - if there was a chance that I could retain memories of my father, then I'd take it.

I mean, I'd probably punch out the smug little git as well, which might not help with the whole brain injury thing, but still.

Puja

[Digby]

How we approach risk as a society, and how we operate as individuals and as a collective is certainly up for debate. Football can take out heading which removes much of their risk, what we do, what the martial arts that involve head contact do is much trickier.

I'm not sure this is the start of the end of the road, it could be, but it could also be the start of new learning that allows the game not just to continue but to flourish. Either way it's important not to put our heads in the sand.

[morepork]

….. this could be the start of the end of rugby.

This was my initial reaction, as much as I chided myself for thinking it. We are becoming a more risk averse society by the year.
Dreading when the long suffering Mrs Mellsblue reads this - there will be a battle to be had over the kids continuing to play. She has already raised concerns at various points.
I find it horribly ironic the rugby union has done more than almost all to research this issue and now risks being hoisted by it’s own petard.

Mine too.

I believe I've mentioned on here that my memory is utterly banjaxed. Medical investigations haven't shown conclusive physical damage, but the brain is so poorly understood that it's nigh impossible to rule it out. I have problems with mental illness, mood swings, difficulty concentrating, and I don't remember any of my childhood. All of those things could and might be the fault of the mental illness, but I do wonder whether the number of games I played through concussion have not been at least partly the cause.

It is worth noting that I still play. My brain's already fucked and I have experienced nothing in this world quite like a game of rugby so I don't want to give it up.

However, if I were to acquire a time machine and meet my 18 year old self, I'd probably tell him not to play. Even with the friends and the fitness and the drive that rugby has brought to my life - if there was a chance that I could retain memories of my father, then I'd take it.

I mean, I'd probably punch out the smug little git as well, which might not help with the whole brain injury thing, but still.

Puja

Assuming you are being sincere here, if you aren't in your mid-sixties, you need to stop playing. Today. Get an MRI and your brain N-acetylaspartate/creatine ratio checked and look at your white matter. Fucking hell mate.

[Puja]

This was my initial reaction, as much as I chided myself for thinking it. We are becoming a more risk averse society by the year.
Dreading when the long suffering Mrs Mellsblue reads this - there will be a battle to be had over the kids continuing to play. She has already raised concerns at various points.
I find it horribly ironic the rugby union has done more than almost all to research this issue and now risks being hoisted by it’s own petard.

Mine too.

I believe I've mentioned on here that my memory is utterly banjaxed. Medical investigations haven't shown conclusive physical damage, but the brain is so poorly understood that it's nigh impossible to rule it out. I have problems with mental illness, mood swings, difficulty concentrating, and I don't remember any of my childhood. All of those things could and might be the fault of the mental illness, but I do wonder whether the number of games I played through concussion have not been at least partly the cause.

It is worth noting that I still play. My brain's already fucked and I have experienced nothing in this world quite like a game of rugby so I don't want to give it up.

However, if I were to acquire a time machine and meet my 18 year old self, I'd probably tell him not to play. Even with the friends and the fitness and the drive that rugby has brought to my life - if there was a chance that I could retain memories of my father, then I'd take it.

I mean, I'd probably punch out the smug little git as well, which might not help with the whole brain injury thing, but still.

Puja

Assuming you are being sincere here, if you aren't in your mid-sixties, you need to stop playing. Today. Get an MRI and your brain N-acetylaspartate/creatine ratio checked and look at your white matter. Fucking hell mate.

I am sincere, but every medical investigation I've had so far has resulted in doctors telling me there's nothing wrong with me (with an implied "Stop wasting our time") so it is entirely possible that it's just mental illness. And I'm f*cked if I'm allowing that to take any more of my joys from me.

Puja

[morepork]

what sort of doctors? Did they put the leeches on you? Not the place to get into it here, but if your memory and mood is because of repeat trauma, then you are at risk for dementia if you keep playing. No sugar coating it.

[Danno]

https://www.theguardian.com/sport/2021/ ... by-success

Interesting. I had no idea these were being used.

[Which Tyler]

https://blogs.bmj.com/bjsm/2021/11/17/c ... ased-risk/

Conclusion:

The introduction of the Head Injury Assessment alongside several other measures used to aid clinicians in the recognition and diagnosis of concussion appears to have significantly increased the rate of reported concussions over the period 2002 to 2019.

The introduction of Graduated Return to Play protocols has increased both the mean and median number of days absence following a concussion. Importantly, this process has limited players returning to play in less than 6 days since its introduction and eradicated its occurrence since the 2014/15 seasons.

Given the increased education, lowering of the diagnostic threshold and the stability/ reduction in other injury rates in the professional game, it appears the rise in concussion incidence in the last decade is largely driven by increased awareness and reporting by medical staff. However, the changing nature of the sport itself may not be ruled out as a potential reason for this change.

https://www.theguardian.com/sport/2021/ ... government

Plan to tackle concussion in sport published by UK government

A 10-point action plan to confront the issue of concussion in sport has been published by the government, with the aim of introducing new “technological advancements” to help against injury by autumn of next year.

Also included among the recommendations are plans to develop concussion protocols that will apply across UK sport, a new approach to training protocols for professional sport, and asking the Premier League to look at new forms of governance that would put player welfare on a higher footing.

[badback]

I find the concussion conversation unnerving. Having had multiple concussions playing, I wonder to what extent it does now impact me or will later. I’ve had a low grade headache non stop for decades. But…cause and effect is hard to prove. Esp as I’ve always had migraines too. No real other issues as far as I know related to concussions. Then there are all the joints and lower back that seem pre arthritic. I just try to keep active and keep the weight off. Rugby was fun to play. I got injured before I took it too far. I enjoy watching it. But I have not encouraged my kids to play… that said one of mine is doing gymnastics at a high level and that’s bad for your body. So.

[jngf]

I find the concussion conversation unnerving. Having had multiple concussions playing, I wonder to what extent it does now impact me or will later. I’ve had a low grade headache non stop for decades. But…cause and effect is hard to prove. Esp as I’ve always had migraines too. No real other issues as far as I know related to concussions. Then there are all the joints and lower back that seem pre arthritic. I just try to keep active and keep the weight off. Rugby was fun to play. I got injured before I took it too far. I enjoy watching it. But I have not encouraged my kids to play… that said one of mine is doing gymnastics at a high level and that’s bad for your body. So.

I know that contact is an aspect that lot’s enjoy about rugby however a 15 a side version of touch maybe the long term way to go? - presumably same fate for rugby league ?

[padprop]

I find the concussion conversation unnerving. Having had multiple concussions playing, I wonder to what extent it does now impact me or will later. I’ve had a low grade headache non stop for decades. But…cause and effect is hard to prove. Esp as I’ve always had migraines too. No real other issues as far as I know related to concussions. Then there are all the joints and lower back that seem pre arthritic. I just try to keep active and keep the weight off. Rugby was fun to play. I got injured before I took it too far. I enjoy watching it. But I have not encouraged my kids to play… that said one of mine is doing gymnastics at a high level and that’s bad for your body. So.

I know that contact is an aspect that lot’s enjoy about rugby however a 15 a side version of touch maybe the long term way to go? - presumably same fate for rugby league ?

I've often thought that touch sevens would have alot of potential. It advertises itself on being a game of evasion and you could still imagine blockbuster moments with good footwork and footraces.

I feel 15's would be far too clogged up. The pitch would need to be 100 metres wide at least.

[Banquo]

I find the concussion conversation unnerving. Having had multiple concussions playing, I wonder to what extent it does now impact me or will later. I’ve had a low grade headache non stop for decades. But…cause and effect is hard to prove. Esp as I’ve always had migraines too. No real other issues as far as I know related to concussions. Then there are all the joints and lower back that seem pre arthritic. I just try to keep active and keep the weight off. Rugby was fun to play. I got injured before I took it too far. I enjoy watching it. But I have not encouraged my kids to play… that said one of mine is doing gymnastics at a high level and that’s bad for your body. So.

I know that contact is an aspect that lot’s enjoy about rugby however a 15 a side version of touch maybe the long term way to go? - presumably same fate for rugby league ?

I've often thought that touch sevens would have alot of potential. It advertises itself on being a game of evasion and you could still imagine blockbuster moments with good footwork and footraces.

I feel 15's would be far too clogged up. The pitch would need to be 100 metres wide at least.

Beach rugby pretty much.

[Puja]

I find the concussion conversation unnerving. Having had multiple concussions playing, I wonder to what extent it does now impact me or will later. I’ve had a low grade headache non stop for decades. But…cause and effect is hard to prove. Esp as I’ve always had migraines too. No real other issues as far as I know related to concussions. Then there are all the joints and lower back that seem pre arthritic. I just try to keep active and keep the weight off. Rugby was fun to play. I got injured before I took it too far. I enjoy watching it. But I have not encouraged my kids to play… that said one of mine is doing gymnastics at a high level and that’s bad for your body. So.

I know that contact is an aspect that lot’s enjoy about rugby however a 15 a side version of touch maybe the long term way to go? - presumably same fate for rugby league ?

I've often thought that touch sevens would have alot of potential. It advertises itself on being a game of evasion and you could still imagine blockbuster moments with good footwork and footraces.

I feel 15's would be far too clogged up. The pitch would need to be 100 metres wide at least.

Have you ever watched a game of top-level touch rugby 7s? It's a nightmare - the effort put into the tactics and training means it stops being a game of rugby where a tackle is replaced by a touch and instead becomes this weird game of the attack seeking quick touches to try and disarrange the defence and run through them while they're trying to retreat.

Puja

[Banquo]

I know that contact is an aspect that lot’s enjoy about rugby however a 15 a side version of touch maybe the long term way to go? - presumably same fate for rugby league ?

I've often thought that touch sevens would have alot of potential. It advertises itself on being a game of evasion and you could still imagine blockbuster moments with good footwork and footraces.

I feel 15's would be far too clogged up. The pitch would need to be 100 metres wide at least.

Have you ever watched a game of top-level touch rugby 7s? It's a nightmare - the effort put into the tactics and training means it stops being a game of rugby where a tackle is replaced by a touch and instead becomes this weird game of the attack seeking quick touches to try and disarrange the defence and run through them while they're trying to retreat.

Puja

My daughter loves playing this game, but I take your point.

[Which Tyler]

https://bjsm.bmj.com/content/early/2022 ... 021-105170


Abstract:

Objective The efficacious Activate injury prevention exercise programme has been shown to prevent injuries in English schoolboy rugby union. There is now a need to assess the implementation and effectiveness of Activate in the applie setting.

Methods This quasi-experimental study used a 24-hour time-loss injury definition to calculate incidence (/1000 hours) and burden (days lost/1000 hours) for individuals whose teams adopted Activate (used Activate during season) versus non-adopters. The dose-response relationship of varying levels of Activate adherence (median Activate sessions per week) was also assessed. Player-level rugby exposure, sessional Activate adoption and injury reports were recorded by school gatekeepers. Rate ratios (RR), adjusted by cluster (team), were calculated using backwards stepwise Poisson regression to compare rates between adoption and adherence groups.

Results Individuals in teams adopting Activate had a 23% lower match injury incidence (RR 0.77, 95% CI 0.55 to 1.07), 59% lower training injury incidence (RR 0.41, 95% CI 0.17 to 0.97) and 26% lower match injury burden (95% CI 0.46 to 1.20) than individuals on non-adopting teams. Individuals with high Activate adherence (≥3 sessions per week) had a 67% lower training injury incidence (RR 0.33, 95% CI 0.12 to 0.91) and a 32% lower match injury incidence (RR 0.68, 95% CI 0.50 to 0.92) than individuals with low adherence (<1 session per week). While 65% of teams adopted Activate during the season, only one team used Activate three times per week, using whole phases and programme progressions.

Conclusion Activate is effective at preventing injury in English schoolboy rugby. Attention should focus on factors influencing programme uptake and implementation, ensuring Activate can have maximal benefit.

[Puja]

https://bjsm.bmj.com/content/early/2022 ... 021-105170


Abstract:

Objective The efficacious Activate injury prevention exercise programme has been shown to prevent injuries in English schoolboy rugby union. There is now a need to assess the implementation and effectiveness of Activate in the applie setting.

Methods This quasi-experimental study used a 24-hour time-loss injury definition to calculate incidence (/1000 hours) and burden (days lost/1000 hours) for individuals whose teams adopted Activate (used Activate during season) versus non-adopters. The dose-response relationship of varying levels of Activate adherence (median Activate sessions per week) was also assessed. Player-level rugby exposure, sessional Activate adoption and injury reports were recorded by school gatekeepers. Rate ratios (RR), adjusted by cluster (team), were calculated using backwards stepwise Poisson regression to compare rates between adoption and adherence groups.

Results Individuals in teams adopting Activate had a 23% lower match injury incidence (RR 0.77, 95% CI 0.55 to 1.07), 59% lower training injury incidence (RR 0.41, 95% CI 0.17 to 0.97) and 26% lower match injury burden (95% CI 0.46 to 1.20) than individuals on non-adopting teams. Individuals with high Activate adherence (≥3 sessions per week) had a 67% lower training injury incidence (RR 0.33, 95% CI 0.12 to 0.91) and a 32% lower match injury incidence (RR 0.68, 95% CI 0.50 to 0.92) than individuals with low adherence (<1 session per week). While 65% of teams adopted Activate during the season, only one team used Activate three times per week, using whole phases and programme progressions.

Conclusion Activate is effective at preventing injury in English schoolboy rugby. Attention should focus on factors influencing programme uptake and implementation, ensuring Activate can have maximal benefit.

Cool... what's Activate?

Puja

[Which Tyler]

Cool... what's Activate?

https://www.englandrugby.com/participat ... g/activate

[Gloskarlos]

Have been running activate sessions with my u14’s all season. Do it as part of a warm up game. They’ve all bought into it, think it’s an easy task to incorporate.

[Which Tyler]

Have been running activate sessions with my u14’s all season. Do it as part of a warm up game. They’ve all bought into it, think it’s an easy task to incorporate.

[Gloskarlos]

To be fair to the RFU - any course you go on, or have been on since around September last year has had a heavy Activate promotion. Been adopted pretty well as far as I can see around local clubs to me. The trick is to make the exercises a little more fun by incorporating them into a game or a competition, otherwise players can find them a little tedious.

[Which Tyler]

To be fair to the RFU - any course you go on, or have been on since around September last year has had a heavy Activate promotion. Been adopted pretty well as far as I can see around local clubs to me. The trick is to make the exercises a little more fun by incorporating them into a game or a competition, otherwise players can find them a little tedious.

At Tewkesbury, I've been banging my head against a brick wall for a couple of years now - Head Coach is of the "Shit happens, there's nothing you can do to reduce injuries" mindset, and has percolated that down.
I've got a couple of my patients doing it off their own bat, and my nephews have agreed to start as well, whilst my brother has agreed to bring it up at Kingsbridge.

As you say though, making it fun, and ideally, fun and slightly competitive manner is a huge factor in boosting participation.

Personal anecdote time - I used to treat, and play against a promising young squash player (England age-grades). When he was 12, I put him on an exercise programme that was pretty similar to Activate (and Pilates), in that it was a bunch of rehab exercises given before any injury, with the hope being that it would help reduce severity of any injuries, as he'd have a head-start on any rehab. He went from 12 to 20 without missing a single tournament due to injury and earned himself a reputation for being indestructible - despite being a bit of a sick=note pre-puberty (which is why I did it in the first place). N=1 and all that, and it went significantly further than Activate, and tailored to the individual, but still.

[Gloskarlos]

We had a spate of concussions at the start of the season - the vast majority from some over zealous school rugby, but 2 or 3 from our club games. I'm not saying the link undeniable and direct, but since October the only other concussion we have had has been a player in the Worcester DPP sessions who picked his up tackling a kneecap. No further concussions from any training or games at the club with my age group. Even for naysayers there is plenty to be lauded in the warming up of key muscle groups in the activate program, there are plenty of exercises therein to be challenge and interest if that is what died in the wool head coaches want. I have seen the benefits first hand, just like your squash story, and even if they don't go that far for every single player, there is absolutely nothing to lose and plenty to gain by being thoroughly limber before any session. Now - trying to convince my Vets team to adopt is another matter, we still stand in a circle every Tuesday evening and pass a ball around until everyone turns up, then straight into it....

[Mellsblue]

I have an end of season coaches meeting in a couple of weeks when I will have this on the agenda, and I’d like to be well prepared. What’s the science behind it, ie why does it reduce incidents of concussion?