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Concussion (Merged Threads)


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4 minutes ago, unapologetic pedant said:

Once something is medicalized, doctors and drug companies get paid to diagnose and treat it.

You'll get savaged by anyone who knows what they're talking about because that is an embarrassingly ignorant and wrong post.

As for Parkinson's: bloke I used to work with was diagnosed with it at aged 65. Most times you'd meet him, and certainly any time you saw him doing public engagement (a key part of his job), you'd be hard pressed to tell. But then you'd miss the absolute exhaustion his condition caused him, the days when he couldn't work, the confusion in day to day tasks when he didn't have focus and, somewhat crucially, the medical support from therapy to drugs that enabled him to manage his condition.

But, yeah, it's probably just a pharma conspiracy or doctor overreach.

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I have posted this opinion a number of times but Rugby League really needs to take some action or face huge legal challenges and players will continue to risk brain injury. 

In RU, all contact above the shoulder is a penalty and the sanction starts at a red card and you mitigate from that.  This needs to come into RL asap. There's plenty of contact with the head which goes unpunished, grapple tackles with players having their heads banged into the ground.

HIAs are a nonsense, concussion can't be diagnosed in 10 mins in a changing room. There will always be accidental blows to the head, but the game really needs to wake up.

If someone can explain how allowing contact with the head and neck makes the game better or more exciting, other than the "game's going soft" brigade, then please post it. I can't think of anything that justifies players risking long term brain injuries.

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1 hour ago, gingerjon said:

As for Parkinson's: bloke I used to work with was diagnosed with it at aged 65. Most times you'd meet him, and certainly any time you saw him doing public engagement (a key part of his job), you'd be hard pressed to tell. But then you'd miss the absolute exhaustion his condition caused him, the days when he couldn't work, the confusion in day to day tasks when he didn't have focus and, somewhat crucially, the medical support from therapy to drugs that enabled him to manage his condition.

I take that on board. Worth saying though that men used to retire at 65 and were lucky to last much longer thereafter. We start losing brain cells from around the age of 20. So by our mid 60s there`s bound to be significant cerebral atrophy. I`m merely questioning who benefits from giving an official title to a particular rate or type of degeneration.

 

1 hour ago, gingerjon said:

You'll get savaged by anyone who knows what they're talking about because that is an embarrassingly ignorant and wrong post.

I had roughly three decades observing the psychiatric profession and the effects of the medication they prescribed, beginning as a child in the late 1970s when my mother was first sectioned under the mental health act and diagnosed with schizophrenia. Won`t go into details, but it`s an inexact science at best.

I heard Prof Susan Greenfield say that neuroscientists only fully understand a small percentage of brain function. Against that backdrop, diagnosis and treatment of mental disorders is inevitably hit-and-miss.

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44 minutes ago, Wakefield Ram said:

HIAs are a nonsense, concussion can't be diagnosed in 10 mins in a changing room. There will always be accidental blows to the head, but the game really needs to wake up.

While I agree with your overall sentiment that significant change needs to happen, can I just pick up on this point as a matter of practicality. 

If we are not able to assess concussion in 10 minutes using a HIA (I am no medical expert so I am not contending that this is true or not), what is the alternative? Will we simply take every player off the pitch who has recieved a head knock/high tackle for the remainderof the match?

"The history of the world is the history of the triumph of the heartless over the mindless." — Sir Humphrey Appleby.

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The lawyer dealing with the case has highlighted the 6 day break from concussions being not enough.  No evidence to support that from him only reference to the NRL model.

What isn’t considered often enough are the players who’ve been concussed.  How many I’ve seen in my lifetime must be in the hundreds, me included, but when asked if you’re ok - yep, no problem.

Have we seen any in 2021 get clearly concussed, leave the pitch and then return?  

Complete minefield.

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Some interesting facts here from the RFL on concussion. Its quite lengthy but I think the following is very important as it means that the RFL is currently following best practice and sound advice:

The RFL follows the Berlin (2016) Consensus Statement on Concussion in Sport which is considered best practice. 

Also with regards insurance it seems that the RFL are well covered:

Insurance
Insurance is annually reviewed with insurance companies now requesting information on concussion cases.  We provide quarterly reports on concussion cases so they can review how many concussion cases there have been and check if the protocols are adhered to.  The insurers have also visited Community Clubs to check their training and awareness and record keeping. As such the RFL’s insurers are aware of the work that the sport has done in minimising issues arising as a result of head injuries and whilst the marketplace for getting this type of insurance has become ever more challenging, there is recognition of the work that has been done in this area, which has allowed the level of insurance to be maintained.

The policy the RFL currently has in place is comprehensive and effectively operates on an employer’s liability basis if the claim was brought against the Club and on a public liability basis if the claim was brought against the RFL.

The insurance is on a “losses occurring” basis rather than on a “claims made” basis – this means the insurance that would cover any claim(s) made would be the insurance policy that was in place at the time of the incident/injury i.e., if a player brought a claim for injuries caused as a result of playing between 2000 and 2005, it would be the policy in place at that period.

https://www.rugby-league.com/governance/medical/concussion/concussion-statement

 

Edited by Damien
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15 minutes ago, Damien said:

Some interesting facts here from the RFL on concussion. Its quite lengthy but I think the following is very important as it means that the RFL is currently following best practice and sound advice:

The RFL follows the Berlin (2016) Consensus Statement on Concussion in Sport which is considered best practice. 

Also with regards insurance it seems that the RFL are well covered:

Insurance
Insurance is annually reviewed with insurance companies now requesting information on concussion cases.  We provide quarterly reports on concussion cases so they can review how many concussion cases there have been and check if the protocols are adhered to.  The insurers have also visited Community Clubs to check their training and awareness and record keeping. As such the RFL’s insurers are aware of the work that the sport has done in minimising issues arising as a result of head injuries and whilst the marketplace for getting this type of insurance has become ever more challenging, there is recognition of the work that has been done in this area, which has allowed the level of insurance to be maintained.

The policy the RFL currently has in place is comprehensive and effectively operates on an employer’s liability basis if the claim was brought against the Club and on a public liability basis if the claim was brought against the RFL.

The insurance is on a “losses occurring” basis rather than on a “claims made” basis – this means the insurance that would cover any claim(s) made would be the insurance policy that was in place at the time of the incident/injury i.e., if a player brought a claim for injuries caused as a result of playing between 2000 and 2005, it would be the policy in place at that period.

https://www.rugby-league.com/governance/medical/concussion/concussion-statement

 

This is the important bit. Really, as long as the RFL can show that they were following best practice *and ensuring their members were doing the same* then no more can realistically be expected.

Build a man a fire, and he'll be warm for a day. Set a man on fire, and he'll be warm for the rest of his life. (Terry Pratchett)

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1 hour ago, unapologetic pedant said:

I had roughly three decades observing the psychiatric profession and the effects of the medication they prescribed, beginning as a child in the late 1970s when my mother was first sectioned under the mental health act and diagnosed with schizophrenia. Won`t go into details, but it`s an inexact science at best.

I certainly wouldn't belittle what sounds like a horrendous experience and I would go so far as to agree with you that with regards to the behavioural aspects of the brain precious little is really known.

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Build a man a fire, and he'll be warm for a day. Set a man on fire, and he'll be warm for the rest of his life. (Terry Pratchett)

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If anyone thinks that these players won't win a large settlement, then I think they are being a bit optimistic.

Employers have a duty of care. You only have to look at Stevie Ward retiring at 27, you've got 3 players in the article with dementia at a comparatively very young age.

The more players who come forward, the more the case will build. In the NFL the settlement is now approaching 1bn dollars. Workers have sued previous employers for exposure to asbestos decades after it happened. 

What's happened can't be changed, but the game really needs to act like RU has and change the culture and take head/,neck contact out of the game.

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20 minutes ago, gingerjon said:

This is the important bit. Really, as long as the RFL can show that they were following best practice *and ensuring their members were doing the same* then no more can realistically be expected.

Does best practice include doing little or nothing to advocate rules that lessen impact and reasonably reduce risk? I've seen nothing other than a recent crackdown on head hits. A commendable move but not nearly enough and it should have come in years ago. The RFL's and NRL's efforts have fallen well short of where they should have been.
 

They don’t want to tamper with the product and so do a bit of window dressing to make it seem they take duty of care seriously.  

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2 hours ago, Dunbar said:

While I agree with your overall sentiment that significant change needs to happen, can I just pick up on this point as a matter of practicality. 

If we are not able to assess concussion in 10 minutes using a HIA (I am no medical expert so I am not contending that this is true or not), what is the alternative? Will we simply take every player off the pitch who has recieved a head knock/high tackle for the remainderof the match?

In the NRL, they now have an additional sub for head injuries. Completely understand your point, but turn it round and think how you would justify in court sending a player back on the pitch with a potential undiagnosed bleed on the brain because it would spoil the game when a club has players not selected sat on the sidelines.

When players welfare takes precedence, I suspect this is the direction the game will take. We can't stop accidental head contact, but we can mitigate the risk as far as possible. If clubs and coaches find it disruptive, then not sure how that trumps protecting players from brain injuries.

If it means teams need extra subs for head injuries, why not?

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1 hour ago, Wakefield Ram said:

In the NRL, they now have an additional sub for head injuries. Completely understand your point, but turn it round and think how you would justify in court sending a player back on the pitch with a potential undiagnosed bleed on the brain because it would spoil the game when a club has players not selected sat on the sidelines.

When players welfare takes precedence, I suspect this is the direction the game will take. We can't stop accidental head contact, but we can mitigate the risk as far as possible. If clubs and coaches find it disruptive, then not sure how that trumps protecting players from brain injuries.

If it means teams need extra subs for head injuries, why not?

I think you are right.

The problem with this on going debate (as I have mentioned on here before), is that high tackles are a bit of a red herring.

Of course we must try and reduce high tackles, and that is us being seen to be doing something, but with a high impact collision sport like Rugby League there will always be head knocks from 'normal' legal play.  Head clashes, heads coming into contact with knees, hips, elbows etc will cause head knocks.

We can protect those players by removing them from the pitch but ultimately the nature of the sport will cause head knocks unless it is fundamentaly changed beyond recognition. 

Edited by Dunbar
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49 minutes ago, Dunbar said:

We can protect those players by removing them from the pitch but ultimately the nature of the sport will cause head knocks unless it is fundamentaly changed beyond recognition

I don’t it has to go that far to achieve a reasonable balance between care and entertainment. The collisions before a rotating bench and ten metre defensive lines were far less yet the game was still recognisable. Rules could be progressively changed yet still retain the essence of what makes the game appealing. Even a shorter season would allow more recovery time but like everything in this world today, money dominates every decision.

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It takes wisdom to know when a discussion has run its course.

It takes reasonableness to end that discussion. 

 

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2 hours ago, Wakefield Ram said:

If anyone thinks that these players won't win a large settlement, then I think they are being a bit optimistic

 

100% right @Wakefield Ram

Rugby League has massive problems ahead. People within and outside the game are aware of this. I have heard a couple of people who work in sport (not Rugby League) who are well informed saying exactly that just recently.

Anyone on here disagreeing with you on this one is utterly deluded.

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Grim Stuff. In order to mitigate this how does 7-8 metre offside with 12 players sound? 

Less collision speed but more desperate flailing arms?

Noting that RL has two stories on the BBC UK page I'm just hoping that RL doesn't become the sacrificial lamb that allows Boxing and RU to carry on. 

Yes this whole thing is horrid but if boxing is allowable then ....

TESTICULI AD  BREXITAM.

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2 minutes ago, corvusxiii said:

Grim Stuff. In order to mitigate this how does 7-8 metre offside with 12 players sound? 

Less collision speed but more desperate flailing arms?

Noting that RL has two stories on the BBC UK page I'm just hoping that RL doesn't become the sacrificial lamb that allows Boxing and RU to carry on. 

Yes this whole thing is horrid but if boxing is allowable then ....

7-8 metre offside means defence goes back less far, spends proportionately longer per tackle already back, set and waiting to come forward, and therefore has greater line speed. 

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43 minutes ago, Saint 1 said:

7-8 metre offside means defence goes back less far, spends proportionately longer per tackle already back, set and waiting to come forward, and therefore has greater line speed. 

So a 1 metre offside results in higher collision speeds and consequently higher risk of damage.  Maybe 50m offside is the answer. 

TESTICULI AD  BREXITAM.

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I have posted this before a long time ago but for those that missed it, this is what RL looked like in 1954. The WC final, with 5m defensive lines and no rotating bench (maybe no bench?). Different, more expansive and loop passing. It still looks like RL and I'd happily watch it.

 

My blog: https://rugbyl.blogspot.co.nz/

It takes wisdom to know when a discussion has run its course.

It takes reasonableness to end that discussion. 

 

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4 hours ago, gingerjon said:

I certainly wouldn't belittle what sounds like a horrendous experience and I would go so far as to agree with you that with regards to the behavioural aspects of the brain precious little is really known.

The question I posed in the previous post was whether frailties which would previously have been accepted as the usual signs of ageing are now being diagnosed as symptoms of dementia. If the definition of the condition has expanded, comparing data from different periods cannot be a valid exercise. And a causal relation with playing contact sport is thus harder to ascertain. Likewise, attributing culpability to the governing bodies of contact sports.

The burgeoning classifications of autism seemed a reasonable point of comparison at the other end of the age range.

Is it beneficial to label childhood habits a medical condition and place the putative sufferers on an autism spectrum? Or would it not be better to regard their behaviour as part of the human spectrum and allow them to grow up free of medical interventions?

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8 hours ago, Wakefield Ram said:

I have posted this opinion a number of times but Rugby League really needs to take some action or face huge legal challenges and players will continue to risk brain injury. 

In RU, all contact above the shoulder is a penalty and the sanction starts at a red card and you mitigate from that.  This needs to come into RL asap. There's plenty of contact with the head which goes unpunished, grapple tackles with players having their heads banged into the ground.

HIAs are a nonsense, concussion can't be diagnosed in 10 mins in a changing room. There will always be accidental blows to the head, but the game really needs to wake up.

If someone can explain how allowing contact with the head and neck makes the game better or more exciting, other than the "game's going soft" brigade, then please post it. I can't think of anything that justifies players risking long term brain injuries.

RU is an extremely dangerous sport, arguably more so than RL. While RU has a lower frequency of impacts than RL, the impacts themselves are bigger. An 18 stone centre (who previously would have weighted 12 to 13 stone) hitting you is the equivalent of a mini car crash. And the impact doesn’t have to be direct to the head to do damage (most impacts are not to the head). The result of an upper body collision (a common impact) can be whiplash, ie. rapid brain movement. You often see a player’s head jerk forward when hit on the body. CTE was defined in the BBC source as:

CTE can develop when the brain is subjected to numerous small blows or rapid movements - sometimes known as sub-concussions

Edited by DC77
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49 minutes ago, RayCee said:

I have posted this before a long time ago but for those that missed it, this is what RL looked like in 1954. The WC final, with 5m defensive lines and no rotating bench (maybe no bench?). Different, more expansive and loop passing. It still looks like RL and I'd happily watch it.

 

I`ve seen this more times than the Rate My Takeaway bloke has had hot dinners. It`s sometimes in my mind when lamenting the current lack of intent to promote the ball out of the tackle. Pertinent question is whether these 2 minutes are typical of the 80? And of course tackling is very different nowadays.

The French women put together some attractive offloading passages last Saturday. Predictably accompanied by morose TV pundit disapproval of the "not pushing the pass" and "needing to complete sets" type.

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58 minutes ago, unapologetic pedant said:

I`ve seen this more times than the Rate My Takeaway bloke has had hot dinners. It`s sometimes in my mind when lamenting the current lack of intent to promote the ball out of the tackle. Pertinent question is whether these 2 minutes are typical of the 80? And of course tackling is very different nowadays.

The French women put together some attractive offloading passages last Saturday. Predictably accompanied by morose TV pundit disapproval of the "not pushing the pass" and "needing to complete sets" type.

A little digging and here's footage from three years earlier. Frenetic stuff. Scums and play the balls contested which needn’t return. Poor quality but good enough to get a feel for the game back then. 

 

Edited by RayCee
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It takes wisdom to know when a discussion has run its course.

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7 hours ago, Wakefield Ram said:

If anyone thinks that these players won't win a large settlement, then I think they are being a bit optimistic.

Employers have a duty of care. You only have to look at Stevie Ward retiring at 27, you've got 3 players in the article with dementia at a comparatively very young age.

The more players who come forward, the more the case will build. In the NFL the settlement is now approaching 1bn dollars. Workers have sued previous employers for exposure to asbestos decades after it happened. 

What's happened can't be changed, but the game really needs to act like RU has and change the culture and take head/,neck contact out of the game.

Players from their 20s to their 50s. 

I’d hazard a guess that for RU the concussion issue and resulting brain damage is getting worse as players are much, much bigger than just a couple of decades ago...”80 neck” as Jonathan Liew referred to those who play it today. You don’t really hear so much of older players with problems, or at least not to the extent of more recent players. Up until professionalism RU players still looked like regular sized blokes, so the collisions to the body wouldn’t have been anywhere near as impactful as they are now. A wirey, slight figure like JPR Williams wouldn’t be allowed on a rugby field today for his own safety, unless he bulked up by adding about four stone of muscle to withstand the increased blows.

The difference with RL is it has always been professional, so while the change in physicality has likely increased, such a change probably wouldn’t be anywhere near as profound as what has happened in RU, therefore I’d posit that those with problems in RL are more evenly spread out among those who played the game over various decades. 

The most obvious thing that can be done to make both codes safer is players having  less bulk. These are collision sports, so impacts to the body will happen unless you want to do away with them which would make them different sports (therefore unlikely to happen). It’s lessening the effect of those impacts that will be the issue to solve, something that is very difficult.

In football it’s much more straightforward as the main issue was the weight of the ball, and the high frequency with which they were headed both in training and during games. That England ‘66 team has been littered with brain issues. Spending time solely heading a ball hanging from the ceiling was the norm in training according to Geoff Hurst. Those laced balls were bleedin heavy, and during a game soaked up water and mud, making it even more hazardous. And play back then was more aerially based, with wingers getting to the byline and swinging in cross after cross, while others just went direct by launching it high upfield. 

 

 

Edited by DC77
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I recall heading water soaked soccer balls and yes, the impact was noticed even for one noted for having a hard head. The issue for RL is the repetitive nature and severity of the collisions in the modern game. Some people will be less affected due to genetic differences and the position they play on the field.

Edited by RayCee

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It takes wisdom to know when a discussion has run its course.

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