Concussion in sport; the continuing story

Something of a “game of two halves” in the past few days from The Times in the continuing story around rugby and head injuries.

In a Sunday Times (paywalled online) interview; “Simon Shaw: There are days I’ve forgotten completely, that concerns me” the former Wasps and England lock gave what I thought was a pragmatic account of living with the physical toll of an elite rugby career. As the title suggests, whilst he considers his general health “fine” there have been times when he’s forgotten a day which causes anxiety – if not for him, then for his family. It wasn’t entirely clear, but these appeared to be ‘blanks’ in short term memory rather than the longer terms lacunas reported by Steve Thompson.

When asked about the claims initiated by Steve Thompson and others, Simon concludes that “I greatly sympathise with all those guys and you have to be sensitive to their needs. With regards to my situation, I was more complicit than anyone in my staying on the pitch. I played because I wanted to be in the shop window. Nothing was gonna stop me. I wasn’t wholly responsible, but 99 per cent I’d say.”

A frank admission, particularly in the current climate.

 His interview – I expect intentionally – is in stark contrast to the article from today’s Times (again, paywalled online) interview with Dr Ann McKee, neuropathologist and a name known to many for her work at The Boston Brain Bank, and in the investigation into Chronic Traumatic Encephalopathy ("CTE").

The emphasis of the article is inevitably on Rugby, but the narrative identifies potential risk of any contact sport, where “every little blow contributes to an accumulative toll” and where “sub-concussive hits which are asymptomatic … accumulate over time to increase risk to CTE”. 

In an earlier Guardian interview Alix Popham, another claimant in the group litigation, recalled starting playing rugby at age four, and whose consultant considered he’s “had over 100,000 sub-concussions. Minimum.” With the broader narrative of Dr McKee, how much damage might have been caused before the proposed defendants ever became of aware of his existence?

Dr McKee “ … understand(s) that someone who is passionate about rugby might want to play it, but I would definitely delay that age of playing until teenage years or later.“

The suggestion that contact sport – particularly rugby – should be delayed until late teens may well generate an extreme reaction and the proverbial frothing at the mouth; “it’s health and safety gone mad” with accompanying ‘frothy’ suggestions that we ban the climbing of trees, the riding of bikes and any other childhood activity that might lead to (head) injury. Which of course is nonsense.

But at what point does risk aversion strip away key elements of a sport and with it the appeal of taking part? And at what point do parents become so fearful of an event (which may never occur) that they never expose the child to the sport in the first place? Absent that chance in childhood, how many of our elite athletes might we have never seen? How many past and present enthusiastic amateurs would never have had their their enthusiasm sparked?

If we keep in mind the context of organised sports, then safety in sports (and of course generally) has, through knowledge and experience, consistently developed and improved and I expect is most focussed where children are involved. The awareness of potential harm, how we might prevent it and how we best respond when it materialises will continue to evolve, for children and adults, amateur and professional, and regardless of litigation.