It’s the middle of a game. Two close rivals, neither giving an inch. Hard hits. Messy breakdowns.
A player goes into contact carrying the ball, goes to ground and presents the ball to their team’s side. In the melee of the ruck, an errant boot, unclear whether it belongs to one side or the other, strikes the player in the head. Fade to black.
The coach on the sidelines knows. He always knows.
“Get ______ off the ______ field.”
The athlete is confused and can’t remember what happened. They were even wearing a scrum cap, but honeycombed pieces of fabric do nothing to stop the scrambling of the brain underneath. It’s a concussion. No doubt about it. This player is done for the day.
Some time off, then back on the field. Rugby is rugby, and the seasons are shorter than anyone ever wants them to be, but long enough that things happen. Another half of rugby is played on another day, but the player feels a headache and leaves the field on their own accord. They do not return to play.
This story is from September 2006, and the player was me. I was playing for Bishop’s University’s first team against our cross-town rival, l’Université de Sherbrooke in my first game of the season.
I was in fourth year and I had worked hard to get in shape that year after spending a couple of years on the seconds team, the so-called “Killer Bees”. It wasn’t the first game that the team had played that season, but I had suffered a hamstring pull in training camp (after driving from Vancouver to Lennoxville in four days, which probably contributed…) so it was my first opportunity to make a mark on the team in nearly three years.
When I had first arrived at Bishop’s as an eighteen year old freshman (“frosh” as we call them), I immediately found a place as the starting fullback and played in a couple games before spraining my ankle simultaneously in a couple spots in a friendly game against alumni celebrating the first twenty years of the program (1983-2003). After that, I never quite got fit again, and played for the Killer Bees, mostly as a flanker.
Having not really taken my rugby too seriously after that injury, it was only when I went on exchange in third year to the University of Worcester, playing with their seconds team in a weekend men’s merit table (I think we were essentially in the eighth or ninth division in the English pyramid) that I decided to really re-apply myself to rugby.
Before university, I had played high school (Earl Marriott Secondary) and junior club rugby (Bayside RFC) in British Columbia, where it was a nearly year-round event. There would be club rugby in the fall, school rugby in the spring, and representative and sevens rugby in the summer.
Between the various teams, I was a part of many winning sides and played with fantastic players, including national team members.
I only add this context to say that it was a hard decision to walk away from rugby, but I also knew that playing wasn’t going to be my longterm future. I had played enough to know my limits and to witness firsthand those that just had everything, physically and skill-wise, that I never would.
What I did have, was my education, and whatever that might lead to. I was in my fourth year of undergrad and had a meteoric rise from being a C student in my first year to being an honours student, applying to graduate school. That was what was on my mind in the week between sustaining my concussion against Sherbrooke and when I stepped onto the field the next weekend at the University of Ottawa. After one half of rugby, and feeling a headache, not really knowing whether it was the lingering effects of a concussion or just dehydration, I took myself off the field and never played a minute of university of rugby again.
I also added in the context of having other injuries, whether it was sprained ankles or hamstring pulls. Things happen over enough time playing a sport. I could also add in suffering from mononucleosis as being another thing that derailed my university rugby career.
The point is that it’s not unusual to suffer injuries or illness. The difference is that with concussions, though definitely not the most common (estimates are that they are maybe 1 in 7 rugby injuries), they are perhaps the most misunderstood.
Sprain an ankle? We have an excellent idea how to treat that and a straight forward window for returning to play.
Not so much with concussions.
First, let’s be clear what a concussion is. The Mayo Clinic defines and describes them as such:
A concussion is a traumatic brain injury that alters the way your brain functions. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination.
Although concussions usually are caused by a blow to the head, they can also occur when the head and upper body are violently shaken. These injuries can cause a loss of consciousness, but most concussions do not. Because of this, some people have concussions and don’t realize it.
Concussions are common, particularly if you play a contact sport, such as football. But every concussion injures your brain to some extent. This injury needs time and rest to heal properly. Most concussive traumatic brain injuries are mild, and people usually recover fully.
A concussion is a traumatic brain injury.
We need to think of them that way. It’s not about “seeing stars” or anything folksy or fun. You’re not supposed to black out. It’s brain trauma. Period.
This injury needs time and rest to heal properly.
I took a year off. Between September 2006 and 2007, the only rugby I was involved in were non-contact touch games. In September 2007, after a sufficient amount of time off, and with no symptoms to speak of, I started playing men’s club rugby with my old friends at Bayside RFC, in my hometown of White Rock, B.C., while I was in grad school at Simon Fraser University.
It was a great year and I had a lot of fun, bouncing between the second and third teams. I think I ended up playing nearly every position imaginable that year, from those that I had extensive experience with, centre or flanker, to those where I probably wasn’t the best option, such as fly-half.
At the end of the season, I received my first (and only) individual award I had ever had in any sport I had played. Award winners at Bayside RFC (and many other clubs, including my current club, the Ottawa Irish) are given glass beer mugs, etched with the club’s logo, award, and player’s name. It is one of my most prized possessions, and is to be hand-washed only, for fear of the dishwasher stripping it of its content.
None of that would have been possible without appropriately waiting to get healthy. Like most athletes, I can be stubborn and dumb about many injuries, whether it’s hamstrings, fingers, or ankles. My ankles, in particular, have suffered a thousand pains at this point, and in fact, I sprained my ankle again the day of that awards ceremony and went from the E.R. to the banquet. I got the privilege of drinking from my mug while leaning on crutches.
But the brain is something else.
In 2013, the Ottawa rugby community was shaken to its core. On May 3, Rowan Stringer, the co-captain of John McCrae Secondary School, and a member of the Barrhaven Scottish Rugby Club, played in a day-long tournament with condensed games with her school:
In the third game she was tackled, removed from play and shortly after complained of a headache. The following Monday she had a game after school and was feeling great and ready to play. In this game someone stepped hard on her head and her headache returned and she suspected she had a concussion but told no adult. Wednesday May 8th after school was her last game. She was not feeling well but wanted to play and in this game she sustained her last concussion which led to Second Impact Syndrome and her death on May 12th.
This was and is a tragedy. There are no reasons that Rowan should not be with us today. I did not know her, but I know many who did. I also know that since her death, concussions have began to take on the level of seriousness that they deserve.
It shouldn’t have to come to this, but we’re already at this point. Lisa MacLeod, Member of Provincial Parliament in Ontario has been advocating for the passing of “Rowan’s Law”:
- A coroner’s inquest into Rowan’s death concluded with 49 recommendations across different levels of government and multiple provincial ministries for enhanced concussion awareness and treatment.
- The coroners recommendations includes: making concussion awareness mandatory in Ontario’s curriculum, the promotion of an annual Brain Day awareness campaign, and better tools for coaches and players to identify and treat concussions.
- Rowan’s Law would create an expert advisory committee to Ontario’s Premier that would advise on the implementation of the Ontario specific recommendations.
- Every jurisdiction in the United States has concussion related legislation, Ontario would be the first in Canada.
If you live in Ontario, you can sign the petition supporting Rowan’s Law. No matter where you live, you can raise awareness through social media and the use of #RowansLaw.
…and now yer Starting XV:
- Passing legislation is one step, and it’s certainly important for the province of Ontario to do it. It’s actually kind of shocking that no Canadian jurisdictions have concussion-related legislation while every U.S. state does.
- Beyond legislation, sports themselves give guidelines on what to do. World Rugby has their own concussion protocols. I urge every player, parent, coach, and athletic therapist to be familiar with the material there.
- But for there to be a real positive impact, there absolutely needs to be a cultural shift in how we approach player safety in general, and concussions specifically. And this shift is universal. It has to be for it to succeed. Legislation and protocols are just the parameters that we are supposed to work within, but they are meaningless until it changes mindsets and actions. Old school mentalities who assume that athletes are just two hundred odd pounds of meat and bones need to get on board with the reality that human beings are complex, and that brain trauma is no laughing matter.
- The first place that we can have an impact is on training grounds. Every coach needs to be a leader in player welfare. That starts with setting clear, honest, expectations. I want my players to know that I value their health and safety, and that no game, not even a championship, is more important than their future, rugby or otherwise. As a coach, we have to practice what we preach. That’s what being a true leader is about. I have no respect for coaches who give lip service to player welfare and then directly contradict themselves, and I have no doubt that others react the same way. Set these expectations, and then follow through in the way that you coach proper body positioning in contact, tackle techniques, and how you deal with collisions that show signs of potential head injuries. Most of all, be consistent with your messaging and your actions. Players matter.
- When I returned from my year off following my concussion, I had been around rugby for ten years and was still only 23. I had been on teams that won tournament trophies and championships before then (and after), but I definitely took great pride in finally being individually recognized. I don’t tell these stories to brag, but to serve as examples that there will always be The Next Thing. I want players to know that if they miss time because of a concussion, there will always be something later. Take care of yourselves.
- That’s where the cultural shift has to go to, beyond coaches and rules. It has to be accepted and practiced by players. We can’t know what’s going on in their heads. They know their bodies better than us. They need to be able to honestly speak about symptoms, and they need to be responsible in following the Return to Play protocols. Return to Play is a staged approach, with set intervals. It’s also non-linear, with players having to back up stages if symptoms return. As an amateur coach, I see players twice a week for practice and on game days. There’s a lot of time that’s up to them.
- Education and awareness are everyone’s business. I didn’t really have any resources a decade ago and basically just resorted to a mixture of old wives’ tales and common sense. That’s not good enough, and while it led to me being overly cautious, being misinformed could have also steered me the other direction.
- One of the biggest tropes in sports movies is the player who gets injured and returns at the end of the game to help his team win the big championship. I get uneasy about this messaging. It’s one thing to overcome some adversity, and I have no doubt that the best champions play hurt, but we need to be clear about what level is acceptable.
- I use a three-tiered description of injury occasionally. There’s sore, there’s hurt, and then there’s injured. I’m basically sore all the time now. That’s what happens. It’s especially bad the day after a game. Sundays are a day of rest. I think it’s absolutely appropriate for players to be sore. One description I particularly like about the sport is that rugby is akin to going for a ten kilometre run, while being simultaneously kicked and punched. You’re going to be sore. Being hurt is that next threshold. It’s when something is off, but you can will yourself to play through the pain. Maybe it’s a little extra strapping on the shoulder or knee, maybe it’s an ankle brace. Sometimes you have to tape your fingers up. This is the level where that movie hero ought to reside. Rugby is a tough sport and tough players play hurt. The third level is injured. When you’ve pulled a hamstring and can’t walk, let alone run, you have no business being on the field. You’re no help to anyone. In my view, concussions skip the first two levels. You are either injured or you are not. I don’t want anyone thinking it’s normal for your brain to be “sore” the next day, or to play “hurt”. You are injured. You need to heal.
- One way that I think we can avoid that movie trope crap is to speak about concussions for what they are. Let’s talk about concussions being brain trauma. Let’s understand that minor brain trauma is still brain trauma. With enough time and healing most concussions appear to have no longterm impact. It’s when repeatedly injured, or when returning before fully healed that we see some of the most devastating impacts. It can be something sudden, like the week that took Rowan Stringer from us too soon, or it can be over a long period of time, where repeated brain trauma leads to chronic traumatic encephalopathy (CTE). Neither should be allowed to happen.
- I’d like to see television commentators be at the forefront of changing the way we speak about and perceive concussions. Let’s avoid using phrases that glorify or diminish them. Enough with “getting rattled”, “seeing stars”, or “not knowing what day it is”. Stop praising players for “fighting through a fog” and “willing themselves to win” when they play concussed. I’m hoping that PRO Rugby will use their position as a startup trying to grow the game in North America to establish appropriate language and description in their coverage, including the live-streaming of games, where many new fans will be watching. Set the standards that we want to aspire to, not the bare minimum.
- Another way PRO Rugby can lead the charge will be in their game management. I think it’s an appropriate step that teams ought to be allowed to remove a suspected concussed player from the field to be examined, similar to a blood substitution. While the potentially concussed player is being examined (preferably in a dark, quiet room), another player can take their place. If the player is concussed, the substitution would be permanent. In order to make this an effective option, I’d propose that the substitution not count against the normal number allotted (usually 7 or 8, depending on the league), and that a player previously subbed off (for non-concussion reasons) would still be eligible to return to the field in the place of a concussed player. This would be a compromise that allows coaches to continue to make tactical substitutions but not be punished for valuing player welfare.
- There have been too many examples in professional sports, rugby or otherwise, where players have been allowed to play when they are clearly demonstrating symptoms of concussions. We’re doing a disservice to everyone involved if we cheapen how much we value people, which is what players are first and foremost. I watched the documentary “League of Denial” and found it to be both heartbreaking and infuriating how a multi-billion dollar organization like the NFL can chew up and spit out its players, and then actively work to bury the science behind concussions. I have no idea how the Hollywood film starring Will Smith coming soon dealing with the same story will handle it. It’s such a fine line to try and speak truth to power while being entertaining.
- I want everyone to know that I honestly believe rugby to be a transformative and amazing sport. It’s a sport that carries risks with playing. It’s impossible to completely avoid the potential for concussions, but it is possible to mitigate. There is a reason that the popularity of rugby is growing in contrast with football, and part of that is the way that everyone engaged in the sport is a part of a community that wants to ensure longterm participation. We have no desire to chew up and spit out our players. We want young children to engage with the fun side of the sport through non-contact flag rugby and work their way up to an age when it’s appropriate and healthy to introduce safe tackles and rucks. We want players to leave the playing field on their own terms, and remain engaged for the rest of their lives, whether it’s coaching, administering, or cheering. That preference for safety is part of the appeal of rugby in contrast to its cousin. You can see it when one of the top coaches in the NFL, Pete Carroll is proselytizing about the benefits of rugby tackling as opposed to the head-first approach typically used in football, it’s a way to incorporate player welfare side-by-side with tactical and technical decisions that lead to winning.
- Risks can’t be completely avoided. Just this past weekend, working on a project, I accidentally backed into a lightbulb in my basement workshop, with its low ceiling (twice, actually). Thankfully, I wasn’t hurt and it just meant having to clean up a mess. I know stories of individuals getting concussions from the most random of events, inside and outside of sports. My first concussion (I’ve had two that I know of) came in gym class when I was fourteen, and a basketball hit me in the back of the head. I’m not going to propose a ban on gym class or basketball (maybe on teenage jerks…). Other injuries have bizarre origin stories. I found out that a player of mine dislocated his shoulder while having an overnight sleepover with his girlfriend camping. A former teammate sprained his ankle stepping down from a sidewalk crossing a street. Accidents happen. It’s how we react to them that will define us.
Brent Smith is a player, coach and director with the Ottawa Irish Rugby Club. You can follow him @brentssmith.