Opinion Articles


Rugby: Injury, Risk, Public Debate and History


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In the 2016 European Rugby Cup quarter-final between Saracens and Northampton Saints, no fewer than four of Saint’s leading players were not available for selection, due to on-going assessments for concussion sustained during previous matches. Their absentees included the England captain, Dylan Hartley, who  had been knocked unconscious in the final 6 Nations match of the tournament, confessing the following day that he had no recollection of raising the trophy in the post-match presentation in the Stade de France, nor of holding a discussion in the Stadium with his parents after the celebrations.

Regrettable as these absences proved to be for Saints and their supporters, the benching of these injured players demonstrates a constructive and collective step forward by a sport whose history is in some senses inseparable from the injuries sustained by its enthusiastic participants. The unequivocal statement from the sport’s governing body, World Rugby, in launching its #RecogniseandRemove campaign and amending Law 3.10 on 1st August 2015, made clear that: 

World Rugby's number-one priority is player welfare and any clear signs or symptoms of concussion or suspected concussion - at all levels of the game - must result in the immediate and permanent removal of players from the playing or training environment”.

Behind the science, worries about the dangers of participation in rugby continue to loom large for even the most famous of today’s stars. Jeremy Warburton, father of Welsh skipper Sam, stretchered off with a head injury the previous week, encapsulated the genuine concerns felt by many parents on the touchline when he wrote “Fingers crossed for Dylan Hartley. I know as a parent from last week it’s a sickening feeling…Relieved beyond belief that Sam’s ok. But images [of Sam being carried from the field] make me realise I won’t shed a tear when it’s all over”.

These incidents at the elite level of the game have only served to amplify the call made in a recent open letter by 73 doctors, academics and health professionals to ban tackling in rugby games and training for children under the age of 18. The signatories stated:

"The majority of all injuries occur during contact or collision, such as the tackle and the scrum" and, in calling for a switch to touch and non-contact versions of the game, further emphasised "These injuries, which include fractures, ligamentous tears, dislocated shoulders, spinal injuries and head injuries, can have short-term, life-long and life-ending consequences for children."

Undoubtedly sincere, these comments provoked enormous feedback around the world in the various media channels. Science and opinions were exchanged, sometimes vociferously, as the pro- and anti-rugby tackle camps sought to gather support for either their defence or dismantling of the junior contact version of the sport. But can the game survive these medical practitioner-led pressures at elite and grass-roots level? And are there any precedents in rugby’s evolution that can help contextualise this latest debate?

From its earliest days, rugby football has been associated with player collisions, rather than just ‘contact’. However, the game’s origins were firmly grounded in kicking the ball, rather than passing it, meaning that injuries to the legs and shins via the quite legal practice of ‘hacking’ - rather than head injuries and concussion - drew the concerns and criticism of the game’s early detractors. One such concerned individual, who signed himself ‘A Surgeon’, wrote to The Times November 23rd, 1870 to complain about the lack of intervention by the Head Master of Rugby School, whom he accused of being blind to the life-changing dangers of the sport:

 “I[..]have within the last few days been consulted in different cases of injury resulting from the practice of ‘hacking’….One boy with his collar-bone broken, another with a severe injury in the groin, a third with a severe injury to his ankle, a fourth with a severe injury to his knee and two others sent home on crutches, ought to be sufficient to call the attention of the Head Master to the culpable practice of hacking, a practice that has nothing whatever to do with the game, but which frequently injures for life…”

 

The Rugby-loving community could not let this stand, highlighting the health-giving properties of the game, the importance of the moral character it built and questioning the statistics offered up as ‘inventions’ or slanted toward a pre-set agenda. Robert Farquharson, Medical Officer to Rugby School, argued that the School could not be held responsible “for other institutions playing her game with violence and excess”.

Nevertheless, he conceded that “It is impossible that 500 boys can engage two or three times a week in rather a rough game without accidents happening…” and made an early and enlightened call on 2nd December 1870 for other medical officers of public schools to supply statistical data on rugby injuries.  There was, perhaps, little surprise that neither parents nor the family doctors were previously unaware of the physical knocks being encountered when one of the 'Ten Commandments' of the Edwardian public school was suggested that "I must show no emotion and not kiss my mother in public"

Exactly where the truth lay was never established, but this public agitation reflected in many ways the challenges facing the retention of ‘hacking’ in the development of a universally acceptable set of Laws for the game. The rejection of handling the ball, tripping and hacking an opponent below the knee had already been the key trigger points for the breakaway foundation of the Football Association on 8th December 1863. Less than 7 years later, and within 60 days of this correspondence stream in ‘The Times’, 32 representatives of 21 rugby clubs met at the Pall Mall restaurant on 26th January 1871 to found the Rugby Football Union. Hacking was swiftly eliminated from the revised Laws of the game. The 2016 debate emerging over the injury risks to school age children tackling in rugby thus greatly echoes the 1870 commotion surrounding injuries to young players in the game. Plus ce Change!

Whilst our historical research at Saracens Rugby Football Club has failed to unearth evidence of letters to the Club from concerned mothers or members of the medical profession from this early era in the sport's evolution, it is clear both groups were vocal at times, as it is documented that Club Hon Sec A.J. Wilson played in the 1905-06 season away game v Rugby despite being "forbidden to do so by both his doctor and his wife, as he had hardly recovered from the effects of an operation".

From the surviving records of participation in the game it is clear, that the pain suffered from injuries incurred on the football field were to be borne with a manly bearing and disdain, regardless of their severity. Little wonder, then, that many of our early Saracens players, like their modern-day professional and amateur cohorts, appear to have played through physical injury and adversity, when respite care, rest and recovery might have been a better choice. 

Returning to the modern era, the debate on safety in rugby continues unabated. A ground-breaking pilot study on concussion in schools rugby has been announced in Dublin, which will follow 200 teenage players at 5 schools over the 2016/17 season, studying the effects of rehabilitation on post-concussion adolescents.  Meanwhile, UK sport awaits the ‘Sport Duty of Care’ review led by Baroness Tanni Grey-Thompson at the Government’s request, the terms of which include “the prevention and management of brain injuries, catastrophic injuries and other medical issues”.  These recent initiatives have been contextualized in the most tragic way possible with the announcement of the untimely death of 17 year old Huddersfield Giants academy player Ronan Costello, following an injury sustained in a match against Salford on 11th June. His heartbroken family acknowledged “that this was a tragic accident…He was a loving and caring 17-year-old lad…We are so proud of him and his achievements”. 

The science-led medical interventions of World Rugby and the current debate in the pages of the Press are to be welcomed, illuminated as they are by the historical precedents in the evolution of the game of rugby football.

Please note: Views expressed are those of the author.

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