MILD head injuries are often dismissed as “part and parcel” of sport and not taken seriously enough, according to the doctor for Scotland’s national rugby squad.
Dr James Robson, who previously looked after the British Lions, said concussions are viewed as a “badge of honour” but warned that growing scientific evidence suggesting they can mask serious long-term brain injuries can “no longer be ignored”.
In a paper co-authored with Dr Iain Murray from Edinburgh university’s department of trauma and orthopaedics and Dr Andrew Murray from SportScotland Institute of Sport, Robson tackles what he regards as a worrying apathy to concussive injuries that has existed at both professional and amateur levels in many sports.
American football, rugby, boxing, ice hockey, soccer, cycling, skiing and equestrian sports are all cited as pursuits with high risks of concussion.
Their report, written for the Clinical Journal of Sport Medicine, warns that attempts to stem the epidemic, including the wearing of headgear in rugby and face shields in ice hockey, “have made no difference to the incidence”, adding: “The key problem is that, until now, concussion has not always been taken seriously enough by players, coaches, and medical staff.”
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Their comments, while aimed at sport generally, are likely to fuel fresh debate over whether sufficient steps have been taken to protect youngsters who play rugby.
In 2011, Ben Robinson, 14, of Carrickfergus in Northern Ireland, was checked for concussion during a school fixture but passed the coach’s basic tests. Two days later, he died with a brain injury that doctors compared to those witnessed in victims of a car accident.
It is estimated that almost half of rugby players aged younger than 20 years have sustained a concussion, which is now the third most common match injury; a rate of up to nine concussions per 1,000 player-games in Britain is comparable with that of American football and ice hockey.
Dr Allyson Pollock, author of Tackling Rugby and a public health academic who has campaigned to make the game safer, says more radical measures, such as banning scrums and tackles, are needed.
Pollock said: “The fundamental problem is that rugby is a collision sport and most injuries occur during contact and especially during the tackle and scrum. Until contact is decreased and the tackle and scrum removed from the game children will continue to be at serious risk of injury and concussion.”
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She added: “There is a duty of care and a legal requirement to protect children from harm. Far too little is being done by the government and rugby unions to prevent injuries from happening and to protect children.”
Robson and his co-authors argue that convincing society of the importance of recognising concussion is “particularly challenging because most athletes who experience concussion seem to recover without readily apparent consequence.
“It is now clear that prompt recognition and appropriate management of concussion improves the short- and long-term health outcomes for players. A fundamental cultural change in the perception of this condition is needed.”
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Last year, the Labour MP Chris Bryant accused the British sporting community of “turning a blind eye” to the issue of concussion in sport amid a study showing only 42% of rugby players were removed from the field of play following concussion.
A cross-party report co-authored by Bryant pointed to a $765m concussion lawsuit in the United States brought by former NFL players for long-term brain injuries sustained while playing the game and warned that UK sport “cannot afford something on [that] scale”.
Efforts are, however, being made to raise awareness of the dangers of concussion. Last year, the Welsh Rugby Union launched a concussion guidance document which was sent to all rugby clubs in Wales.
A similar leaflet drawn up by the Scottish government was distributed informing coaches, teachers and parents on how to spot the signs of concussion and what action to take.