Conversations about concussion in sport can bring up diverse opinions. Some of those involved, such as athletes, players, governing bodies, medical professionals and coaches have different ideas about how to approach the identification, management and prevention of concussion.
But despite these differences of opinion, there has been a growing recognition across the sector that there is a need to protect the participants of sport, at all levels, from the short and long-term consequences of head injuries.
Some of the measures being used are increased training, promoting safe playing techniques and using concussion management guidelines, including things like ‘if in doubt, sit them out’ and a graduated return to activity.
The UK Concussion Guidelines for Grassroots Sport were launched by the Government and the Sport and Recreation Alliance in 2023.
In this blog we talk to Prof John Fairclough, of Progressive Rugby, an advocacy group focused on enhancing player welfare in rugby union.
Tell us about your organisation, your members and the work you do…
"Progressive Rugby was founded in February 2021 by a group of unpaid volunteers comprising former professional players, experienced medical clinicians, academics, referees, coaches and educators.
"All of whom love the game but had become increasingly concerned at the rising number of players suffering with poor brain health and diagnoses of early onset dementia and probable Chronic Traumatic Encephalopathy (CTE) in their relative youth.
"Some members of the group who have had this diagnosis including Steve Thompson, Carl Hayman, Alix Popham and Michael Lipman (all parents in their 40s). And we have seen first-hand symptoms like confusion, extreme fatigue and mood swings that disrupt their lives and the lives of those they love.
"As a group, we are satisfied that the causation between sub concussions and degenerative brain disease is proven. (Sub concussions are the thousands of impacts (regulation tackles, rucks, collisions) from playing the game that cause microscopic brain damage but are symptom free.)
"We are not alone, with bodies including the US National Institute of Health (NIH), Concussion Legacy Foundation and Royal College of Pathologists in Australasia also taking that stance.
"We want rugby to maintain its physicality, but for measures to be introduced to better protect the short-and-long-term brain health of players."
What would that look like?
"In the elite game that means an urgent need to reduce the number of sub concussions players experience. In simple terms, less rattles of the brain in the skull. This means implementing strict game limits, reduced contact training and protected rest periods.
"Additionally, we want to see more robust concussion protocols. I find it astonishing that in 2024 an elite player can return to the field just seven days after suffering a diagnosed concussion.
"In the community game the changes needed are far less extreme. We’d like to see a 'community of care' created by coaches, players and parents all sitting a non-onerous concussion training module at the beginning of each season. So everyone is informed and empowered to raise concerns on the side line or pitch.
"Secondly, an effective communication system to inform schools, GPs, parents and other sports clubs of an individual who has a concussion so they can be managed appropriately.
"Finally, and in many ways most importantly, abide by the mantra ‘if in doubt, sit them out’. In my opinion, there is no match or any circumstance which justifies leaving a player on the field when you suspect they may have a brain injury."
What do you wish more people understood about concussion?
"The good news is that players and fans are more aware of concussions than ever before, and that’s because it’s a hot topic in sport. As well as rugby, it’s become an increasingly discussed topic in football, boxing and cycling and gets regular media coverage. And, as a body, Progressive Rugby gave evidence at the DCMS Select Committee on concussion in sport.
"One area always worth reiterating is that you do not need to receive a blow to the head to suffer a concussion. They can be caused by any mechanism that results in the rapid acceleration or deceleration of the brain within the skull. An example of this is when drivers suffer whiplash in car accidents or in an entirely legal, but high impact, rugby tackle. A player not hitting their head does not mean they haven’t suffered a brain injury."
What advice would you give to a parent?
"Rugby is a fantastic sport and offers a host of benefits including teamwork, fitness, discipline and friendship. Like many other sports (such as football, BMX, skiing, rock climbing, horse riding) it carries risk of injury. Like all of them, it would be entirely wrong to suggest that rugby is pre-destined to cause long-term problems.
"As a parent, the important thing is that you are happy that the club you choose has the right environment and standard of coaching. Young players start graduated contact at U9 but well-run clubs won’t expose children to competitive contact until they are satisfied the child is ready to partake.
"And always remember ‘If in doubt, sit them out’ for a minimum of three weeks – if your child still has symptoms, they require longer."
What are the top 3 things you would like to see happen to strengthen concussion management and prevention across the sports sector?
"Firstly, we are glad to say one has already happened: the introduction of the UK Concussion Guidelines for Grassroots Sport to align recommended concussion management in all sports alongside the ‘If in doubt, sit them out’ mantra.
"Secondly, having a system across sports that could inform all relevant parties of a concussion or suspected concussion that can ensure effective management.
"And finally, a mandatory non-onerous training module to be sat by coaches, players, referees and parents each pre-season to ensure an evolving culture of care, particularly in the rugby family."