Seeing lights – Steve White-Cooper

Concussion or brain injury has been a talking point for the past two weeks, since Dr Barry O Driscoll (uncle to Brian and medical advisor to the IRB) resigned in protest at how the authorities were trivialising concussion.

Then to really put it in the spotlight (in the way only football can) Hugo Lloris, the Tottenham Hotspur) goalkeeper, resumed playing despite his manager, Andre Villas Boas stating that Lloris had been knocked unconscious and as having no recollection of the event. At one point Lloris was about to be stretchered off, his legs having given way when he tried to stand after regaining consciousness. Lloris insisted on playing on, which Villas Boas praised for showing “character and personality.” The situation has caused much outcry by professional bodies in both sport and the medical world – which Villas Boas has been surprised by – pointing to the fact that a precautionary CT scan after the game showed no signs of concussion.

And that probably sums it up. Villas Boas is a very intelligent man, but still young to management and leadership, and perhaps forgot the one thing that his own captain, Michael Dawson, questioned about himself…

“He took a really bad whack and I was worried when he went down and stayed down,” said Dawson. “When he got up his legs gave way, but he stayed on and made two good saves.

“I lead those boys but safety is the most important thing. He was in a bad way, but, by the time he came around, he was wanting to stay on.”

Villas Boas forgot one of the most crucial aspects of leadership – Duty of Care. Regardless of what Lloris had to say the club, the medical advisors and Villas Boas should have taken him off for his own safety. The fact that he did not have concussion is beside the point – what happens if he did and what might have happened if he had another knock to the head?

Does sport require a fatality to learn the lessons the rest of the world learnt many years ago? Brain trauma is a serious thing. At my school any child suspected of being knocked out or having concussion were immediately “off games” until medical assessment. Two concussions meant no rugby for the rest of the year – and that was a rugby playing school in Berkshire in the 80’s. Why? Because a child at a rival school had died the previous year following a head injury caused in a rugby match.

Barry O’Driscoll is a doctor, his nephew the outstanding player of his generation famed for his ability to recover from the “attention” afforded to the best. His opinions should be heeded. It is not just that players are bigger, weigh more with more force per impact (although that is noted) it is because the brain is a fragile thing and our understanding of it is still extraordinarily limited in relation to the leaps in medical science.

I remember back to my playing days when a player was knocked out horrifically in a Premiership game to a point where he fell over three or four times. Despite this the player stayed on the field for 20 minutes with coaches hoping that the concussion would wear off, despite a team mate demanding that the player leave the field, as he could not remember his own position. Back then a player with concussion was required to sit out for a mandatory 21 days before being allowed to undertake full contact. However in this instance the player had a cat scan on the Wednesday and was picked to play the following Saturday. An external physio who treated the player was furious with the selection and was very keen to report the club to the RFU. But the player felt he had to play to maintain his position simply because he could not afford to show that he was expendable, he was essentially a small exchangeable cog in the team’s machine.

The O’Driscoll story brought to light the $765m (£490m) settlement the NFL (American National Football League) will pay to fund concussion-related compensation, medical exams and research after more than 4,500 former players had sued the league, alleging it concealed the risks of long-term brain damage. The sad stories of four times Super Bowl winner Mike Webster and fellow NFL great Junior Seau highlight the dangers that professional sports people face in collision/contact environments – both were found to suffer from the degenerative brain condition CTE, usually attributed to punch-drunk boxers. Sadly for them the effects led to severe depression and psychological problems and violence (Seau shot himself in the chest).

Earlier in the year it was widely reported that heading footballs continuously (in the way a professional might) could lead to long term problems. This was 11 years after a coroner declared that former England football Jeff Astle’s death (at 59 in 2002) was caused by degenerative problems caused by heading heavy leather balls.

Duty of Care is a tenet of military leadership and even within the chaos of Afghanistan and Iraq it has been raised – sometimes from hard lessons but sometimes due to medical advice. Soldiers are ordered to wear ballistic eye protection and ear defence – officers and SNCOs who do not enforce the order will be charged; new generations of helmets have evolved to reduce whiplash injuries and also to protect the skull better, simply by being better fitting and preventing whip lash or the head “rattling” within the helmet.

And yet despite all of this we sit in a situation where a high profile and supposedly intelligent football manager and a governing body of rugby have both seemingly trivialised a potentially life threatening condition. Has professional sport reached a point where results matter more than the weight of medical opinion? At least in the past we could blame our old friend ignorance…but it would seem that even the lessons from other sports are not being heeded.

It must be remembered though that Lloris did make a couple of good saves that earned Tottenham a glorious point – let’s just hope that he, Villas Boas and the football community do not come to regret that point in the future.

Seeing lights – Steve White-Cooper







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