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Published 2 months ago 27th November 2022 by Ronan Quirke

I am not sure if you are familiar with the name Dave Duerson. A defensive back with the Chicago
Bears American football team, Duerson was only 50 years of age when he died back in 2011. He was keenly aware of chronic traumatic encephalopathy. This is a brain condition linked to multiple
concussions that can affect sufferers, causing, amongst other things, depression and dementia.

He had been a long-time member of the NFL players union and had advocated for further research into the effects of multiple concussions on players after their careers had ended. He succumbed to depression and ended his own life by shooting himself in the chest. His final act was to request that his brain would be examined after his death and it was for that reason that he ended his life by a gun shot to the chest rather than to his head. He wanted his own body to be used in the research that he had so long advocated for. Boston University researchers ran tests on his brain during the post mortem and their findings showed that Duerson had developed the same trauma-induced disease that had already been found in more than 20 deceased players.

Duerson had complained to his family about his deteriorating mental health in his final months. His death reminded the American Football community that for all the reform in the management of concussions and other on-field brain trauma in recent years, the damage to past players remains a vestige of the game’s more brutal times.

This was back in 2011. Watching the Autumn rugby internationals recently, I was reminded of Dave
Duerson, how sadly his life ended and what his legacy is after his brain was preserved for analysis.
Rugby has a problem and is continuing to develop a legacy of problems. Players are so much bigger and more powerful now than ever before. The sport has certainly tried to clean itself up from a player welfare perspective. They have left other sports behind in head injury assessment and concussion protocols and return to play protocols, yet watching the games over recent weekends, I could not help but think that the game is in trouble.

Take the yellow card incident in the Ireland v South Africa game as an example. The South African full back Cheslin Kolbe was dismissed for 10 minutes in the first half for a tackle that saw Mack Hansen lifted above the horizontal. That means that his hips were above his shoulders. He has then been lifted further and dropped to the ground. With the added weight of Kolbe following.

The reason the referee did not issue a red card was because the Irish winger landed first on his elbow and not on his head. Had he landed on his head then it would have necessitated a red card. But why did he land on his elbow first, then shoulder and not on his head? Pure luck.

The South African had endangered his opponent by lifting him in the first place above the horizontal.
There was no necessity to lift him at all as a second South African, Pieter Steph du Toit, had also engaged in the tackle and to put it mildly, Mack Hansen was going nowhere. The lifting was both unnecessary and dangerous. It served no competitive advantage for the South Africans. Perhaps they were hoping that Hansen might drop the ball in the tackle so that the South Africans could retake possession in a dangerous area of the pitch. That would however, be no excuse for the tackle that was executed, as it displayed a lack of any duty of care by the South Africans for their Irish opponent.

In 2005 Brian O’Driscoll was named captain of the Lions for the tour of New Zealand. This was the
pinnacle of his career, he was the best player in the world at the time. His first test match against the All Blacks lasted 90 seconds after he was lifted above the horizontal by New Zealand captain Tana Umaga and hooker Keven Mealamu. He was driven into the ground head first in a manner that could have broken his neck. He was lucky, in that he only dislocated his shoulder, but his tour was over.

The tackle went unpunished by the referee and subsequently went unpunished, after review, by the citing commissioner. After watching the tackle on Mack Hansen a few weeks ago, I had to wonder if rugby has learned anything in the intervening 17 years?

The best scrum half in the world right now is probably Frenchman Antoine Dupont. He was red carded in the France v South African game in Paris a few weeks ago for causing Cheslin Kolbe to land on his head. Kolbe was airborne, attempting to recover a cross kick near the French line when Dupont made contact with him, whilst he was in the air, causing Kolbe to flip and land on his head.

He could quite easily have broken his neck. Dupont was red carded and given a four week suspension.
In the Ireland Australia game last week, scrum half Nic White suffered a nasty blow to his head whilst tacking Mack Hansen and preventing an Irish try. Moments later he attempted to tackle Josh van der Flier and the Irishman’s knee made contact with the Australian’s temple. Two bangs to the head inside a minute. Play was stopped and he was assessed on the pitch during which time he visibly staggered. To my untrained eye, he looked dazed. He left the pitch for a head injury assessment and returned some minutes later having passed the assessment and resumed playing for the remainder of the match. This was incorrect on so many levels. He should have been replaced and stood down for the remainder of the game. Indeed, he has subsequently been told that he cannot play rugby for 12 days as a result of the head injuries he received. The rules are clear, the stagger on the pitch should have been the defining matter. The referee could be heard saying that he saw the player stagger. A return to the pitch should never have been an option. The medical team failed him.

It is their job to act in his interests, to be his advocate when he cannot think clearly or make rational decisions. Of course he wanted to return to the pitch, but he cannot be the decision maker. That is what the head injury assessment is for. That is what the concussion protocols are for.

In commentary, Alan Quinlan was clear in his view that what was happening was wrong and sent out such a bad message. It made for uncomfortable viewing that is for sure. If Nic White had received another bang to the head in his remaining time on the pitch, then it could have had catastrophic results.
Ben Robinson was 14 when he died. He was playing an Ulster schools rugby match in 2011 and he suffered a blow to the head. That caused his brain to swell. He was allowed to play on despite showing signs that he had suffered a significant concussion. He died of second impact syndrome when his swollen brain was subjected to a second devastating blow. As I watched Nic White return to the Landsdowne Road pitch on Saturday, I genuinely feared for his life. It was as if Russian Roulette was being played with his life.

Steve Thompson was the England hooker when they won the Rugby World Cup in 2003. He cannot remember winning the World Cup. He is now 44 years of age. He has early onset dementia. Ryan Jones is a former Wales Rugby captain who won 75 caps for his country. He is now 41 years old. He too has early onset dementia caused by probable chronic traumatic encephalopathy. The same condition that Dave Duerson wanted more research on. The same condition that cost Duerson his life.

A recent study of former Scottish rugby internationals has found that they are three times more likely to develop Parkinson’s Disease and twice as likely to develop dementia compared to the rest of the population of males of equivalent age. The study cohort is only 1500 people and so struggles to meet statistical significance but it points to a problem that necessitates further research.

So rugby has a problem and is nurturing a host of problems that will raise their heads in future years.
Surely former players will look to be compensated for any ill health that can be attributed to their
professional rugby careers. What will it take for rugby to change? The spear tackle on O’Driscoll should have been the last time we ever saw that tackle. It wasn’t. The death of Ben Robinson should have been the last time that anyone was put at risk of second impact syndrome. It wasn’t. For all their nice words and protocols rugby hasn’t developed the zero tolerance that is needed to protect

It is a game centred on physicality. If you take physicality out of rugby then you are not left with much. But you can retain physicality in the game and remove danger. You can ensure that players do not land on their head when airborne. The actions of Antoine Dupont were not deliberate but they were reckless. He failed to demonstrate any duty of care for his opponent. The actions of the doctors who assessed Nic White last Saturday were reckless and again failed in their duty of care to the player, worse still that the player was, at that time, their patient.

Playing contact sport always carries a risk of injury. As Donnacha Ryan once told me on Extra Time, ‘look Ronan it isn’t a tickling contest’. I get that. But as an ancient Greek physician might say, ‘primum non nocere’, first, do no harm.

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