DOCTOR James Robson is confident the new system for dealing with head knocks in rugby is working well – and helping to cut down on the health risks of a sport that is becoming more physically gruelling every year.
Players can now be taken off the pitch and assessed for any sign of concussion before being allowed to return, and when concussed are now subjected to more subtle and thorough tests before they can play again.
Scotland’s team doctor at the Rugby World Cup and one of the most experienced medical men in the sport, Robson has found the Hawk-Eye replay system particularly helpful, as it shows possible injuries that might not have been picked up by the naked eye in real time.
“I like it and I think it’s working well,” Robson said. “I’ve really enjoyed having the Hawk-Eye information. In the Samoa match we used it for Alasdair Dickinson – he got a big challenge, he appeared OK, but the challenge was such, with him being bowled over, that we decided to take him off for head-injury assessment.
“We go in and review from several angles and all agreed that although it was a big challenge, it looked perfectly fine. I was happy for Dicko to go back on, because he sailed through his assessment. We kept a close eye on him from then on with heightened awareness because you’ve taken him off once.
“There were other big collisions, the likes of John Hardie, when he got bumped back and just seemed to bowl over but then he sprang back up. He just kept bouncing back. We had a heightened awareness of him because we had a head injury with him in the Japan game.”
While Dickinson was conscious and co-operative throughout, there are times when medical staff can be subjected to verbal abuse or even attacked by players who are not wholly aware of what they are doing.
There may also be occasions when a player sounds entirely lucid when answering questions on the field, but is actually trying to play down a knock he knows is affecting his judgment.
When dealing with head knocks – or indeed any other kind of injury – the answer in every case when it comes to deciding whether a player should go off, Robson says, is to resist being influenced by anything other than your professional opinion.
“There’s only one boss in that decision,” he said. “I would possibly get into trouble with people with the language I sometimes use, but I use the same language as the players, so if they tell me to f*** off on the pitch I simply reply in the same vernacular.
“There was a good example recently when one of the players didn’t want to be stretchered off. It was on the pitch pre-World Cup.
“I said, ‘that’s fine, you walk off the pitch, no World Cup’ – it makes that much of a difference if you’re treated correctly. [He agreed to be stretchered off and] lo and behold he got in the squad, because the injury healed in the requisite time.
“Sometimes you have to be really careful though. Sometimes because they have a head injury they’re not responsible for what they’re saying.
“Quite often they’ll be more aggressive than normal. Once, many years ago, I had one of the players take a right hook to me because he thought I was the opposition peering over him. Sometimes they get into a combative state, really very aggressive, sometimes they are crying like a baby, other times they are just a bit confused.
“Sometimes the other players make the diagnosis – ‘Doc, he’s not right, he doesn't know the calls’ – and things like that. There’s a whole spectrum of things going on. It has become really interesting.”
Sometimes players report delayed symptoms, as in the case of Hardie, who did interviews right after the Japan match and seemed perfectly fine but was later ruled out of Scotland’s next two games after the matchday doctor had a word with Robson.
“It can be subtle,” Robson continued. “Some are very subtle. Look at John Hardie, he clashed heads with David Denton in the last minute and a half of the game.
“We ran on, and one had a big cut to his forehead, one had a big cut on the back of his head. That’s not unusual, and he appeared to function fine, but after the match, the matchday doctor came along and said, ‘let’s just have a look at that footage together', and we determined the was a little bit slow getting up.
“I thought he wasn't concussed, but was a little uncertain, so we carried on the process and a couple of days later when we did his tests one of them was just a bit off, so we had to err on the side of caution.
"That’s not a popular decision with the coaching staff, but it’s one they support, because ultimately you could lose him for the tournament if you don't manage him correctly.”
The treatment of players has moved on a great deal from the days when concussions often went undiagnosed, and Robson is sure the desire to be as safe as possible has not gone too far.
“There are things we probably missed 10 years ago that we are now treating as concussion," he said. "Are we over-treating? I think not.
“We’re being ultra-cautious, because we’re still not sure what the outcomes are. The more cautious we are now without destroying the integrity of the game, the fewer problems we’re likely to have in the future.”
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