Knocking Concussion on the Head

As published on PunditArena

In September it was announced that Nathan White was retiring from professional rugby based on medical advice following a concussion injury. The Connacht and Ireland prop arrived in Dublin from his native New Zealand in 2012 to join up with Joe Schmidt at Leinster before moving onto Connacht the following year.

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Prior to his injury against his former employers last March, White had established himself as a valued squad member in Schmidt’s Irish squads, garnering 13 caps in the space of eight months following his debut in August 2015. Sadly, he will not be adding to that tally.

The attritional nature of the professional game may be a joy for the public to behold but it has come at a cost. Between 2006 and 2012, Leinster duo Bernard Jackman and John Fogarty were the only professional rugby players to retire through concussion. However, in the past three years alone Craig Clarke, Declan Fitzpatrick, Kevin McLaughlin, David McSharry and now White have all suffered a similar fate.

When this is considered in isolation, it may seem that concussion is far more prevalent in the modern game. However, due to better education on the topic and heightened awareness of its signs and symptoms, players are now more likely than ever to take a sensible approach when dealing with brain injuries.

The rise in players retiring or taking long periods out of the game to recover from head injuries is a direct result of a more accepting culture within the game whereby players feel empowered to make the right decision for their health. Given the consequences of such trauma, rugby can no longer embrace those who make a heroic return to the field following a severe blow to the head. However, steps need to be taken to ensure that players are protected on a weekly basis and over the long term.

Headway, the brain injury services and support organisation, has teamed up with Ireland’s leading player GAA, soccer and rugby unions to launch Concussion Aware, a campaign in association with laya healthcare and LifeStyle Sports. The initiative is being backed by the likes of Irish captain Seamus Coleman, Dublin footballer Johnny Cooper, former Leinster rugby player Luke Fitzgerald and Donegal Ladies footballer Kate Keaney, and encourages coaches and athletes of all levels and ages to put their health to the fore and to remember, “If in doubt, sit it out.”

To get a better understanding of the players’ views on concussion, the Irish Rugby Union’s Players’ Association (IRUPA) has worked on a number of initiatives to determine the best means of further educating its members. Over a 16-month period between 2014 and 2016, the incidents of concussion amongst IRUPA members rose by 3.7%. The common perception may be that the increased physical nature of the sport has been the most significant factor, yet it must also be considered that there is a growing acceptance amongst players and coaching staff that concussion is an injury which needs to be taken seriously.

In an IRUPA survey carried out in October 2014, 13% of players who were concussed admitted that they were not confident that their head injury had cleared when they returned to play. In 2016, the same question was asked of IRUPA members with this number reducing to 10%. Although this figure remains high, it nevertheless represents an improvement of players’ concerns over a short period of time and an unwillingness on their part to take risks when it comes to brain injuries.

Last year, IRUPA in partnership with the IRFU, developed an online training course highlighting the signs, symptoms and effects of concussion. This module was made compulsory for all professional players in Ireland. It was designed to offer the players an interactive learning experience whilst providing real case studies of head injuries and testing their knowledge of the issue with a series of questions. This education tool, allied to World Rugby Concussion Management resource, has helped to provide players with the requisite insight to make informed decisions on the field of play.

In order to establish how effective the education drive had been in the period, IRUPA followed up with direct questions on players’ understanding on Head Injury Assessment (HIA), symptoms of concussion and the Graduated Return to Play Protocols (GRTPPs). The below statistics represent the changes in players’ awareness from the IRUPA surveys carried out in 2014 and 2016:

  • 2% players had a good to excellent understanding of HIA – + 14%.
  • 9% players had an excellent to good understanding symptoms of concussion – + 9.9%.
  • 8% players had a good to excellent understanding of GRTPPs – + 8.8%.

These results provide a direct correlation between the heightened awareness and understanding on the back of educational initiatives. Although it is recognised that knowledge of concussion has progressed amongst its membership, IRUPA continues to look for innovative ways to improve its methods of education to ensure players are making decisions with all the necessary information at their disposal.

As Omar Hassanein, CEO of IRUPA states: “Players must take responsibility to protect their health and well-being even in the heat of the moment. There has been a marked shift in the attitude towards concussion throughout professional rugby, but while we have made progress in raising awareness of the prospective dangers associated with concussion and its long-term effects, there is further ground to be made.”

To that end, the introduction of the Head Injury Assessment and its subsequent introduction into World Rugby’s regulations is seen a huge step in the right direction for the welfare of the players. Whilst this is certainly an improved position, it should also not be the final stance.

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Although there have been significant developments in the area from a professional perspective, there remains plenty of work to be done on the ground level. Speaking at the launch on Tuesday on Grafton Street, Kieran Loughran, CEO of Headway commented: “It’s evident that there is still a huge lack of awareness amongst the general public when it comes to concussion. 1 in 2 of those surveyed as part of our research admit they would not recognise the signs of concussion – this needs to be addressed.”

“It comes down to knowing the signs of concussion and looking after your team-mates and yourself,” Seamus Coleman added. “If a player is concussed, they may be in a confused state so will be relying on their teammates and coach to recognise that something isn’t right. If there is a shadow of a doubt, it’s so vital that they come off the field of play and sit it out. It might sound dramatic but you really could end up saving a player’s sports career, we’ve all seen some of our heroes having to retire early due to the impact of concussion.”

For further information visit http://www.concussionaware.ie and check out the campaign on Headway Ireland’s Facebook where you can download your personalised Concussion Aware frame to show your support.  

Players are also encouraged to show their support of Concussion Aware by wearing uniquely designed elite performance bootlaces, created especially for the campaign, and on sale in LifeStyle stores nationwide and online. 100% of the proceeds will go directly to Headway and to raising further awareness of the dangers of concussion.

A Lyttle Bit Special

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As published in InTouch Magazine (IRUPA), November edition.

As Ulster took to the field against Northampton in their last pre-season fixture, one name was at the tip of everybody’s tongue. Charles Piutau took up his position at fullback and duly whetted the appetite for the season ahead with some nice touches and electric breaks. But while it was a promising start for the All Black, it was the performance of a young winger from Donaghcloney that intrigued the Ulster faithful.

On his first start at the Kingspan stadium, Rob Lyttle’s first piece of action was a delightful sidestep and offload to his Kiwi colleague. Within a few moments Lyttle was demonstrating his defensive prowess, while it was his pass that put Louis Ludik away for the game’s first try. As the youngster sized up the subsequent conversion, Dan Tuohy, commentating for Ulster Rugby remarked that he “didn’t know he [Lyttle] could kick,” to which Tommy Bowe replied: “that boy can do everything.”

Not even a first senior appearance in the opening round of the Guinness Pro12 appeared to faze the youngster. Amidst all the fanfare surrounding Ruen Pienaar, Lyttle emerged from the bench as an early replacement for Craig Gilroy to seize another chance in the senior side with aplomb. In claiming two tries, Lyttle inspired Ulster to a 29-8 victory over Newport Gwent Dragons. Lyttle has since featured in all of Ulster’s Pro12 games to date.

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A former student of Royal Belfast Academical Institution, Lyttle made the controversial decision to move to fierce rivals Methodist College Belfast for his final year of school in 2015. As fate would have it, RBAI ultimately prevailed that year but Lyttle’s star was already on the rise. Progressing through the underage representative ranks, the youngster was inevitably picked up by the Ulster Academy.

At just 18, Lyttle featured prominently in the British and Irish Cup for Ulster ‘A’ last year. Despite his tender years, the quality of his performances saw him drafted in as the 24th man for the Pro12 on several occasions. He was simultaneously to the fore as Queen’s University sought promotion from Division 2A of the Ulster Bank League. Given his form, Lyttle was naturally disappointed not to make the U20 Junior World Championship panel in June. However, the Irish 7’s Development squad duly came calling.

With the likes of Piutau, Bowe, Ludik, Gilroy, Jared Payne, Andrew Trimble, Stuart Olding and Jacob Stockdale all potentially vying for places in the back three, Lyttle faces a stern challenge to become further established at Ulster. But after such a blistering start, he has certainly made his mark.

Up for the Fight

As published on PunditArena

As Tommy Bowe battled his way back from a knee injury he sustained whilst playing against Argentina in last year’s Rugby World Cup, there were times during his rehabilitation that made him think that he had played his last game of rugby. Having picked up four serious injuries in consecutive seasons, Bowe has endured a luckless second stint with his home province.

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Speaking at the Ulster Public Panel Discussion as part of IRUPA’s Tackle Your Feelings campaign, in partnership with Zurich, the Irish winger admitted that having spent so much time on the sidelines, it’s hard not to question whether he would ever get back on the pitch.

“I’ve chatted with Stephen Ferris and Felix Jones about when you’re told that it’s not going to get any better and that’s always the fear. That’s what keeps you up at night.”

Having undergone kidney surgery just prior to his return to Ulster in 2012, Bowe was then dealt a further blow when he picked up a significant knee injury in December of the same year. While Bowe returned to fitness in time to travel with the Lions to Australia the following summer, a broken hand threatened to rule him out of the series. A groin injury sustained in the narrow defeat to New Zealand then forced him to miss the entirety of the 2014 Six Nations.

“This is my 13th season in professional rugby and I’ve found that mental health has become a huge area of concern in sport. Throughout my career I’ve found it difficult to deal with injury, but it’s equally tough when you are dropped or have a bad game.

“The mental side of sport is so huge nowadays, especially as you’re trying to get the best out of people. A lot of it is about being able to perform under pressure in some big, big games but with that come the highs and the lows. It’s important to work at trying to keep yourself on a level playing field, so that you’d don’t go too high when things are going great and you don’t go too low at the other end.”

Also speaking on the evening were IRUPA CEO Omar Hassanein, Dr. Eddie Murphy, Irish Women’s Sevens International Hannah Tyrrell and former Ulster fullback Bryn Cunningham, who was forced to retire early from the game.

Given the macho perception of the sport, people find it difficult to imagine the players dealing with little more than the bumps and bruises. The panel therefore explored the importance of mental wellbeing and how Ireland needs to be more proactive in resolving emotional challenges before they escalate into a crisis. The discussions were another step towards achieving the vision of a society that embraces emotional vulnerability.

“When I was a teenager, I struggled with my own self-confidence,” Tyrrell admits. “I had low self-esteem and a poor body image. I just viewed myself negatively in every aspect. I developed an eating disorder. For some reason I felt that if I were skinnier or prettier, people might like me, or I might perform better in school or in sport.

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A talented soccer player, Tyrrell turned her attentions to Gaelic Football when the Dublin U14 management came calling. Thereafter she progressed through the ranks to the senior side, winning several All-Ireland titles along the way. But beneath her sporting glory, Tyrrell was facing up to a greater challenge.

“I wasn’t very good at communicating my feelings,” Tyrrell explains. “I took everything on myself and in time I began to restrict my food intake, binging and purging before I began to self-harm.”

Having sought help, rugby provided Tyrrell with an outlet to grow, develop and indeed take stock of her experiences.

“I took up rugby in 2013 just after the women had won the Grand Slam. As I was very sporty and ambitious, it was always something that I thought I’d love to try. I was just coming out of my recovery and so I needed it to keep me on the right track and provide another goal to focus on. Rugby aside, the camaraderie I’ve enjoyed and the friends I’ve met means it’s one of the best decisions I’ve ever made.

“I’m very thankful I went to rugby training that evening.”

Ireland: Five Surprise Selections Schmidt Could Make Ahead Of The November Internationals

Ireland’s recent endeavours in South Africa have shown the merits of introducing a dash of freshness into the camp. Several fringe players put their hands up in the intimidating environments of Cape Town, Johannesburg and Port Elizabeth.

While they ultimately failed to finish out the job, several of the more inexperienced troop will have undoubtedly benefitted from the experience. Many of those will now look forward to playing important roles as Ireland seek to secure their first ever win against the All Blacks

Joe Schmidt has often been criticised for neglecting to pick untried, albeit form, players and that is unlikely to change as he chases that elusive victory over New Zealand. Lists of this nature therefore often tend to be a fruitless exercise. However, now that he is believed to have committed his long-term future to the country, perhaps he will consider those who will be at the heart of the side he is due to depart in 2019.

The likes of Garry Ringrose and Ross Molony have long been touted for international recognition, but there are several others who are more than capable of making the step up and contributing to both the short and long-term future of Ireland.

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Joey Carberry

Following his brief consultancy period with Leinster, Graham Henry apparently stated that Irish rugby need not fear for the day that Jonny Sexton hangs up his boots. The reason? Joey Carberry.

Entering into the season as Leinster’s fourth choice out-half behind Cathal Marsh and Ross Byrne, Carberry grasped his opportunities with aplomb and has been a revelation when tasked with steering the Leinster ship.

While Sexton’s return may hamper Carberry’s immediate first team hopes, the Auckland-born youngster has shown enough quality to suggest that he is at home at this level and is destined to thrive. There are aspects to his game that will undoubtedly need tending to, but his raw footballing ability and attacking nous ensures that an exciting future lies ahead of him.

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Dublin , Ireland – 26 August 2016; Joey Carbery of Leinster during the Pre-Season Friendly game between Leinster and Bath at Donnybrook Stadium in Donnybrook, Dublin. (Photo By Matt Browne/Sportsfile via Getty Images)

With a two-try salvo against Treviso in the opening game of the Pro 12, Carberry announced himself on the domestic scene in some style. Needless to say, Joe Schmidt will certainly have noticed his compatriot’s impact.

As has been Schmidt’s want, Carberry can expect to be invited along to train with an extended Irish panel ahead of the November series. Should his form continue apace, he has every right to be included on merit. Carberry turns 21 on the eve of Ireland’s game against the All Blacks, but while he may yet be too young to be thrust onto the highest of test stages, he stands a reasonable chance of being Paddy Jackson’s standby when Ireland take on the Canadians.

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Jack O’Donoghue

Rassie Erasmus was left angered when Jack O’Donoghue was stretchered from the field during Munster’s 28-14 win over Edinburgh on Saturday. Thankfully, the 22-year-old returned to the sidelines before the end of the game, but such has been his influence that O’Donoghue has become an integral part of the South African’s plan for the province.

Despite having received a call-up to the Six Nations squad ahead of Ireland’s fixtures against Italy and Scotland, Schmidt resisted any temptation to summon O’Donoghue to South Africa in the summer opting instead for Ulster’s Sean Reidy and Rhys Ruddock of Leinster.

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Yet competition on the international front is as fierce as ever. The likes of Jamie Heaslip and CJ Stander remain top of the pile, Tommy O’Donnell remains in the mix while Josh van der Flier’s return to form at the weekend will not help O’Donoghue’s claims.

However, with Sean O’Brien and Peter O’Mahony still on the comeback trail, O’Donoghue’s impressive early-season form means that Schmidt can’t overlook the Munster man. With all the tools to be a top class No. 8, Jamie Heaslip’s eternal tenure at the base of the Irish scrum may ultimately give way to the Waterford man.

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Darren Sweetnam

While Rob Lyttle has been grabbing all the headlines with several notable performances for Ulster already this season, Darren Sweetnam has become a central figure in Erasmus’ Munster revolution.

The former Cork hurler joined the academy in October 2012 but struggled to make much of an impact whilst several of his colleagues pushed on. Erasmus now refers to the outside back as one of his ‘go-to men’ and simply puts his gradual progression down to his distracted rugby beginnings.

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Although the back three department is a congested space, Sweetnam’s attributes are sure to have found their way onto Joe Schmidt’s radar. Defensively sound, tricky in attack and dominant in the air, the Bandon man is technically superior to a number of those at Schmidt’s disposal. If he continues in this vein, Sweetnam will get his opportunity in green sooner rather than later.

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Dan Leavy

Highly regarded at Leinster, Leavy was pinpointed as a potential back row star of the future before Josh van der Flier jumped the queue and became an international player during the 2016 Six Nations.

Finally, having endured a sometimes-difficult beginning to his professional career, Leavy has seemingly overcome his injury problems to feature regularly in the Leinster side this season.

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Featuring in all of the opening games of this campaign, Leavy has proven himself to be a valuable asset in Leo Cullen’s squad. Ironically, given that it is one of Leavy’s principle attributes, his versatility may have counted against him last weekend.

Having been shifted about between 6, 7 and 8 (performing well in each) Leo Cullen preferred to call upon more regular custodians of those shirts in Heaslip, Van der Flier and Jordi Murphy on for the Ospreys’ visit to the RDS, while it was Rhys Ruddock who first emerged from the bench to replace the latter.

However, with several prominent displays already, including a superb evening in Edinburgh where he claimed two tries, Leavy’s resourcefulness stands his international prospects in good stead.

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Alan O’Connor

International recognition would be a fitting chapter in Alan O’Connor’s story.

Rejected by Leinster, O’Connor’s career seemed to be written off before it had even begun. Having failed to make the Ireland U-20s side for the Six Nations in 2012, O’Connor was subsequently included in the travelling party to the Junior World Championship in South Africa. However, before the squad flew out O’Connor was informed that he would have no place in the Leinster Academy upon his return. Allen Clarke of Ulster duly capitalised.

Despite Franco van der Merwe, Pete Browne, Dan Tuohy and O’Connor all competing for a spot in Ulster’s second-row, the 24-year-old has managed to become the frontrunner for the position on a weekly basis.

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Following Paul O’Connell’s retirement last year, Schmidt has looked to several options to fill a considerable void. One of those, O’Connor’s Ulster colleague Iain Henderson (the man many see as being the most capable of filling those considerable boots), has been regularly shifted to accommodate the in-form Dubliner.

Furthermore, in what was something of a surprise, Connacht’s Quinn Roux earned a call-up in the summer and acquitted himself well. On that basis, O’Connor can’t be too far away.