Researchers express concern about unsafe attitudes to concussion among rugby players in Ireland

Seán McCárthaigh

A new medical study has expressed concern about unsafe attitudes to concussion among non-professional rugby players in Ireland, particularly at school level.

Research on the knowledge and attitudes of rugby players in clubs and schools in the Republic to concussion and related brain injuries also identified some gaps in relation to coma and the symptoms of concussion.

The authors of the study said it was “somewhat concerning” that 35 per cent of school players said they would continue to play a sport while also having a headache that resulted from a minor concussion. In contrast, only 14 per cent of club players held the same view.

While all players were generally knowledgeable about concussion, the study identified “a significant knowledge gap” about chronic traumatic encephalopathy (CTE) – a progressive brain disease linked to repeated concussion.

The views and attitudes of over 520 IRFU-registered rugby players from 17 clubs and five schools were surveyed as part of the research.

According to an Irish Rugby Injury Surveillance Report, concussion is the most common injury diagnosed in non-professional men’s and women’s rugby clubs in Ireland.

Under current IRFU protocols, players should immediately leave a game if they suffer a suspected concussion.

The research team from UCC’s School of Medicine and Cork University Hospital said it was evident that the attitude of some players to concussion is still influenced by important matches.

The survey revealed that 11 per cent of school players claimed they personally felt a concussed player should return to play during a semi-final game compared to four per cent of club players.

Similarly, 20 per cent of school players said most athletes would feel a concussed player should resume playing in such a scenario compared to nine per cent of club players.

Another finding showed seven per cent of school players felt concussions were less important than other injuries but just three per cent of club players held the same view.

Overall, rugby players in Ireland were able to identify concussion signs and symptoms correctly 78 per cent of the time.

However, the research revealed that approximately a third of both club and school players incorrectly believed that wearing a scrum cap can prevent a player from getting CTE.

The survey also highlighted that 42 per cent of both groups incorrectly believed that symptoms of CTE can be witnessed immediately following a concussion.

There are approximately 20,000 registered club players of rugby in the Republic as well as 22,600 school players.

The study, whose findings are published in the Irish Journal of Medical Science, was designed to explore the impact of gender, playing level, experience and concussion history on knowledge and attitude to concussion and evidence linking CTE to head injuries.

It noted that available data indicated a high prevalence of players continuing to play rugby despite being aware of their concussion as well as a tendency to intentionally avoid seeking medical attention after a suspected concussion, particularly during high-pressure or “important” games.

Almost 9 out of 10 respondents said they had received previous education about concussion.

However, only eight per cent said they have received prior information about CTE, while 76 per cent were largely unfamiliar with the disease.

The survey found 46 per cent of club players had experienced a medically diagnosed concussion at least once in their playing career with 16% recording three or more diagnosed concussions.

Among school players, 41 per cent had experienced a medically diagnosed concussion with four per cent having three or more diagnosed concussions.

Only 26 per cent of club players and 30 per cent of school players never had a suspected previous concussion.

The study found club players scored significantly higher than school players in relation to knowledge about concussion and correctly identifying signs and symptoms of concussion.

However, it also found that some common misconceptions exist among both groups including statements relating to experiencing coma.

Just 15 per cent of club players and 11 per cent of school players correctly answered that an athlete who gets knocked out after getting a concussion is experiencing a coma.

The survey found no significant difference between male and female players apart from safe attitudes to concussion where females scored significantly higher.

There were also no significant differences between the groups based on years of playing experience.

The authors of the report said the results, when compared to similar previous studies, suggested there had been a positive shift in the attitudes of rugby players in Ireland towards a safer approach overall.

They claimed such a finding might reflect the IRFU’s ongoing efforts to promote safer practices at both club and school levels.

The study recommended that renewed educational efforts should highlight that specific circumstances and perceived importance of a game should not be factors that influence a player’s decision to keep playing after a suspected concussion.

It called on the IRFU to integrate up-to-date, evidence-based information on the disease into existing education resources and for coaches and other key personnel to be supported and encouraged to proactively convey this information to players.

The study concluded: “Players showed good concussion knowledge, indicating other factors such as the desire to play, performance pressure and the lack of awareness of long-term risk may still contribute to unsafe attitudes.”