Physio Chris Tuckett finds a book on concussion echoes his own belief that rugby needs reforming

An 'entertaining and engrossing' read

I touched on the main topic covered in this new book seven years ago in a short article for Frontline magazine. Re-reading it, I stand by what I wrote, and Concussed would seem to corroborate my stance. My article led one reader to suggest that my piece was ill-informed, biased and should be pulled from the Chartered Society of Physiotherapy's website. I saw this as a typical reaction from those ‘in the game’.

Written by the journalist Sam Peters, Concussed is an eloquent, entertaining and engrossing read. I found myself consuming its 400-odd pages in a few days and it provoked many disappointed ‘shaking-of-the-head’ moments as well.

The simple truth is that rugby injury rates have risen sharply in recent years – and continue to do so. The data is more comprehensive than when I expressed my thoughts in 2016, and, shamefully, the trends have continued unabated.  

The book is exceptionally well-evidenced and backed by references, while the views of respected experts are included in the narrative along with graphs in the appendices. Sam Peters strives to be impartial where possible, shares his personal love affair with rugby and is charitable towards some of those involved (including medical personnel from the Rugby Football Union (RFU)), where another author might not have been. Yet the over-arching and unavoidable conclusion from the book is that rugby is a game that still has not got to grip with the inherent risks, while commercial elements still supersede player-welfare ones. 

Sam Peters’ brutal simplification that the brain is an organ that cannot be ‘strengthened’ to avoid brain damage is irrefutable. Yet researchers and the RFU continue to advocate for strengthening surrounding tissues further in a continuation of the arms-race identified in the book. Modern-day rugby players are faster, stronger and bigger all over the pitch, resulting in bigger ‘hits’ and more symptomatic and asymptomatic concussive incidents. While more data are available at the professional level, records of amateur or school age team injuries are still largely non-existent – despite children’s brains being more at risk of second impact syndrome. And the book shares devastating accounts from families impacted in this way.

The ‘blood-gate’ scandal

The book also contains concerning examples of medical professionals (doctors and physiotherapists) placing the goal of ‘winning’ above patient/player care – the most well-known being the infamous ‘blood-gate’ scandal whereby a physio handed a player a ‘joke’ blood capsule while ‘treating’ him on the pitch. This gave the coach the excuse he needed to replace the player with a substitute. As a result, the physiotherapist was removed from the Health and Care Professions Council register, although, interestingly, the doctor involved (who soon after the capsule incident cut the player's lip to provide a ‘real’ injury) did not lose his licence to practise. My own pitch-side experience was one I remember very painfully due to pressure from the ex-professional rugby player coach to keep schoolkids on the pitch despite their obvious concussive state. Club-level medical staff often experience a split loyalty with the coaching team when it comes to protecting players’ welfare and this is a source of much trouble.

Fundamental change is needed

I highly recommend this book to all physiotherapists working in all sports, but perhaps particularly to those working in rugby. While I fear that those who should read the book probably won’t – as they will dismiss it for 'fearmongering' or being ‘biased’ – I nevertheless hope it will engender change and provide rugby with a platform to improve how it operates for the safety of its current and future players.

As Sam Peters notes, the latest timebomb has now been detonated as some rugby union players who took centre stage after the game went professional in the mid-1990s – some becoming World Cup winners – are beginning to show worrying signs of severe neurological illness and disease. This is the latest wake-up call for rugby to take action.

My motto would be: remember, if in doubt, sit them out! 

Chris Tuckett is a physiotherapist and a director of allied health professions at an NHS trust

X (formerly Twitter): @HealthPhysio

To read Chris’s review of The Shoulder: Theory and practice, click