The Knock-on Effect: The headache that can lead to a life of pain

By Dylan Cleaver, Dana Johannsen

Critics say urgent solution is needed for brain damage problem, report Dana Johannsen and Dylan Cleaver.

Nicky Allen, centre, died at the age of 26 from a catastrophic head injury incurred playing club rugby in 1984. Photo / AAP
Nicky Allen, centre, died at the age of 26 from a catastrophic head injury incurred playing club rugby in 1984. Photo / AAP

Rob Allen believes that the New Zealand Rugby Union has engaged in careful PR, which has effectively "laundered" the long-term dangers posed to their players by concussion.

You have to assume "laundered" is not a term he chose flippantly. When it comes to this issue, Allen doesn't do flippancy.

Allen's young brother, former All Black first five-eighth Nicky, died in 1984, aged 26, after suffering a catastrophic head injury while playing club rugby in Wollongong, Australia. The younger Allen had a history of playing-related concussions.

Rugby has attempted to demonstrate they are taking the issue seriously, Allen says, but it is just "window dressing".

"By its nature, the game cannot avoid high levels of head injuries."

Allen, who played at representative level in Auckland and Northland, had no interest in re-engaging in the concussion debate until former All Black Leon MacDonald's struggles with head injuries hit the headlines.

"Why was he allowed to continue playing with that level of risk?" Allen asks. "Did he continue to play because it was his living? I'm not saying he did, but surely the NZRU has a duty of care to injured players. It also surprises me that they don't step in earlier in order if only to manage business risk."

When contacted by the Herald, MacDonald declined an interview.

"Rugby has a problem. They won't do the right research on the problem because it will be frightening," Allen claims. He believes at least a quarter of all senior rugby players will suffer concussion.

"There is brain damage in every concussion that never repairs.

"I think there's a cover-up as to the extent of it. They have to cover it up or else mums and dads would not put their kids into the game if they knew they were playing a game where head injury, brain damage, is high risk."

The cumulative effects of concussion remain a contentious issue even among the medical community.

"Because the brain is sort of tethered down in certain places, you get what we call a shearing injury, like a stretching," says neurologist Dr Rosamund Hill.

"So parts are tethered down and parts get stretched and that disrupts the connections at a microscopic level. The result of that tearing and stretching - diffuse axonal injury - is you get a disruption of the connection of the brain cells.

"Those disruptions are also associated with chemical changes that go along with it. So you can't see it on a scan, which is very frustrating for people. You can have a very significant concussion, but things will still look normal on CT or MRI scan."

Which is why Dr Bennet Omalu's work, outlined in yesterday's Herald, on the brains of deceased NFL players was so far-reaching: the likes of Mike Webster's brain, from the outside, looked perfectly normal.

Allen says his views are not those of an embittered anti-rugby agitator. Far from it, he spent a lot of his life trying to reach the upper echelons of the game. What he doesn't like is the smoke and mirrors approach to concussion.

"They have got a problem and they can't come up with a solution.

"I'm astounded they haven't taken far bigger steps in relation to concussion than they already have. The game is inherently exposed to head injury. That's the nature of rugby and therefore the ongoing consequences of it are huge unless there are big changes to the rules."

Brent Anderson, the NZRU's community and provincial rugby general manager, believes his organisation is doing everything they can to inform players and coaches of the risks associated with concussion. He points to the ACC RugbySmart programme, which has heavy emphasis on recognising, assessing and managing concussion.

In operation since 2001, every coach is required to complete the course every year so they are exposed to the most up-to-date best practices.

"Why would we cover it up? It's absolutely in our interest to make the game as safe as possible," says Anderson.

"We have RugbySmart emblazoned across the front of our referee jerseys at ITM Cup to fully emphasise how seriously we take it, how would that be a cover-up? The ABs' media polo shirts have RugbySmart on it, so whenever they're being filmed by the media that message is getting across in the most public setting possible."

Dr Martin Raftery, the IRB chief medical officer, believes the issue has become a news media plaything.

"They've got to sell the story so they do tend to blow it up. In [the media's] defence, some of the people doing the research are also magnifying issues without having the data there to support what they're saying," Raftery says. "Having said that, we still have to be aware that there potentially is a problem and that's why we're moving forward now rather than waiting to see what comes out of research elsewhere."

Dr Steve Marshall, a New Zealand academic based at the University of North Carolina, has seen the scaremongering effect "misreporting" can have. People, he said, have become unnecessarily panicked about the risks of playing American football.

Even so, and taking into account the fact that NFL data does not always mesh easily with rugby because of the different way the game is played, Marshall believes we must take notice of the research.

"I'm convinced based on the data we have that the more concussions you accrue the more likely you are to have a whole host of negative outcomes, including Alzheimer's and Parkinson's," he says. "It's not just the high-profile afflictions either. Depression is far more prevalent than Alzheimer's, for example."But it's very important to note nobody is doomed here. Some players who suffer bad concussions may never suffer negative effects, but we don't know. One day we'll learn more, but for the meantime we have to treat everybody as if they're fragile - and that image does not necessarily fit for rugby."

Especially not at grassroots level, where telling your mates you've got a headache and you're not feeling great is as likely to earn a chiding as it is a week off.

Nicky Allen - disaster waiting to happen

The news of Nicky Allen's death came as a great shock to a country that was aware he had special talents, but had never seen the full array of his instinctive gifts. With the benefit of hindsight, Allen was perhaps a disaster waiting to happen.

"In terms of the history of Nick's concussion, he started to suffer when he was at school at Auckland Grammar," older brother Rob says.

"He would come home and he couldn't remember parts of games, but it just wasn't taken very seriously in those days.

"He then suffered a very heavy concussion while playing with me at Kamo, in Whangarei. He was unconscious for at least 10 minutes, which is a really long time to be out cold, so to speak. He had a month or two out and then returned to rugby."

Allen was a bit of a rugby nomad. An artist on the field, he was also prone to a number of other injuries that restricted his appearances for the All Blacks to nine and his tests to two.

By 1983 he was used outside another burgeoning first-five, Grant Fox, for Auckland, but another injury saw him move to Australia, where he played club rugby in the 1984 season.

It could have just been any suburban match at any suburban ground - albeit one with an unusually hard surface - but in this particular club match a former All Black, one of the most talented players of his generation, was tackled, fell back, whacked his head upon the ground, fell into a deep coma and never woke up.

"I was in Whangarei and got a phone call from my parents saying he had been badly injured and it wasn't looking good. Somebody had got hold of Andy Haden and he had gone around and broken the news to my parents," Allen recalls. "I rang a doctor I knew and explained the circumstances as I knew them to him. He told me to get myself over there because it didn't sound like Nick was going to live."

Allen had suffered a severe bleed on his brain, was breathing only with the assistance of machines and, with his family at his side, the decision was made to switch off life support. On Sunday, October 7, 1984, Allen died.

After speaking out about the risks of head injuries, Rob Allen recalls taking a call from somebody at the NZRU, informing him that Nicky had not died as a result of concussion. One of his doctor friends was so incensed he was in the process of drafting a response when Allen told him he would rather let that sleeping dog lie.

"It's laughable they consider it wasn't concussion," Rob Allen said.

Yesterday: We detailed US research that links multiple concussions with long-term neurological problems and its relevance to our rugby codes.

Tomorrow: What is league, criticised for being "light years behind rugby" in recognising and managing head injury risks, doing to make the game safer? We catch up with Dean Lonergan, whose on-field fit still makes for tough watching 21 years later.

- NZ Herald

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