Paul Tito's career ended on March 3 this year, playing for his adopted Cardiff Blues in Treviso, Italy. "It was a poor one to finish on," he says from his home in Oakura, near New Plymouth.

On the contrary, most medical experts would say it was exactly the right one to finish on.

In the 62nd minute of the match, just another on the endless treadmill of fixtures the big European clubs embark on, Tito was replaced by Ma'ama Molitika. It's a banal statistic that tells nothing of the preceding drama.

Tito had gone in to make a front-on tackle, got his head in the wrong place and was left dazed. Worse, the ball had spilled loose and, despite Tito being in a foggy state, instincts honed over a lifetime of rugby kicked in.


"I dived for the ball. I wasn't feeling a hundy [100 per cent] already and that's when I collided with this big bugger. Not good."

As far as concussions go, it was big.

Tito returned to Cardiff, where he sat around at home for a month, not doing anything except creating a black cloud above his head.

In his spare time he had the opportunity to contemplate not just the events at Treviso, but another bad "knock" he had taken during a New Year's Day fixture against Welsh rivals Ospreys. There were a couple of other "knocks" too, which Tito had not reported.

To doctors, particularly neurologists, this would be a staggering oversight; to rugby players, according to Tito, it is part and parcel of the life of a professional.

"I think that's everyone's attitude," he says of failing to disclose injuries. "If you stop for every injury you have, you wouldn't play often. Ninety-five per cent of the boys I know will try to get around it."

Therein lies rugby's biggest dilemma: how do you effect a quantum shift in attitude, yet still cultivate players with the necessary tough-as-teakness to play at the highest level?

Tito's attitude may seem blase, shockingly so, but it permeates every level of the game.

Stephanie Bygrave didn't quite know how to react when she saw her husband Mike get laid out after a heavy collision in a club game. Fear and concern was writ large on her face. When Mike's Auckland University teammates and friends saw her state ... they laughed.

"They were saying, 'Oooh Steph, are you worried?' she remembers.

"They made me feel like I was over-reacting, like I had to play it cool and couldn't let on I was worried."

Mike, who had been concussed twice before, suffered transient global amnesia - characterised by short-term memory loss and repetitive behaviour.

As a confused and increasingly paranoid Mike asked the same question every 30 seconds during the drive to hospital, Stephanie failed to see the funny side of brain injuries.

New Zealand rugby folklore is littered with stories of bravado on the field - Colin Meads playing with a broken arm, Buck Shelford and his torn scrotum, and Dick "Red" Conway, who had a troublesome digit amputated so he could tour South Africa in 1960.

Our rugby culture demands a tolerance to pain. Getting back into the fray after a bone-crunching tackle is seen as a mark of a courageous player.

Dr Steve Marshall, an academic whose interest in concussion and rugby was piqued by Otago University's ground-breaking RIPP study in 1993, calls it the "badge-of-honour syndrome".

Marshall has been based since 1994 at the University of North Carolina, where he leads the Injury Research Prevention Centre.

"It is not wanting to let the team down. The game has evolved but the attitudes of some players haven't," Marshall says. "With muscoskeletal injuries there's a certain amount of bragging rights. The brain is different - we have to remove concussion from that part of the discussion. The brain is an organ of enormous complexity, but it's also an organ that has the ability to heal itself. But it needs time to heal.

"We need to convince players that they are doing their team a favour when they take themselves out of the game with a concussion. There are bigger things at stake here than points on the board. In saying that, the NZRU is making genuine ground."

Some of the ground has been gained by the ACC-driven RugbySmart programme. Operating since 2001, it gives information to all coaches and referees - from the under-14 grades through to the elite level - about best current practice on how to recognise, manage, assess and treat concussion.

Still, the messages remain at odds with deeply ingrained rugby culture.

It wasn't really Tito who called time on his career, but his wife, Hayley.

She got "really forceful" with their doctor after what Tito euphemistically describes as "an average month at home". He couldn't drive because his vision remained blurred. He couldn't even watch television for any length of time because it would spark severe headaches. With two young children buzzing around - Libby and Ollie, now 3 and 2 - Tito wasn't much use to anyone.

He couldn't exercise, the primary release of the athlete. Even now he limits himself to two jogs a week.

The doctor asked Hayley why he didn't know all that information about her husband before; she explained that was how rugby players worked.

"In the end the doctor sat me down and talked about the problems I could face after rugby," Tito says.

He looked at his kids, too, and, at 33 going on 34, rugby's significance started to fade. "I thought, 'What if I play one more game of rugby and something bad happens to me?' What if I wasn't able to chuck a ball around with my kids. It was sad I wasn't able to go out on my terms, but there are a lot of people worse off than me."

Among that number he counts Taranaki and Chiefs prop Shane Cleaver, whom he has spent time with recently. At just 25, at the start of a professional rugby career, Cleaver is wrestling with the same decision Tito had the luxury of making after 14 years of earnings.

"He's the sort of guy I feel sorry for," Tito says. "He has to make a decision and it might be the hard one."