Rugby: Getting head around injury risk

Conrad Smith lies prone after making a poor tackle. Photo / Getty Images

As New Zealand rugby attempts to become a world leader in its management of head knocks and concussion, it may find it can never do the right thing.

Across all mediums last week, the consensus was that Conrad Smith should consider retiring after suffering another concussion - his second this year. He also suffered concussion in 2010 and has endured several significant head knocks over his career.

To many, that's enough for him to be branded a madman for continuing to play. It was even suggested he would be setting the perfect example if he retired now - a sacrificial lamb to illustrate to his peers just how seriously everyone should be about concussion.

On one level, this heightened concern and caution is to be welcomed. It's a far cry from the bad old days when players were encouraged to deny they had been concussed. It's a vast improvement from when players would be mocked as soft if they were knocked out during a game, or singled out for forfeit or good-natured ridicule when the doctor asked them their name and they couldn't remember.

No matter how wistfully the old timers speak of those days and yearn for their return, they weren't good: they weren't anywhere near as endearing or as fun-filled as they might seem in the retelling.

Yet nor should there be rejoicing at this new state of affairs, where every head knock comes with a veiled warning that it is potentially career-ending. The reason New Zealand is leading the way in management of players who suffer concussion is that each case is treated as it presents.

There is no blanket rule as there used to be when a mandatory stand-down period was imposed. Every player who suffers a concussion must pass a gradual scale of testing that links to their level of activity at training. No one can con the system and the prevailing attitude in professional circles is that concussion victims are off limits to subtle, or not-so-subtle encouragement they get back on the field.

Research in the field is lacking but what's not disputed is that any player forced into playing before he has fully recovered from a concussion is putting his immediate health in serious danger.

What every rugby follower in New Zealand can take a degree of comfort from is that the welfare of the players is paramount. In the case of Smith, he won't be lacing up his boots again until he's passed rigorous tests and satisfied various medical staff that he's ready to play.

But it's the question of Smith's long-term health that remains uncertain. The medical fraternity can't agree on the effects of continued brain injuries. There are conflicting views about degenerative damage caused by accumulated incidents.

The prevailing view in New Zealand is that there is not yet compelling, if any, evidence to suggest that a player who endures repeated head knocks will be more prone than his peers who don't, to suffer degenerative brain conditions later in life.

Research in the United States, based on studies involving NFL players, takes a different view and there is a growing lobby of doctors who say it is almost a negligent stance to not assume repeated blows increase the likelihood of longer term damage.

But playing professional rugby increases the likelihood of individuals suffering from all manner of degenerative conditions post-career.

Any loose forward who lasts a decade at the top level can expect to need at least one shoulder replacement before they are 50, if not two. Many players can look forward to crippling joint pain and any number of osteoarthritis complaints.

Given the emotional and financial rewards a long career can bring, players will take their chances at what the 'after-life' holds.

Without conclusive, indisputable proof that their long-term health is being endangered by repeated head knocks, those who suffer multiple concussions are more likely to carry on playing than they are to retire.

Smith, should he be passed fit to resume playing, is almost certain to do so. That doesn't mean the rugby fraternity has been irresponsible or negligent in its care of duty. It doesn't mean Smith has set a poor example to younger players or dismissed the seriousness of concussion.

All it means is that on the balance of the evidence, he's concluded that he's comfortable with the level of risk he may or may not be taking by continuing to play.