1 September 2002

Sport is taking head injuries seriously and the case of rugby coach Dean Ryan has helped to speed up the process

Ignorance can be a disaster – afterwards. Before that it can be quite a joke. It is like that with concussion. Ask Dean Ryan, Gloucester’s huge hard-man coach. If you are really stuck, ask me.

It must be 34 years ago that I got knocked out for 10 minutes at Haydock one Saturday, got a lift home, rode again and fell again at Leicester on the Monday, did the same on Tuesday and continued to bump round with varying degrees of impairment for the rest of the season. It was just four years ago that Ryan was knocked cold right on the whistle in Perpignan, came back to Newcastle and then within a week was knocked groggy against both Sale and Wasps before finally being laid out proper in full view of TV cameras at Bath. I got away with it. Exactly a year ago this week, Ryan realised that he hadn’t.

In the middle of the night, to the great alarm of his wife and two young sons, he had a full-scale epileptic attack. “After the convulsions were over,” he said in that deceptively quiet voice of his at Gloucester’s Kingsholm ground last week: “I was very dazed and rampaged round the house, fell over, crashed into a wall. My wife called an ambulance but it was not until our local GP came round that I calmed down. He realised what had happened straight away. It all made sense at last.”

For without knowing it Ryan had been having minor seizures two or three times a month ever since he returned to playing after his bad concussion against Bath. “In the day time I would suddenly feel very strange, like an adrenalin rush, at night time it would be nightmares. When I went to the doctor’s they said it was stress. But after the attack they discovered there was still some blood residue from the original bruise on the brain and trauma epilepsy can come if there is something in there to interfere with the electric waves in your head. It was a big shock to me. Of course, I was an extreme case but none of us players had ever connected epilepsy to concussion injuries before.”

For a moment you are struck by the apparent contradiction of Ryan’s position, preaching the perils of head injuries but then preparing 15 enormously powerful young men to launch into full-scale contact with their opponents. We are in a little, cubicled office set in the gallery above the gym. His and director of rugby Nigel Melville’s laptops are on the table, an array of high-tech training equipment is downstairs, round the glass window comes a V-sign made up of two sausage shaped fingers attached to what turns out to be a grinning Phil Vickery, the club captain. The penny drops.

For there need be no contradiction. The binding lure of rugby and the other contact sports runs as strong as ever. The risks will always remain but the preparation of the athletes and the assessment and rehabilitation of injuries is light years ahead of what it was. Any big club will have an exact benchmark of the individual speed, strength, skills, heart-rate and even body fat of every player back to which they work after injury. Except for head injuries. Except until now.

Before the start of this season every player at Gloucester underwent the Cogsport test, an internet delivered computer test devised in collaboration with the distinguished Melbourne-based neurologist, Dr Paul McCrory, who made his name with studies of concussion in Aussie Rules footballers. Using a pack of cards as stimuli, it assesses, to use its own jargon, “psychomotor function, decision-making, problem-solving and memory.” In essence it is a computerised version of Snap and Pelmanism and the results, especially those of the front row, are secret. It is only one part in filling what has been, for many sports, a sickening void in the treatment of head injuries. But at last it gives a baseline test against which recovery can be measured.

The Gloucester project was planned before Ryan’s arrival by the club’s medical officer, Dr Rob Mackay, and is matched up at Newcastle where all players were tested pre-season under the eye of Graham Wilkes, one of the few British representatives at last year’s Vienna concussion conference. These two men, along with Peter Hamlyn’s definitive work in boxing and the ubiquitous Michael Turner’s initiatives in racing, are setting a new agenda for head injury treatment which other sports will find no option but to follow.

The FA’s Alan Hodgson is keeping a watching brief and, while clubs were sent new guidelines last year, even some Premiership teams still have an attitude towards concussion not much better than the notorious “out cold, but got back up to score the winner” incident with Michael Owen in the World Cup warm-up match in Morocco four years ago.

No sport has any room for complacency. Last year a southern-based jockey drove all the way up to Kelso in Scotland, got knocked out in a incident-packed race, somehow passed the doctor, drove 400 miles home and next day rang up in horror at not recollecting a yard of his return journey. Next year racing will become the first sport to institute a Cogsport benchmark for all its participants at a cost of £100,000 a year.

“It is a start,” says Dr Turner, who was behind the first major head-injury conference in London four years ago where both Peter Hamlyn and Paul McCrory spoke, “but our attitude to concussion is still bizarre. In no other medical condition can you give a set time for recovery as most of our six-day, or 21-day tariffs do in sport.”

The echo chimes back from Gloucester: “If one of my players injures ankle ligaments, we immediately set in place a controlled rehab programme,” says Ryan. “If he gets knocked out we just used to say “play again in 21 days’. It was absolutely ludicrous.”

There is a long way to go. There will be all sorts of problems in exact diagnoses in the course of play or during a racing afternoon. Should there, for example, be a “head-bin” like a “blood-bin” in rugby? And how would you avoid coaches abusing it to change players on the pitch? But Dean Ryan’s example, and the work of Dr Turner, Peter Hamlyn and the other pioneers, insists that ignorance can no longer be an option.

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