Proposed " Class Action"

Smart gumshields that record the forces involved in collision sports are being used in the men's Six Nations for the first time. The gumshields, which contain a chip to record gravitational forces, are being gradually rolled out in professional rugby union. Few doubt that represents a step towards helping to better understand collision sports, but some of the research has been questioned by concussion experts, and there are calls for further change. Here's what you need to know. What is the background? Rugby union faces a crisis over safety, with hundreds of former players taking the game's governing bodies to court over the management of head injuries during their careers. In October, World Rugby confirmed smart mouthguards would be worn at the WXV - a new international competition - before being brought in worldwide from January 2024. That came after several trials and two academic studies funded by World Rugby - the results of which it said provided "players and parents with greater confidence than ever before into the benefits and safety of rugby". In October, chief medical officer Dr Eanna Falvey told BBC Sport the introduction of gumshields would be a "really positive" change. The gumshields - made by Prevent Biometrics - record the gravitational force (G-force) and direction of force involved in contacts, which are known as "head acceleration events". They can provide real-time data to a doctor or official on the sidelines, and be utilised to inform the Head Injury Assessment (HIA) process players go through after head contact. What did World Rugby's research say? World Rugby funded the Otago Community Head Impact Detection study (Orchid) and its Elite Extension study, which was undertaken by Ulster University. The Orchid study used smart gumshields to examine cumulative head acceleration events (HAEs) in male rugby players in New Zealand from the under-13 age group through to elite level. It found 86% of forces on the head in community rugby are the same or less than those experienced in general exercise such as running, jumping and skipping, while 94% are lower than those previously measured on people riding a rollercoaster. The Elite Extension study, which looked at both men's and women's rugby, found most contact events in the elite game do not result in significant force to the head, though forwards are more likely to experience force events than backs. World Rugby said the data provided "a complete picture of playing rugby like never before". Its chairman Sir Bill Beaumont - a former England captain - adding the Orchid study was "concrete proof" the organisation was putting time, energy and effort into making the sport even safer and would "never stand still on player welfare". World Rugby has developed minimum specifications for smart gumshields - which include independent testing - and says it will review them every six months. The Prevent Biometrics gumshield was chosen for roll-out as World Rugby said it was the only manufacturer to meet its specifications. A trial in 2019, when players from Welsh clubs Ospreys and Blues wore smart gumshields during a Pro14 match, used Protecht gumshields. What has been the criticism? The Orchid study's lead author acknowledges the technology is still in its infancy. Professor Melanie Bussey, of the University of Otago, said: "Player safety is our utmost concern, and this technology is giving us the best chance we have of understanding the multifactorial nature of head injury in sport. "But we need a lot more research to understand the clinical relevance of this data. That is how science works." However, two concussion experts have said data from force events below 10G should have been disregarded, and there should have been greater detail for data recorded over 60G. Events under 10G are similar to those experienced riding a rollercoaster or trampolining. Recent studies have found American Football players diagnosed with concussion had HAEs ranging from 40-150G. Professor Alan Pearce, of La Trobe University in Melbourne, said it was "quite puzzling" that all forces over 60G were grouped together in the study. "There is plenty of evidence to say that there are a lot of impacts, not just concussive impacts, above 60G, so it takes out a lot of data," he added. "Rugby is saying a lot of the hits are no different to skipping and running... that's a clear case of if you're starting to collect data below 10G, well you can say things like that." The main author of the Elite Extension study said all impacts above 60G were grouped together because there were such a low number of them. But Dr Doug King, a New Zealand-based expert in head injury and head biomechanics, said concussions often occur above 90G and was therefore concerned the data was not showing "the full picture". An academic paper presented to the International Research Council on Biomechanics of Injury last year said the technology in the Prevent gumshield underestimated acceleration in higher-speed impacts Professor Damian Bailey - director of the Neurovascular Research Laboratory at the University of South Wales - said: "There are justifiable concerns that some of the really big impacts that can really cause damage are going to be missed - going above 100G, for example. "It can be quite rare, but these are events that are really important to capture." In a statement, Prevent Biometrics said its Intelligent Mouthguard system was "the most widely evaluated and independently scrutinised head impact sensor on the planet" having gone through "thousands" of laboratory tests that were peer-reviewed and published. World Rugby said the studies were independent, and data had been "accurately reported in full and independently peer-reviewed". Of the seven co-authors of the Orchid study, five declared conflicts of interest, and two co-authors of the Elite Extension study were declared as World Rugby employees. While it is common for sporting bodies to fund academic research, Prof Pearce said "a number" of scientists were "very concerned about the independence aspect". "We're walking a very fine line between true independent research where funding organisations, including sport, should be able to give the money but have absolutely no involvement whatsoever," he said. In response, the lead author of the study told the BBC that World Rugby was "not involved in the study's data processing, data analysis and interpretation of the research or outcomes" of the research to protect its integrity. Prof Bussey added: "As academic researchers we have our own ethics and standards to uphold. Our research stands as independent work that has been published in one of the top scientific journals in our field and has been independently peer-reviewed by multiple, highly reputable, senior researchers in our field. "We stand by our findings and our own integrity as researchers. From the outset our position with world rugby was that 'we will follow the data wherever that takes us'."

There are four from my own club, three of whom I knew well. One of which I am not surprised at as his career was finished very prematurely by head injuries- I got to know him very well at the time and despite my medical training it shocked me to hear of it. Another was very high profile at the time. The other two are two brothers, whom I knew reasonably well but I never knew either of them to struggle with concussion. Both of them struggled with various other injuries but never concussion. It just goes to show what was going on behind the scenes. 

Link if anyone is interested- 

You need to scroll to the bottom to see the list in full. 

As long as good tackling technique is being coached there should not be a problem. 

There has not been enough research in the women's game on issues such as concussion, rugby bosses have admitted. Concerns are being raised by experts over head injuries in the sport and the gap in knowledge about how they are sustained, prevented and treated. Ex-Wales centre Alecs Donovan said when she got concussed playing for Ospreys she was "not even sure we had a physio. There wasn't that medical support". World Rugby said there was a "definite need" to close the gap in knowledge. Women's rugby in Wales has hit new heights with a surge in popularity and professional contracts for the international team. ... World Rugby said it was working with other organisations on projects to gather data in the women's game, including the debut of smart mouthguards at the new WXV tournament.  Donovan, 32, and her ex-Wales teammate Elinor Snowsill were both affected by concussions during their careers. Donovan, who played for Wales until 2021, said one time "I actually didn't know I was concussed" when she suffered a head injury while playing for her club side about seven years ago. Ospreys declined to comment. Fly-half Snowsill, who retired from international rugby in 2023, said there was still a reliance on male research for the women's game. She told Wales Live: "Most of the things we do currently - the way we eat, the way we train - a lot of it is driven from and based on research on male athletes. "But, we have completely different bodies, we play differently and we train differently. "I think it's really important in concussion and in other areas that we increase how much research there is out there, specifically on female athletes." Researchers say much of the focus around head injuries has been on the men's game for many years. Cardiff Metropolitan University lecturers Dr Izzy Moore and Dr Molly McCarthy are collaborating with higher education facilities around the UK to work on filling that gap in people's knowledge. Dr Moore said the lack of female-specific data meant "we are missing a huge piece of the jigsaw puzzle in looking after our female players". One of these projects - led by Swansea University - involves gathering and monitoring data by using mouthguards that measure the force of head impacts during play and analysing videos from training and matches. Dr Moore said: "When we look at the videos in the women's game we see over 50% of head impacts are occurring as players fall to the ground. "Whereas in the men's game they have the stronger necks and they sustain head impacts mainly through direct body contact in a tackle event." World Rugby data suggests women sustain head injuries mostly through head-to-head contact, which is different to that of a number of academic institutions in Wales. Dr Moore said the age both sexes start playing might affect how they play and suffer injuries, with women often playing for the first time at university. This gives their male counterparts a 10-year head start, with the early years "really important for developing their skills and tackle proficiency". She added: "We may have women players who are going out on to the pitch for the first match they play and are still learning how to tackle. That may increase their injury risk."

Thomas Owens, co-lead investigator on the University of South Wales (USW) study, said research found that retired players with a history of concussion had mild cognitive impairment. "This is a state whereby the cognitive function of these individuals, in term of the way someone thinks, remembers information, processes that information and co-ordinates the body's movements declines over time, and particularly throughout ageing". He said this put them at "increased risk of developing neurodegenerative diseases later in life". But the researchers said not everyone who played contact sports would go on to develop cognitive decline. ... Scientists at USW's neurovascular research laboratory analysed the brain health of 20 retired players aged between 60 and 80 who had suffered concussions. For the first time, researchers found they had reduced blood and oxygen flow to the brain due to less nitric oxide, which helps blood vessels regulate blood around the body. Some exhibited signs of mild cognitive impairment and all were outperformed by the control group in cognitive function tests. The researchers said this was the first study to determine mechanisms that may cause cognitive decline and has implications for other contact sports. It is hoped the research may contribute to improving protection for players and help with the introduction of pitch-side blood or saliva tests for concussion. Mr Owens said: "It's important to note that we don't want to stop players playing rugby, but we want to make them inherently aware of the risks associated with forms of brain trauma and concussion. "Make them aware, improve the way that we detect concussion at the pitchside and then improve the way we care for players following retirement." ... There are other studies taking place investigating the health of former players. Lifestyle changes, including poor diet, alcohol dependency and lack of exercise may also accelerate the cognitive decline of former athletes. USW researchers said they recognised this study had limitations in the relatively small sample size and it relies on participants remembering past concussions. But they are aiming to carry out a larger study and investigate the potential differences in brain health between male and female athletes in contact sports.

It's not about using today's knowledge to hold the past responsible though, it's about trying to understand if the past's knowledge was applied at the time. If it wasn't, there's a case. The whole thing with tobacco is not 'we know there's a problem now, so we'll hammer the tobacco companies for what they did then', it's 'the tobacco companies knew/suspected more than they let on for a couple of decades so we'll hammer them for the damage done while that was the case.'

What's (potentially rightly) worrying people in rugby is that there *could* be a similar situation - and part of the court case is to get to the bottom of that - or at least start the process. I don't want to fall into lazy 'no smoke without fire' cliches, but people are a bit worried for something where they know no-one's done anything wrong. 

On the second bit, it'll end up being like car insurance. *If* there's actually a case to answer, and to be honest all anyone at the moment is doing is - probably rightly - looking into it, then it'll be at best 'being a rugby player was on the balance of probability a contributory factor', and settlements will have to reflect that.

You're absolutely right that we're probably sailing into the waters of existential crisis at this point, but we can't (and arguably shouldn't) therefore just wish it away.

Very well argued Sid, I agree. 

There are a number of points to consider.

 

A governing body has a duty of care to its players. The crux of any legal case is when did the RFU etc know of the potential for injury and what did it do about it.  If the dangers were known but nothing was done about it then the legal cases stand a good of winning but on the other hand if the dangers were not known and therefore nothing was done because of this, then it reduces the chance of a succesful claim.  For me of us, this is a 'new injury' and not known to us when we started to play - unlike, for example the chances of a broken leg.  Players accept a certain chance of injuries - would they have played if they knew head injuries could cause dementia? 

Secondly is there a difference between playing as a social amateur (pre 1995) and a semi-pro/professional player post 1995 (talking just Rugby Union here).  For the latter the employer has a duty of care in addition to the governining body; but for the former who other than the RFU etc had a duty of care?  Does that duty of care fall upon the coaching or medical staff who may have insisted a concussed player get back into action. How far down the 'chain' does the responsibility/duty of care lie? 

Does the player share any responsibility - for example knowingly playing on when injured?

Thirdly, how do you separate when the damage was done - was it the first injury in a club game as a amateur, or a third knock playing for your club as a professional or a concussion whilst on international appearance.  How easy is it to understand who is responsible?