The South African rugby team’s medical caretaker Craig Roberts MD has given the entire Bok squad a clean bill of health – an exceedingly rare feat in the crash bash environment of international rugby. Despite a few minor strains and the travel-related fatigue that comes with foreign territory, the Springboks are all available and raring to go against world champions New Zealand. That’s the good news I’ve been digesting, but it comes against the backdrop of a health issue that hasn’t been given nearly enough attention, mostly because its life-threatening symptoms only materialise in later years.

Concussion is a reality in modern-day rugby. It is, however, not regarded as a potentially life-threatening injury. Players and medical staff concern themselves more with cuts to the eye, knocks to the joints and bruises to the flesh than with extended damage to brain tissue. This is ironic, considering that the brain is the organ all players will have to look to for their livelihood once their on-field talents and physical attributes have faded.

Australian journalist and author Peter FitzSimons (a former Wallaby) has been beating the drum on the issue, highlighting the long-term dangers of concussion which is about to impact another generation of ex-players. In a recent article, he berates the IRB’s so-called “five-minutes” test that allowed a severely concussed George Smith to return to the field in the deciding test match against the British & Irish Lions. While fans and commentators hailed Smith’s resurgence as a miracle, FitzSimons was one of the few voices calling the situation a disgrace.

In other sporting codes, the after-effects of brain injuries are starting to get some attention – and the lawsuits are mounting up. Grievances by 4,500 former American football players in the National Football League (NFL) in the USA culminated in a class action suit brought against the sport’s governing body, recently settled with a $765 million pay-out. Not only has the league been forced to update its protocols for dealing with concussion and related injuries, but it is now rolling out a mass medical exam programme to determine the full extent of the issue. It’s also investing $10 million into a research fund.

Considering that American football is a sport where helmets have been mandatory since 1943, one can only imagine the sea of trauma-induced head injuries lurking within the rugby-playing fraternity.

Yet very few players opt for the protection of high impact foam headgear. When they do, it’s usually because they have already suffered some sort of head injury. As an ex-international player that celebrated space instead of the heavy collisions, I understand the impact that one goes through in an international game – but it takes credible research and understanding to be able to show the possible impact that those head knocks may have on a player’s future cognitive ability.

Every time I engage in conversation about players we see with post-career afflictions, it astounds me to hear the number of alternative theories that abound, all detracting from the seriousness of the collision-intensive game. From high stress environments, to sucking fertilizer-poisoned golf tees while enjoying the long walk spoiled – the lack of research and evidence only dilutes the focus that is needed to tackle the issue at hand. We need more scientific facts and studies to support those arguments highlighted by FitzSimons.

As eager and fighting fit youngsters, minor concussions can be shrugged off within minutes. It’s only in later years that players really feel the true effect of concussions, seeing stars for longer periods of time and struggling with short-term memory recall.

I can recall at least four games I played in where the entire second-half is a blur, as a result of a knock to the head. In two of these – a Super Rugby clash against the Brumbies and a World Cup warm-up against Connacht – I was robbed of any memory of the game itself and the post-match events.

FitzSimons, in his effort to publicise the threat of concussion to players today, came up with a short verbal exam that tests the recall ability of the subject, and can be used to assess whether someone is suffering from any of those ramifications. To my relief, I managed to pass his examination on a flight en-route to Brisbane. But I wonder how many others wouldn’t be as fortunate me and, even worse, don’t realise they could be victims of long-term damage to the brain.

There is clearly a problem in professional rugby and more people within the structures of the game need to be made aware of the dangers. But, it seems, few are interested in listening. Ex-IRB medical advisor Barry O’Driscoll (a former international himself and uncle to the fleet-footed Brian) resigned from his post of 15 years at the IRB last year, citing the organisation’s lack of understanding about the negative effects of concussion. He too raised the red flag following the treatment of George Smith in that final test match, calling for an urgent review of the way the IRB deals with concussion.

In America, much of the research conducted by the NFL has focused on Chronic Traumatic Encephalopathy (CTE) in elite athletes. CTE is a form of encephalopathy, a progressive degenerative disease often associated with people who have a history of multiple concussions. It is already clear that damage to brain tissue can also cause other forms of neurological damage. Despite these findings, and similarly disturbing studies from other sports, rugby has yet to commission research into the area. Given this, it’s hard to believe that the IRB’s Sideline Concussion Test is an effective tool to combat the problem.

As South Africans, we don’t have to look hard to find top players suffering from brain-related diseases, with Joost van der Westhuizen the most obvious example. Other sufferers include Andre Venter, Thinus Linee and the late Ruben Kruger, all of whom were handicapped by diseases that could have had trauma-induced beginnings. And if the strike-rate is so high within a small group of household names, the scary question is how much deeper does the problem go?

These former stars get our attention, sympathy and support but how many others, in every level of South African rugby, are being sent back into the field after a seemingly innocuous concussion that could in fact cause long-term damage or even life-threatening ailments?

Right now it feels like the test against the All Blacks is the only life-threatening event ahead of us, but we urgently need the South African Rugby Union to commission in-depth research into concussion, as well as make provision for the young men of the game to be tested on a regular basis. It’s the least we should do for those who put their bodies on the line for our provincial or international teams.

It’s a cold hard thought, I know, but New Zealand can be a cold hard place and it makes you think just a little bit harder about what we are actually all playing for and whether each game really is a life or death experience. DM

Read more:

• Former IRB medical chief demands action on concussion on ESPN Scrum
• Sideline concussion test a disgrace from the Sydney Morning Herald
• NFL Agrees to Settle Concussion Suit for $765 Million from the New York Times