Rugby concussion, ski trauma and horse racing’s orthopedic textbook

Domhnall MacAuleyDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

Concussion is in the news again. In the first of the Six Nations Championship matches, George North of Wales suffered two blows to the head during the game against England. Peter Robinson, whose son Ben died in 2011 at age 14 after a schools match in Northern Ireland, was quoted in the Times “We are using these players as guinea pigs. I thought Ben’s death was the tipping point when they realised they had to do something, but I don’t think anything drastic will happen until there is a tragedy involving a famous star live on TV. We need a culture change.” Since the weekend, the medics, the coaching team, the concussion protocols and the rugby hierarchy have all been criticized.

Rugby has a problem, there is no doubt, and concussion is a major worry for players and the future of the game. Professionalism has changed the nature of the sport. The players are bigger and stronger, the hits are harder, and it has become an impact sport in contrast to the pre-professional game in which the primary skill was in avoiding the tackle. Medicine must take a strong position, and a recent BMJ editorial and editor’s comment  were encouraging, but the medical reaction should be evidence-based rather than emotive. The science is complex, as Paul McCrory, a world expert from Melbourne, has often pointed out — most clearly at last year’s World Congress on Injury and Illness in Sport. We cannot predict who will be affected and how, but we need to remember: concussion is brain damage, even if it is transient.

The world skiing championships were a stark reminder of the risks of downhill ski racing. Live sport may also mean televised trauma. As Ondrej Bank approached the end of his run in the downhill component of the combined event, he lost control after a jump at around 75 miles per hour.

The crowd gasped and watched silently as medics administered to him within full view of the grandstand. The television shots were mercifully discreet, but the horror was clearly reflected in spectators’ faces. Skiing authorities have been working hard to make the sport safer. but this event reminded viewers of the high risks. It was another blow to the Beaver Creek organizers who had hoped for a glorious and flawless event showcasing the best of the United States. The US mens’ downhill team had helped maintain morale among supporters already disappointed by Lindsay Vonn’s failure to bring home the expected gold medal after her superb return to form in Europe following her cruciate injury.

But let’s leave the final sports medicine reflections to the truly legendary jump jockey AP McCoy, who announced that he will be retiring at the end of this season. After what will be soon be 20 successive champion jockey titles and an orthopedic textbook litany of fall-related injuries, including 29 fractures, he intends to hang up his silks at the end of this season. “I’m so up on medical things now I could nearly be a doctor … You only worry about your head or your spinal column. Everything else, some way or another, will repair in time.”

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