Tackling Rugby: What Every Parent Should Know

By Allyson Pollock

On 29 January 2011, Benjamin Robinson was playing rugby for his school. During the match he sustained a concussion but was not taken off, and was allowed to continue with the game, in which he endured a second impact. When play ended, he collapsed, dying two days later as a result of his injuries.

Every week young children are hospitalized on the playing fields of Britain. Yet the subject is rarely investigated, injury data are not systematically collected, and as a result any real attempt to work out how to make youth rugby safer is flawed. Using meticulous, peer-reviewed research, leading public health specialist Allyson M. Pollock sets out the true risks associated with the sport, raising uncomfortable questions for politicians and the educational authorities.

• Language: English
• Publisher: Verso Books
• Release date: Oct 7, 2014
• ISBN: 9781781686034

Book preview

Tackling Rugby

Tackling Rugby

What Every Parent Should

Know About Injuries

Allyson M. Pollock

First published by Verso 2014

© Allyson M. Pollock 2014

All rights reserved

The moral rights of the authors have been asserted

1 3 5 7 9 10 8 6 4 2

Verso

UK: 6 Meard Street, London W1F 0EG

US: 20 Jay Street, Suite 1010, Brooklyn, NY 11201

www.versobooks.com

Verso is the imprint of New Left Books

ISBN-13: 978-1-78168-604-1

eISBN-13: 978-1-78168-671-3 (UK)

eISBN-13:978-1-78168-603-4 (US)

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Library of Congress Cataloging-in-Publication Data

A catalog record for this book is available from the Library of Congress

Typeset in Fournier by MJ & N Gavan, Truro, Cornwall

Printed in the UK by CPI Mackays

For Hamish and Hector and their cousins,

Lucy, Patrick, Olivia, Alastair, Neil, Kelly,

Jamie, Catriona, Rory, Rebecca, Annie,

and for all children who love to play

For Ian Basnett

Contents

Introduction: Play the Ball, Not the Child

Part I. Foul Play: The Hidden Truth about Rugby Injuries

1. Another Injury, but Not Another Statistic

2. Rugby’s Web of Interests

3. A Pilot Study of Injuries

4. Marginalising the Cause of Public Health

5. The Indemnity Question

6. The Cost of Injuries

7. Impossible to Ignore

Part II. Hospital Pass: Questions for Parents to Ask

1. What Is the Risk of Injury if a Child Plays Rugby?

2. How Does the Risk of Injury in Rugby Compare with Other Sports?

3. What Kinds of Injury Are Common?

4. What Is Concussion and What Effects Can It Have on a Child’s Long-Term Health and Academic Progress?

5. How Much Time Do Injured Children Lose from School and Sport?

6. What Phase of Play Is Most Dangerous?

7. Which Is the Most Dangerous Position to Play In?

8. What Other Factors Affect the Risk of Injury?

9. What Steps Can Be Taken by Children and Schools to Prevent Injuries?

10. Will Protective Equipment like Mouth Guards and Head Guards Make a Child Safer?

11. Are Injuries a Big Reason for Children Giving Up Rugby?

12. What Are the Financial Costs of Rugby Injuries?

13. Can a Parent Withhold Consent for Their Child to Play, Especially in Schools Where Rugby Is Compulsory?

14. What Questions Should a Parent Put to a School about Its Injury Procedures?

15. Where Can Parents Seek Help?

16. What Can Be Done to Improve the Monitoring of Injuries in Rugby and Other Sports?

Part III. Peroration

Acknowledgements

Appendices

Notes

Further Reading

Index

Introduction

Play the Ball, Not the Child

Today in the United Kingdom it is almost impossible to have a rational conversation about the risks of rugby to children without provoking shrill cries about the ‘nanny state’. Every year more names are added to the list of children seriously, and occasionally fatally, injured playing the game, yet our schools, sporting authorities and government departments are failing even to properly monitor rugby injuries or assess the risks. It is as if we have collectively chosen the bliss that comes with wilful ignorance to avoid the uncomfortable truth that the evidence may reveal.

Throughout the playing season, images of heads slamming against heads, bodies colliding with bodies are beamed to our TV screens from the grand stadia of the professional game. The same is happening on the windswept school pitches where our children compete. For every man injured in professional play, thousands of young boys and girls are being hurt. The vast majority of them will never make professional players, but no matter. Believing that the game is their moment of glory, the children throw themselves into the fray until, damaged, they are discarded, and new children take their place.

Studies show that injuries to children as a result of rugby are common, and can have very serious consequences. We need to have an urgent debate about whether the rules of children’s rugby should be radically changed, and whether it should remain a compulsory sport in some schools. This book does not call for an outright ban on school rugby, but it does demand that more rigorous evidence is collected to inform a discussion about how this much-loved game can be made safe for children. Once the true facts about rugby injuries become widely known, many parents may indeed be moved to call for a ban on school rugby. But as a matter of urgency we must, at the very least, ask why parents are not required to give consent for their children to play; why rugby remains a compulsory part of the curriculum in many schools; and why we do not systematically monitor and publicise the risk of injury from what is obviously a dangerous sport.

Original research presented in these pages suggests that children playing rugby have at least a one-in-six chance of being seriously injured during a season. A separate study, from an accident and emergency department in Northern Ireland, found that 43 per cent of all sport-related injuries in secondary school children were attributed to rugby, three times more than any other sport.¹ Evidence confirms that injuries resulting in a prolonged absence from rugby and from school are common, and often bring wider physical, financial and psychological costs for children and their parents.² A significant proportion of injured children do not return to play within three weeks, and their injuries can have a profound impact on confidence and education. There is an established, although small, risk of permanent disability and even death from playing rugby.³ Crucially, a large proportion of young players who have suffered serious injury believe that it was preventable.⁴

Concerns about the safety of rugby, especially for young players, are not new. For over thirty years there have been warnings.⁵ The evidence is stacking up, despite this being a shockingly neglected area of study. But the issue has been obscured and hidden from public gaze; injuries are ‘rugby’s dirty secret’.⁶

In January 2011, fourteen-year-old Benjamin Peter Robinson from Northern Ireland collapsed on the rugby field after a tackle in the final minutes of a match. He later died. At his inquest in September 2013, the coroner ruled that Benjamin died from ‘second-impact syndrome ’. Second-impact (or double-impact) syndrome occurs when a player sustains a second brain trauma before recovering fully from a prior concussion or other serious brain injury. Benjamin had continued to play for twenty-five minutes following two heavy collisions and concussion, before a final blow killed him.⁷ Criticism was levelled at the school for allegedly attempting to hush the matter up, and the police initially failed to investigate properly. It was the children who finally spoke out, saying they knew that Benjamin had been knocked out earlier in the game and that he ‘didn’t look right’.⁸

Lucas Neville is another victim of the game, although he has lived to tell the tale. He was just eighteen years old, a brilliant scholar and in the last year of school, when called upon to play in the last minutes of a school match, despite having previously been concussed in rugby training. He suffered a second, serious brain injury that left him seriously and permanently disabled. He is now suing the school and the hospital in Dublin for more than €5 million in damages for negligence – the school for failing in its duty of care to him.⁹

Although, shamefully, the cases of Benjamin Robinson and Lucas Neville received very little attention from politicians at the time, they did highlight just how high the stakes are. Several of the injuries commonly sustained by rugby-playing children are extremely serious. Concussion is one of them. Aside from the risk of second-impact syndrome, head injury can cause internal haemorrhaging and bleeding, hearing loss, blindness and long-term or permanent damage to the brain. Then there are the spinal injuries also prevalent in the game, especially among forwards, which can leave young players paralysed for life. A glance at the websites of charities like Hearts and Balls, set up to help seriously injured players, reveals the hidden dark side of rugby and the anguish of so many families struggling to cope with the life-long consequences of a single moment on the pitch. And not to be underestimated, there are the smashed bones and torn ligaments that can cause lasting physical damage, put an end to the enjoyment of sport and have profound psychological effects. Most of these injuries occur during tackles and scrums – the contact elements of the sport.

One thing is for sure, we are not doing enough to prevent these injuries, and that will only change when the tyranny of silence surrounding the subject is broken. If the arguments for changes to the game or a ban on children’s rugby sound extreme in the current climate, it is only because our ignorance is so deep and the taboo of speaking out so great. Information on school rugby injury is scanty because rugby unions and public authorities have conveniently failed to collect systematic data or to provide parents with clear information about known risks. The refusal to make a serious attempt to gather that evidence raises the question of why so little is being done.

A key explanation is the commercial power of the sport itself. That power, concentrated in the top-tiers of the professional rugby unions, recoils at the idea of proper monitoring of rugby injuries, perhaps because it knows that the facts could create a backlash of bad publicity and litigation and put parents and children off the game.

Rugby unions are large businesses. Over an eight-year period (2004/5 to 2012/13) the English Rugby Football Union (RFU) grew its revenue by 81 per cent, from £84.8 million¹⁰ to £153.5 million¹¹ – by far the biggest revenue of any rugby union in the world. During the same period, the revenue of the Welsh Rugby Union grew by 48 per cent to £61 million,¹² and its Irish counterpart grew its revenue by 58 per cent to €61.2 million.¹³ Rugby union as a whole was the fastest growing market of any sport globally from 2005 to 2009.¹⁴ A look through the accounts of these unions reveals a preoccupation with income generation – recruiting players, growing the fan base and expanding corporate and government sponsorship.

In England, viewing figures for international rugby demonstrate the game’s popularity. In 2011, the Six Nations tournament matches attracted an average of 4.6 million viewers, with the most-watched match, between England and France, being seen by 9.6 million people on BBC1.¹⁵

In terms of participation, rugby union is the most popular high-impact collision sport and the third most popular team contact sport worldwide.¹⁶ There are an estimated 6.6 million rugby union players in the world, across 119 countries; 2.4 million of them are registered players and around 1.5 million are women players.¹⁷ The sport is increasing in popularity internationally, with a hundred countries now occupying a world ranking, and rugby union ‘sevens’ (an abbreviated form of the game) returning to the Olympic Games in 2016. However, compared to the big international sports the numbers involved are still small – football had 38.3 million registered players worldwide in 2005.¹⁸

The rugby unions need parents to send their boys and girls into the system, from school teams to junior clubs to college and university teams. Without them there can be no game. As the Guardian reported of the English RFU, ‘Among various initiatives is a desire to install Wi-Fi into more rugby clubhouses, on the basis that modern teenagers won’t hang around long there otherwise. A World Cup on home soil in 2015 is also a perfect opportunity to encourage more women to embrace the sport, both on and off the field. In terms of inspiring the next generation it promises to be English rugby’s Olympic moment.’¹⁹

England has the largest number of rugby union players of any country in the world. It is estimated that 1.2 million children play rugby in schools and clubs in England. However, between April 2012 and April 2013, only 0.5 per cent of the over-sixteen population of England played rugby union or league regularly, compared to 6.6 per cent who went swimming, 4.5 per cent who took part in athletics and 4.5 per cent who played football.²⁰ So in England and parts of Scotland, rugby union is widening its base from its roots as an elite sport for public school boys. In the last few years, in an effort to expand its income, rugby has extended its reach, opening its doors to both genders, as well as all ages and social classes. Rugby unions are targeting new initiatives at poorer areas, such as Newham in East London and parts of Lothian in Scotland, to get fresh blood into the game, a drive that will only exacerbate the existing inequalities that see poor children suffer a much higher injury rate than the well-off.²¹ More women are taking up the game than ever.²²

If the numbers playing rugby at youth and amateur levels were to decrease, so too would rugby’s support base and, consequently, the sponsorship and broadcast revenue that generates the income for the business. Information about levels of injury is a threat to this business model, which is why requests for data may be met with hostility or refusal. But as I show in Part I, rugby authorities occupy a key role in a web of powerful interests embracing the sport – a web that knits together sport, finance, big business and government. This alliance is a formidable barrier to change.

Of course there are arguments extoling the benefits of rugby. One of the most widely accepted of these is that participation in sport encourages a healthy lifestyle and prevents obesity. It is true that keeping children active and fit is beneficial both for them and for society. The 2009 national survey for England indicated that about 30 per cent of children between the ages of two and fifteen are overweight, while about 14 to 20 per cent are obese.²³ These rates are the highest in Europe. Obesity reduces life expectancy by an average of three years, or eight to ten years in the case of severe obesity, and costs the NHS around £4 billion annually.²⁴ The health benefits of sport go well beyond obesity and physical fitness; it can even have a positive effect on mental health.²⁵

The impact of rugby on obesity, mental health and physical well-being is not known. Moreover, the advantages of sport do not mean that children should play one that is dangerous. Injured children are not active, and a painful experience can turn a child off sport – many children who give up rugby altogether cite injury as the reason. Evidence shows that participation in sport does not have to equate to injury, but Britain lags badly behind in protecting children from harm. Swedish children have among the highest levels of sports participation in Europe, but the lowest rates of injury and obesity. That has not come about by chance, but due to the range of sports on offer, a well-established