Concussion In Sport

Author: Josh Easterbrook

A serious issue for Sporting Governing Bodies (hereinafter: SGB) is the problem of safeguarding participants when it comes to concussion. Concussion can be a result of the natural physicality of the sport or a result of violence outside the scope of consent/duty of care as discussed above. According to Dr Hans Förstl, since 1890, there have been on average 10 deaths per year incurred while Boxing and 80% of those deaths are a result of neck or head injuries[2]. The International Boxing Association (AIBA) is responsible for England Boxing and together, the organisations must efficiently safeguard participants within Boxing. An example of how AIBA have attempted to protect athletes is shown through the suspension systems that is implemented after being knocked out during a fight.

A screenshot of a cell phone

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Neidecker J, et al. Br J Sports Med, 2018,

The above diagram shows the suspension system in the US, put in place to reduce the effects of concussion and safeguard the participants. It is inferred, due to this being a policy of AIBA, that England Boxing will follow a similar system. Similar to boxing the SGB that governs Rugby in England (RFU) have a procedure called “return to play” and this outlines the pathway that a player must follow, depending on age, in order to be cleared to play after suffering concussion[3]

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England Rugby

According to World Rugby’s latest injury audit, concussion is the most reported injury for a sixth consecutive season and subsequently produced an 8-point-plan in order to tackle this issue[4]. They have announced new measures to ensure that the head “is a no-go area” and came into force as of the 3rd January 2017[5]. In recent years, the issue of concussion in football has become a highly debated topic after medical research into the effects of repeatedly heading the ball and how it will impact the athlete in the long term were revealed.  Like the RFU, The FA have introduced a return to play guidelines as a result of the international conference on concussion in sport was held in 2012. The new policies on safeguarding football players from concussion include a pre-season screening every year and an Emergency Action Plan to be put into place across all stadia and training grounds[6]. However, the most extensive rule change that the FA have put into place in order to reduce the effects of concussion is to do with the officials. The officials must now stop the game if there is any sign of a head injury and it has outlined the protocol for medics to follow when managing head injuries. The FA state; “if there is any suspicion of the player having sustained a concussion, the player must be removed from the field of play, and not allowed to return.” [7]

While it is clear that all of the above governing bodies have set out similar procedures to reduce the effect of concussion once it has taken place, they have also adjusted the playing rules of the sport itself to prevent the occurrence of concussion happening again. AIBA have created a rule that all amateur and youth boxing participants must wear protective head-gear when fighting[8]. This rule change is the biggest adaptation in relation to the physical act of the sport however the AIBA and England Boxing have a responsibility for the safety of the participants before, during and after the event. The Watson v British Boxing Board of Control (2001) case was a catalyst for safeguarding at venues across all major sporting events. The claimant suggested that the medical care he received at the Middlesex hospital, after suffering a brain haemorrhage during the fight, should have been readily available at ring side and this was a breach of the duty of care owed by the SGB to the athlete[9]. This case was one of the first times that an SGB was found to be negligent and therefore breaching the duty of care, it forced AIBA to ensure that a medical handbook was produced and published and now requires a paramedic’s to be onsite to assist in such instances[10]. It can be inferred that this case did not only provoke the SGB of boxing to improve its safety management but also showed other governing bodies such as the RFU and the FA and their respective International Governing Bodies that there is a duty of care owed by them to the athletes. The correlation between this case and the requirement for paramedics to be present at all major sporting events shows this case to be a major turning point for safeguarding policies of SGB.

Rugby Union has revised its laws of the game in order to prevent concussion. The laws regarding tackling and scrums have been under high scrutiny. It previously measured high tackles as above shoulder height and this was proved to be 4.3 times more likely to cause injury than a tackle made in low-contact[11]. The RFU proposed a change to law 9.13, approved by World Rugby, which means that a high tackle is now considered to be above armpit height to reduce number of concussions in the game[12]. The RFU and World Rugby are also targeting the safeguarding of other injuries that are non-consensual within the sport. The organisation restructured the laws of the scrum as a result of several high calibre cases against the officials, governing bodies and athletes. It is agreed as part of the field of play doctrine that all athletes owe each other a duty of care and with that the officials and SGB also owe the participants a duty of care. The Smolden V Whitworth & Nolan (1997) case was amongst the first case brought against an official. It was claimed that the official breached his duty of care after not instructing the front rows to engage sufficiently and this case could be argued it is was the catalyst for the RFU change the engagement sequences used by officials[13]. A major case that has forced World Rugby to make more adaptations to the laws is the Vowles v Evans & Welsh Rugby Union Board (2003). It was an incident which caused serious injury to Vowles as a result of the scrum collapsing. The specialist front row had to go off for an injury and was replaced by a flanker, that was not trained in this position, and he was found to have caused the scrum to collapse. The referee did not enquire about his level of expertise in the position and therefore found to be liable for the injury sustained by Vowles. The Welsh Rugby Union were vicariously liable for this as a result of being the employer of Evans[14]. Subsequently, World Rugby have adapted certain laws of the game in order to prevent this type of incident occurring more frequently. Law 3 states if not all players in the front row are suitably trained then the referee must order uncontested scrums[15]. These cases are another example of the SBG attempting to safeguard the participants and uphold behaviour and sporting conduct through assessing the cause and putting actions in place to prevent or reduce effects.

Written By: Josh Easterbrook


References:

[1] Available at: https://www.nhs.uk/conditions/concussion/ accessed on: 12/11/18

[2] Förstl, Hans. 2010, Boxing – Acute Complications and Late Sequalae, available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003467/ accessed: 12/11/18

[3] England Rugby, available at: https://www.englandrugby.com/mm/Document/MyRugby/Headcase/01/30/49/57/returntoplayafterconcussion_Neutral.pdf accessed on: 12/11/18

[4]Available at:  https://www.bbc.co.uk/sport/rugby-union/43541743 accessed: 13/11/18

[5]Available at:  https://www.world.rugby/news/213339 accessed: 13/11/18

[6] Available at: http://www.thefa.com/get-involved/head-injuries-in-football accessed: 13/11/18

[7]Available at:  http://www.thefa.com/get-involved/head-injuries-in-football accessed: 13/11/18

[8] Safety measures in boxing. Available at: https://bjsm.bmj.com/content/36/6/394 accessed: 13/11/18

[9] Watson v British Boxing Board of Control (2001) QB 1134 available at: https://www.casemine.com/judgement/uk/5a8ff8cd60d03e7f57ecd9c0 accessed on: 13/11/18

[10] AIBA Medical Handbook, available at: https://d152tffy3gbaeg.cloudfront.net/2015/02/20161101_AIBA_MEDICAL_HANDBOOK.pdf accessed on: 13/11/18

[11] Available at: https://www.world.rugby/news/351855?lang=en accessed on: 13/11/18

[12] Available at: https://www.world.rugby/news/351855?lang=en accessed on: 13/11/18

[13] Smolden V Whitworth & Nolan (1997) PIQR P133, CA available at: https://www.lawteacher.net/cases/negligence-duty-cases.php accessed on: 13/11/18

[14] Vowles V Evans & Welsh Rugby Union (2003) EWCA Civ 318, available at: https://www.bailii.org/ew/cases/EWCA/Civ/2003/318.html accessed on: 13/11/18

[15] available at: https://laws.worldrugby.org/amends accessed on: 13/11/18

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