Concussed Book

BOOK TALK

RUGBY'S TRUTH

Sam Peters is a rugby writer who has been credited with driving cultural change to the sport's attitude towards head injuries and concussion. Jade Craddock spoke to him about the concussion crisis, how its ‘dirty secret’ was finally made public and what rugby union must now do to save itself. 

Words: Jade Craddock
 

Firstly, let’s start at the very beginning. What drew you to rugby in the first place?

I loved the combination of physicality and skill, I loved the speed of the game, the camaraderie, the teamwork, the adrenaline, and even the fact that you knew you could get injured. That element of risk was unquestionably attractive to me. And I just thought it was a fantastic game that combined skill, bravery, and determination, all while rolling around in the mud. Which, as a youngster, I loved doing!

During these formative years, were there ever any incidents you experienced that made you consider the possible dangers?

When I first started, certainly playing mini rugby, it wasn’t something that I ever noticed – as I grew older, into my teenage years – I was knocked out a couple of times playing. I certainly had teammates who were as well and for us, it was normal to carry on playing. 

There was always some talk about a three-week mandatory stand-down, but the actual diagnosis of concussion on the field wasn’t something I ever remember. And then as I got to university, I started noticing more and more knockouts on the field. Again, it was standard to carry on playing. I started to understand that the older you got and the more physical the game became, the greater the risk. 

 

 

Image | Local supporters watch an amateur game of rugby where tackle height laws stipulate contact must be below the sternum. 

 

You then moved into sports journalism and covered rugby. How did this change your perspective on the sport?

I went from being a fan and a player to being a journalist and a reporter. There is some tension there when you’re a sports reporter because inevitably you’ve grown up being a fan of the sport, hero-worshipping the players. I’d watched the 2003 World Cup Final in a pub with all my mates in my very early twenties and it was a huge change to then walk into a profession where you are charged with covering sport. 

But having gone through journalism training and done a postgrad diploma in newspaper journalism, in my mind I was always a journalist and a reporter first and a fan second. It was just clear to me quite quickly that the tolerance of injuries in professional rugby was so much higher than I’d ever imagined or believed possible. 

Watching at close quarters week in, week out exposes you to certain realities. Severe injuries were being laughed off as part and parcel of the game. I saw the changing nature of the sport after it went professional in the late 90s and it seriously concerned me that there was such a culture around these injuries – most noticeably head injuries – that I felt was far beyond acceptable levels. I was shocked when I started going into the changing rooms after matches, seeing the scale of the damage the sport was taking on the players.

You began to investigate the issue of head injuries and concussion, not everyone – including those who were meant to protect players – was on board. How shocked were you by this and their reluctance to even acknowledge the possibility of a problem?

The lack of rigour that was shown by some of the doctors in powerful positions and in charge of a research budget was most noticeable. There was this lazy, almost convenient belief that players weren’t developing neurological problems. They weren’t seeing, in their words, a ‘group of demented retired players’.

As soon as I started looking at previous research papers and they started to do more investigations, it became clear that there was a problem. There were serious research pieces that had been done which had established this idea of a causal link between repetitive head injuries and early-onset dementia (and other neurological problems) and it was quite shocking. 

I wrote about a forum at Twickenham where I felt some of the doctors were treating it in a light-hearted manner. Presentations were done in what I and the other journalists believe was a humorous portrayal. When sportsmen and women were being knocked out, I just found that awful – a culture where doctors, players, coaches, fans and the media were all being tricked into thinking this was all a laughing matter. 

Concussion was just something that happened and then passed with no long-term effects, we were told to stop moaning and stop being alarmist. That was a pretty telling time for me and it really did inform my attitude because I started to think nobody was looking out for the players. Nobody was actually taking this issue seriously, so I worked pretty hard to make sure the issue didn’t go away. 

How did the players feel about this at the time?

I didn’t feel that the players were getting the right information, they weren’t able to make informed choices about whether they played. So, I thought it was extremely important that the subject was explored much more deeply and reported on more widely. Fortunately, I had a platform then, at the Mail on Sunday so I wrote about it for a number of years and made myself pretty unpopular in the process. 

 

 

Image | Concerns over the sanctity of the game have been put to bed after a few blockbuster games at the Rugby World Cup. Here the All Blacks showcase the best of their skills against Namibia. 

 

Indeed, you faced a fair bit of counter-rucking from all quarters throughout your campaign, one of the criticisms that was levelled at you was about the preservation of the sport. Can rugby survive whilst finding effective ways of protecting players?

Absolutely, and I often have to begin a conversation or any sort of discussion around this with some sort of justification that I’m not trying to attack rugby. My point throughout is that there needs to be a more honest representation of the risk.

I’ve got no doubt that the conversation, or where rugby finds itself today, has been created in no small part by this sort of ludicrous presentation of data. People were pretending it was safer than the game ever had been, pretending there wasn’t an increased risk when it was so obvious to anybody that there was, and the results unfortunately are evident now. 

I still believe the sport can be a beautiful, brilliant game which focuses more on skill than it does power. And I do think some significant strides have been made to improve concussion awareness. People understand the risks much better now, but there’s a huge amount of work to be done.

Given the schedules of the players, one proposal you put forward is to play and train less frequently, but is there also a need to focus on technique as well?

If we’re talking about the professional game, I think we still need to look at training loads and the exposure to matches, which are still far too high. There are still excessive amounts of rugby played and too many injuries in training. In terms of amateur rugby, I am a believer that lowering the tackle height is progress. New regulations will reduce risks of second impact syndrome, it will create a game which is more fluid and more encouraging for smaller players. Turning rugby into less of a direct collision sport, which it has become, and more of an evasive game, where skill is valued as much as power. 

Culturally, we need referees, coaches, parents, and players to collectively buy into the idea that your brain is uniquely precious. It is different to dislocating a shoulder or a knee, you only get one brain and it needs protecting. ‘If in doubt, sit it out’, needs to be remembered all the time. It’s not warfare, it’s not anything more important than just a game and people forget that. I will never accept that playing sport should be a life-or-death situation. 

 

 

Image | Autumn leaves: Could training less frequently benefit the players? Rugby continues its search for the magic wand. 

 

Something that occurs at a junior level is the gross difference in size that can occur naturally between players. How would you address this?

It is always ridiculous in my mind to have those complete mismatches on a child’s sports field – why would you have that? Why not look at the model of the greatest rugby-playing nation on earth, New Zealand? Weight categories for junior players would make much more sense. 

It was always my experience at school that the big guys who could score four or five tries in a game struggled as they got older. Nearly everyone caught up physically and they hadn’t learned those evasion skills, the passing skills, or the spatial awareness which others perhaps had to. I don’t think that’s fun for anyone when you’ve got a couple of players who are bigger than everyone else on the pitch.
 
It doesn’t make sense to me why we don’t have weight categories for younger players. I think that would be a sensible and reasonably straightforward move, but it’s been resisted by the RFU for many years when to most people it’s common sense.

And the lack of data and lack of research that has been done into injuries at schools, at that level is another scandal. Frankly, I think it’s outrageous that so many decisions are made without data to support them. Rugby gives so many positives, but it’s completely ridiculous to suggest it comes with no risk or minimal risk. There is danger involved in playing rugby, just like there is in lots of different sports, but rugby’s injury risk profile has always been higher. Since the game went professional, I think there’s been a radical spike in its injury risk profile, which was denied for a long time. 

As awareness at the amateur – and particularly junior – level grows about head injuries, how can we ensure the medical provision and personnel are in place?

The provision of medical care and the cost associated with providing that medical care has always been a massive challenge for the game. Some of the medical provisions a notch or two below the professional level are so far from where they need to be. It’s going to cost money, and it’s going to have undoubted commercial implications, but what’s the alternative – the man with the bucket and the magic sponge?! Certainly, when it comes to concussion awareness and education there needs to be a continued push to make sure injuries aren’t missed wherever possible. 


It’s an absolute necessity to inform players and parents about the risks, but that can induce fear. What would you say to parents whose children are thinking about playing rugby?

I’d say it’s still a brilliant sport. You’re right to have some concerns about children playing. I got injured myself, with several shoulder dislocations, but I still played the game again and again, I loved it. I’d make sure they were happy with the culture of the club their children are at. You must be happy that there is a good understanding of what they’re looking out for when it comes to concussions on the pitch. Finally, there has to be a culture where the children’s health and well-being are placed ahead of anything else. 

I finish Concussed writing about Ben Robinson, a schoolboy who lost his life playing in Northern Ireland. A number of head injuries were missed and there were really obvious signs and indicators that he had suffered a brain injury. Sport should never allow that.

Rugby clubs and parents need to work together to ensure the values and the things we love continue but put a check and a balance in there to ensure the thing that’s most important and that’s children’s brain health. 

How do you think the fans have taken to the dangers of head injuries and their repercussions? 

You only have to see the response to the Owen Farrell situation, his tackle in England’s warm-up game against Wales was universally condemned by fans. The decision to pull back on what was looking like a ban was overturned and the ban was reinstated. That whole scenario showed how far the conversation has come, there’s now a universal acceptance that we need to stamp out high head shots in matches. 

I think there is a huge change in attitude, but there will always be some who say that the players who have been diagnosed with early-onset dementia are in some way charlatans or not telling the truth. I’ve spent a significant amount of time with these players, I’ve spent a significant amount of time with people who aren’t in the professional spotlight who’ve suffered really significant problems. There are too many campaigners who have so much belief, energy, and will to keep the message alive. It’s due to those campaigners that change has happened so far. 

The World Cup has certainly brought up the issue of tackling again – especially from an English point of view – but also the question of the disciplinary panel, and whether it’s open to human error…

It’s not a perfect process. I think the point is that any tolerance for head-high contact needs to be extremely low. There was talk for quite a long time about a zero-tolerance approach to head-high tackles and that disconnect between the language and the reality was quite clear early on. There’s definitely a human element which comes into any sort of judicial process. 

The vast majority of these collisions are accidental, but if that’s caused by recklessness and a lack of care on behalf of the tackler. It needs to be ensured that people are thinking all the time about the safety of the person who is being tackled – and indeed the person making the tackle – that will effect change and that’s where we can make real progress. 

Another issue has been the diagnosis of concussion. A lot of the systems in place don’t seem fit for purpose. Is the bunker review system an improvement? 

I think anything that enables the identification of potentially concussed players on the pitch to take them off is a good thing. I think the HIA system is still clearly missing a significant number of on-field concussions and not all of them are being picked up. 

I write about a number of scenarios, including Nic White, the Australian scrum-half, and George North, who went through the HIA process but were still allowed to play on. That’s causing people to lose faith in the system. The bunker system makes sense to me as long as the judicial panel follow what most people would consider a sensible process, generally, that’s a reasonably good move. 


Discussions have largely been around men’s rugby, is there a potential danger of letting women down if more focus isn’t given to them?

There is evidence to show that women are more susceptible to concussion and there are a lot of different theories as to why that may be. And I think wherever there isn’t a media spotlight or scrutiny, there’s potential for poor practice and potential for things to go wrong. Professional rugby union is changing partly because of the media scrutiny and I don’t think the women’s game has that spotlight on it at the moment, although that spotlight is definitely growing. 

I talk about people like Kat Merchant, the former England player, who talked very openly and honestly about the situation she found herself in. A lot of this has come about because of the leadership of the players and what they’re prepared to talk about. Women’s sport is absolutely flourishing and thriving, and rugby embodies that which makes it such an important talking point.

What if we are still at the tip of the iceberg, are there many players out there whose stories aren't yet being shared?

There are so many reasons not to speak out when you’re in the professional environment and it’s so hard to go public with concerns. People who rock the boat are often considered to be people you don’t want in your team. You’re constantly being put under pressure to be quiet, to toe the line, to not raise the red flag and I think that’s a problem. I commend those players who have come out so openly about their problems.

Negativity that has come towards some players who have been diagnosed with early-onset dementia is shocking and that’s where there remains a massive education piece to be done. I think there is a risk that the problem is even bigger than I felt it had been a decade ago but that remains to play out over time. 


Your own relative Martin Peters – of the 1966 World Cup winning England football team – experienced his own battle. There was news this week of a football Brain Health Fund, how was that received?

It’s a £1 million fund which is a start. I think the work of people like Dawn Astle (Jeff Astle’s daughter) and Adam White of the Concussion Legacy Foundation who now works within the PFA is fantastic. It seems to be that the PFA are much more open to this now. For so many years, it was just too big a problem to address, so it was just parked, pretending it was not there. 

I think some sort of fund for players after they retire is a good idea that would certainly be welcome in rugby. Moving towards that there must be some sort of support given post-retirement when these issues arise, that’s entirely reasonable as a duty of care to an employee. 

There aren’t many other professions I can think of where you could routinely bash your head against other people’s heads or routinely get brain trauma and then essentially be left to deal with it on your own afterwards. That doesn’t seem fair or the right way to look after our people and I think that needs to be addressed in rugby. 


With the World Cup starting, do you look forward to it, or is there always a degree of fear over player safety?

I still enjoy the game and still love watching it, but I watch it differently now. It concerns me how physical the game has become; I don’t think that’s what rugby was invented to be. I think the professionalisation of rugby has radically altered the way it impacts (literally) the participants. I still watch it and wince from time to time because I know the toll this will take on the players in the short, medium and longer term.

I still support England – despite it being quite hard at the moment the way they’re playing – and I am looking forward to the tournament. I’m really looking forward to France and how they go on home soil. That first game in Paris was absolutely fantastic.

There are lots of reasons to watch the sport and in some ways, I’m sorry I’m not going to be in France. I hope the tournament goes well, I hope it goes seamlessly from a concussion perspective, but anyone who’s a rugby fan knows there’s going to be significant injuries as the tournament progresses.

If you could look ahead 10 years, what are your hopes for the game?

I would look very much to groups like Progressive Rugby who are calling for a significant reduction in the amount of contact training. There are so many injuries and concussions still suffered in training. Far fewer games for the top players. Properly protected rest periods and longer stand-down times following a concussion. Going back to a sport which was more based on skill with less emphasis on power would make it not only a healthier game to play but also a much more attractive spectacle for fans. There’s a lot of work to be done, but I remain optimistic that rugby can have a flourishing future. 

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