Health: Concussion in Sport

Lord Addington Excerpts

Thursday 27th February 2014 Grand Committee

Asked by

[Lord Addington]

To ask Her Majesty’s Government what advice they are giving to (1) sports national governing bodies, and (2) national medical services, regarding concussion sustained in sporting injuries.

[Lord Addington (LD)]

My Lords, I first thank everyone who bothered to put their name down for this debate. I would like to say why I felt that a discussion on this matter would be worth while. When we start talking about concussion and injuries and the areas around them it is important to try to get the whole situation in context. When it comes to head injuries there is always a great deal of fear within any organisation, and quite rightly so, because we are not entirely sure what happens. If your head goes, everything goes. Every time you talk about this, in particular when there is the idea that children will be involved, there is a fear reaction. Also, in sport—and this is probably very true of my own sport, rugby union—there is the machismo. “Well, it didn’t do me any harm”, a player will say as he twitches and staggers. However, that reaction always comes in.

I want to look at a debate which started at the elite level of the game. Here I pay tribute to Chris Bryant MP, who I first met on the Commons and Lords rugby trip about 10 years ago. Not a bad centre, likes to run straight and does not miss many tackles: that is my assessment of Chris. He has done a great deal of work at the professional end of the game. In the period of time since I had my flirtation with the top end of the game—and when push comes to shove it was a flirtation—professional rugby union players have got bigger, stronger and harder. They have gained weight and got fitter. They are now basically monsters. One of the biggest changes in the game is that they now take the defence more seriously and look for heavier collisions more frequently.

The other side is that those players are professionals. They have a structure which looks after them, which is aware of them and has invested in them on dozens of different levels to observe what is going on. At all levels there is a great incentive to make sure that people are functioning properly. Most of sport does not have that. It is also the case that most sport is played at an amateur or community-level basis, where people are not playing or training primarily because they are paid but because they want to be there. They enjoy the process. There are some, possibly not in this debate but quite frequently in other situations, who cannot understand this process and the fact that people enjoy what they are doing.

Virtually all sports have a danger of concussion and head injury. They involve people moving around and bumping into each other, and occasionally bumping into very hard balls travelling very fast. All sport has an element of risk. All sport will have to try to adjust and ensure it knows what it is doing. All of sport will have to interact with the National Health Service to make sure that these problems do not become chronic. As we become more aware of these problems we tend to discover more of them.

At the amateur, more participatory, casual end of sports, people frequently play more than one sport. The specialist at the top end will concentrate on one sport alone. That is why I frame this debate in these terms. Rugby union, rugby league and possibly gridiron football, although not that much of it is played in this country, look for a collision, as do the martial arts. In other sports it will occur as an inevitable part of the game at even the most casual level. In basketball, players are not supposed to hit each other, but people jump up for the ball and two of them can hit each other. If they do not clash heads and elbows, there is a nice hard surface to bang their heads on. It will occur. For example, in football, if the defender, goalkeeper and the forwards all go up for the same ball, all trying to head it—or the goalkeeper punch it—there is the possibility of impact. It has occurred at the top level of the game.

I have tried to look at how all sports manage to get the information running through themselves about what they should do and how they manage to get this down to the more vulnerable groups. In this case, children and the young are more at risk—more of them apparently have head injuries and more come into casualty. Much of this may be simply because the young climb trees, for instance, or cross roads less carefully than others, but it still occurs. They are more at risk not only from the one incident but the secondary incident. How do we take this on board and encourage the sports themselves to identify when somebody is at risk? How do we make sure that the people who are in charge of the organisations and of coaching know to tell the rest of them when to step down? How do we tell the medical services when they should take action and when they should tell you to go home? Very importantly, how do we tell them when not to overreact?

There is a general consensus that exercise is the wonder drug. It helps prevent types of cancer and even dementia. Most people take exercise, at least initially, through a sport. If we could all be trained to jog the 2.3 miles 2.4 times a week that are required to keep our bodies healthy, we all would and we would not have to worry about this—but we do not, as people find it basically fairly boring. How do we interact and make sure that this is going on?

When it comes to examples of good practice, the best culture I have seen for dealing with injuries is probably in anything to do with riding or the equestrian world. I live in Lambourne, the valley of the racehorse, and in National Hunt jumping, people come off the horses fairly frequently. I have seen quite an intimidating tea-towel about some old National Hunt jockey—I cannot remember which one, but he had X number of wins, rides and broken bones—which showed which bones he had broken flying off a horse. In that sport, a hard hat is the thing you absolutely always wear. The sport knows that people get hurt and it shares doctors now with rugby union. In rugby union, you probably have twice the amount of person to practise on but similar types of injury.

How do you get that culture down into the grass roots? Rugby union has a very good scheme, which seems to be a brand leader, called “Use your head”. It comes down to a culture of making sure that introductory-level coaches are taught how to deal with people who have head injuries. Will the Minister encourage all sports to get similar types of schemes going? We need to encourage people to take part.

Also, how do the medical services react? They should not just say, “Don’t do it for X number of weeks”. That would mean people will ignore you, because most of the time—statistics prove this—although you have a slight headache and feel slightly giddy, you are fine. We do not want to go back to assuming that you are not in danger, but most of the time you are fine. It is when this gets compounded and, on the odd occasion, the freak event and the panic occur. How do we square this circle of reaction? Can we please have some guidance about what are the best schemes? How can we address this and get through?

We are told not to go to accident and emergency all the time as we are clogging up the doors. Will the other elements of the National Health Service know when to refer you on, when to tell you not to panic, when to tell you to rest and when to come back? That is what I am trying to get at. If we overreact here and act inappropriately we get rid of the benefits of sport. If we do not react at all, we will have occasional cases of tragedy and then more commonly occurring cases of impairment and damage in later life. We have got to work these together. What are the best practices for what we are doing and how are we going to bring them together? That is what I am trying to get at here.

I hope that this is the start of a process in which the NHS and all the sporting bodies talk to each other. They need to ensure that there is communication at the grass roots, at the schoolboy—or schoolgirl—level, and that people know what is going on and what is best practice. If they do not, we are in danger of creating another case where overreaction, bluff and basic ignorance mean that we end up with slightly less competition—not just in sport but in any competitive environment—and a few tragedies are the result. We do not want that. We want to go forward with activity and safety. That is something that we can achieve and we should try to.