Grassroots rugby league has a serious problem with concussion
Source: https://www.stuff.co.nz/news/110780486/-

2019-02-24 16:21:11

Repeated concussions from rugby league hits and tackles cost Peter Rikiriki his mental health. It's cost others their lives. But there's no coherent plan for protecting players from the danger. Carmen Parahi investigates.

Peter Rikiriki has paid a high price for the love of rugby league.

He counts nine bonafide concussions in fourteen years but says there were probably more knocks to the brain he hasn't accounted for.

"We would get a knock or tackled, feel dizzy but just carry on and shake it off," he says.

Of his nine concussions, Rikiriki was knocked out only three or four times. The rest were impact hits, "bell clangers" or "seeing stars" he calls them.

On one occasion he took a hit, kept playing, finished the game, walked off the field, showered then came to in a locker room filled with players from the Mongrel Mob Porirua team. They'd played on a different field altogether. He had no memory of how he got there. When he eventually found his own team they filled in the blanks. Yes, they saw him take a blow to the head during the game but he got up and carried on. They all laughed about it including Rikiriki.

After the longest blackout he suffered, he came to standing at a bar with a beer in his hand. "I just thought getting knocked out was part of the game," he says.

It was the ninth hit in 1999, and the only one he sought medical advice for, that ended his playing ambitions.

"The final concussion I had problems with blurred vision, dizziness. I had to sit down, confusion. The headaches were really bad."

Scans found nothing wrong but the pain continued. He didn't know what was wrong with him. Then the anxiety started.

"I was having attacks going into the supermarket. I'd be pushing the trolley around, I'd get a tingling sensation, the hair would stand up on my arms. I just wanted to get out of there as soon as possible."

At the time, neither Rikiriki nor his GP connected the concussions to his declining mental health. He was diagnosed with depression and prescribed antidepressants.

He had to give it up his plastering job. His marriage with four children broke apart.

"I was sitting at home feeling worthless. I didn't see my friends as much, stayed home, slept a lot.

"For me, being on the field was everything, it shouldn't have been," says Rikiriki.

"It's just a game - put it into perspective."

He eventually went back to school and gained a diploma in exercise science.

During his studies he became aware of the impacts of concussion. He went back to his GP, asked if all of his concussions could have caused the depression and the doctor agreed.

"It was a vicious cycle resulting from my concussions," says Rikiriki.

THE AMATEUR CONCUSSION GAME

Doug King believes concussion is the biggest issue facing amateur rugby league clubs.

He says Rikiriki's case is typical of athletes who've suffered multiple concussions.

King has studied and written numerous academic papers on the subject. A clinical nurse specialist, he's played the game and run the sidelines for decades as a voluntary medic for rugby league and union.

"About 98 per cent of concussions do not involve the loss of consciousness," says King.

"Impacts to the body can result in concussion because it's all transferred up. Anything can cause it. It's the shaking of the brain. It's like a big bruise and it needs time to heal."

In 2017, ACC received 21,149 concussion claims, 7615 were sports related. Of those, 443 were rugby league claims with $1,626,691 paid out.

In one study, King stuck electronic mouthguards into rugby union and league players mouths measuring the impacts per player per game for a whole season.

"When I finished at the end of the rugby season we were looking at 70 impacts per player per game, 15 for under 9 year olds.

"One season of twenty rugby games, I had 20,000 impacts.

"In rugby league I was looking at 50-odd impacts per player per game at premier level for males, 36 for females, 11 for under 11 year olds."

Despite the growing evidence about brain injuries too many clubs continue to dismiss concussion protocols, King says.

As a medic he makes no apology for hauling players off the field and standing them down. But it's made him unpopular.

King has been spat at, sworn at, threatened and himself knocked out trying to manage players with concussion.

He's been banned from four clubs in the Wellington region, three union and one league. He won't name them.

"I've had one player die in my arms, another player nearly die in my arms and it's taught me a big lesson. I'd rather be wrong and say sorry to the guy I take off than be wrong and say sorry to his parents."

In both cases, King later found out the players suffered prior concussions.

"Unfortunately, players keep dying not only in league but in union. So we want to stop that and manage it properly."

WIN AT ALL COSTS

Rikiriki has coached league for the past 18 years from kids to adults in club and provincial teams, and the under 16s national side.

He says players and their parents would argue with him on the sideline for taking them off for a suspected head knock.

King says he has seen a player knocked out but their trainer helped him to pass the on field test to stay in the game.

"People will rort the rules as much as they can to make it an advantage," he says. "It's not sportsmanship but it happens."

At other times, opposition teams will say a player has concussion or note it down on the team sheet to get them out of the game.

"If player X is going to make or break the team then you'll do whatever you can to get rid of him," King says.

Players, families and coaches are taking greater risks because there are high stakes in the game now.

"Some parents put a lot of effort into their kids to become sports stars, to earn big money so they can live off them. It's an issue." King estimates less than two percent turn pro.

Dr Simon Mayhew is the medical specialist and concussion spokesman for New Zealand Rugby League (NZRL). He also takes care of the Junior Warriors and admits even the top players "tell pork pies."

"A lot of people won't own up to being concussed," says Mayhew. "They can't play for three weeks but they desperately want to."

He says the NZRL takes concussion seriously and has laid out procedures for everyone involved in the game. But he concedes the stand down time and concussion diagnosis is problematic.

CONCUSSION CONFUSION

The NZRL recommends concussed players stand down for three weeks.

"It's basically been a number they've plucked," says King.

Mayhew agrees it's arbitrary but he's following current worldwide guidelines. "Unless you get sophisticated testing, you're going to be sidelined for at least three weeks," he says.

Of the players King has tested, 60 percent weren't symptom free after 14 days. He says it takes another 11 days before it's clear, so 25-28 days.

"92 percent of people will be symptom free at about 90 days," he says.

Auckland Rugby League has the most teams in the country. It has its own three step concussion plan, separate to the NZRL.

If a player has suspected concussion, goes immediately to A&E and is cleared by a doctor they'll be allowed to play again the following week.

Both Mayhew and King are opposed to the Auckland policy.

They say not all ED doctors understand concussion. King says it can take up to 48 hours to develop, doesn't show in a scan and sports concussion tests aren't used at every hospital or medical centre.

Both believe a medic on the sideline, who saw what happened should make the assessment using specialised field tests instead.

But team trainers with concussion expertise, St John's and medics are a rarity at footy games. King wants trainers to be mandatory for every team. Mayhew says it's an ideal.

Auckland Rugby League Football Manager Pat Carthy says Auckland's 32 clubs can't afford it.

"We have 250 games a weekend. We play over 92 grounds. St John's isn't able to offer that coverage and we wouldn't have the $10-20,000 dollars a week to do that."

Carthy is sticking to his body's plan.

He says it forces players to seek medical help. If they don't go to A&E on the first day and want back on the field in a week, then they have to visit one of two specialist clinics in Auckland or pay for an expensive neurological report. Players who don't will stand down for three weeks and won't play again without a doctor's clearance.

When first interviewed, Mayhew said the NZRL's 21-day stand down rule was mandatory. But after talking to him about Carthy's comments, and after the two men spoke later, Mayhew softened his comments, telling Stuff he "strongly recommends" three weeks.

He concedes the NZRL and ARL are sending mixed messages.

"That's the problem. And I'm not going to talk about the politics of that. But there is some politics involved there. What I can say is NZRL has followed consensus guidelines."

The NZRL's website has also sent mixed messages.

Stuff went through its policies and found old rules mixed with new. It was raised with Mayhew who agreed it was confusing. He called Stuff the next day to say he'd got the old information removed from the website.

Stuff did a stocktake of all 17 league province's websites, most show little to no guidelines, outdated policies or some simply link to the NZRL.

"It concerns me that different bodies are making their own rules for what should and shouldn't happen," says King. "We should all be singing off the same sheet, we should all be doing the same thing. It's totally confusing."

He says the NZRL leadership is failing player safety.

"They've got a medical panel and I'm part of it but we've never met. We've never had anything to do with the game at all. We're purely on there as names."

Rikiriki says the duty of care has improved but believes concussion management needs to be stricter at club level. "It's about looking after yourself so you can go back to work on Monday."

THE IMPACT ZONE

In 2010, King recommended lowering the tackles. Anything above the armpit, shoulders and head should be ruled a no go, penalty area.

"There is an inherent risk," says Mayhew. "It's a contact sport. You can make as many rule changes as you like there's still going to be collisions.

"It's hard. The prevention is about technique and fitness."

Despite the risks, King still encourages children to give league a go. "It's just a game. Go out there and have fun. If there's an injury, allow them to recover properly."

Rikiriki says teams need to spend more time on tackling techniques and safety around the collision area. He's been sharing his concussion story at coaching seminars and with young players hoping they'll learn from his experience.

He says more professional players need to role model how to manage concussion properly.

"I love rugby league, we all love rugby league but it's just a game."

POLICY CONFUSION

Concussion information held by NZRL provinces:

Northland - Factsheet, no date or mention of 21 day stand down, Concussion report card

Auckland - Own concussion policy

Counties Manukau - 2016 factsheet

Waikato - Couldn't find concussion information on website

Coastline - No website, no concussion policy

Bay Of Plenty - March 2008 policy, review date March 2010

Hauraki - No website, no concussion policy

Gisborne - No website, no concussion policy

Taranaki - Link to NZRL policies

Aoraki - No website, no concussion policy

Hawke's Bay - NZRL Laws of the game 2012, no concussion policy

Manawatu - Feb 2015 policy

Wellington - Apr 2010 policy

Canterbury - 2014 factsheet, no mention of 21 day stand down, Feb 2015 policy

Otago - NZRL Laws of the game 2012, no concussion policy

Southland - Link to NZRL policies

West Coast - Rugby league pledge 2012, no concussion policy

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