What are the injury risks involved in playing rugby?

I’ve had some interesting interactions over the years with organisations who have made bold (inaccurate) claims about the risks of participating in rugby. Here is a humble start to shape some information for parents who want to know more about some of the immediate and possible long term injury risks that come from playing rugby. I’ve tried to be as concise and candid as possible. Weighing up what to include and exclude is a an important issue when shaping and crafting injury risk information for public consumption. Feedback is welcome on this!

Physical activity for liberation and repression

Many governments are trying to “nudge” their residents and citizens to be slightly more active.

But some governments are doing the opposite.

Some governments are trying to repress their citizens to be more docile.

We see only glimpses of the brutality. But these glimpses are enough to convince any reasonable uninvolved onlooker to side with the unarmed peaceful protesters, the children in schools, the girls sitting on benches.

Belarus (a country I have never been to) has seen 80 days of peaceful protests by citizens demanding fair elections. The “government” has censored media, tried to expel opposition political leaders, and begun a brutal regime of repression against the protesters. The repression has resulted in deaths of many, and physical trauma and mental trauma for hundreds, if not thousands of detained people.

But people in Belarus persist. For months they have staged powerful demonstrations of their commitment to their cause. As someone spectating from afar, I could be criticized for succumbing to propaganda campaigns. But I have seen enough footage to be convinced of whose side I choose. When faceless goons brutally repress protesters who are simply standing, talking or walking, one side loses any claim to legitimacy. The goons have kidnapped children from school.

And still the protests persist. In response they sing more, march more and dance more. It is politics through physical activity. Muscular goons versus peaceful marchers. Who will win?

John Lewis, the USA civil right campaigner and congressman spoke about the “good trouble, necessary trouble” he got into. One of the most important methods for change was marching. Being present, occupying physical spaces and antagonizing the “official” order of things were seen to be a legitimate action in the face of oppression.

Can we and when should we teach and encourage “good trouble”? And how can we it be used most effectively? The risks of engaging are in good trouble are very real. Physical, spiritual and material harm may result and the is no guarantee of success. Can this form of physical activity be called “healthy”? Perhaps it will be for the protesters in the future, but not immediately.

Control of physical activity

On the other side of creative, celebratory protest, are the officials ordered to maintain … order. Denying people movement is a well established form of punishment. Shackles, locks and walls are all used to limit people’s physical activity, both on an individual level and a population level. Yet wherever there is dominating power, there is resistance to it. For example, Mark Norman (2017) notes that while prisons are institutions built to physically contain certain individuals, they are also sites for the development and expression of vibrant physical cultures.

Outside of prisons too, there is a ever-present interplay between autonomy and control. In the day to day hum-drum of life:
Individuals spend time, attention and money trying to control their own bodies, their emotions and health.
Governments spend time, attention and money trying to control other people’s bodies, emotions and health.
Organisations spend time, attention and money trying to control their members.

Good control for physical activity

Control is often an unpalatable word though. Instead, policies in relatively peaceful nations which promote physical activity use terms like encourage, inspire, manage, nudge, and educate as proxies for their desire to control. Most often, physical activity promoters emphasize the liberating potential of physical activity. The idea that being physically active will somehow free oneself from stress and other people is appealing, and the therapeutic effect of activity is increasingly popular in policy, with its association to mental well-being. Physical activity policies cannot impose strict regulation of physical activity (expect perhaps for school physical education), and so increasing emphasis is given to controlling  physical landscapes to facilitate increased population physical activity rates.

A final thought

There have traditionally been 3 “domains” of physical activity – work, leisure and routines of daily life (including active transport). I wonder where a protest march would fit? Hmmm, we might need a new domain.

After Covid, how much rugby should children play?

When this Covid pandemic finishes, you might be thinking about which sports will be best for your child. Well, rugby is clearly enjoyable for many people, and is helpful for fitness and socializing (though of course most other children’s sport have similar benefits). Rugby, apparently, has also been “building character since 1823“, according to the global governing body.

But if you are thinking about encouraging your child to play rugby, do consider this new research which shows an alarming rate of concussion (brain trauma / brain injury) in school students who play rugby. In a study of 416 New Zealand high school rugby players, the findings indicated that 69% of players had sustained a suspected concussionduring their playing of the sport at school. Did you read that properly? 69%? Really? Does that seem high?

You may be shocked at these stats. And if you’re a staunch rugby defender, you may be very skeptical about this research. Let’s go through some potential issues:

You might think it was done by biased researchers with an anti-rugby, anti-risk agenda. But, actually, of the 8 researchers involved, 4 work for New Zealand Rugby, including the “lead” researcher. The other 4 researchers work for various universities.

You might think the children are exaggerating when reporting their brain injuries. But actually, we can infer the number of concussions could be even higher than the reported figure, for two reasons. First, the researchers state: “NZ Rugby has a mandated 21 or 23-day stand-down period if a player has been removed for a suspected concussion depending on their age. While this policy prevents players with a suspected concussion from returning which is an important safety consideration, it may also have the detrimental side effect of increasing nondisclosure in players.”
Second, the researchers state “the responses of the current sample may not include the characteristics of players who have withdrawn from rugby participation due to concussions or the risk of possible concussions.” So for anyone who thinks the 69% is overstating the issue, it might reasonably be that 69% is an understatement.

You might think the “suspected” concussions reported by the participants weren’t always diagnosed by a doctor – it was sometimes only the children’s views about specific concussion symptoms. Well, 31% of participants did receive a medical diagnosis of concussion, which is still very high, right? So should we give the benefit of the doubt to the other children and adolescents who participated in the research? We may as well, right?

You might be angry about this perceived attack on one of the great sports in [insert your country here : ) ]. If so, have a chat to children who you know and see what they think about this research.

You might not be able to access the article because you’re not at a university and it’s behind a paywall. If that’s the case, you could email the researchers to inquire about a free copy! Or pay the journal £34 to get access to the article! Or lobby the government that you as a (probable) tax payer, deserve access to research conducted on school children by sports organisations and universities!

To conclude …

Should we agree that no matter how fun and “character building” an activity is, if it imposes a 69% concussion rate risk during a student’s schooling, there should be some serious reviews? If you disagree, what’s your “acceptable risk”? Is 50% of children having a traumatic brain injury acceptable? Or 49%? I wonder what percentage of the children themselves think is tolerable when it come to traumatic brain injury in school sport.

Joe P

The Pandemic and the Effects on Activity

As I wrote about in my recent book, physical activity is deeply political:

“Promoting physical activity requires suggesting (and sometimes dictating) what people do with their time, their money, their bodies and their minds. By espousing meanings of, reasons for, and policies to promote physical activity, a vast array of experts, from policy makers to academics and health promoters are, without hyperbole, engaged with the meaning of life.”

It’s unusual to emphasise something in parentheses, but

so unusual has this pandemic been,

so devastating the effects,

and so wide-ranging the interventions, that it is worth reflecting on.

The first three months of this pandemic has exposed many failures by governments to implement good policies to combat the virus. At the same time, the ways physical activity is organised and arranged has been the subject of intense debate. Here’s a rough chronology …

Concrete interventions deployed to keep people from moving too close. Rules, signs, instructions all deployed to manage people and their movement

Tensions between “stay at home” messages and “exercise for health” messages

The rationale of being active for “mental health” being emphasised by many spokespeople, seemingly to alleviate the built-up tensions of people confined for too long.

Anecdotal increases in people exercising in parks, with police required to manage belligerents who are not exercising (enough)

Anxiety about social distancing (which should really be called physical distancing).

The subsequent guilt of being out for too long, or shaming of those who are out for too long

Possible annoyance at others not remaining distant enough.

Possible shaming of those seen to be flouting the rules.

Urgent revisions made to cycling routes and pedestrian routes in some cities.

The erosion of at least some goodwill about distancing.

Academics have also responded. For example:

A litany of programmes and promotion material to get people active during lockdown

Academic journals dedicating issues on future of sport (in Managing Sport and Leisure and European Journal of Sport Management)

Intense questions about whose authority counts. For example, criticisms of lockdown “PE” on youtube

Most recently, in Ireland, “young people are being asked to choose having sex online or over the phone to stop the spread of Covid-19.”

The imposition of various degrees of limitations on all of us, and the transgressions that will inevitably occur will be testing for everyone. It is undoubtedly the case that we all need to manage our physical activity in different ways for the (un)foreseeable future. This will require heightened attention to sympathy, tolerance and respect for our own physical activity AND inactivity, as well as others’. Good luck to us all!

Joe Piggin

There is nothing inherently good about physical activity

Unfortunately people move, act and perform for all sorts of awful, harmful, destructive reasons.
It’s physical assault by bullies, thugs and criminals.
It’s peer pressure from body shamers.
It’s using exercise to punish children.
It’s 69% of children getting concussion from a school sport.
It’s your golf game during a pandemic.
It’s commuting employees putting themselves in harm’s way.
It’s marching for a racist ideology.
It’s “law enforcement” shooting children dead and police brutality.
It’s worker exploitation.

So there is nothing inherently good about moving your body. We need to advocate and promote positive movement. Since we imbue movements with specific goals and meanings, we need to look out for and confront physical activity which oppresses and marginalizes. We need to condemn activities which hinder the flourishing of human potential.

‘It’s a lockdown, but don’t stop exercising’

GUEST CONTRIBUTION: Matthew ‘Tepi’ Mclaughlin, @HealthTepi, PhD Candidate @Uni_Newcastle Chair ISPAH Early Career Networktepi

 

‘It’s a lockdown, but don’t stop exercising’ is the message from the UK Government during the Coronavirus pandemic of 2020.

On the back of this stance, a few people have been quick to suggest this may increase the nation’s physical activity. Or it could go the other way.

Tweet 1

I suggest it will decrease during lockdown.

Personal Case Study of the Mclaughlin Family

Our family unit currently consists of myself and my parents, whilst I am home from Australia (where I am doing my PhD and live with my fiancée).

Dad works at a busy café, regularly sending me screenshots of how he’s done 10,000 steps whilst at work. The café is closed due to the Government directive.

Mum’s a gym bunny, her classes have closed at the gym.

I cycle 26km a day commuting to work, I now walk from my bedroom to the office.

Last week, we set up home gym in the back garden. We’re lucky, we could afford the equipment. We have the skills to set up a safe exercise circuit. We’re all motivated. We don’t have children to look after. We have a back garden. The weather has so far been kind.

We’ve been out each day since.

family1
Photo: Mclaughlin family undertaking the daily workout to start the day, 25/03/2020.

So yes, it may appear we’re ‘exercising’ more….but I suggest we’re doing less overall physical activity during this pandemic. Between us, we’re doing less active transport and less occupation-related physical activity.

Some reasons why we won’t be more active during this pandemic

Reason 1: We might exercise more during our leisure, but we’ll do less active transport and work related physical activity.

Reason 2: Gyms are closed, so exercise routines are disrupted.

  • Do people have the skills to be active outside a gym? I.e. they don’t have the ‘physical literacy’ to be active at home
  • YouTube videos may partially replace a gym, but they likely won’t achieve the same intensity of or duration of physical activity as a gym visit
  • Some may think this is an opportune time for a ‘break’ from exercise

 Reason 3: The privileged might, but others won’t exercise more.

  • Some may have a ‘spare room’ or a garden to exercise in, many won’t.
  • Some may have access to equipment, many won’t.
  • Some may not normally have to work, so may already have been physically active at home (e.g. home gym)

 Reason 4: Many of us have been instructed to leave the house under no circumstances, not even for exercise

  • “Extremely vulnerable” people are instructed not to leave the house, and that list is long

**NEWS FLASH**

Data from Fitbit suggests a decline in step count last week of 9% in the UK compared with the same time last year. It looks as though I was right, unfortunately.

Post the Coronavirus pandemic, will physical inactivity be recognised as a pandemic?

Possibly.

In the long term, this may have some unanticipated benefits. The ‘stage’ that physical activity has been given by politicians is bigger than ever, just by being mentioned. The negative emotions people feel from this lockdown may last, people may attribute them to “not getting outside” or “not moving about”. I suggest Dr Karen Milton may be right:

milton tweet

 

Physical activity and The Great British “Lockdown”

Today was the first day of the British “lockdown”. Seeing the devastation wrought upon countries such as China, Italy and Spain, the UK government has finally(!) taken more serious steps to overcome the Coronavirus. Their official advice is below.

gov lockdown

While the advice / rules are generally clear, there is still some confusion – for example, what counts or what does not count as essential. More detailed advice about leaving the house was provided in a document on the government’s website:

gov 2

In reply to a journalist’s question about how much running, cycling or walking people should do each day, one government minister replied that they should do what “ordinarily would have done”. So if this advice is followed, there won’t be an upsurge in the nation’s physical activity levels, since many/most in the population don’t ordinarily meet government guidelines for physical activity anyway.

After more than a week of very limited movement outside of home, I decided to go for a walk after lunch to a local park. Here’s my thoughts on that. Rewatching the video I noticed I said the UK government still “encourage” exercise … but in hindsight, that was probably too strong … “allow” exercise is probably closer to the truth!

Part 1: Avoiding Other People


Part 2: At the Park


Part 3: The End of the Walk

I am not sure what the future holds for these sorts of excursions. It looks like the situation in the UK `is only getting worse with more than 80 people dying today from the virus. It is quite possible even walking, running and cycling for exercise will need to be eliminated for a while. Keep safe everyone!
Joe P