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the researchers state “the responses of the current sample may not include the characteristics of players who have withdrawn from rugby participation due to concussions or the risk of possible concussions.”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

An urgent call for clarity regarding England Rugby’s injury claims – update

A couple of weeks ago, Prof Alan Bairner and I wrote an analysis of England Rugby’s false and misleading injury rate claims. Here is the link:

http://idrottsforum.org/feature-piggin-bairner170523/

I can now report that England Rugby responded. Here is the initial response – with names redacted:

Dear Joe, 

Thank you very much for your email and for bringing this to attention.

The RFU takes player safety extremely seriously. I would like to take the opportunity to respond to your email and to you and Professor Bairner on your editorial (An urgent call for clarity regarding England Rugby’s injury claims). 

We acknowledge that an editing error was made in the wording used as part of our Rugby Safe booklet, which was published two years ago. It should have read: There is no evidence to show that rugby poses a specifically greater risk of catastrophic injury than other sports and other activities to align with the graphic used directly after it on page eight (screengrab attached). This was a mistake as part of the publishing process.

We want to ensure all our resources include accurate information, so will be undertaking the following:

  • Amending the 2015 Rugby Safe booklet to remove the inaccurate wording with immediate effect (the 2015 document has already been removed from our website)
  • Publishing an updated Rugby Safe booklet next season using the latest research and findings

The RFU has apologised to Colin Fuller for the error. It was not our intention to mislead. We will continue our ongoing commitment and work to ensure player welfare is central to all that we do.
Yours sincerely,

###### #####

RFU 

##### ####

For more see:

Piggin, J. & Bairner, A. (2017) An urgent call for clarity regarding England Rugby’s injury claims. Nordic Sport Science Forum http://idrottsforum.org/feature-piggin-bairner170523/

Rugby, rules and rhetoric

As I once said “We are all discourse analysts. Whether we are reading, debating or writing policy we are attempting to understand the political dynamics at play in its construction and predict the ramifications of its implementation.”

Here I look back on the previous year and examine how the rugby world faced two major public furores; first an open letter calling for the removal of rugby in schools, and second, a major reworking of the rules of rugby. The benefit of hindsight helps us a lot here. I take this press release and consider it in the context of what subsequently occurred.

So, the day after an (admittedly provocative) open letter calling for a ban on tackle rugby in school sport was released (March 1), World Rugby released this statement (March 2). The fact World Rugby’s response came out very quickly after the letter is noteworthy. This was over 1,000 words crafted to reassure the public, via the media and twitter, that there was no problem to be concerned about. Below I respond to some extracts from the press release:

WR: “As a global governing body, our responsibility is to minimise the risk in our sport and we continue to be committed to making rugby as safe and enjoyable as possible for all ages through education and promotion of correct preparation and playing techniques, prevention strategies and minimising and managing the risks associated with one of the world’s fastest-growing team sports.”

JP: “Minimising risk” and “as safe as possible” are relative terms. They are purposefully vague, since it would be unthinkable for “one of the world’s fastest growing team sports” to remove tackling.

WR:“We are leading the agenda in sport …”

JP: We should be wary of any organisation that wants to grow its sport around the world AND lead the agenda of child safety, especially in schools. School safety should be the responsibility of schools.

WR: “Never have players, medics and management been so aware of the risks of injury …”

JP: Until later that year, as it would turn out, when World Rugby would “aim to change culture in the sport to ensure that the head is a no-go area”.

WR: “Results from the World Rugby Sportswise Survey (2015) revealed …”

JP: The SportsWise survey was eventually retracted.

WR: “84 per cent of parents believing sufficient measures are taken by schools and sports clubs to protect children against injury during sports and activity.”

JP: Given that World Rugby has made significant changes to the conception of “the head”, it seems 84% of parents were wrong. Perhaps they had not been informed properly.

WR: “It is true that there is an element of risk in everything that we do in life …”

JP: This statement elides the real and measurable risk from playing collision sports.

WR: “Compared with other sports and activities, rugby has a relatively low injury severity rate despite being known for its physicality.” [note – the term “severity” was added after it was pointed out to World Rugby that there earlier claim was erroneous and misleading.]

JP: Well this is sort of true and sort of false. It’s true when looking at the Australian sport injury data, but false when considering other research on injury risk. A variety of research published in the BJSM notes a high rate of severe injuries.

WR: “However, the call for a ban on tackle rugby is not based on evidence nor does it add to our understanding of the important issues surrounding player welfare.”

JP: Given that World Rugby had to retract their evidence about risk in rugby and change their press release, I would encourage a more humble view about what “evidence-based” means. Secondly, I suspect that the letter contributed in part at least to the reformulation of rugby’s treatment of the head, so I suspect that it did add to player welfare.

WR: “This is a vocal minority that doesn’t reflect the views of millions of people who embrace the wonderful game …”

JP: Rates of concussion are increasing, and I suspect World Rugby had to act in order to preserve either a decrease in popularity of young people playing rugby, or the threat of litigation.

WR: “As the American Academy of Paediatrics (AAP) stated within a 2015 policy statement, although removing tackling would reduce the risk of injuries to players, it would fundamentally change the sport.”

JP: Hmmm, now World Rugby say that there is evidence that that removing tackling would decrease the risk, albeit evidence from another policy statement.

WR: “… this uninformed call for a ban.”

JP: It depends what you mean by “uninformed”. I suspect the other signatories of the letter just wanted children to be safer at school, and not made to forcibly take part in high impact collision sports.

WR: “As parents we believe that the safeguards are in place and will continue to improve and that the character and benefits of the game far outweigh the relatively low risk of injury.”

JP: Sadly World Rugby did not completely change their press release to remove all the erroneous material. Perhaps I will send them an email.

 

For more, see

Piggin, J. & Pollock, A. (2016) World Rugby’s erroneous and misleading representation of Australian sports’ injury statistics. British Journal of Sports Medicine, [Online First] doi:10.1136/bjsports-2016-096406

 

World Rugby’s erroneous sport injury statistics

Yes, all sport has an element of risk, but if there is one thing that is non-negotiable, it is the provision of accurate injury statistics to the public. Unfortunately, this document called the World Rugby Sportswise Survey has been in the public domain for nearly a year. Even with a cursory viewing of the “Australia” graph, something seems incorrect:
world-rugby-sportswise-survey

(Note: As of 16 September 2016, World Rugby has claimed to retract this but a simple web search reveals it is still available various places online). To be clear, the data in the Australia graph above is incorrect. The statement that “compared with other sports and activities, rugby has a relatively low injury rate …” is also incorrect. For more see http://bjsm.bmj.com/content/early/2016/09/15/bjsports-2016-096406.extract

When it becomes known that erroneous data are publicised about risk in sport, the publishers should clearly retract them and display the correct data. The original, more valid Australian government data is below: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549097
injury-stats
You can see that the “participation based” data shows rugby is the 4th most injurious sport, per 100,000 participants.

Very problematic claims about injuries manifest elsewhere. For example, the publishers of “Rugby Safe” in England should make some corrections to their document as well. See the very problematic quote below: http://www.englandrugby.com/rugbysafe/

rugby-safe-quote

There is actually a lot of evidence. For example, here is a screenshot of an academic article by CW Fuller which totally contradicts CW Fuller:

risk

It is therefore inappropriate for this comment to appear in a document discussing safety.

Let’s hope the public can be provided with accurate statistics by organisations with significant marketing power, so parents and children are better informed about risk in various sports. It is no longer enough to dismiss safety concerns by saying that “everything has risk”. When children are made to play particular sports at school, they and their parents should have a good understanding of the risk involved.

This problem of falsely representing injury risk has occurred recently in another collision sport – the NFL:  http://www.nytimes.com/2016/07/28/sports/football/nfl-concussions-youth-program-heads-up-football.html?_r=0

Joe Piggin