The round three clash between the Sharks and the Eels saw four players fail HIA throughout the match Source: Parramatta Eels

With the NRL facing more scrutiny about concussion rules a few weeks into the 2021 season, Dr Alan Pearce discusses what needs to be better.

In 2021 the NRL’s concussion rules are under more scrutiny than ever before.

The third round saw eight players ruled out mid-match after failing a Head Injury Assessment (HIA) with the Cronulla Sharks versus Parramatta Eels clash resulting in four concussions alone.

At present, the NRL has already enforced two rule changes regarding concussions following the commencement of the 2021 premiership season. Following the first round, the NRL ruled that players who fail an HIA will need to be cleared by an independent neurologist within 11 days of suffering the concussion.

A change that created some confusion, as some believed that meant the NRL was following the AFL’s decision to rule a player out for at least a week. However, that couldn’t be further from the truth with five of the eight players suffering concussions last week named for their respective round four matches.

The Inner Sanctum spoke with Associate Professor in Neurophysiology at La Trobe University Dr Alan Pearce about concussion safety and the value of the rules being introduced. With Pearce asserting independent medical assessors are less likely to feel pressured by clubs and players.

“I think having an independent medical assessor is a good thing. Because it takes it out of the responsibility of the club doctor to feel a little bit pressured to get the player back as quickly as possible,” he said.

“Whereas someone who is an independent medical assessor doesn’t have that obligation. If the doctor is going to assess the player as a patient and say, okay do I see signs and symptoms, what are they reporting how severe are those symptoms that they report, what is my medical prognosis of their recovery going to be like. 

“With a club doctor there’s always the pressure not just from coaching staff but we know from the research that players themselves can try and pressure doctors to say you know what I’ve got a headache but I’m actually okay, I think the headache is not from my concussions but I had a drink last night or I was listening to some loud music or I went for a run/jog and I pushed too hard and I think that’s what is causing my headaches rather than anything post-concussion.”

“So that can also put undue pressure onto the doctor to try and sign them back quickly. So, I think that’s a good thing. 

“One of the things though having a club doctor is that a club doctor knows the player really well. While the science doesn’t necessarily support this I do know that there is some anecdotal evidence to suggest that the club doctors knowing the players really well can actually teeth out what actually is concussion and what may be some other effects. The headaches or nausea may be coming from neck soreness or some shoulder soreness that is impacting on a nerve that is travelling to the brain, there are two sides to the argument.”

The second new rule to be announced was the controversial 18th man, not set to take effect until next weekend, for a team to activate the 18th man they will have to have three players fail an HIA throughout the match.

The policy isn’t untested with the 18th man being brought into the NSWRL in the 2020 premiership season. However, NSWRL teams didn’t need three players to fail their HIA but only needed one player to fail to switch in the 18th man.

Whilst the NRL is looking to avoid clubs exploiting the 18th man rule, the caveat of three players having to be ruled as concussed before the substitution can be brought in is being seen as a purely cosmetic change that will rarely need to be utilised, with how rare it is for three players from the same team to fail an HIA.

Mid-season rule changes are often seen as controversial, with the increase in players suffering from concussions, changes need to be made for the sake of player safety without impacting the general play too heavily.

The fourth round featured a bizarre decision to not immediately pull Canterbury Bulldogs halfback Lachlan Lewis from the field, following a head knock as he tackled Rabbitoh Josh Mansour.

Lewis remained on the field for the entirety of the Bulldogs attacking set much to the bewilderment of fans and the commentary box, before the referee ordered time off and for a trainer to help Lewis off the field.

Following his removal, Lewis failed the HIA and was ruled out for the remainder of the match.

Had the 24-year-old engaged in a play in the additional 90 seconds he was on the field there was a significant risk that he could take a second knock and do more damage. 

Whilst it is unrealistic for every player who receives a head knock to be escorted off the field and undergoes an HIA when a player is stumbling around and unable to run following a knock it should be expected that they are removed from the field to undergo testing without a team being able to complete an entire set. 

In his fourth season, Lewis is yet to have a proven history of concussions, however, studies have shown that NRL players have a high rate of concussion with a 2020 study noticing that in a group of 11 former players, the men had an average of 38.4 concussions throughout their careers, with one player suffering 125 concussions throughout his career. The study also found an average of 7.7 head knocks per player involved a loss of consciousness.

It shouldn’t be dismissed that athletes in a contact sport have an increased risk of concussion but with each concussion increases the risk of concussion and makes recovery a longer process. However, management and rules with less grey area of when a player can return would be in the interest of the player welfare.

Dr Pearce described that a minor hit to a player with a history of concussions can have the player go down and take them out of the game for an extended period of time.

“The scientific evidence is telling us that the more concussions you have the longer or more severe the symptoms and it does take longer to recover.

“Now the other side of it too is that for every subsequent concussion you get, you need less of an impact force to get concussed. So someone, who has a history of concussions, it may look like an innocuous hit to someone but they then go down very badly and they’re out for quite some time. 

“Because what we see is that the brain tissue becomes more vulnerable with every concussion. While every concussion is individual and everyone responds individually we need to take a bit of a conservative approach and have guidelines for subsequent concussions within a two-year window. 

“If they have had more than one concussion then the second concussion needs to have this amount of time out if they have a third concussion this amount of time out, but I think if you have a player that is getting multiple concussions then we’ve got to seriously think about their future as well.”

Along with the introduction of the 18th man in 2020, NSWRL instituted that a player who suffers from a concussion will have a mandatory stand-down period of 14 days, focusing on the interest of player welfare and recovery.

The lack of consistency regarding concussion protocols is a concern for player safety at the top level of the game, as the NRL is often a faster and more intense game than local and representative leagues across the country.

Dr Pearce noted that regardless of the level senior Rugby League needs consistent regulations, and listen to the recommendations for junior leagues.

“A concussion at any level doesn’t discriminate in terms of how quickly someone recovers and we should be having standardised regulations at all levels of the game whether it’s NRL or D Grade club level it should be pretty much the same. 

“Then if we go to juniors then it should be based on children’s recommendations of recovery which are even longer.”

Fans and experts alike are calling for the NRL to get serious about concussions. In the interest of long term player welfare, there needs to be an acknowledgement from the League that changes need to be made, taking on board the recommendations from experts without rushing the changes in.

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