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Friday 20 April 2018

Croker clarify head injury guides

New GAA rules on concussion should help modernise attitudes and prevent a repeat of Rory O'Carroll's case

Dessie Farrell and Liam O'Neill. Picture credit: Paul Mohan / SPORTSFILE
Dessie Farrell and Liam O'Neill. Picture credit: Paul Mohan / SPORTSFILE

CROKE PARK has released its latest guidelines on how to treat concussion injuries in the GAA, stressing the prerequisite that a concussed footballer or hurler should never be allowed to resume playing on the same day.

The association also advocates a "medically supervised" return-to-play protocol to ensure that a player who has suffered concussion NEVER returns to action while any symptoms persist.

However, despite recent high-profile examples in the All-Ireland senior football final and in English soccer where concussed players stayed on the field, the GAA has decided against introducing a mandatory 'stand-down' period for a concussed player ... or to introduce a 'concussion sub rule' along the same lines as the blood sub rule.

In the latter scenario, any player diagnosed with such a brain injury (to give concussion its graphic definition) could be immediately replaced, even if his team had already used up its full allocation of subs.

There are fears that such a rule could be manipulated by team managements seeking to make an extra substitution, but GPA chief executive Dessie Farrell conceded that the association might have to consider such a move in the future.

"It's definitely something to look at," said Farrell, a member of the GAA's Medical Scientific and Welfare Committee which yesterday delivered updates on its national injury database and concussion guidelines for 2013-16.

"I know it (concussion) is not as evident obviously as a blood sub, where blood is drawn, and the argument will be, well, could it be used to just replace a player?" he expanded.

"I think what we need to do first of all is develop the culture within the organisation; that everyone understands what concussion is about and how serious it is.

"If you look at what happens in other sports, they've evolved their policies as they've become more familiar with the subject matter and more comfortable in dealing with it. I think it's definitely something to be looked at in the future."

The GAA's most recent concussion controversy arose during the All-Ireland SFC final when Dublin full-back Rory O'Carroll stayed on the pitch despite suffering concussion in the latter stages, at which point the eventual champions had already exhausted their five bench options.

The following day, manager Jim Gavin clarified that they only found out after the game that O'Carroll had been concussed and would have replaced him immediately if they had known.

"If a player is concussed he should have been off," said Gavin at the time.

"He had a bang to the head, as did Jonny Cooper and Philly McMahon, along with one or two others. Jonny came straight off because he was diagnosed with concussion and he even vomited up there in the dugout afterwards, but if we had known the extent of Rory's injury he would have been off."

Then, just a few weeks ago, Tottenham found themselves engulfed in controversy after their goalkeeper Hugo Lloris took a shuddering bang to the head against Everton but insisted on staying on.

Intriguingly, the Medical, Scientific and Welfare Committee yesterday released statistics from its national injury database which revealed that less than 1pc of GAA injuries have been diagnosed as concussion. The figures (0.8pc football, 0.5pc hurling) seem relatively minuscule but Dessie Farrell does not believe the problem has been exaggerated.

"We did a piece of research on it ourselves, just internally within the players association," he explained. "It wasn't evidence-based because players are not completely au fait with the subject matter either, but the indication to us would have been that a lot more players have experienced concussion at various stages throughout their career."

The former Dublin captain includes himself among those players who have suffered concussion and played on. He recalled "getting a blow to the head in a club game, in a championship match in O'Toole Park ... and coming to afterwards and trying to figure out why I wasn't in Mobhi Road, Na Fianna, and wondering how come the clubhouse had been moved from the left side of the pitch to the right side. But again, it's part of the culture, you drive on and you play on."

Ger Ryan - chairman of the Medical, Scientific and Welfare Committee - was asked if they had considered framing a motion for GAA Congress whereby you 'stand down' a concussed player for a minimum period.

Template

"Yes, we did give consideration to that," Ryan replied, "but having had a look at the level of concussion injury, having taken the expert advice, we believe that the guidelines are sufficient and that they're a very good template for managing concussion. Obviously, like any new guidelines that you announce, we will review how effective they are and if they are doing the job we expect them to do."

What the guidelines do contain is a strict "return to play" protocol. These include:

p Never returning to play on the day of injury.

p Never returning to play while "symptomatic".

p An initial period of 24-48 hours' rest post-concussion.

p A gradual return-to-play protocol, progressing through the following rehabilitation stages: no activity, light activity (such as walking, swimming), sports-specific exercise (running drills), no contact training drills, full contact practice, and finally return to play.

p Generally each of these steps should take 24 hours, so that the athlete would take approximately one week to complete his rehabilitation - once they are asymptomatic at rest.

p If post-concussion symptoms occur, a player should drop back to the previous asymptomatic level and try to progress after a further 24 hours' rest.

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