Club Measures How Hard Rugby’s Hits Really Are

from NY Times:

Opetera Peleseuma, left, and Aidan Jordan of Hutt Old Boys Marist wore patches behind their ears to measure the hits they took during their match in Wellington. The patches measured the force, direction and rotation of any impact.

WELLINGTON — How much of a beating does a rugby player take during a game? While players measure that in aches and pains, which cannot be quantified, an amateur club is now trying to take a scientific approach to determine how jarring those hits are and how they might lead to concussions.

The long-term effects of blows to the head and the way concussions are diagnosed has been news not just in rugby, but in the National Football League, boxing and other sports.

In New Zealand, where rugby union is the national game, the Hutt Old Boys Marist club is taking a high-technology approach to the issue. The club is using electronic mouth guards and patches stuck behind the ear to measure the force, direction and rotation of any impact during a game. The data are suggesting that players sometimes face the same strain as when two cars collide.

Each mouth guard and patch uses an accelerometer and gyroscope to calculate the exact point of each impact and the G-forces behind it. The N.F.L.’s Seattle Seahawks and San Francisco 49ers used similar mouth guards last season.

Doug King, a specialist nurse in the emergency department of a Wellington hospital, is the medic for the Hutt Old Boys Marist, often known as H.O.B.M., and he is conducting the research on the rugby blows as part of his second doctorate.

Last year he introduced to the club the King-Devick test, a screening that can help determine whether a player has suffered a concussive incident during the game.

A player does an initial test in the preseason to record a baseline score. The players are then tested after every game, and if anyone is three seconds slower than his baseline score, he is deemed to have suffered a concussion. Because the test is calculated on an iPad, it can even be used during a game if a concussion is suspected.

Last year there were five concussions witnessed on the field, but another 17 were diagnosed through the King-Devick test (which is named after another King, not Doug).

This year, H.O.B.M. is taking it a step further, using the King-Devick test in conjunction with the data collected from the mouth guards and patches, which register anything from 10 G’s worth of force or more.

An F-16 fighter-jet roll is equivalent to 9 G’s of force, although that is over a prolonged period of time compared with an impact in a rugby game. A car crash at 65 kilometers, or 40 miles, per hour is about 35 G’s.

“The highest G-force recorded was 205 G and the player played the whole game with no signs of cognitive injury post-match,” said King, who began his research into concussion after watching a rugby league player die on the field in 1998 as a result of concussions and cranial bleeding.

In the short time the devices have been used at the club, most of the recorded impacts have been around 10 to 20 G’s, with some up to 40 G’s. The average impact is 22 G’s.

In a game two weeks ago, there were more than 3,000 recorded impacts, but there were no witnessed concussions on the field, and no concussive injuries were detected after the game through the King-Devick test.

“I think the message out of all of this is that no one knows the impacts that are going on in rugby union,” said King. “It’s never been done before in New Zealand. It’s never been shown.

“Research in the States is coming out that the range of 68 to about 106 G’s worth of force is when a concussion happens. I’ve gone over that, and I’ve got no concussions symptoms coming through. Yes, N.F.L. is totally different to rugby union, but a head is a head.” King always gets the final say on whether a player can return to play after an injury, a concussion or a suspected concussion. (If a concussion is confirmed, then a player needs to take at least three weeks off and be cleared by a medical official before he can play again.)

Justin Wilson, the coach of the H.O.B.M. senior team, has seen a cultural change since the introduction of the King-Devick testing.

“I think early on last year it was difficult for the players to even grasp the concept of what was going on. But as the season wore on and now we’re into our second season, it’s almost become just part of what we do,” he said.

Players have become less blasé about concussions as they have become better informed. Coaches and players now readily accept decisions to bench players after they suffer a blow to the head. Warm-up routines now include neck-strengthening exercises.

“It’s just about looking after the player. We want them to be healthy when they leave rugby as well as when they’re in the game. It’s really important,” added Wilson.

Polonga Pedro, 31, has been playing for the H.O.B.M. first team since he was 18. He has never suffered concussion but has seen others who have.

“Guys don’t remember anything, even after the game is finished. Long into the night they come up and say ‘Who won the game?’ It’s quite scary,” said Pedro, a forward who is using the mouth guard and patch for the trial.

“The thing that gets me now, is the guys that get the knocks and not knowing during the game. That’s scarier because there are no signs, except if you’re much slower on your baseline tests.”

The raised awareness has not dissuaded Pedro from playing rugby; in fact, he said, he is reassured by the professional approach the club has taken toward dealing with head trauma.

He has found the mouth guard is chunkier than standard ones, which means he has to remove it to call a play at line-outs. But otherwise they are no hindrance. Sweating has caused some patches to fall off during games, but generally players do not even notice them during play.

Wilson and King would like to see more being done on concussion by those at the higher levels of the game.

The New Zealand Rugby Union, which governs professional and amateur rugby in the country, has signed up with the Zurich Consensus, which set guidelines on how to diagnose and manage concussions, along with protocols on when players can return. The guidelines are based on information garnered from a number of sports familiar with hard blows, including rugby union, rugby league, the N.F.L., Australian Rules Football and soccer.

Ian Murphy, the medical director for the N.Z.R.U., said the King-Devick test was currently not recommended by the Zurich Consensus, because it was an “as yet unproven test in terms of its sensitivity and reliability in assessing sports concussion.”

But Murphy, who is aware of King’s work, welcomes any research that could improve knowledge about concussions and their long-term effects.

A study sanctioned by the N.Z.R.U. and the International Rugby Board is looking into the long-term physical and psychological effects of rugby injuries, but the response has been poor so far, and researchers need 550 more people to respond to gather the necessary data. (People can sign up at rugbyhealth.co.nz.)

Over all, Murphy believes the N.Z.R.U. is doing enough to deal with concussions by adopting the Zurich Consensus for professional rugby and by using its RugbySmart program for amateur rugby.

RugbySmart provides seminars, DVDs and information online for coaches, referees and players, covering topics like nutrition, proper technique and how to deal with injuries. One of the 10 sections is focused just on concussions.

Every coach coaching amateur teams in New Zealand is required to complete the program.

“I am comfortable that we are doing what people would hope we are doing, and that is acknowledging the issue, accepting that we don’t have all of the answers and actively looking to participate in getting those answers,” Murphy said.

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