Greg Smith is the Centre Director of the Centre of Sport Science and Human Performance at Wintec.
There has been significant attention paid to the occurrence of concussion in sport recently. Rugby has received a lot of this attention in New Zealand.
As the game has evolved the athletes have become larger, stronger and faster. I would estimate that professional athletes are now at least 10kg bigger than when I entered the professional game in 1996. Rule amendments have resulted in the game becoming faster and while the combative nature of the sport has remained constant the contact intensity has magnified resulting in significantly larger body contacts.
A number of rugby identities, both past and current have gained media coverage and spoken out about their battles with concussion. These battles have included accounts of sustained periods on the side-line waiting for concussion symptoms to clear so they may return to play through to the ongoing battle some players face as they try to function on a daily basis.
The box office have added to the attention on this topic. The recent Will Smith movie ‘Concussion’ gave a graphic account of the damage repeated and sustained concussions caused professional American footballers. Within this factual account Will Smith plays the character of Dr Bennet Omalus, a forensic pathologist who fights against the efforts of the National Football League to suppress his research on chronic traumatic encephalopathy (CTE) brain degeneration suffered by professional football players.
I believe the recent focus on concussion within sport has brought much needed attention to an injury that struggles to be understood. Concussion is an invisible injury. You can’t see it, the effects can be varied and it is difficult to understand. Having watched a recent game of ‘oldies’ rugby where men who once were prime specimens hobble around after each other it struck me that most injuries have simpler prognosis and treatment plans. Most injuries can be understood. Tendons reattached, joints replaced and muscles repaired etc. Concussion it seems is more complicated with a far greater range of symptoms and possible outcomes.
I know from experience that recovery from concussion is complex. Repeat concussions ultimately finished my rugby career at aged 30. This end point did not come as a surprise. It was a result of 20 years of head knocks. These started at aged 10. I would frequently take knocks to my head that resulted in loss of memory. I often had no recollection of the content of games and trainings. It was a joke among family and friends that I would ‘wake up’ after trainings and games to check on the score and how I had performed. As a young boy I started to be known as the guy with a hard head. I believe I fed on this and continued to knock my head around with intent in an attempt to embellish these perceptions further.
As I progressed through the grades I sustained lots of other knocks. My introduction to senior club rugby was met with a knock that resulted in four weeks of serve headaches and vomiting. I remember taking a knock in a New Zealand under 21 trial that resulted in the loss of all memory of where I was, who I was playing for and who I was playing against. However more importantly at the time was the realisation that I had forgotten the lineout calls. An awkward moment as I stood at the front of two lines of players waiting for me to throw the ball to them. As I got older finals rugby, Ranfurly Shield challenges, Super Rugby games and test matches were all played under the cloud of concussion.
The thing about the examples I have highlighted and many more through my career was that I was selective about how I reported what was happening to me. I knew the significance of each injury was hard to measure and that I could control the medical treatment plan and the extent to which game time was missed depending on what I told medical staff. At times I knew I should not have played but I did. Many times I went straight back out. I didn’t want to give up my spot, I wanted to do what I was best at. I wanted to play.
Towards the end of my career I sustained a series of knocks that proved to be game changers. The first of these were during a Super Rugby game in which I had my head stood on. The two knocks that followed the Super Rugby game were less significant but the resultant symptoms intensified.
The symptoms scared me for the first time in my career. Previously I would recalibrate the new level of normal function after a knock and carry on. I had previously accepted that while the knocks were doing damage I was able to cope. I had told myself that I was invincible. Rugby was my job. I had financial goals and rugby was how I’d achieve them. Rugby was also my identity and I derived self-worth out of being Greg Smith the rugby player.
What scared me about the new symptoms was the extent of lost function. Function was impaired to the extent that everyday life was not easy.
- I temporarily lost the ability to speak.
- As speech returned I realised I had forgotten words I once knew.
- I had lost the ability to pronounce words that started with p, m and s.
- Light sensitivity became an issue and I couldn’t sit in a room with the lights on.
- Noise was intolerable.
- Anything that required sustained concentration was not possible. I couldn’t concentrate for longer than a minute. I couldn’t sit at a computer or drive a car.
- I was intolerant and not myself.
However I continued to play. Announcing myself ready to go when I came close to passing the neurological tests rugby had in place.
During 2004, my last year of rugby, I saw four or five different brain specialist. I was getting myself checked out and looking for the doctor that would tell me I could continue playing. No one did though. They all told me it was time to stop.
I was told that any further damage would result in the permanent loss of brain function and that the risk of suffering a stroke from a head knock was high. By the time I gave up, my symptoms were worse. MRI scans showed scarring in my cerebellum, the part of the brain responsible for functions such as language, attention and coordination. When my brain became overloaded it would go into spasm and I would experience nystagmus - a condition in which my eyes would blink uncontrollably. Initially closing my eyes was the only way to manage this brain malfunction. Later I was required to wear glasses as a management strategy. I was also diagnosed as having post-concussive depression and was required to take anti-depressant medication to manage this.
I know I was lucky I stopped when I did. I will never know what might have happened if I hadn’t stopped. However I was provided a reminder that my body has sustained damage when I played a social game of rugby in 2012. Following a knock in the back of my head I suffered two transient ischemic attacks, (mini strokes) that resulted in temporary shutdown of the entire left side of my body. I haven’t played again!
I was lucky. I made poor choices that led me to the brink of permanent disablement. I escaped just in time. It has taken years to rewire my brain and a great deal of awareness to manage my symptoms, some of which haven’t gone completely.
Everyone that plays rugby understands that there’s a risk of being hurt whenever you go out there. That’s always been the case. We do this by choice.
What I advocate for is make good choices and empowering people to help you make choices when you get injured. While personal responsibility is important young athletes might require others to help the decision making process.
Listen to your body. Look after yourself first. Impairments caused by head injuries are hard to measure, and the science is still new. Be aware of what you are experiencing, and report it honestly to your doctor.
Remember that it’s only a game, and while it’s important, it’s not the be all and end all of who you are and all you will achieve. Being an athlete is not your identity, it’s just something that you do for a period of time.
Gaining another concussion (that's me underfoot)