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Head Injuries in Sport: Can More Be Done to Prevent Concussion?

Rugby players in scrum | Head Injuries and Concussion in Sport

Concussion has become a major talking point in the world of sport, largely due to the rollout of significant legislative changes in how head injuries are managed and assessed on and off the field of play. This is particularly true of rugby, whose governing body has recently introduced new directives for punishing high tackles — the leading cause of serious head injuries within the game.

The treatment of head injuries in sport has proved a sticking point for well over a decade. Despite new research highlighting the damaging long-term impact of successive blows to the head, sport governing bodies have been slow to act on the mounting evidence, perhaps through fear that major rule changes could dilute the enjoyment of the sport for players and fans.

But with young players like Welsh international forward Jonathan Thomas being forced to retire from the game with life-changing brain conditions, it’s clear that the management and assessment criteria of serious head injuries need to be addressed.

Here, we look at how different sports address the issue of head injuries, and comment on recent legislative changes which could prove invaluable in curbing instances of harmful concussion.


As one of the world’s most physically demanding sports, rugby has a high rate of head injury. Indeed, concussion represents almost half (47%) of all injuries sustained by a tackler, and 20% by the ball carrier. It’s believed that at least one concussion occurs in every professional rugby game, with one-third of all severe blows to the head occurring during the tackle.

Historically, World Rugby took a tough stance on concussion. Players were required to come off the pitch and not play for a week — previously three weeks. All that changed in 2012, however, when the Pitch Side Concussion Assessment (PSCA) was launched; a five-minute concussion test to check if players should be allowed to return to the field.

The PSCA has faced criticism since its launch, with ex-players and sports medical experts arguing that cases of concussion need to be addressed more thoroughly to prevent further brain trauma and cognitive impairment. Speaking to the Scotsman, former Ireland international player, Barry O’Driscoll, said that World Rugby was guilty of “trivialising concussion” and that “there is no test that you can do in five minutes that will show that a player is not concussed”.

Rugby players tackling | Head Injuries in Sport

On 3 January this year, World Rugby introduced a new zero-tolerance protocol on high tackles. Under the rules, the severity of punishment for reckless tackles has increased, with players now facing match bans for the worst offences. It’s hoped the legislation will give more protection to ball-carriers and tacklers, reducing the risk of serious head and neck injuries.

However, like the PSCA, World Rugby’s new high tackle protocol has received criticism, with the Guardian calling it “disingenuous” to refer to it as law change at all. It argues that high tackles have always been penalised, and that increasing sanctions for individual challenges doesn’t address the real issue of concussion within the sport.

Following World Rugby’s rollout of tougher high tackle penalties, Rugby Football Union’s chief medical officer, Dr Simon Kemp, predicted that further legislative change is likely in the professional game. He said that the new protocol doesn’t go far enough in addressing the tackle-to-concussion ratio, and that new initiatives were being considered which he hopes will address the head injury risk to the tackler, and not just the carrier.

With concussion now accounting for 25% of match injuries, more must be done to prevent serious head injuries which could prove debilitating for young players. In our view, World Rugby should change its stance on the PSCA protocol, and provide greater education on the long-term cognitive impact of concussion.


In late 2016, an in-game incident involving Manchester United’s Anthony Martial raised questions about the FA and Premier League’s approach to concussion and head injuries. During a match with Watford, Martial clashed heads with Daryl Janmaat, receiving extensive treatment before being cleared to play on. Minutes later, an error by Martial led to Watford’s opening goal, and the player was then substituted, clutching his head as he left the pitch.

Martial’s injury, and subsequent error, prompted much debate around the topic of concussion in football. Pundits and sports medical professionals alike have voiced concerns that the MUFC forward should have been substituted earlier, particularly if club doctors suspected that he had suffered a concussion.

Historically, the Premier League left it up to team managers to determine whether a player should be allowed back on to the field following a suspected head injury. Ahead of the 2014/15 season, however, the association introduced new rules on how clubs and match officials should deal with suspected concussion – passing the responsibility to club doctors rather than coaching staff.

Under current guidelines, medical staff enter the field of play to assess the injury, and determine whether there has been a loss of consciousness. If the player was knocked out, they’re removed from the pitch and not permitted to return.

Football player heading the ball | Head Injuries in Football and Sport

In cases where the injured player hasn’t lost consciousness, a brief assessment will take place to determine whether they have any symptoms of concussion. Medical staff can also review footage of the incident, to determine the order of events and impact of the injury.

As well as this, all players are now required to undergo a pre-season neurological assessment, making it easier for doctors to measure their recovery rate should they suffer a head injury.

While these measures appear comprehensive in safeguarding players against repeat concussion, the case of Anthony Martial does raise questions about the concussion assessment process, and the judgement of club medical staff.

Like the PSCA protocol used in rugby, the concussion assessment criteria used in football does have its critics. Luke Griggs of the Headway Brain Injury Association believes that the assessment doesn’t go far in enough in ascertaining whether a player has clear-cut signs of concussion, and has voiced concerns that too many professional players are allowed to play on after a serious blow to the head.

Speaking to Sky Sports, Griggs said: “We are concerned that the ‘if in doubt sit it out’ approach isn’t being adopted in all cases. If players continue after a concussion, a secondary knock can significantly exacerbate the damage to the brain and cause real problems.”

Given the serious impact concussion can have on cognitive performance, it’s vital that young players are protected from the life-changing effects of repeat concussions and head injuries. Team doctors should commit to a ‘safety first’ policy that puts the well-being of the player before the ambitions of the club.

Horse Racing and Show Jumping

It may not be a contact sport like rugby or football, but horse riding has more concussions than any other sport, with an average of 25 concussions in competitive show jumping events and 17 in flat terrain races (per 1,000 player hours).

So concerned is the British Horseracing Authority (BHA) by the number of concussions in equestrian events that it’s launched a new initiative aimed at preventing head injuries sustained by professional and amateur riders. This has been developed in conjunction with the Professional Jockeys Association, The Injured Jockeys Fund, and the Racecourse Association.

Under the new protocol, the BHA will introduce improvements to its current standards and procedures, with a special focus on enhanced education, regulation and research. It plans to replace the current annual cognitive screening with more rigorous Cogsport neuro-psychological testing, and introduce Scat5 testing to medical teams at the racetrack — bringing equestrian events in line with other professional sports.

Jockey falls off horse | Head injuries in Horseracing and Sports

In a bid to raise awareness of the widespread issue of concussion in equestrian sport, the BHA has also launched a hard-hitting poster campaign in conjunction with the Headway charity. The ‘If in doubt, sit it out’ campaign was developed to give jockeys help in spotting the warning signs of concussion, as well as practical guidance on what to do after suffering a serious head injury in a fall.

Dr Jerry Hill, chief medical officer of the BHA, was one of those behind the new head safety initiatives. Recognising concussion management as one of the biggest issues facing equestrian sport, Dr Hill and his team have begun work on a range of safety improvements, with a special onus on improving the education and awareness of concussion among jockeys.

Speaking to the Racing Post, Dr Hill said: “While British racing has for some time been a pioneer on this topic, I am determined that we remain at the forefront of scientific research, education and regulation when it comes to this crucial issue.”

Changes to baseline neurological testing represent a pioneering shift in the safety of equestrian sport. While the more rigorous testing process is expected to take longer, it should offer greater insight into the long and short term impact of concussion, and make it easier to track the rehabilitation process of individual jockeys.

It’s encouraging to hear the BHA’s commitment to improving research, education and regulation around concussion. We only hope that the recent protocol changes prove effective in reducing head injuries, particularly among young riders at the start of their career in the sport.


Despite the fierce nature of boxing, the sport takes a comprehensive and infallible approach to head injuries, ensuring that amateur and pro fighters aren’t unnecessarily exposed to the long-term impact of repeat concussion.

In the UK, boxers stopped in a bout are suspended for 28 days, rising to 45 if they’re physically knocked out or have suffered serious punishment to the head and upper body. After their suspension period is up, they must receive clearance to spar again from the British Boxing Board of Control (BBBofC). This rigorous concussion assessment is carried out by a BBBofC doctor, and can involve an MRI brain scan in extreme circumstances (alongside the routine annual brain scan required from all professional fighters).

Boxers sparring in ring Head Injuries and Concussion in Boxing

Unlike other contact sports, whose governing bodies have been slow to adopt a more rigorous approach to head injuries, British boxing has been at the forefront of concussion prevention for some time. One, two or even three doctors are ringside at every professional bout, with ambulance crews on standby in case of severe head trauma. Referees and fight officials are also extremely quick to react when a fighter is in obvious distress following a blow to the head, reducing the likelihood of a potentially life-changing secondary impact.

While boxing is an inherently dangerous sport, the safety regulations governing both pro and amateur fights mean that young boxers are less likely to suffer the consequences of repeat concussion than rugby players. With the help of leading neuro-surgeons like Peter Hamlyn, the BBBofC has developed a concussion assessment framework that other sporting bodies can learn from — and one that proves that erring on the side of safety can make all the difference in safeguarding the cognitive well-being of young sportsmen and women.

Through our work helping athletes to recover from a sports injury, we recognise the life-changing impact concussion and head injuries can have — both in the short and long-term. That’s why we take an active role in raising awareness of the dangers of head injuries sustained in sport. To find out more, visit our sports injury page or contact our team today.

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22/07/2017 No Comments

Hudgell Solicitors buys Josie Robinson Solicitors and looks to develop new work areas in growing London practice

Josie Robinson

Experienced clinical negligence specialist Josie Robinson has joined Hudgell Solicitors’ growing London practice as the firm seeks to benefit from her expertise and expand its client work into new areas.

Josie ran her own practice, Josie Robinson Solicitors, which has been purchased by Hudgell Solicitors.

With 15 years’ post qualified experience in running clinical negligence claims, Josie has forged a successful career in the industry, having previously worked for 10 years as a physiotherapist.

That experience of manging both injury recovery from a health perspective and overseeing complex compensation and rehabilitation claims, helped Josie develop a niche practice in medical negligence in sport at her own firm.

It led to her firm acting for sports men and women, who had their careers cut short due to negligent treatment of sports injuries, including an award of £300K for a professional football player at the beginning of his career.

She said: “When injuries happen doctors and physiotherapists often have to make quick and accurate medical decisions as to the nature of the injury and the best course of treatment.

“These decisions can be life changing for a professional athlete and if the wrong diagnosis and course of treatment is made, the athlete may never recover and will be unable to return to their sport often with a huge loss of future earnings.”

“Claims arising from negligent management and treatment of sports injuries, either at the elite or club level, have been a successful niche area of work for me, due to my background in physiotherapy.

“It is a growing area of my work, particularly in light of the increased awareness of the risk of brain injury from repeated concussion injuries in rugby, football and other contact sports and the serious consequences to players if these injuries are not managed correctly. Mistakes can be made by treating clinicians, in the highly charged and competitive sporting environment.”

Josie also brings substantial experience in handling mental health medical negligence claims, another area in which Hudgell Solicitors has increased its workload in recent years and is looking to expand upon following her appointment.

She has experience of representing families at inquests following the death of a loved one, recovering substantial sums for financial dependency, where the death was avoidable.

“It is a really exciting opportunity for me to use my expertise and experience to help influence the development of a growing firm like Hudgell Solicitors, so it is something I am really looking forward to,” she said.

“My practice was successful and certainly something I could have continued with, but I wanted a new challenge and to be able to use my knowledge and skills to make a bigger impact.  As part of a firm like Hudgell Solicitors I will be able to influence the development of key areas of the business.”

Josie said she was impressed by new plans for the firm outlined by recently appointed chief executive Amanda Stevens and managing director Neil Hudgell, when she met them before making the switch.

Hudgell Solicitors has recently announced its plans to grow new areas of business whilst developing and strengthening its core areas of serious injury and medical negligence claims and Josie feels the move has come at the right time and is a perfect fit for herself and the firm.

“It is a very good fit for me in terms of the opportunity and challenge I was seeking, and I am sure that Neil and Amanda saw an opportunity to further develop their rehabilitation support given my background in physiotherapy,” she added.

“I have maintained close links with my previous profession, advising the Medico Legal Association of Chartered Physiotherapists (MLACP) on legal issues and providing legal updates.

“They also want me to help develop new areas of work given my background in sports and mental health medical negligence cases and with my experience of running my own successful practice I am well placed to contribute to business development.”

Hudgell Solicitors chief executive Amanda Stevens said: “We are delighted to have secured the services of Josie, whose skills, knowledge and experience will be a huge benefit to our work in London and the surrounding areas.

“Josie has a track record of successfully representing clients in all areas of clinical negligence, but importantly she has had vital experience of working in some niche areas within her own firm, which we feel will be of real value to us as we look to further develop our offering.

“Josie’s knowledge of running her own practice will certainly be of great assistance, as we look to further develop and grow the business into new areas, whilst she will also strengthen our core service offering of clinical negligence compensation claims given her significant experience in this area”

“We have exciting plans for our operations in London and adding Josie to the team is a key part of that.”

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14/06/2017 No Comments

Sport will never be more important than ‘life and death’, and attitudes around player welfare are thankfully changing

Eva Careiro

‘Some people believe football is a matter of life and death, I am very disappointed with that attitude. I can assure you it is much, much more important than that’

It is without doubt one the most famous sporting quotes ever, by legendary former Liverpool Football Club manager Bill Shankly.

Although made in jest, there has perhaps been an element of truth to it in terms of how sporting clubs and organisations have adopted a ‘win at all costs’ mentality in years gone by – certainly when you look at the very top level of professional sports.

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23/09/2015 No Comments

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