Today, I have joined 70 doctors and academics in writing to the government calling for a ban on tackling in rugby matches, saying that injuries from this 'high-impact collision sport' can have lifelong consequences for children. I speak from both professional and personal experience.
I remember as if it were yesterday, that autumn afternoon 11 years ago when my son’s school phoned me at work to tell me my child had been injured and hospitalised for a second time while playing rugby. I was sickened, upset, anxious and angry. School should be a safe place for children. The first time my son was injured the school had described it as ‘bad luck’ and promised that he would play in the third and fourth teams where he would be less at risk of injury. But on that day, the firsts were a boy short due to injury, my son was fast and a winger and the obvious choice, and so he was taken out of the middle of the match he was playing in the thirds and played as a substitute in the first team. His small slight frame was no match for the huge boys and during a bad tackle he was kneed in the face and his cheek was shattered.
The school ‘played him up’ without his parents’ permission and knowledge. It put the game and winning before the safety of the boys and did not consider the risk. If staff had looked at their data, they would have seen that this was not a good thing to do; injuries are more frequent in the firsts and seconds, and an injured child is more likely to be injured again. My son was relatively fortunate: a year later another mother would be told that her child was rendered quadriplegic, paralysed from the neck down. In Scotland, six children were paralysed from the neck down playing rugby in as many years.
As mothers, we do everything we can to protect our children from harm; we watch their diets, their dental care, but we feel powerless about contact sports. Rugby is compulsory in many independent schools, where it is a modern-day form of conscription in which sons are thrust into gladiatorial contests.
Parents’ anxieties are often sidestepped by rugby’s governing bodies, which give them all sorts of assurances about the improvements to the game and the safety of coaching, but little data about injuries. The authorities don’t encourage reasoned debate and do not engage with concerns about lack of injury data in schools and clubs across the land. That creates a climate in which rugby fans feel free to abuse critics as if they were traitors to some cause — many of the posts to my Twitter feed are unprintable.
But rugby is not war or nationalism and in the face of official complacency I became determined to gather the facts about injuries from all studies of rugby worldwide so parents could make up their minds about the risks. It took more than ten years because neither the sport’s authorities nor the government collect good data.
Our own small study in Scottish schools, the first UK study in 11 years, showed how dangerous rugby can be. We found that the average child player had a one-in-six risk of being injured in a season, many injuries were serious and more than two-thirds required more than three weeks away from play. In other studies, the risk of injury in a season varies from 10 per cent to 90 per cent, depending on the definition of ‘injury’. Injury reporting is another problem. Concussion is under-reported and often unrecognised but can account for more than 25 per cent of injuries in some studies, as can fractures.
But why was there no official data? The short answer is that no data means no problem and owning up to problems is not in the rugby authorities’ interest. Rugby is a global sport with huge commercial interests, sponsors and backers. The government pours billions of pounds a year into sport, including developing and promoting rugby through the school curriculum and other initiatives. RBS, which we the public largely own, sponsors rugby from our taxes but won’t give full details. Schoolboy rugby is increasingly seen as a grooming system for the professional game.
Schools are supposed to be a safe arena for organised sports, so how is it that injuries can go unrecorded? The failure of government and rugby authorities to collect data is also a failure to comply with the UN Convention on the Rights of the Child. This clearly states that government ‘shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical and mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation… while in the care of parent(s), legal guardian(s) or any other person who has care of the child’. The UK became a signatory to the convention in 1991 but its record in protecting children is abysmal, as the lack of data collection testifies.
Children are vulnerable and we owe them a special duty of care. Children think they are invulnerable and invincible when the opposite is the case. Injuries are among the most common causes of death in children, and sport and leisure, in some age groups, are responsible for 25 per cent of injuries, and are a huge cost to children, their families and society. Billions of pounds every year are spent on injuries.
The debate about injuries is drowned out by anecdotal accounts of the wonderful benefits of rugby, how the camaraderie builds self-esteem and confidence and decreases violence. But there is no evidence that a collision sport with violent contact decreases violence. Moreover, the alleged benefits may be true, but they are not unique to rugby. Every sport makes the same claims, but the risks of injury in rugby are specific to the game. Because, make no mistake, contact is where most injuries occur, during the scrum, maul and ruck, but above all, during the tackle. The injuries sustained during contact are not mild bruises: they are serious and include fractures, concussions, dislocated shoulders and ligamentous tears. It takes some force to wrench a child’s shoulder out of joint and to knock a boy out, smashing his brain, leaving it bruised and bleeding.
There is a huge paradox here. To raise concerns about rugby injuries provokes cries of ‘nanny state’, but rugby is part of that state too. It is taxpayers who make the game possible by collectively funding it and by providing an NHS which treats the children; we provide rehabilitation and care and education and welfare services, and legal aid, when it goes wrong.
Meanwhile, the authorities respond by saying that the research doesn’t take account of their new developments, which include a range of initiatives, such as concussion monitoring. But will any of them work? Will they stop injuries? We won’t know because they don’t and won’t collect comprehensive data. And there’s the rub. It’s the reputation and the image of the game that counts, the need to be seen to be doing something rather than the right thing: preventing injury.
During the course of my ten years of research, two things came home to me. First, the complicity of the government and rugby authorities in failing to collect good injury data on every child injured playing sport, particularly rugby, across the land; and second, the anguish of the mothers and the injured boys who were often telling their stories for the first time. Voicing their concerns, many felt powerless.
Then there is the testimony of those who care for the injured. ‘The first part of my career,’ wrote a nurse from Ireland, ‘was in the Mater and Beaumont — the Mater has a large serious orthopaedic injury unit and it seemed to be always half-full of teenage boys from a rugby field, and the other half car crashes. I have never let my children play rugby, and people think I am exaggerating when I tell them why… I think rugby is absolutely brutal, and cannot be classified as a sport in its current form.’ A paediatric neurosurgeon told of his concerns about the neurosurgical and orthopaedic injuries to children as a result of rugby in his area, ‘but no one wants to know’.
So, there are three questions for rugby’s governing bodies, local authorities, schools and government to answer. First, how many children are injured each year playing contact sports such as rugby and what is the pattern and nature of the injuries? Not only does the government not know, it has not bothered to inform parents that some sports put children more at risk than others. So, second, in whose interests are they acting?
Third, if your school records injuries, how does it audit them and what do they consider to be an acceptable number of injuries among children playing rugby in a year? I asked this after my son was injured and after I had conducted my audit of all injuries in the upper-sixth. The reply, ‘We expect every child to be injured at some time while playing rugby’, floored me, but confirmed the result of my audit.
As a doctor in clinical practice, I was taught that every injury ought to be avoidable and preventable. There should be zero tolerance. In clinical medicine, every death and complication should be audited. In industry, construction firms have zero tolerance for injury, so why is it acceptable that children should be paralysed or die at play? To make matters worse, rugby is being introduced to the poorest areas. What an irony that the children already most at risk of injury should have to face new risks.
‘What doesn’t kill you makes you stronger’ is a familiar refrain. But injuries are the most common reasons for children giving up the game. In Australia, New Zealand and South Africa, fear of injury is cited by fathers as the main reason for saying rugby is the sport they are least likely to encourage their child to play. Some injuries are carried for life. Any professional or club rugby player will tell you about their or their friends’ long-term physical problems and even cognitive decline in later life. It should not need professional players bringing class actions and litigation for everyone to wake up to the risks and costs of injuries and to safeguard children.
The child’s game should be child’s play, it should not be allowed to mirror the professional game. If this means changing the rules so that contact
elements are removed, then so be it. The rights of the child to be protected from harm must come before the needs of corporate sponsors and the rugby industry and its complex web of business interests that protect and preserve the status quo. But change will only happen when the government has convened a proper inquiry into injuries and sport and put in place an injury-monitoring system to cover every child in the land. It will only happen when the corporate professional rugby unions no longer have control of the child’s game.
This article was originally published on 22 November 2014