Reaction to uncomfortable truth about concussion in women's rugby shows hope for the game

Last week, I wrote about ongoing research from Dr Elisabeth Williams at Swansea University, which found that concussion is likely a much bigger issue in women’s rugby than men’s. The reaction was wholly positive: parents asking what they can do to help prevent their daughters from suffering concussions, players supporting the research, and lots of other journalists picking the story up. I was able to talk about my experience with brain injuries from rugby on three BBC Radio shows. The conversation about concussion in women’s rugby became a central discussion point.

In all honesty, I felt some guilt that even talking about concussion in the women’s game may be doing a disservice to the sport. It’s hard to strike the balance between telling people rugby is great, but it also could cause long-term damage to your body and brain. But the last week has shown that head injuries are being taken seriously at the elite level of women’s rugby, at least.

Bristol Bears Women revealed to The Telegraph that they are using gum shields with sensors in them to track head impacts during rugby training and matches. They are the first elite women’s side to use these gumshields, which are also being used by men’s sides Harlequins, Gloucester, and Leicester Tigers. Bristol Bears player and Wales captain Siwan Lillicrap told Kate Rowan: “As a player it gives you that reassurance that when you have had a big collision, you will find out the impact of that… as a player, it gives you that security over what you have experienced and felt in a game. It gives you more confidence, which is a real positive.” Lillicrap is also Head of Rugby at Swansea University, where Dr Williams’ concussion research is based. The Wales captain will understand the value of this research more than many, having seen the results of Dr Williams’ research using gumshields with sensors in the university’s men’s and women’s teams last year. According to The Telegraph, the cost of the gumshields Bristol use is about £1,000 per player per year. I wonder if these will soon be mandatory for all elite players.

Last week also saw the brain injury association Headway call for more research to be done to see if women are more susceptible to concussion than men. Headway’s Deputy Chief Executive Luke Griggs suggested that this could be because women are better at reporting concussions than men. Griggs told BBC Sport: “If it is the case that women are better at reporting this, are more honest, less prone to taking chances on their health, then it's up to males to step up and actually learn from this and improve their behaviours so they are taking fewer chances.”

While this may well be true, it’s also clear from Dr Williams’ research that the whiplash motion some women make in tackles is a pretty good indicator for why concussion is more likely in the women’s game.

Since writing last week’s column, I’ve heard a few distressing anecdotes about brain injury that match my own experience. One woman told me that she suffered a concussion playing rugby on a Sunday but had to work the following day. She told her manager that she couldn’t work due to her concussion, but her manager said that it was a self-inflicted injury, and therefore she had to come into work. There were a few other similar stories: mums who had no rest time, women sacked for being refused time off with a concussion, and even a woman who was turned away from A&E with a packet of paracetamol who later collapsed as a result of a brain injury. These are all grassroots players, and that’s where my concern still lies.

Maggie Alphonsi, England rugby legend, wrote this week about how the rewards of playing rugby far outweigh the risks for her. She spoke about one terrible concussion she suffered and how she changed her head position on the pitch to avoid receiving concussions. For Alphonsi, rugby stopped her going down a different path in life. I entirely understand the benefits of rugby to young people. For some, it teaches respect, offers them a community they don’t have access to, and shows them that they can be a great player no matter their size. One thing I have recognised this week, from the reactions to the concussion piece and with news of harsher lockdowns, is that we cannot underestimate the positive impact rugby can have on lives.

I’ve seen replies to Alphonsi’s column that say the benefits do not outweigh having early onset dementia at forty. In reality, it’s not a black and white decision, is it? It’s not like anybody decides they wants to sacrifice their brain health for rugby. We know there are risks. Every club has an older member who props up the bar and will tell anyone in earshot of the terrible injury that snuffed them at the peak of their career. We have also heard of spinal injuries, broken necks, paralysation. There are risks we all take when we put our boots on.

The difference with this risk is that it feels like the gravity of it has been kept from us. There’s a personal responsibility involved of course; we need to educate ourselves about these risks. But there is a responsibility on the governing bodies too. If there has been any communication with grassroots clubs to reassure them about the latest findings, then I have missed it. All I’ve heard from the RFU is that they take player welfare “very seriously.” It wasn’t until I spoke to Dr Williams that I truly understood the higher risk women’s players face with concussion.

I am an RFU first aider (which you could be too, if you have a day to spare and want to spend it in a freezing cold rugby club in East London) and the course covered concussion symptoms in adults and children, but didn’t teach anything about the impact of neck strength, or importance of head control, despite the RFU clearly knowing this at the time. The England women’s team has been aware of the need to build neck strength for years and have incorporated this into their training since 2014 for this reason, according to a senior England player.

Last week, I spoke about my own brain injuries and how I was seriously considering if I’ll play again. I feel more positive now, and that’s because we are talking about brain injuries more openly. I will never again be pressured to play on, I’ll recognise concussion symptoms in others as well as myself, and I’ll keep learning. I’ll strengthen my neck and I won’t go straight back to playing matches. After the pandemic, I’ll build my training load up strengthen my lower body to make sure my body position in tackles is as safe as it can be. Let’s keep the conversation moving, too. We need to keep talking about brain injuries to make sure everyone is aware of the risks and what to do if they sustain one.