George North never much liked to talk about concussion. In 2015 he was ordered to take a four-week lay-off because he had taken four bad blows to the head in five months. In the end it was nine weeks before North could say he felt OK and almost six months before he was able to play. In one of the few in-depth interviews he did give on this topic, to Rugby World, North explained that he considered quitting for good. “I thought: ‘I don’t deserve this, I don’t need this hassle in my life.’” At the end of it all, he said, “the biggest lesson I learnt, and I’d emphasise this to anyone who has concussion, if it’s not right for you then stop. Don’t do it.”
A year later, North has been hit again. Against Leicester on Saturday he jumped to take a bouncing ball and fell over the shoulder of Adam Thompstone. As he landed his head bounced down on the ground. He lay still, seemingly unconscious. Two minutes later, North was led off the pitch for a head injury assessment. And then he was allowed back into the match. Northampton’s head coach, Jim Mallinder, insisted that North had not been knocked out. The club have since decided that North needs to be referred for further assessment. They say that if he was knocked out neither Mallinder nor their medical team knew about it.
There is a lot to unpack in all that, which is why Premiership Rugby and the Rugby Football Union have convened an urgent Concussion Management Review Group to try and make sense of what happened. But one thing is immediately clear. World Rugby’s concussion directives state: “Any player with concussion or suspected concussion should be immediately and permanently removed from training or play.”
It appeared that Northampton failed to apply the most basic, most important rule of concussion. And that in doing so they exposed him to extreme, and unnecessary, risk.
As the subsequent debate proves, rugby has come a long way in a short time on this issue, though it still has not moved quickly enough for some.
North said himself said last June that “some old-school fans thought admitting concussion made you soft”. These days most players, fans and journalists understand that a brain injury is not something you just shrug off with a nod of your head. It can kill, and players with a history of multiple concussions are at greater risk. And yet one thing Northampton did not admit was that they got this one wrong. Instead, in their latest statement, they tried to explain the incident away.
North suffered a concussion during Wales’s Six Nations match against England in 2015, which went unseen by the medical team. This raised awareness about the need for pitchside medical staff to have access to video replays so that they can look again at any incidents they may have missed. At the start of this season, Premiership Rugby announced that they were adopting a new video system, myplayXplay, which would allow medics to review head injuries in real time. Each club now has a pitchside video reviewer whose sole job it is to monitor this footage, record it, and refer any suspicious head injuries to the doctors.
Corin Palmer, Premiership Rugby’s head of rugby operations, promised that myplayXplay would “ensure players receive the best possible support from the sidelines”.
Now, Northampton say “it is important to note that the video footage is not always the full range of replay angles available to the TV viewing audience at home” and that “the medical team can only base their decisions on the evidence available to them at the time of assessment”. In short, they say that myplayXplay does not do what Palmer promised it would. The medics would apparently be better off watching the game on TV.
If Northampton are right, and the new technology does not provide the necessary footage, then it needs to be improved. But you have to ask why Northampton needed to use a video replay at all. North was not injured in a melee, there were no bodies in the way to obscure the view. Exactly how many new angles and video replays do you need to see what is abundantly clear live to the naked eye? North hit his head hard, went limp, and lay motionless for a minute. World Rugby’s own guidelines state that any one of those three things is evidence of a suspected concussion. You do not need to be a neurologist to make that diagnosis.
Northampton also explained that North was “fully assessed by the doctor away from the pitch using the established protocols and processes”. But here is a curious thing. This year Premiership Rugby extended the amount of time allowed for head injury assessments to 13 minutes. North was off the pitch for just over seven and a half minutes before he was let back on. So Northampton’s medical team were apparently able to complete those “established protocols and processes” in almost half the time Premiership Rugby believes they could take.
World Rugby does have a fail-safe written into the laws. If the referee decides – with or without medical advice – that a player is so injured that the player should stop playing, they can order that player off the field.
Which would be a hugely controversial move in a major match. But if there are more cases like this one, the authorities might have no choice.
