LET'S TALK SPORTS LAW

[Author: Arpit Bansal, Law Graduate from Jindal Global Law School, India]

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Introduction

The evolution of sports has been notable and progressive in every area, redefining the debates of its significance over time. Contact sports have always been under the radar due to their speculation of endangering athletes in various sports for instance- National Football League and World Rugby. It is imperative that due to the physical need of these games, several conjectures have been raised about health issues and most proficiently, concussion related injuries. Concussion essentially is a type of traumatic brain injury which is caused by significant forces to the head that show transient, delayed sign and symptoms like headaches, drowsiness and sometimes may led to memory loss. Concussion has been in the news for the past decade because of injuries that have ended in lifelong damage in certain cases.

One of the most common concussion-based disease that has come to the attention is chronic traumatic encephalopathy (CTE) which is caused by repeated brain trauma leading to loss of brain tissue. There are several sports news headlines which are abundant with reports concerning the NFL and Rugby players suffering from CTE, dementia and maybe in some cases- Alzheimer’s. These repurcussions led to a point where the athletes had to file a lawsuit to claim compensation, leading to two landmark cases in the sport. The mentioned cases are- Maxwell v. National Football league (NFL) and Steve Thompson & others v. World Rugby (WB) which depicted the crisis of negligence on behalf  of the sports authorities leading to life ending diseases. In both these cases, the data showed 18 concussions per 1000 athletes which clearly indicates the importance and ramifications of this issue.

NFL Concussion Crisis

American Football has always been in the news and has gained an unprecedented popularity. However, this sport has also faced a lot of scrutiny over the years because of its inherent physicality and violent nature. Though the sport has evolved and survived by putting bars on all the condemnation and criticism, it is only recently that several medical research and reports have shown the actual image of this game. The studies have substantiated that a lot football players possess a risk of brain damage diseases and injuries that are not curable, which also raises the question of safety protocols being implemented recklessly. NFL has always denied the question of negligence on their part over the interpretation of concussion procedures but the problems have always been lurking around the background.

To resolve these issues, in 1994, NFL formed a Mild Traumatic Brain Injury (MTBI) Committee constituting of medical researchers, physician and trainers to formulate reports and to evaluate this issue scientifically. However, in 2009, a report came out suggesting the inconsistencies in the MTBI Committee on the basis that several concussion injuries were omitted from the studies to keep this matter under the radar. Subsequently, the Committee was disbanded and a new one was formed- NFL Head, Neck and Spine Committee. Furthermore, NFL also made changes in their rules regarding concussion; first, the presence of neurosurgeon at the side-lines was mandated and banning ‘the crown of helmet’ hit outside the tackle box.

The major concussion breakthrough  came in the ground breaking lawsuit of $ 765 million filed by the retired and active players for the compensation of injuries caused by the game. In this case, retired as well as active players contested about the compensation for the injuries that they have sustained while playing the sport. Furthermore, they argued that the MTBI committee rejected the evidence of linking brain trauma-CTE, due to the lack of objective and scientific evidence. However, the league agreed to settle the lawsuit for $ 765 million which was certainly a win for NFL based on the fact that they never accepted or admitted the liability that these injuries were caused by the sport.

During this lawsuit, a new situation was discovered that NFL had given the NIH (National Institute of Health) $30 million to perform a study on brain injuries in football, but withheld the funds after learning that Boston University professors Ann McKee and her colleagues would be involved in the NIH study (Vinton). This decision came after the settlement of lawsuit to protect their image and appease its critics. Finally, in 2016, NFL admitted this fabrication and also the connection of concussion injuries to CTE causes by this sport . NFL is prominent and still one of the most followed sport in America which is why future generations of players will undoubtedly find it more difficult to launch a similar suit. And attempts to establish in court that they were deceived would certainly be thwarted by the NFL’s well-publicized awareness initiatives.

World Rugby

Similar to NFL, the issue around concussion has gained a lot of attention pertaining to the safety of players being the number one priority in World Rugby. A major reason of these concussion injuries as stated by World Rugby is the increase size and speed of the players allowing them to play at higher level and creating huge impact in the game. Injuries in rugby are mainly caused by tackling which predominantly is the cause of concussion related brain disease (CTE). Unlike NFL, Rugby has zero tolerance policy towards concussion injuries, which support their approach of recognizing potential concussed player and accordingly provide any kind of necessary assistance. However, the issue of inconsistencies present in the concussion procedures came into question last year when former England captain Steve Thompson filed a lawsuit demanding compensation for the injuries caused while playing the game.

Steve, who is a world cup winner has been diagnosed with dementia and has been joined by eight other former players. He claims that dementia is caused by the injuries while playing the game and also, that he cannot even remember the world cup winning moment. According to the reports submitted, all these players have been diagnosed with dementia with a probable CTE for which the cause is nothing but repeated blows to the head. The players will look for review for the outcomes that they are encountering, just as the effect on their work possibilities and the expenses of care they and their families will without a doubt require. Because of this lawsuit, if a current player reads this and decides to wear protective headgear and/or change their technique when clearing up a ruck, then this recent action has resulted in a beneficial outcome. This case acted as an eye-opener for the rugby association as well as for players to follow the rules and protocols of concussion more carefully.

Concussion Protocols and Methods in NFL And World Rugby

The main pressing issue here is whether or not the lawsuit and allegation of demanding compensation has changed the course of concussion in both sports. Secondly, the liability of concussion injuries on NFL and World rugby does not change the fact that these injuries are the cause of brain trauma diseases (CTE). However, there is an upside to this; as I have mentioned above- both these leagues have now become more cautious in terms of handling concussion injuries as well as in formulation of new rules and procedures. Furthermore, the evolvement of technology has proposed a vivid option to these sports to get past these concussion crises and substantiate on the improvement and recovery of players. Both NFL and WB have made sufficient number of changes and have also established the use of video and scientific technology to enhance the protocols of concussion. Some of the rules and regulation of concussion in NFL and WB are given below:

National Football League (NFL)

There are certain protocols that have been put together by NFL to judge the condition of each player separately; and after assessing their conditions, a plan is formulated for the recovery. There are few rules that every team in NFL has to follow to ascertain that player safety comes first and ‘winning isn’t everything’. The steps are mentioned below:

• A team of designated spotters will be on the lookout for anything that could indicate a concussion throughout each NFL game. Some are sitting on the sidelines, while others are watching from a booth above.
• It is mandatory to have a neurotrauma expert at the sideline of every game as if any player shows sign or symptoms of any brain related injury, a timeout is called, and the player is taken off from the field for the examination.
• The next rule is for the players who are either returning after long time or had sustained injuries and making their comeback. It is three step process:
• Resting and avoiding all physical training except stretching.
• Aerobic exercise and then cardiovascular and strength training.
• Advice from neuro-trauma expert and team doctor on player’s progress, permission to resume practice and play in games.
• The Head Impact Telemetry system (HITS) which can be built in a normal NFL helmet to check the location, magnitude, duration, and the direction of the impacts is very effective and promising. It is evident that the HIT System has proven to be beneficial in measuring athlete impacts during play, as well as assisting in rule adjustments and modifications. Kick-offs were moved up 5 yards from the 30 to the 35-yard line, which was a huge change.
• The use of video analysis has emerged to be one of the extremely prevalent method to provide assistance with concussion spotting. Every major professional league like Australian Football League, National Football League, Cricket Australia, Major League Baseball, the National Hockey League, National Rugby League, and finally World Rugby have resorted to this technology. It is imperative to note that according to consultants, Video Analysis can be used to prevent common concussion plays but also can be helpful for concussion countermeasures.  

World Rugby

As I have mentioned above, rugby has a zero tolerance policy when it comes to the concussion injuries or any other kind of injuries. And after the lawsuit they become more proficient in terms of managing the activities of concussion by establishing prominent procedures and rules to avoid such injuries. There are certain procedures that must be followed by the teams as well as players, some of them mentioned below:

• World Rugby HIA Process : The HIA process is a multi-step and multi-test assessment process which evaluates and suspect concussion injuries of players with the help of these four inter-related elements:
  • All players and team management completed a concussion education session within the previous 12 months.
  • All players completed a baseline concussion assessment (SCAT 3 minimum) within the previous 12 months.
  • All team medical and tournament match-day medical staff completed the World Rugby training modules for ‘Concussion Management’ and ‘Medical Protocols for Match-Day Medical Staff’.
  •  All team doctors, match-day doctors and match-day immediate care leads attended a face-to-face pre-tournament HIA process and concussion management training session.

• World Rugby Injury Surveillance study: this injury surveillance study is a part of Rugby World Cup (RWC) which constitute of analysis of all the concussion resulting from matches and training activities. A report is being prepared on the basis of the study which shall mandate every team to submit their analysis of concussion procedures and injuries. Basically, this study cross-checks the HIA process and helps in development of new rules and protocols.
• Rugby Graduated return to play protocols: this a six-stage process that must be followed by every player before participating in the match:
• When a player is diagnosed with a concussion, they are closely monitored and may only begin the return to play protocol if they are symptom-free.
• If a player makes a return from an injury to the field, progression is maintained on every stage so that if there are sign of reoccurrence of the injury, the activities should discontinue.
• Players are treated according to their current and past injuries; player response is noted at each stage of return to play.
• Start with light exercise then, slowly allowed to do weight training.
• Before being cleared to progress to the next step, the player must remain at the pre-concussion baseline level, free of signs and symptoms, during the activities prescribed in each phase and afterward.
• Before the player is allowed to return on the field, he/she should take a mandatory neuro-cognitive test.
• Eye-tracking technology: this virtual reality technology, also known as NeuroFlex is to record vertical and horizontal head movements of athletes and record the data to generate a report for medical personnel. This technology is a part of HIA (Health injury assessment) and is a key approach towards the goals of injury reduction and management.

Conclusion

Concussion started as a minor setback for player and teams and didn’t gain any attention until the cases where players sustained life-endangering injuries. Both these sports are dependent on the physicality of the players and concussion injuries plays an important role in terms of determining the future of the player as well as the teams.

The future of both of these sports is still uncertain but due to the innovation of many new technologies, the assessment process of concussion has become easier and effective; an important thing to notice here is neither World Rugby nor NFL had a clear answer on those lawsuits which effected a lot of players and their families and eventually led to the question of ethics, integrity, which gained a lot of criticism towards the game. It is evident that we cannot change the outcome of the past injuries of players who gave their heart and soul to these sports, but one thing we can do is learn and adapt from it.

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*For any query, feedback, or discussion, the Author can be contacted at [bansalarpit18@gmail.com]

*NOTE- The opinions and views expressed in this article are that of the Author(s) and not of SLPRR- the expressed opinions do not, in any way whatsoever, reflect the views of any third party, including any institution/organisation that the Author(s) is/are currently associated to or was/were associated to in the past. Furthermore, the expressions are solely for informational and educational purposes, and must not be deemed to constitute any kind of advice. The hyperlinks in this blog might take you to webpages operated by third parties- SLPRR does not guarantee or endorse the accuracy or reliability of any information, data, opinions, advice, statements, etc. on these webpages.

PREFERRED CITATION: Arpit Bansal, “A Comparative Study of Concussion Procedures and its Effects in NFL and World Rugby” SPORTS LAW REVIEW INDIA, available at: <https://sportslawreviewindia.blog/?p=3718(opens in a new tab)> 7 December 2023.