Pat Lambie’s shock retirement has brought the subject of concussion-related injuries starkly into the spotlight, writes CRAIG LEWIS.
On 18 January the rugby fraternity was rocked by the news that Springbok and Racing 92 flyhalf Pat Lambie had been forced into retirement at the age of 28. The cause: ongoing effects of multiple concussions.
It served as a stark reminder of the risks related to head injuries in the game, which are not always fully appreciated. To begin to delve into this integral topic is a complex task, but one that is of utmost importance.
As a case study, Lambie’s tale of a career cut short by concussion is particularly poignant and pertinent. In 2010, the rising star was on top of the world after leading the Sharks to a famous Currie Cup win at home with a Man of the Match performance in the final, before earning his first Springbok call-up.
In the years to follow, Lambie remained a prominent figure in South African rugby, but he was no stranger to injury. There was a torn bicep and a serious neck injury, but it was a fateful collision suffered in a Test match against Ireland in 2016 that would ultimately prove to be the beginning of the end for Lambie as a rugby player.
In the first half of that match on 11 June, Lambie was knocked out cold in a collision with Ireland loose forward CJ Stander. Months after the incident that left Lambie unconscious on the turf of Newlands, concerns began to arise when he continued to display symptoms and could not start training.
At one stage, Lambie’s concussion was verging on uncharted territory in terms of its length, prompting former Sharks team doctor Alan Kourie to look into some alternative theories. Kourie studied research related to the fact that Lambie had previously suffered from migraines and had also suffered neck injuries, with indications emerging that this could play a part in triggering Post-Concussion Syndrome.
Kourie consulted other specialists and they all concurred that Lambie’s symptoms were related to post-concussion issues rather than the concussion itself. After being put through a procedure called the ‘Buffalo Protocol’, aimed at reducing the syndrome and which involves slowly returning to exercise until the player is ready to take part in full-contact sessions, Lambie was eventually given the all-clear to play again.
Hope was restored, but then he took another head knock, this time in a Super Rugby game against the Kings, on 13 May 2017. In the weeks to follow, Lambie suffered from headaches and sensitive eyes, while waking up with what could be only described as a feeling of being ‘hungover’. After weeks of information gathering, he was referred to two independent specialists, a neurologist and one on concussion, while the Sharks medical team also sought the opinion of a UK-based specialist who has dealt with over 1 500 cases of concussion.
With results of an MRI and an EEG (electroencephalogram), all three doctors, including Kourie, were of the opinion that a period of three to six months without contact was necessary. It was around this time that Lambie first admitted to SA Rugby magazine that he had briefly begun to consider retirement. Instead, he made one more attempt to start afresh by taking up a contract with Racing 92 in France.
But the cruel rugby gods had other ideas. Not long after joining Racing, Lambie suffered another blow to the head in a Top 14 clash, the effects of which lasted around 40 days. He recovered and returned to action once again, but in April 2018 he sustained yet another head knock in their European Champions Cup semi-final against Munster.
Lambie did his utmost to shake it off, even featuring in the first few minutes of the final, before suffering a serious knee injury.
‘I didn’t want to say anything about the semi-final incident because I didn’t want to miss out on the final, which was a bit silly,’ he later admitted. ‘Anyway, I injured my knee and I thought, “Oh great, maybe it’s a blessing in disguise” because it would give me a lot of time to get my knee and my head right. But the longer my knee rehab went on, the longer my symptoms lingered and the more appointments I had with neurologists here in France.’
Desperate not to give in, Lambie attempted rest, different courses of medication, neck and jaw treatments, eye rehabilitation, multi-vitamins and various exercises. Finally, following the advice of two neurologists, he accepted that retirement was his only option.
That is the cautionary tale of Pat Lambie: a player who won two Currie Cup titles, earned 56 Test caps and slotted a long-distance penalty to secure a famous win over New Zealand in 2014. He has retired with a warning to avoid contact sport or any strenuous exercise.
It’s a timely reminder of the effect of concussions, further emphasised by similar retirements of other professionals such as Ben John, Jared Payne, Dominic Ryan, Jonathan Thomas, Kevin McLaughlin, Dave McSharry and Peter Grant. The list goes on.
Then there are the cases of Cillian Willis and Jamie Cudmore, who have gone to court with the allegation that their former clubs were negligent in the manner they treated the head injuries that curtailed their careers.
It’s been nearly six years since Willis suffered a career-ending concussion. Featuring for the Sale Sharks, the former scrumhalf alleges he was cleared to play on, despite suffering two head injuries in a match against Saracens in 2013. Also aged 28, he was forced to retire a short time later due to concussion-related problems.
In 2015, Cudmore sustained a concussion in a European Cup semi-final for Clermont against Saracens, but was reportedly deemed fit to play on. A couple of weeks later, he suffered another head knock early in the final against Toulon, staggering back to the changing room where he vomited. Again, he was somehow allowed to return to play.
Subsequently, Cudmore had a scary few months enduring headaches, insomnia, restlessness, fatigue and bouts of anger and depression. The former Canada lock was inspired – along with his wife Jennifer – to form the Rugby Safety Network, a foundation that aims to support and educate players who have suffered from concussion.
In his autobiography, The Battle, former Ireland and British & Irish Lions captain Paul O’Connell recounts how he suffered a concussion on his Test debut, and how he scored a try that he couldn’t remember afterwards.
‘There are stories like that everywhere,’ Cudmore said. ‘It’s more important when you have a concussion because not only can you have serious symptoms after the fact, you could also be dead. Getting a second impact soon after a first impact can kill you. Nobody needs to die playing sport.’
Cudmore, who is taking legal action against Clermont, has regularly expressed his view that there is a big onus on the medical staff and team management to take the correct action when a player is concussed.
‘Rugby players never say no. They always want to play. That’s not the problem. The problem is when the doctors or team managers, in the heat of the moment, want their best players on the field. What they’ve got to realise is that when their best player is concussed, he is obviously not in his best state and needs to be taken off the field and protected.’
Cudmore has also pushed for more work to be done on tackle technique and even for law changes to allow more players on the bench to remove the pressure of keeping injured players on the field due to limited replacements.
To its credit, World Rugby has in recent years sought to place an increased emphasis on player safety, and at the end of 2016 announced details of its zero-tolerance approach to high tackles.
World Rugby’s directive came after a research study in which 611 head injury assessment (HIA) incidents were reviewed from 1 516 elite matches between 2012 and 2015. The results showed that 76% of all head injuries occurred in the tackle, and 72% of HIA incidents in the tackle occurred to the tackler (making the tackler’s risk of head injury 2.6 times higher than the ball-carrier’s). The study also found that body position, speed and the direction of tackle all influence the risk of head injury in the tackle, ultimately leading to more stringent on-field sanctions being enforced that were aimed at lowering the tackle height.
The subject of player safety has gained increasing prominence. Towards the end of last year, the French Rugby Federation championed a proposal to lower the legal height of a tackle to waist level. Meetings on the topic had been organised after Stade Français teenager Nicolas Chauvin died in hospital after suffering a broken neck, which triggered a heart attack during a match in Bordeaux.
The RFU also recently began trials that saw the legal tackle height lowered to below the armpit, but quickly aborted the experiment after seeing a counterproductive rise in the number of concussions.
And just days after Lambie had officially announced his retirement, SA Rugby and other key stakeholders held a workshop involving medical professionals from the local rugby fraternity as part of a process of refining concussion protocols.
Professor Jon Patricios, one of World Rugby and SA Rugby’s specialist concussion consultants, facilitated the workshop.
‘It was important that SA Rugby reflected on its concussion protocols with respect to current research and international protocols,’ Patricios commented.
Slowly but surely, the topic of rugby-related concussion and the dangers involved with head injuries is increasingly coming into sharp focus. It’s long overdue, while for Lambie it may well prove to be an important part of his legacy.
– This article first appeared in the March 2019 issue of SA Rugby magazine.