When it comes to head injuries in sport, prevention is better than cure

The Six Nations rugby championship is upon us. There are just a couple of weeks to go before the annual battle for oval ball supremacy among England, France, Scotland, Ireland, Wales and Italy. History says the trophy will be heading across the channel: each Six Nations championship held the year after a British Lions tour has been won by France. The Lions went on tour in 2013, so maybe the French will be sipping champagne on March 15, when the final matches are played.

I'm no rugby expert. I can't comment on what the form books says this year, but I enjoy watching the Six Nations - the physicality, speed and athleticism of modern rugby is breath-taking. But one thing I can comment on is the need for the best possible care for any player unfortunate enough to suffer a head injury.

Intense negotiations 

This is all the more salient given the news in Tuesday's Guardian about the ongoing legal wrangle between the National Football League and retired NFL players.

Some 4,000 former players sued the NFL, arguing that the NFL knew about the dangers of on-field head injuries long before it did anything, or enough, about them. It was also alleged that the NFL hadn't adequately assisted injured players once their careers were over.

Last August, after two months of what were described as "intense negotiations", the parties reached agreement to settle the litigation. The NFL did not admit liability, but the outline agreement was that the NFL and NFL properties would pay a total of $765 million for injury settlements and medical benefits for retired players. The money would also be used to fund medical and safety research and to pay all litigation expenses.

But as the Guardian reports, the $765m settlement has been rejected by a federal judge. Judge Anita Brody is not happy with the level of financial documentation submitted by the parties. She also doubts that the agreed sum will compensate all the retired NFL players who may one day be diagnosed as suffering from a brain injury. She doesn't doubt that the settlement was reached in good faith, but has, in effect, sent the parties back to the drawing board.

Collective Bargaining Agreements

Professional sport in Britain is conducted on different lines to the United States, where Collective Bargaining Agreements (CBAs) underpin the majority of sports. I am not a sports lawyer, but my understanding of CBAs is that they exist primarily to ensure that salary caps are in place. Salary caps are intended to keep costs down and create parity between clubs. CBAs also, as I understand it, have a considerable bearing on litigation between the leagues and players. Under the American CBA model, players have discernible rights against leagues, whereas here in Britain sportspeople like rugby and football players are employees of their clubs, not the governing leagues.

For this reason, threats by England footballers to strike back in 2003 (when they objected to the treatment of Rio Ferdinand over a missed drug test) may have shown admirable camaraderie but had no legal basis.
Likewise, it may be that officials on high in rugby, football and other UK professional sports look across the pond at the NFL litigation and breathe a tentative sign of relief, in the belief that the absence of CBAs here means that huge class actions against the leagues aren't heading their way.

Perhaps; a sports lawyer will have the answer. But two things are abundantly clear: first, even if the leagues in Britain may not be about to receive a massive head injury class action claim, individual clubs undoubtedly owe a duty of care to their players and could be sued; and secondly, the law is one thing - proper care and due diligence for sportspeople is another.

Prevention is better than cure

So, as we look forward to the Six Nations, it strikes me that we should redouble our efforts to ensure that the government takes the lead and sets an example. It should state unequivocally that clubs must, as a priority, ensure that the best possible awareness of the consequences of head injuries exists among everyone from managers and coaches to players and medical staff. Likewise, schools must take the best possible care of pupils who play sports like rugby and football. And similarly, those in charge of the national teams as they go into the Six Nations.

It's great news, for example, that from next season all professional rugby players will undergo a concussion training programme - but here's hoping the various Six Nations teams will also find time to talk their players about the risks of head injuries before the tournament.

We all want to see a fast, pulsating and impassioned contest for the Six Nations title. We don't want to see players suffering brain injuries that could have been prevented, which lead to litigation. Prevention is better than cure. Here's hoping that British sport - and its administrators all the way up to the government - wake up to the reality of traumatic head injuries suffered by those playing sport.

When it comes to head injuries in sport, we can learn a lot from looking to America

Hugo Lloris returned to the Tottenham Hotspur line-up on Sunday, but not to the kind of game he'd have liked. The Frenchman has been in the wars lately, with a controversial head injury in his team's fixture against Everton on 3 November. The last thing he would have wanted was to be on the end of a 6-0 drubbing by an effervescent Manchester City frontline.

But at least Lloris was fit to play. Too often, this is not the fate of sportspeople who suffer head injuries. The tragic example of American high school football player Charles Youvella is a case in point. Just over two weeks ago, Youvella died after sustaining a head injury while playing a game in the Arizona Interscholastic Association.

By all accounts a brave and talented player, Youvella's injury came in a Saturday night game, when he was felled by what witnesses described as a 'routine football tackle'. Routine it may have been, but the back of the young man's head hit the ground with considerable velocity. Two days later, on Monday 11 November, Youvella was dead of a traumatic brain injury - notwithstanding, in uncomfortable echoes of the Lloris incident, the fact that immediately after the initial impact he got to his feet and lined up for two more plays.

High stakes

Terrible, premature deaths like Youvella's remind us of the high stakes in many sports, from football, whether American or in the form of 'soccer', to rugby, horse-racing and boxing.

No one would seek to ban people from taking part in sport, the upsides of which embrace an individual's health and sense of self-respect and have a wider societal benefit in fostering discipline, camaraderie and teamwork.

But in many things America shows the way - and last August the National Football League agreed to a $765m (£478) out-of-court settlement with a group of former players who had sued the league for, as The Guardian put it, "its role in hiding or underplaying the effects of brain trauma in the game, while glorifying its violence, a cover-up which has been exposed in a series of recent books and documentaries." Happily - in a development that we should applaud - Microsoft co-founder and Seattle Seahawks owner Paul Allen last week announced that he will fund a two-year, $2.4 million study into whether repeated blows to the head can lead to dementia.

American football is not only sport in the spotlight for its alleged laissez-faire attitude to head injuries. Just this week, 10 players from the National Hockey League began legal proceedings against the league for negligence and fraud, alleging that the sport’s officials should have done more to address head injuries but instead celebrated a culture of speed and violence.

Too robust?

Could the same thing happen here? British sporting culture prides itself on being robust, on taking the knocks and getting up and playing on. But 'being robust' can have deadly consequences. Hugo Lloris was, thankfully, lucky; the next footballer encouraged to play on after a head injury might not be.

The key message is that prevention is better than cure - especially when it comes to brain injuries. We must remain vigilant and astute to the dangers of 'getting on with it'; so too must we keep a watchful eye on medical developments in this complex area. And, looking across the pond, we could sensibly take a leaf out of Paul Allen's book - at the same time as hoping that British sportspeople don't find themselves forced to take class actions to achieve recompense for traumatic head injuries.

All's not well that ends well when there's a risk of serious brain damage. Spurs were wrong to let Hugo Lloris play on

"It's OK. I'm fine. I want to carry on."

These words are often heard by boxers when they've come round after a KO punch. Whether the fighter is out for just a few seconds, or a matter of minutes, his instinct is almost invariably to fight on.

In fact, the boxer's brain and nervous system have been scrambled so much that he doesn't even realise that the referee has stopped the fight. The minutes of unconsciousness are precisely that. They're lost forever. There's no getting the time back, there are no memories to retrieve. To be 'out cold' hints at just how much damage has been done by the KO blow: after all, we're at our coldest when we’re dead.

A disturbing response

As a lifelong football fan, only rarely have I seen head injuries of the kind that boxing fans often witness. But last Sunday's game between Tottenham Hotspur and Everton yielded one. And the way it was dealt with cannot but be disturbing.

Huge Lloris, the Spurs goalkeeper, was knocked out when challenging for the ball against the onrushing Everton striker Romelu Lukaku. To view the footage on YouTube is to see that Lukaku's knee clatters forcefully into Lloris's head. The velocity must have been easily the same as a boxer landing his best punch.

No wonder, then, that Lloris was rendered unconscious. There is doubt as to whether the goalkeeper lost consciousness completely or suffered a 'transient' alteration of consciousness but what is abundantly clear is that he took several minutes to recover. But astonishingly, and despite his French keeper's unsteady feet when he was finally able to stand up, the Spurs manager Andre Villas-Boas did not substitute Lloris. He had a very able deputy in Brad Friedel, but decided to let his injured goalkeeper play on - mindful, perhaps, of Football Association guidelines to the effect that a merely 'transient' alteration of consciousness does not mean a player cannot return to play.

Villas-Boas also elected to ignore the obvious concerns of his captain, Michael Dawson, who appeared to try to persuade Lloris to go off after he got to his feet. "He took a really bad whack and I was worried when he went down and stayed down," said Dawson. "When he got up his legs gave way, but he stayed on and made two good saves. I lead those boys but safety is the most important thing. He was in a bad way, but, by the time he came around, he was wanting to stay on."

All's not well that ends well

So, was all well that ended well? Hardly. Spurs' decision has rightly attracted much criticism, not least from the brain injury charity Headway. Its spokesman, Luke Griggs, had this to say:

"When a player - or any individual - suffers a blow to the head that is severe enough for them to lose consciousness, it is vital they urgently seek appropriate medical attention. A physio or doctor treating a player on the pitch simply cannot accurately gauge the severity of the damage caused to the player's brain in such a setting as there may be delayed presentation of symptoms." And yet more tellingly: "By continuing to play, the player may have caused greater damage to his brain. He should have been removed from the game immediately and taken to hospital for thorough tests and observation."

Headway chief executive Peter McCabe also commented on Spurs' decision here.

Happily for Lloris, it seems that subsequent scans show that he has emerged unscathed from the clash with Lukaku. But, quite rightly, the Professional Footballers' Association (PFA) says that players should be automatically removed from the pitch should they suffer "a severe trauma" to the head that causes a loss of consciousness. So, too, do players' union FifPro and world governing body Fifa.

Those calling for caution are correct. Spurs behaved in a cavalier fashion in letting their player continue. In such circumstances, just like a KO'd boxer, the decision is not the player's; it is the club's. The club should not have taken the risk of Lloris potentially being concussed and suffering serious brain injury.

In boxing, a KO'd boxer is not allowed to fight again for at least 28 days from the date of the KO. Villas-Boas could still set the right example by giving Friedel the nod and resting Lloris for 28 days. But the odds that this will happen must be very long indeed.

A Poor Decision by Churchill

Last week Churchill, the insurance giant, was in the news - and not because it had announced a new series of benign ads featuring a cuddly dog and a well-known actor.

Instead, Churchill made the headlines because it has decided to appeal against a judgment by the high court.

Bethany Probert, now 16, suffered traumatic brain damage and a number of debilitating injuries when she was hit by a car one afternoon in December 2009. The young girl, who was walking home from riding stables, was hit by a driver who was travelling at 50mph along a country lane - too fast, according to the court.

The result of the accident was that Bethany was left with limited walking ability, depression and a lack of concentration or spatial awareness. She requires specialist equipment, a support worker and an open plan, single-storey home - in other words, ongoing care for the rest of her life.

Her mother would have taken some small solace from the court's judgment that Bethany was in no way guilty of contributory negligence. At least, she would have thought, there will be compensation to look after her daughter.

But not if Churchill has its way. The insurer was last week granted leave to appeal against the judgment (which would have seen Bethany paid up to £5m compensation), in what is being seen a test case to determine the extent to which children can be held responsible for their injuries in road accidents.

Churchill maintains that Bethany should have wearing a high visibility jacket as she walked along the road. In the words of a Churchill spokesperson: "While we accept that our insured was liable in part for the accident, we are appealing [against] the decision that he was entirely to blame."

Churchill's appeal can only be greeted with great dismay. Each case is, of course, dependent on its own facts, but the idea that children should be compelled to wear high-visibility jackets on country lanes, lest they are partly at fault for accidents, is ridiculous. I wish Bethany, her family and their solicitors (Richard Langton of Messrs Slater & Gordon) well in their battle against Churchill.