The frantic arm waving from James Robson, Scotland's highly respected and long-serving team doctor, in the aftermath of a head-to-head collision during last weekend's Calcutta Cup match, was a semaphore signal which rugby's rulers have been urged not to ignore. Phil Vickery, the England prop preparing for a return to action after a fourth operation on his spine, and Don Gatherer, the industry-leading physiotherapist who has been treating him, want urgent action to stem the injuries which have left bodies strewn across the fields of the Six Nations Championship.
Rugby's physical nature is part of its appeal and full-time training since the game went open in 1995 has produced bigger, quicker players. The teams in last week's Scotland versus England match were almost two stones per man heavier than in the corresponding fixture 20 years ago in 1990. Simple physics says today's combatants tackle at greater pace and with much more physical force in the impact areas.
At the end of his fifth tour with the British & Irish Lions last summer, Dr Robson warned the players' bulk was becoming dangerous. Since then, the images of Thom Evans breaking his neck in Cardiff, England's Jonny Wilkinson tottering off the pitch in Scotland and Ireland's Brian O'Driscoll (pictured right) hardly getting through a match anywhere without gazing dazedly at an attending medic, have impinged on our memories of great tries and star turns. According to Robson, the hamstring and groin strains of old have been overtaken by shoulder, hip and knee joint injuries, and surgery has become a pro player's occupational hazard.
The 34-year-old Vickery has forged a career out of thousands of the scrums, tackles and impacts integral to the sport. During his most recent stint under the knife, an incision was made in the front of the neck, the windpipe and other vessels were pushed aside, and a worn-out disc was replaced with a titanium implant to clamp together the C6/C7 vertebrae and relieve pressure on the spinal cord. After months of weight training and gradual re-exposure to scrummaging contact, Vickery is hoping to play again before the end of the season. "These collisions are happening on a more frequent basis, there's a breaking point and I believe it's the neck area," said Vickery. "It's a fact of the game and it's a question of how we deal with it, to alleviate as many risks as possible. It's about making young guys train properly, and giving them the right information. It needs to be said at academies and clubs. We've been shutting the gate after the horse has bolted."
There are the accidental occurrences such as that when Kelly Brown of Scotland and England's Ugo Monye clashed heads, or Wilkinson collided with a team-mate's hip while making a tackle. The fly-half subsequently went through the required cognitive test to clear him for action in Paris last night. But the England manager, Martin Johnson, said Wilkinson had been "limited" in his ability to train in the early part of the week; and that the same had been true of Toby Flood after he had been forced off by a blow to the head playing for Leicester on 6 March. Concussion, which used to bring a mandatory three-week rest, is a word rarely uttered these days.
Evans, one of the quickest players in the world game, was caught in a double tackle, the front-on element of which hit his head on Lee Byrne's pelvic bone. Gatherer, a 61-year-old former England physio who has 180 case studies of neck and arm nerve damage on his books, including current Ireland and Wales players, explained: "At 30 degrees of flexion the cervical spine between the head and shoulders goes into a straight line. If you get hit on the top of the head, the force will transfer through the spine and burst out at the weakest point. The contact with Evans looked fairly innocuous, but it could not be vectored out and it burst the spine." A lower vertebra in Evans' neck was pushed 50 per cent out of alignment; Robson observed that as little as a millimetre further might have cut the spinal cord. "If the cord is compromised from C5/C6 downwards it's paralysis," said Gatherer. "From C2/C3 upwards it knocks out the respiratory centres and you may not survive."
There has been talk of adjusting the tackle law but Vickery said: "I can't see any way that changing the laws would help. If you keep adjusting the laws you won't have a game; you won't be able to touch each other." Gatherer said: "If you know you're going into contact, do it as obliquely as you can. Either that or do what a lot of players do, which is go straight to ground or stand up high."
Then there are the more sinister and sometimes outrageous cases. In the Edinburgh versus Ospreys match two weeks ago, the home lock Craig Hamilton was crouched over a ruck when he was charged head-first in a classic "clear-out" challenge by the visitors' prop Cai Griffiths. The Scot was taken to hospital for a precautionary X-ray and no date has been set for him to resume playing. The incident was bang in front of George Clancy, the Irish international referee, who awarded a penalty but not a yellow card, never mind a red. This despite the IRB last November promising a "crackdown" and "stricter policing of illegal clearing out of players off the ball at the ruck" in the wake of Bakkies Botha dislocating Welsh prop Adam Jones's shoulder during the Lions tour. Griffiths was subsequently banned for four weeks, but he will be available for Ospreys' Heineken Cup quarter-final, and Robson is continuing to call for harsher penalties for intentional acts which cause injury.
Accidental or otherwise, the injuries are mounting in big matches. Five players wound up in hospital after the Wales versus Scotland match. The former Scotland No 8 John Beattie has described professional rugby as a real-life version of the dystopian sport of the future (in fact, it was set in 2018) in the 1970s film Rollerball. "[That was] a bunch of highly-paid athletes who risk life and limb to entertain people," Beattie told The Scotsman. "[In] modern international rugby... the punters expect these players to do absolutely everything to win, even if that means flying into a 20-stone man coming at you full pelt." Considering Beattie's son Johnnie is a present-day Scotland back-rower we can be sure he knows what he is talking about.
There is no doubt rugby is aware of its problems. England's RFU is leading the world in collating injury data, and Evans was almost certainly spared paralysis or worse by the immediate care he received on the pitch at the Millennium Stadium. The Buckinghamshire-based Gatherer, who has developed a neck-strengthening head harness catchily known as the "G-strap", is campaigning for specific neck and back training among teenaged players, and education at all ages over correct tackle technique. He participated with Robson and three medical professors in a conference at the Scottish Rugby Union before the Calcutta Cup match, and is working with the SRU at Merchiston School to collate data on how youngsters' necks change with age.
Robson has been included by the International Rugby Board on three recently established medical panels. The good doctor's other main recommendation is for players and coaches to change their mindset from winning the "collisions" to playing the game in space. Right now, that seems a Utopian loser in the head to head battle with Rollerball rugby. As Gatherer put it: "The medics can only say what needs to happen. It's up to the players and officials to do something about it."Reuse content