Concussion: A player’s perspective

After my second cap in 2005, I tore my ACL and in my return after seven months of rehab, I broke my leg. After the 2009 Rugby World Cup Sevens, I badly dislocated my elbow, tearing all the tendons and ligaments completely off and was told I would never play again. I didn??t even hear the words because we were three months from a World Cup in London. I got back in time - albeit with an arm that didn??t fully bend or straighten.Admitting defeat is not something that comes easily to me which is why retiring not on my own terms was extremely difficult.

As any rugby player will tell you, when they are injured all they want to do is get back and play. This involves bargaining with physios - ??but my knee feels fine?? or ??it??s a big game?? - constantly trying to shave time off the rehab process.

As players we are very practical. If we can see an injury or if something hurts we understand not being able to play. However. concussion is the invisible injury- there is no limp, no pain, and no set rehab time. So the bargaining process continues ??what if I wear a scrum hat?'

No-one wants to be the player that says ??I just don??t feel right?? because it doesn??t feel like a valid reason not to play, even though it is the most important reason not to play.

I got my first concussion at 17 when I was knocked out in a club game against?˜Clifton. I threw up afterwards, went to A&E and was sent on my way. I had a headache for a few days but then felt fine. ?˜I was lucky that I was playing at an?˜elite level so my concussions were dealt with effectively and there was no bargaining allowed. My plea to club coaches is to take concussions seriously and know better than the player. I remember asking my coach to play the following week as I genuinely thought I??d be fine. I dread to think what would have happened if they let me play before I was fully recovered -?˜?˜that World Champion status 11 years later might not have been a reality for me.

My aim in writing this piece is to encourage players to be open and honest and listen to their bodies -?˜admitting you have concussion is not a weakness it is a strength.?˜

In the build up to the 2014 World Cup, I had my 10th concussion in a club game for Worcester against Saracens. I was knocked out and convulsing. It was?˜not a scary moment for me as I don??t remember it, but to my family and friends watching, it was?˜a horrifying moment as I was stretchered off.

Seeing the faces of my loved ones in the weeks that followed, I could see a look of concern when I talked about playing again and for the first time in my 14 years playing I had an edge of doubt.

I??ll try and explain the feeling of concussion for those who have never experienced it.

For me it was months of confusion, lights being too bright, noises too loud, not being able to find the right words, feeling overwhelmed in normal situations, a feeling of vertigo while standing still. I would say the wrong words whilst coaching and have trouble focusing on anything as everything became a distraction. I felt agitated and on edge. I missed the Autumn internationals and started to worry whether I??d even make the World Cup.

After four months I started to feel normal again and managed to return in time for Six Nations. My first game back was against France in France in front of 10,000 people and live on Sky Sports. To say I was nervous was an understatement. While my mindset during the Six Nations games was unchanged;?˜if there was a ball on the floor I??d dive on it, if there was three three defenders in front of me I??d take them on without question,?˜training however was a different matter. I??d start thinking ??what if?? and try work out ways of avoiding collisions. This is not me and this is not the player I wanted to be.

I saw training as a matter of getting through it to be able to play. This is when I started to realise that a sevens professional contract might not be a realistic prospect for me but I didn??t want to think about it as I didn??t want anything to distract my attention from the World Cup in France.

In the first five minutes of the first pool game against Samoa I knocked my head in a ruck. It was an insignificant knock really but I didn??t feel right. I continued with the game and even somehow scored two tries but as the game went on I was became increasingly stressed. I turned to a trusted team mate and just said ??look at me?? and she looked, and by my eyes could tell I wasn??t right. It was six minutes until half time and I wanted to cry with frustration as I felt like I was always two minutes behind play and couldn??t make decisions but there was no big collision or obvious reason for me to take a knee. I decided to last the six minutes until half time then speak to the England doctor.

This was one of the hardest decisions I??ve had to make as a player- opting to leave the field in a World Cup game putting further selection at risk but I knew it was the right one. I missed the next pool game but felt ok again by the last one. I decided not to tell anyone back home what was going on as I didn??t want them to worry every time I went into contact.

Four years of waiting since losing that 2010 final and we had another shot at it. We were focused and ready. The feeling of winning that final was my happiest and proudest moment in my playing career, yet deep down I knew it was the last time I??d be playing.

The weeks and months after the final I had what is called Post Concussion Syndrome (PSC) -?˜basically a hangover of concussion symptoms. Loud noises or bright lights caused migraines. If I trained I??d feel sick and get a headache and again had that hard to pinpoint ??not feeling right??.

I spoke to the team Doctor and saw a neurospecialist and decided I would not be honouring my newly held sevens contract. I was not to live my dream of being a professional player.

This was heart-breaking as my body felt fine, physically I was in good shape and I was still in form playing wise. It was a hard decision to make but really it was the only decision for me. I had to start looking to the future and wonder what my quality of life would be like if I continued playing.

?˜I??d had 11 concussions and at what point do you say enough is enough? The combination of the PSC and the emotions behind retiring was a tough, low time for me. Watching my friends live my dream while I was left behind.

This is the nature of sport so I don??t feel special in anyway- just an ex-player trying to find a new identity and purpose. It is tempting not to own up to how you are feeling for fear of looking weak. It is harder than I could ever have imagined and even 10 months after retiring I am still sad about it and question what I??m supposed to do with myself now. ?˜Fourteen years of training to become fitter, faster and better at rugby. Fourteen years of rugby related goals suddenly over. It??s only natural to feel lost and isolated. The temptation is to cover it up, finding a new sport but that only delays facing your demons. I still now find it hard to watch England play, to hear the national anthem and know I won??t sing it again.

The toughest part for me is not having that closure and knowing if it wasn??t for the concussion I??d still be playing now. Unlike many retired players I will not get the chance to play social rugby, or turn up to a fun sevens event and that leaves me with an emptiness I??ve yet to work out how to fill.

I am not bitter and if I could do it all over again I would do everything exactly the same. Rugby has given me friends for life, a sense of purpose and now a World Champion status. The only thing I would do is take more notice of concussion and I wish the current protocols were around back when I was 17 and got my first. I know it sounds terrible to say but at times me and my friends would be laughing about if I got hit in the head with a ball?˜I??d feel dizzy- with the knowledge I have now, I??d have taken it more seriously when I was younger but that??s the value of hindsight.

My worry is that players wanting to secure their position at top level might say they feel better even if they don??t. It??s tempting as who would know? But that is the wrong attitude - a game is not more important that your life. Returning to contact before you are fully recovered is extremely dangerous and will only lead to further concussions. In the position I??m now it??s easy to say but at the time you actually start to question whether you do feel ??normal?? or not and sometimes the want to return for a game almost convinces you that you are ready. This is when it??s dangerous territory, when your desire to play overrides your safety and it is exactly that- your safety.

I hope that young players coming through take notice of concussion and don??t try to hide it- allow yourself to recover and use the new protocols to give yourself the best chance. Rugby feels like everything in the world at the time but there has to become a point where you start thinking of the bigger picture and not be tempted in by the immediate rewards that rugby offers, especially with all the research into the relationship between repeated concussions and dementia. You only have one brain- look after it!

Rugby/ sport/ life is a game of percentages- you win some, you lose some, you get injured, and some unlucky ones will have to retire early.?˜ In that sense I??m one of the unlucky ones but I don??t see it that way I have had amazing experiences playing and will continue my involvement through coaching.

So if you take anything from this take this.

Concussion is a very real issue with massive life-long repercussions if not taken seriously.

Players -?˜ be honest and sensible. Coaches ?˜- be as educated as you can on the symptoms and insist on players going through a graduated return to train regardless of the level and if a player hits their?˜head and ??doesn??t feel right?? take them off.