It's the scariest injury in rugby, but science is on our side.
By Northampton Saints' Tom Lockett

There’s no feeling like it: running on to the field in front of a packed stadium, alongside 14 guys with whom you share a goal, ready to give everything to achieve it. Former players talk about that feeling – they say it’s the one thing they can’t replicate when it’s all over.

The big games are great, but what really gets me out of bed is the fun we have day-to-day. I work in a team of between 40 and 50 people and some of us have grown up together across eight or nine years. We’ve been through everything – good times and bad. We’ve travelled the world together. They are some of the best friends I have, and I get to play elite sport with them.

However, this wonderful sport we play has its risks: the incredible physical intensity we play at means we are at heightened risk of injury.

I’m 23 and already I’ve torn my pectoral muscle, broken both my cheekbones and torn lots of tendons. But the scariest injury I've had is concussion. There are two reasons for that: First, it’s because you don’t have a clear timescale of when you can return and second, because you don’t how it might affect you in the long term.

Rugby is high intensity and confrontational. You simply wouldn’t be able to play in fear, but concussion is something that's always in the back of your mind. What worries me about my long-term health is not knowing what to do to protect it now, whilst still playing the sport I love. Lots has come out recently on ex-rugby players who now suffer with early-onset dementia – that scares me. How can I best manage myself now so that I don’t find myself in the same position then. What can we do now for the next generation of players and at all levels of the sport?

I am currently classed as ‘high risk’ of concussion in the list of players at my club, Northampton Saints. You can be on that list for all manner of reasons: mental health, medical history, learning disabilities – or frequency of concussion. For example, if you have three concussions in 12 months or two in three months, or five or more career concussions then you’re classed as higher risk, and that changes the way you're managed.

Currently, in elite professional rugby, if you are not in the higher risk group then (in certain presentations of injury) it can be possible to return from a concussion in seven to 10 days. If you’re in the higher risk group, it’s always a minimum of 12 days.* The reason that I’m on the list is because of the number of concussions I have experienced, plus I have had a previous concussion where my recovery took longer than 21 days. To further complicate my concussion diagnosis and management, I suffer from migraines. I suffered from migraines long before I was a rugby player, but since playing professional rugby, they've become trauma and spotlight induced. They still happen outside of a rugby setting, but sometimes they can be triggered by a bump on the head.

Rugby’s concussion diagnosis is primarily based on self-reported symptoms – but a lot of the symptoms I get with my migraines are similar to those on the concussion list. If I go to the physio and say, ‘I've got a headache, the light is making me feel funny, I feel dizzy’, it immediately sets alarm bells ringing that I have a concussion – whereas I've had enough experience of both to know the difference.

It would be great to have a black-and-white diagnostic tool that could differentiate between migraines and a concussion. I'm 23 and it's pretty daunting to think about what I’ll be doing at 33, never mind what my brain health might be. That’s why a trusted, objective tool that could diagnose a concussion and then explain the necessary course of action would be so powerful. Something that could inform you: If you take an extra week away from sport now, you’re going to reduce the risk of damage in the future by X amount.

The current system, while improving year on year, is partly subjective and, to a certain extent, you can get around it. Professional rugby players love rugby and want that feeling of playing the sport we love in front of fans. And concussion symptoms are often hard to identity or fully understand. So, when a player is asked ‘how do you feel?’ they might say ‘I’m okay’ even if they are experiencing something that is different from their normal. That’s where a diagnostic tool that says ‘you are concussed’ could take the thinking out of the player’s hands.  

There is increasing coverage around this issue, featuring current and former players. I wasn’t in those team rooms 10 or 15 years ago, so I can’t say what the culture was like when there wasn’t as much information out there, or what it’s like at other clubs today. But at Northampton, we’re pro-active about looking after ourselves, both in the here-and-now and futureproofing, too. We talk about the problem; it’s part of our job and we have a duty of care to be honest with ourselves and each other. In the end, if one of us is hurt, it’s best for him and his teammates if he steps out.   

That’s one of the reasons I visited The Podium Institute at the University of Oxford recently. I spoke to the researchers there about my experiences as a professional athlete and listened and learned about the fascinating research and development they are doing in brain health and concussion, in particular in the pursuit of the kind of diagnostic tool I described earlier.

This research has already influenced the way young rugby players and other athletes recover from this kind of injury. Podium’s SportSmart app features a Concussion Recovery Tool, which guides the athlete through the recovery process using the latest guidelines. When I was younger, the advice I would always get would be take a week off and wear a skullcap – and all that showed me was that my parents and coaches didn’t really know what was going on and therefore weren’t in the best place to advise me. So, I think SportSmart could be good not just for youth and grassroots players, but their coaches and parents, too.

I’m grateful every day for the medical staff at Northampton. They look after us and we couldn’t compete at the level we do without them, but – on a bigger scale – it’s a different challenge trying to solve these problems. I found it incredibly reassuring to learn that this work was happening behind the scenes, with the goal of making my job safer.

I’m convinced this research will bring change to rugby and other sports, making them safer for athletes at every level, while keeping the magic that brings us all to sport in the first place.

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*21 days in non-professional and grassroots sport