Australia's leading authority on brain injuries says the NRL should introduce independent assessments of concussed players, while NSW's most prominent boxing medico has called for automatic lay-offs after head traumas, to reduce the risk of permanent neurological damage.
Cronulla's Ben Ross and Wests Tigers captain Brett Hodgson, due to play the Bulldogs today, have both returned to the field just a week after being knocked out. The NRL leaves it to the clubs and players to determine if a lay-off is warranted but Associate Professor Arthur Shores, from the Research Sports Concussion Clinic at Macquarie University, believes the NRL should eradicate the possibility of club loyalties overriding rational judgments.
"The value of an independent assessor is that bias is reduced," Shores told The Sun-Herald.
"However, as club doctors know their players best, any decisions are best made on a consensus basis between the club doctor and an independent assessor, keeping in mind guidelines based on the sports concussion literature.
"It is believed that when the brain has not yet recovered from the first concussive episode, a second concussive episode could lead to more severe, and potentially permanent, brain damage."
Ross was praised for his supposed courage for playing the week after a frightening collision with Manly's Josh Perry rendered him unconscious and put him in the spinal unit of Royal North Shore Hospital. He was cleared of spinal damage and returned the following week, only to be suspended for seven matches for a late and high elbow to the head of Melbourne's Cooper Cronk.
The Roosters' Braith Anasta continued playing after being sent into Disneyland by Brisbane's Karmichael Hunt. And in the most alarming recent example of a clearly distressed player putting himself at risk, Queensland's Dallas Johnson returned for the second half of last year's State of Origin opener after being poleaxed in the opening minutes.
NSW Boxing Authority doctor Lou Lewis advocated automatic lay-offs to ensure a proper recovery.
"What happens in a concussion is that there's a transient loss of normal brain function," he said. "There is significant brain trauma but if they are given long enough, they can recover. The important thing is that there isn't a repeat of the trauma, and certainly not in a short space of time.
"You just can't keep putting a person through that. It's not just with concussion. Any heavy hit and any tackle causes trauma to the brain.
"Boxers are ruled out for a minimum of 28 days. It's an accepted rule that's taken seriously. That's the absolute minimum. I'd like to see that period extended, if anything.
"If they're knocked out for a second time, they're not allowed to box or spar for three months. That's a universal rule that everyone has to abide by. As a doctor, I'm happy with that. The recovery from brain trauma is something that has to be done properly and treated seriously."
Lewis said it was better to err on the side of caution because it could take up to 20 years for the real effects of repeated concussions to be learned.
"They've done a lot of studies in boxing and there have been less and less serious problems in retired fighters since the 28-day and three-month bans were put in place," he said.
"Sometimes, you need to protect athletes from themselves. We're fortunate in boxing that the rules are universal and accepted. It's not left up to the boxing clubs or the individuals. It's taken out of their hands and that has to be the best solution.
"If it's left to a club or an individual, there's the risk that their judgement may become clouded. Ask any athlete if they want to stay on the field, or come back straight away, they'll say yes every time. There are risks associated with that."
America's NFL is comparable to the NRL for the ferocity of collisions. In league, it's been found that two props hitting each other at full steam packs a G-Force of 10. Human crash-test dummies are rarely allowed beyond 10g for their own safety.
The general practice is for NRL club doctors to perform a series of cognitive tests on players during the pre-season and if the results are the same after a concussion, they're free to play.
The NFL last year held a concussion summit after the deaths of four former players - Andre Waters, Mike Webster, Terry Long and Justin Strzelczyk - were blamed partly on chronic traumatic encephalopathy, more commonly known as punch-drunkenness.
The gridiron competition now has the same sort of baseline cognitive tests used in the NRL, but with a stream of former players complaining about depression and memory loss blamed on brain damage, there are calls for tougher measures.
Wests Tigers doctor Donald Kuah denied it was in his best interests to get a gun player like Hodgson back on the field.
"The bottom line is there has been significant research done in this area," Kuah said. "There was a conference in Prague a couple of years ago where they came out with guidelines. What it said is that returning to sport from concussion isn't about how bad the [head knock] looks initially.
"You could get someone who gets a bellringer and is dazed a bit, but the headache and concussion symptoms could last for three weeks. Whereas you could get someone who is knocked out cold, like Ben Ross, who came back the week after.
"The biggest self-interest for the doctors is not to be sued. In other words, if I put someone back who isn't ready to come back, then I make myself liable. In terms of my self-interest, I need to get the player back out on the paddock in a safe fashion."
Roosters doctor John Orchard said rugby's experiment with automatic one-match rests was abandoned because the players weren't truthful.
"When a doctor asked if they had headaches or other symptoms, they were not revealing them because they feared they would have the automatic stand-down applied," Orchard said.
"Despite the fact players get knocked out, they don't suffer long-term consequences as a result. I don't think you'll find an ex-NRL player that says he's run into problems because he suffered too many concussions and didn't recover properly from them."
Problem being, the game has never been as fast and furious as it is now.
