An editorial in the British Medical Journal has criticised rugby’s “tribal, gladiatorial culture” that sees parents, coaches and schools encouraging “excessive aggression” and playing on when injured.

“Anyone who has spent an hour picking skull fragments out of the contused frontal lobes of a teenage rugby player is entitled to an opinion on the safety of youth rugby,” writes Michael Carter, a paediatric neurosurgeon.

“I’ve done this on several occasions. As a ‘rugby parent’ I’ve observed the school and club game at close quarters, from both sides of the touchline. What I’ve seen and heard suggests that our thinking on the subject may not be altogether rational.”

Carter, noting 20 children have sustained rugby injuries over the past decade that needed neurosurgical consultation or intervention, including two deaths, has called for the age of contact rugby to be increased in the UK from 10 years to 12. In Ireland contact is introduced at the under-8 level in mini-rugby.

Carter believes an injury logging data collection, driven by rugby’s governing bodies and public health authorities, is necessary to uncover how deep this problem goes.

He also made direct reference to the death in 2011 of Ben Robinson, the Carrickfergus Grammar 14-year-old, who sustained three head injuries in one game.

“My son plays rugby, he’s 16,” Carter told The Irish Times. “Not only is it a contact sport it is a collision sport. Squads are getting bigger and more powerfully built, competition is arguably becoming more aggressive. I think there is a risk of severe injury.

Broken necks

Carter, a neurosurgeon at Bristol Royal Hospital for Children, links what he sees on his operating table to rugby’s ongoing concussion issue and references the problems currently experienced by the National Football League in the US.

“In the US there is a large group of ex-professional and college football players whose families have taken out a mass action against the NFL for insufficient care. That is litigation that is highly likely to change the game. It would be a tragedy if litigation could take apart a much loved game in this country.”

Larger-sized players

A solution, Carter said, cannot be found without more information. “We don’t have any evidence, but it won’t be long before we acquire it. We all suspect it is pretty bad but we don’t know. What we need is an injury logging data collection exercise at a national level. The governing bodies and public health authorities must co-ordinate this.

“The smart rugby programme in New Zealand is streets ahead of everybody else in terms of identifying injuries and changes in play to avoid them.

“It’s all about teaching people how to play the game safely and correctly. There has been a lot of research done by Ken Quarrie (a scientist overseeing injury prevention and performance for New Zealand rugby). You need a lot of skill to avoid an opponent in contact sport so it is important to have a primer for that.”

The British Medical Journal editor in chief, Dr Fiona Godlee, added: “Let’s call the current state of monitoring and prevention of rugby injury in schools what it is: a scandal. It needs urgent remedy before more children and their families suffer the consequences of collective neglect.”