Ireland selection of Sexton deemed a ‘failing’ of concussion protocols

Progressive Rugby, the lobby group of former players and medical practitioners for improved treatment of brain injuries in rugby, has condemned the selection of Johnny Sexton for Ireland’s second Test against New Zealand in Dunedin on Saturday , insisting it demonstrates a “failing” in concussion protocols.

Sexton was removed after half an hour of Ireland’s 42-19 defeat in the first Test last Saturday for a head injury assessment (HIA), which he failed. A directive from World Rugby only a week earlier had insisted that under incoming protocols, any player “with a history of concussion or who has been removed from a match with obvious concussion symptoms will sit out of competitive action for a minimum of 12 days”.

After Sexton’s selection for this weekend, seven days after his brain injury, a statement from Progressive Rugby said: “Elite players who fail an in-game HIA1 [the initial assessment] have, by definition, displayed cognitive dysfunction requiring their removal. In our view, this is sufficient evidence, regardless of subsequent testing, to exercise extreme caution for the good of both their short and long-term health. This caution must be further amplified in players with a history of brain injury, as evidence is they are at higher risk of sustaining further concussions and other injuries.”

Sexton’s concussion history has long been a subject of concern, with one doctor who used to treat him at Racing 92 speculating in public in February 2021 that Sexton had suffered as many as 30 concussions in his career. Whatever the actual figure, the 36-year-old’s propensity to suffer brain injury is well known. If the new protocols were to have any teeth, his return to play, barely a week after they had been issued, would represent as poignant a case study as any.

This comes in the wake of continuing question marks about the HIA protocol itself, the process by which players’ brain injuries are assessed. This Ireland tour supplied critics with further cause for complaint when their prop Jeremy Loughman was passed fit to continue after staggering from a collision in the early moments of the midweek match against the Maori.

“Regrettably, the HIA is being exposed,” Progressive Rugby’s statement went on to say. “Last week the process again failed to diagnose a clear and obvious brain injury [Loughman], while three days later we are told it has identified a phantom one [Sexton]. The fact is there remains no examination by any expert that can demonstrate a brain has healed and is not at risk of further damage. As such, if player welfare is truly the game’s number one priority, the only option must be to err on the side of caution – otherwise the new elite protocols are failing in their key purpose.”

World Rugby’s new protocols were announced with much fanfare surrounding the minimum 12-day graduated return to play for anyone with a concussion history or who suffered obvious concussion symptoms, but the small print revealed the only actual change to the previous was to extend the minimum from six days to seven for those with no history or symptoms. It now appears that, in practice, even a player with a history of concussion as long as Sexton’s can return on day seven.

Sexton was removed from the first Test at Eden Park after slipping and colliding with Sam Cane’s legs. Ireland’s head coach, Andy Farrell, later said the fly-half had passed stages of the HIA process, with the assistant coach, Mike Catt, declaring soon afterwards that Sexton was “good to go”.