Bruised and confused: An autoethnography of concussion in rugby union

Abstract

In this autoethnography, I explore my experiences with sport-related concussion. I portray the challenges that the symptoms presented, but I also provide a wider social, cultural and political context that includes the normalisation of pain and injury in collision sports and the discourses that contribute to a culture where players minimise the severity of, and play through, concussion. Following my career, this article showcases a ‘culture of knocks’, highlighting how these discourses are learned and reproduced, the complex relationship between teams and medical staff, and anxiety over long-term consequences.

I stand in the doorway, irritable, regretful and in significant discomfort. I feel like there's a contraption compressing my head – it digs into the sides of my skull, creating the pressure of a thundercloud. No matter what I do, I cannot get rid of it. I squirm, I move, I clench my teeth, but it is always there.

Accompanying the pain is racking guilt. I just wanted some quiet while I worked, but my request came out with just a touch too much aggression. I can’t seem to control my volume or my tone lately. The shock on my three-year-old daughter's face – and the eruption of tears – overwhelms me. She was playing with her dolls. I disrupted that. I made her cry.

I walk back into my room. The contraption is still digging its claws into my brain. It's been disrupting my life, and the lives of everyone around me, for so long. When will it stop? It's been three months. When will I feel normal again? Will I ever feel like I used to? My breathing is manic, and I bite my fist to suppress the oncoming tears.

I’m so scared that I’m going to be like this forever – that I’m going to be a burden on everybody around me, that my family will have to put up with this angry man. At some point, it's going to be too much. If I don’t get better, will I lose everything? ***

This is an autoethnographic exploration and elucidation of my experiences with sport-related concussion. In this article, I illustrate the challenges that the symptoms presented, but I also provide a wider social, cultural and political context that includes the normalisation of pain and injury in rugby (and other collision sports) and discourses that contribute to a culture where players minimise the severity of, and play through, concussion. As such, this work builds upon a growing body of literature that explores the socio-cultural aspects of concussion (Dean, 2019; Liston et al., 2018; Malcolm, 2009; Malcolm et al., 2023; Ventresca and McDonald, 2020), socio-cultural studies of pain, injury and risk (Nixon, 1993; Roderick et al., 2000; Young, 2012) and gendered performances in sport (Laurendeau, 2014; Messner, 1990; Pringle, 2001). As such, it looks to contribute to critical studies of performance sports, and work towards shifting our understanding of, and engagement with, avoidable harm in sporting environments.

Sports-related concussions are a subset of mild traumatic brain injuries, and while they are often trivialised within the sports media as a ‘knock on the head’, there has been growing concern in recent years about the long-term health risks associated with concussion (King et al., 2014). Research has shown that retired football players have an earlier onset of Alzheimer's disease than the general population and the mortality rate from neurodegenerative diseases is three times higher in National Football League players (Partridge and Hall, 2015). Rugby union has a high incidence of concussion (3.89 per 1000 playing hours) (Salmon et al., 2022), and in New Zealand, rugby is one of the primary sites of concussive injury (Theadom et al., 2014). Young athletes are especially susceptible to concussion (with a larger head-to-body size ratio, weaker neck muscles and developing brains; Pfister et al., 2016) and have an ‘increased risk of additional and more complicated injuries to the brain, and a delayed recovery’ (Kearney and See, 2017, 981).

Like Dean (2019), I utilise autoethnography to illustrate my lived experience of concussion, though rather than exploring the consequences of one major injury, I portray vignettes to highlight multiple moments over a 25-year span. I emphasise that, as it is for many athletes, my concussion story is not about one big knock – it is about a culture of knocks. The sports-related concussions highlighted in this article are only a selection of the mild traumatic brain injuries I sustained over my career. Nearly every season included a brain injury that resulted in a rest period, but over 25 years there were potentially hundreds of sub-concussive knocks sustained in training and games that we now know ‘present the risk of microstructural and functional changes to the brain in male athletes’ (Mainwaring et al., 2018, 52).

Sport-related concussion is typically explained through a positivist, biomedical perspective and autoethnography aims to challenge dominant ways of thinking (Adams and Holman Jones, 2011). The quantitative nature of much SRC research tends to emphasise individual responsibility and favour the measurement of certain outputs (e.g., frequency, time of game) while minimising the social structural factors that contribute to concussion (Malcolm, 2018). Autoethnography, and other qualitative methodologies, can complement, challenge and disrupt the centrality of medicine inherent in these perspectives. Autoethnography as a method seems well placed to contribute to our understanding of an injury that is ‘complex’ and requires individual, case-by-case treatment (King et al., 2014). By shifting the gaze inwards, we can reflexively bend back on the self to expose broader cultural issues in society (Ellis and Bochner, 2000). As such, I focus on the ways in which concussion has been understood in rugby union sub-cultures, using my experiences to shine a spotlight on the discourses that contribute to the concussion ‘crisis’ (Malcolm, 2020).

Of course, autoethnographies are a form of memory work, and as Bochner (2017) warns, ‘every autoethnographer must be mindful of the workings of memory’ (p.72). Our memories are always a reflection of how we remember things now, not what we experienced in the moment. As I work through epiphanic moments from my childhood, there are likely to be gaps and perspectives that have shifted as I have aged and become critical. In the concluding section, I touch on a further disruption: the concussion-impaired memory. When one of the primary symptoms of a mild traumatic brain injury is memory loss (Malcolm, 2020), these gaps and distortions can become even greater.

And while autoethnography is an account of self-experience, it also involves others. I may acknowledge that this is a story told from my perspective, but I cannot guarantee that others will not be hurt by what I write (Bochner, 2017). There are a range of characters in my vignettes, many of whom are unidentifiable (such as my early coaches), but some of whom I have ongoing relationships with and are easily identifiable, certainly to themselves (such as my wife). Once this is published, what consequences will they bear? My recollection and perspective of events will continue to change over time, but the text will remain an authoritative account frozen in time (Lapadat, 2017). And what of reputational harm to myself? I have an obligation to describe my experiences authentically, but by foregrounding the challenges I have and may continue to face, might I be risking future employment opportunities?

Ellis (2007) proposes that we employ relational ethics to navigate these quandaries. This requires that we acknowledge and maintain relationships with our participants, checking that they understand how they have been represented and what this will mean for them (Ellis, 2007). For the main characters in my text, in particular my wife and my father, this meant providing an opportunity for them to read my manuscript, discuss any implications, and consent to their portrayal.

So to illustrate a career – a life – disrupted by concussion, I look beyond neat, scientific compartments (Rinehart, 1998), to methods that reveal the contradictions of human experience and the vagaries of life (Lincoln et al., 2011). I write in this way to highlight this messiness (Denison, 2010), to invite the reader to emotionally ‘relive’ my experiences (Sparkes, 1996) and to ‘consider how and why we think, act and feel as we do’ (Ellis, 2013, 11). To continue playing a contact sport when you have suffered a mild traumatic brain injury seems ludicrous, but I did it multiple times, even when writing a PhD which was critical of rugby discourses. Autoethnography allows a window into this experience, and through my writing, I hope to create easily digestible, vivid and evocative illustrations of my rugby experiences that make the choices I made (at least somewhat) understandable. Hopefully, this will encourage others to interpret and feel the fractures in their own lives (Spry, 2001).

1994

I am nine years old, and I love rugby. I’m quite good, I have made loads of friends, and it's something that my Dad, and both my Grandads, love. When I grow up, I will play for my high school 1^st XV, then for the local club where Dad still plays, and maybe, if I’m good enough, one day I’ll be an All Black.

‘Who plays soccer?’ my Grandad asks.

‘Girls’, I reply, smiling cheekily. I know how to play to the crowd. I get a wink and an affectionate rub of my hair for following the script. Sport is the only site where my grandfather feels comfortable playing a caring role. While this is not unusual, it does reinforce traditional conceptions of gender roles in our (wider) household (Hasmanová Marhánková, 2020).

In the early 1990s, rugby union was integrated into every aspect of my life and held a central role in the collective New Zealand imagination. The dominant discourses within New Zealand society position the sport as a positive social force, the ‘national game’ and a ‘real man's game’, where those who do not play rugby are considered abnormal (Pringle, 2001).

When I turn seven years old, my father presents me with a pair of second-hand Mizuno rugby boots and I am in shock. I pick them up and run my hand along the outside, caressing the soft, supple leather and feeling the warmth of genuine hide. I can see the sparkle in his eye and sense the quickening of his heart as he remembers the same experience with his father. As Sparkes (2009) describes, the smell and feel of the football boots join father and son, not just through a communal experience but through memories over generations. I place the hand-me-down boots on my feet as though they are made of gold and spend the next hour running in bursts up the lawn.

Dad calls me over, a serious look on his face, ‘Now you’ve got to take good care of these, Ok?’

Stern nodding.

‘You’ve got to clean them after every practice’.

Even sterner nodding.

‘And polish them before every game’.

Sterner nodding still.

‘Right so come here and I’ll show you how to do it properly’, Dad says, showing me how to clean all the little crevices properly, how to stuff newspaper on the inside so they dry quicker, how to scrub the polish on hard with the rough brush and smooth it down to a glimmering sheen with the fine brush. Cleaning the boots was not just about appearances, or teaching work ethic, but about bonding through rugby, weaving us together through the same fabric of experience (Bochner, 1997).

Sport frames my male relationships (Wellard, 2002), particularly with my father, with whom I am able to build a connection around understanding rules, tactics and players. A number of studies have highlighted the role that sport can play in positive parenting (Coakley, 2006; Kay, 2007), but relatively few have focused on the negative aspects, such as being overly aggressive or the normalising of hypermasculine discourses (Jeanes and Magee, 2011; Wilms, 2009).

Saturdays are spent playing rugby, then watching it on TV. During the week, my brothers and I spend our free time after school playing rugby on the front lawn. I pretend to be a young Andrew Mehrtens as I dodge the tree, avoid the concrete and chip and chase over my brother to win the World Cup.

I’m excited on Saturday as I throw on my green and gold jumper that's at least five sizes too big, link arms with my friends as the coach yells at us about being ‘brothers’, and listen to my boots clip-clop across the concrete pathway as we make our way onto the field. I make a good run and get a pat on the back from my mate, and I’ve converted all the tries so far. I could get ‘Player of the Day’ at this rate.

Matthew tears off around the outside of the defence in a huge arc and nearly scores but he is just pushed over the sideline. I wait as the forwards prepare for a lineout. One of our players jumps high and manages to steal the ball onto our side. It's messy though, and our halfback Andy has to scramble for it. He heaves it towards me, slow and sloppy.

It takes forever to reach me.

I wait, arms raised.

The ball touches my fingertips…

Ooomph.

Little sparkly fairies dance across my vision. I feel mud against my fingers. My mouthguard, curved blue, lies on the grass. There is a feeling in the back of my head that keeps growing and growing. Suddenly, I become aware – of pain, of my location, of what is going on. The impact is intense; I can’t help the tears that leak from my eyes, I can’t shake the feeling of fragility that encompasses me, and I can’t understand how this game that I love could have hurt me so badly.

The coach walks towards me with a water bottle. He's a nice man, he’ll help me.

‘You alright? Yeah, you’re alright. Up you get’, he says with a slight smile. He squirts the water bottle at my head. ‘Don’t let him see that he hurt you’.

I look away. I get back to my feet.

‘Good on ya’, I hear him say as I tentatively head back towards my teammates.

I feel angry, embarrassed, vulnerable and alone. For the rest of the game, I feel detached and incredibly fragile.

In the car ride home, I lash out. ‘It's stupid. He shouldn’t be allowed to even play anymore’.

‘Hey. Hey’, Dad shouts irritably to be heard over my tantrum. ‘That's rugby. You got hurt, but that's part of the game. There's no point crying about it’.

I fold my arms and turn away, muttering angrily into the door. Though I am adamant at this moment that my father, my coach and the player who hurt me are wrong, I absorb these lessons about acceptable masculinity on the rugby field (Pringle, 2001) and these frame my understandings of pain, injury and concussion in this context for the next 25 years.

1999

‘Holy shit’, I hear James mutter under his breath as he notices the red marks that crisscross down the length of my back.

I smile, revelling in the veneration as I prepare for one of the boarding school showers. As a 14-year-old, there are few things that gain the admiration of your peers like the overt symbols of bodily commitment from being trampled at the bottom of a ruck. Visible injuries become medals that represent a commitment to the team/sport and are symbolically significant within the group, and as a marker of ‘rugby corporeality’ to others (Beal and Wilson, 2004; Branchu, 2023; Schacht, 1996). I step into the shower, and while the hot water stings at the pierced skin, it is the wounds that James can’t see that hurt most. My neck, my shoulders, my back, my hips – they all ache from the intense physical hammering on Saturday. This must be what it feels like to be old.

Plus, I have a headache that lingers over everything I do. Hmmmm Ba-bomp…. Hmmmm Ba-bomp. The constant ringing is rhythmically interrupted by the percussive heartbeat in my skull. As the water washes over me, I wonder how long it will take to recover, and hope that this afternoon's training session will reflect our need to rest.

No luck.

‘I don’t know what happened on Saturday, but I never want to see such a gutless display again’, our coach spits as we huddle around him. ‘If we don’t turn up to tackle, we might as well not even bother. Right, five up on the tackle bags, everyone else line up’.

I’m not the only one who winces as we separate into single files and then hurtle into the foam-packed canvas bags. We are yelled at to complete the task faster for 10 minutes before we are told to line up behind plastic cones.

‘Right, one person in the middle of the square, I’ll yell out a colour, and that person runs through to the other side’. The coach seems angry, like somehow we have let him down. I enter the square.

‘Blue’. Kevin charges at me. Ooomph. I thrust my shoulder into his midriff, wrap my arms and he goes down. The effort saps the energy from my body, and I am only just to my feet when the coach yells, ‘Green’. I’m not sure why (work ethic, fear of the coach, fear of peer abuse?), but I keep getting back up, and keep hitting the ground hard. The coach determines the activity, for how long, and who participates, and no one questions his directives. These scenarios, Channon and Matthews (2022) argue, raise important questions about the agency of athletes – rather than critical and reflexive participants, athletes typically defer responsibility and trust that the coach has their best interests in mind. We learn (are punished) for an hour.

It would be nice to think that coaching styles have changed dramatically since this, but over the next 20 years, I encountered multiple ‘punishment sessions’ for unsatisfactory defensive efforts. In fact, Burak et al. (2013) found that more than 91% of participants in their study had experienced exercise as a form of punishment from coaches, and many indicated that they would use it as techniques when they took on coaching roles. This is despite research indicating that such behaviour has detrimental effects, such as increased anxiety, fear, and resentment as well as diminished self-worth and motivation towards sport participation (Battaglia et al., 2017; Gearity and Murray, 2011).

At the end of practice, I feel broken.

I shower again. I barely notice the whispers about my back this time. Instead, I keep ruminating on the words of the coach – ‘weak’ ‘lazy’ ‘soft’ ‘embarrassment’ ‘ashamed’. I close my eyes and the water pummels into my aching shoulders.

2002

I take a deep breath and a smile starts to tease at the edges of my mouth – I’ve got rugby this afternoon. I look down at my bag – my carefully polished boots gleaming – and know I am well prepared.

Once the game kicks off, I find my rhythm and enjoy playing a leading role. With only minutes remaining, I get tackled. Laying on the ground, I turn my body and reach the ball out towards my teammates. There is a tussle above me – legs thrash nearby, there is a loud grunt as two bodies thud to the ground, there is daylight for a moment, and I glimpse someone leaping towards me.

I can see a car moving slowly in the distance. A bird flies from one tree to another. Someone runs past me. Actually, what's going on? Where am I? What is happening?

Like a mist slowly rising, the picture becomes clearer. I’m on a rugby field. I’m playing rugby. I touch my jaw. Owwww. I become aware of a headache increasing in intensity. I slowly get to my feet and look around. What's that noise?

‘Call?’ Conrad stares at me.

‘What?’

‘What's the call?’

I stare blankly back at him. Oh, right, a backline move. Um… …

Conrad is not impressed. ‘We’ll do France’, he announces to the other five backs. He shoots me a dirty look.

Ok. France. France?

The halfback fires the ball to me, and as the opposition rushes forward, I swivel and throw a pass to Conrad. His eyes pop in surprise, and he is forced to evade a defender. Oh, that can’t have been France. The ball comes flying towards me again. Somehow, I catch it and shovel it immediately to the player beside me. As he is tackled, I join the fracas competing for the ball. A short, powerful player charges towards me aggressively, and a pulse of pain sears through my skull as I limply absorb his energy. I almost sob in relief when the ref blows the final whistle seconds later.

I reach for the team drink bottles. Conrad taps me on the shoulder. ‘Bro, what happened there?’

‘Mate, I dunno…’ I reply. I try to avoid further conversation, but he starts analysing various moments. When the ball hit Dave in the head? I scored a try? I try to rewind, but I can’t remember anything specific about the game at all. In fact, I’m having trouble remembering anything.

But by the evening I’m feeling more effects from the regular bumps and bruises. Sitting amongst my mates, I settle in to consume as much rugby and rugby league on TV as possible.

‘Ohhh, that's another huge shot’.

‘Ohhh. There he goes again. Let's see another set of six’.

‘He's run into a brick wall. He might not get back up from that’.

I’ve always been more interested in the skill on display than the brute force in rugby, but now I wonder how much media portrayals played a role in my decisions to continue playing when concussed. McLellan and McKinlay (2011) explain that athletes within the National Rugby League are commonly shown continuing to play, or returning to play within minutes of a traumatic brain injury, and exhibiting far less caution around these injuries than the general public is expected to display. They argue that it is therefore reasonable to suggest that the young people consuming this media may be likely to minimise their symptoms of concussions or have difficulty adhering to injury management advice. Relatedly, Ahmed and Hall (2017) have shown how media portrayals can lessen the severity of public perception of concussion, by presenting the injury in terms that are ‘softer’ (e.g., ‘knock on the head’).

On Monday, I don’t have any headaches, but to be cautious, I follow my medical knowledge about concussion. What's the NZ Rugby guideline? Two weeks off? Ok. I’ll miss this weekend, but I’ll be able to play the next week, because that's two weeks. At training that evening, I passed this information on to my coach.

‘Are you sure?’ He looks at me sideways, like I’m trying to cheat him out of something. ‘You didn’t say anything on Saturday’.

‘Yeah, got a wee knock towards the end’.

‘Right’. He still looks sceptical. ‘Just one game? I’ll see you in a week then’.

I walk off the field by myself.

And I manage my concussion by myself. Much like the Irish rugby players in research conducted by Liston et al. (2018), I downplay the significance of my concussion – to the coach and to myself – and consider the severity of the injury primarily in terms of time away from the sport. This is echoed by AlHashmi and Matthews (2022), who reported that athletes almost always considered their concussion-related health in terms of their ability to perform in the ring. Their knowledge, and lay medical certainty, AlHashmi and Matthews (2022) argue, was often based on information from their coaches. My decisions, and my knowledge of concussion, are influenced by a coach who is generally sceptical of concussion as a legitimate injury.

By Saturday morning, I feel fine, so I decide to have a chat with the coach.

‘Oh good’. The coach looks ever so slightly satisfied – his doubts confirmed. ‘I didn’t think there was anything wrong. You can start on the bench’.

So that afternoon, I take my place on the bench and when a player is injured just 15 min into the game, I run on and play the remaining 55 min, ¹ unaware of the danger of repeated concussions. According to King et al. (2014), the risk of suffering a subsequent concussion is significantly increased in the 7–10 day period following the injury, and the ‘effects of repeated concussions are reportedly cumulative and permanent’ (p.458). It is unlikely that this knowledge would have changed anything though. I emerge from the game ‘unscathed’ and congratulate myself for making the ‘right’ decision.

2009

I am living and playing rugby in Ulster, and I am frustrated with a local rule. Completely contradicting all the rhetoric around player welfare in rugby, we have to play without substitutes. ²

As Howe (2001) points out, rugby environments cultivate a process of bodily disappearance, where pain and injury are normalised and are only referred to if they serve to highlight how the athlete deals with pain or is furthering the club's cause. In this scenario, however, the injured body becomes highly visible, and expectations to play through an injury rise even further.

Bobby, the coach, carries this knowledge like an Atlas Stone. An injury could directly lead to a loss, so part of selection is picking players who are not ‘injury prone’. Bobby eyes the team physio, Kevin, as though he is a fox among his chickens. Kevin's always convincing players to stay down, to seek medical treatment, and worst of all, that their minor ‘invisible’ knocks are concussions.

In a tight match, Rory sprints towards the try line, but just before he can dive, an opposition player makes a lunging tackle, copping Rory in the face with his shoulder. Rory's face distorts and his head is thrown back violently, and Kevin slides in to treat him within seconds.

Bobby strides in. ‘He's fine, he's fine’.

The physio goes through his protocols, ‘Do you know where we are? What's the score?’ I can’t hear Rory's answers, but I hear him insist he is fine in an agitated tone.

Kevin waves his arms towards the referee, indicating that he is removing the player.

‘What?’ Bobby screams, waving his arms theatrically as he stalks towards Kevin. ‘You can’t do that’.

Kevin ignores him and starts to remove Rory from the field.

‘What are you doing?’ Bobby is apoplectic now. ‘There's nothing fucking wrong with him. There goes the fucking season. You don’t know what you’re doing’.

‘Get out of here’, Kevin fires back. ‘I’m looking after the bloody player’.

We go on to draw the match. But a tone of antagonism is set between the coach and physio, and Bobby encourages an atmosphere of scepticism around Kevin's actions and qualifications. Every time he checks on a player, Bobby throws up his arms and murmurs to anyone near him, ‘he's twisted his knee, but I bet you he pulls him off for a concussion’. Some players start to endorse these messages and show reluctance to accept Kevin's diagnoses. He is stripped of authority and even blamed for concussion.

As Malcolm (2009) argues, the existential uncertainty for players and the selection uncertainty for coaches caused by concussion can lead to significant conflict over medical management. Clinicians who face such resistance may compromise to avoid rejection of their treatment, diagnosing only what they know will be accepted (Malcolm, 2009).

The season continues, and we continue to win, but the relationship between physio and team continues to deteriorate and towards the end of the season, Kevin and Bobby are barely talking.

The intensity keeps building – especially as we are still unbeaten, but so is another team – each game seems crucial to maintain our chance of winning the league. The importance of focusing solely on tonight's match has been mentioned a thousand times. The smell of wet mud and grass, and the glare of the old lights on their rickety perches capture my attention briefly as we spread out across the pitch, but I’m quickly reminded that ‘we are here to do a job’.

Twenty minutes in, I wait as the forwards prepare for a lineout. The air is cold. My breath forms clouds in front of me and I tuck my hands into my shorts for warmth. I glance at my opposite. With unnatural intensity, he glares back. The twenty metres separating us seems to have shrunk. I shuffle a few steps to my left – he follows.

There is movement in the lineout, and the ball spins out on the opposition side. Maintaining a connection with the young men on either side of me, I rush forwards, restricting time and space. I have my man lined up. It's a dummy line (he won’t receive the pass). ‘Drift, drift, I call’, as my attention shifts to the next player. I’m going to have to move, he's quick…

Wham! I notice a blur a split-second before he tucks his head into his chest and directs it at my skull. The twenty-metre stare is back, though now it is standing right above me.

You cheat. I try to clamber to my feet and confront this man. While I can feel an impending swell of pain developing in my head, at the moment I am irate at the travesty of being attacked by someone illegally.

He tries to push me back to the ground, but the referee, running past, yells, ‘Hey, leave it alone you two’.

I stand, shove the offender in the back and run on. But then I slow down, then stop. There is a pounding like my neighbour is having a party in my brain.

‘How are you doing?’ Kevin has jogged onto the field and offers me a drink bottle.

‘I’m ok’, I retort, more curtly than he deserves.

‘Just take a moment’, he says slowly, trying to calm me down.

I relent, but I am very aware that I am being assessed. I take the drink bottle from his hand and take a short swig. I glance up and see the game continuing without me, and a swell of nervous energy rises within my chest. We need to win this. I pass the drink bottle back to the physio, yell ‘cheers’, and run back to the action.

As Liston et al. (2006) argue, it is elite sporting environments that are prone to these attitudes of risk and irreverence towards injury. Amateur club rugby is awash with athletes who heavily subscribe to the sport ethic (Hughes and Coakley, 1991), and who sacrifice their bodies in physical illustrations of their commitment to their sport and their team.

2016

This may be the last game I ever play for this club. It means so much to me and I want to leave victorious and proud.

The game is hectic – both teams are willing to spread the ball and run from anywhere. We score a fantastic try, and then we are watching the opposition convert theirs. We go through one particularly exhausting passage, then give away a penalty. I stand next to Finn under the posts, catching my breath, waiting for their kicker to attempt his kick at goal. As he begins to approach the ball, Finn rushes him [in rugby union, you cannot charge down a penalty kick at goal]. He then stops, awkwardly in the middle ground, hoping no one has noticed.

‘Haha, you forget what sport you were playing there for a moment?’ I laugh at him once the kicker successfully slots the goal.

‘Shit, to be honest, I don’t really know what the fuck is going on’, he raises his eyebrows, then begins to jog towards halfway.

I run alongside him. ‘Take a knock?’

‘Yeah, got smoked in that tackle back there’.

‘I’ll call Kevin over, have a look at you’.

‘Na’, he looks me sternly in the eye, then repeats, ‘Na. We’ve only got a couple of young bucks on the bench. I’ll be grand’.

‘Mate’, I start, ‘It's not worth…’ but he interrupts me.

‘We need to win this match’. He trots away from me, and I don’t have the resolve to chase him down and make a stance.

Fraas et al. (2014) found that 34.7% of players failed to report to anyone when they had knowledge of a teammate's concussion. In contrast to the primary reasons cited in that research, however, this scenario was not solely because I didn’t think it was serious enough. Instead, despite knowing the consequences of repeat concussions, I did not act because I didn’t feel I had the power to overrule Finn, and because I did not want to ‘betray’ him.

To overrule Finn and report his head injury to management would be akin to ‘snitching’ in a prison setting (Trammell et al., 2021), and a betrayal of the rugby ‘brotherhood’. Players, who are constrained by the dominant discourses of the context and the varying power differentials, are at times the only people aware of a fellow athlete's injury. As such, they are forced to make decisions about the severity of their teammates’ health, whether they can represent their best interests, and if it is necessary to attract medical support. However, this is not simply an amateur medical assessment but an appraisal of the power dynamics within the context. In a culture where players overconform to the sporting ethic, where hierarchy is strongly promoted, it is unlikely that a junior member of a squad would signal for medical help when a senior member had declared themselves fit to play.

The play continues. We score a fantastic try, but they reply almost immediately. From the kick-off, they make great headway. I rush to the blindside to add an extra number in defence and chase up quickly to pressure the large man in my channel. My timing is off though – he's upon me much sooner than I expected. I try to dip into the tackle, but I’m too late, I’m too upright, and our heads dully thump together. The ball, and the play, move beyond us, and we are left in a clump on the turf.

‘Aaahh’. The other guy exclaims, slowly getting to his feet.

‘Sorry mate’, I offer. I’ve been stunned too, but initially, I want to aid this fallen man as I feel responsible. He smiles wryly to acknowledge the apology, then canters off towards the ball. Then a wave of pain rushes through my head. I compose myself for a second, then head back into the fray, albeit without the confidence of an unimpaired body. All the circumspection and critical awareness that I used when dealing with Finn desert me.

I am aware of the danger, but the perceived importance of the sporting fixture overwhelms my ability to think critically. This highlights one of the key dilemmas of sport-related concussion: while medical staff, coaches, cameras and other technology may aid in the detection of concussion, there is a reliance on athletes themselves to report concussion. Research shows there is significant under-reporting of concussion in sport, and that athletes continue to play with concussion symptoms because they have a strong desire to stay in the game, the situation is perceived to be ‘high-stakes’, they don’t consider their performance to be significantly impaired, and they perceive treatment to be of low efficacy with significant uncertainty surrounding selection (Conway et al., 2020; Ferdinand Pennock et al., 2023; Kerr et al., 2014; Malcolm, 2009). At this moment, the game exists in a vacuum for me, and the sport's discourses – learned over more than 20 years – are automatically, and uncritically, reproduced.

We win. The sacrifices that Finn and I are willing to make contribute directly to the success of the team. We celebrate in the changing room, and I avoid Kevin. The last thing I want is to spend hours at an emergency clinic to hear the same information trotted out apathetically for the tenth time. ‘Stop all activity and rest for a week then slowly build back into training, then play’.

Like the wrestlers in the study by Malcolm et al. (2023), who talked about not having faith in medical staff as they would receive minimal, generic support, I also have a blasé attitude towards the efficacy of getting treatment and believe I can manage the concussion myself. I have probably subscribed to the discourses that have undermined Kevin's authority more than I would like to admit, too.

Finn and I toast each other with an abundance of alcohol on the bus ride home and I feel justified in my decision to stay on the field. We sing, we laugh and we drink.

Cognitive damage caused by concussion has been linked to greater levels of addiction, risk-taking and impulsive behaviour, including increased likelihood of heavy drinking (Alcock et al., 2018). Additionally, higher alcohol consumption has been shown to increase the risk of sustaining a brain injury (Albrecht et al., 2018). However, there is also evidence to suggest that alcohol is neuroprotective following a concussion (Mathias and Osborn, 2018), though this is complicated by multiple factors including blood-alcohol level and timing of consumption (Kelly, 1995).

The next morning, I wake with a hangover. I have been allowed to sleep through the night, but I have to take on the parental duties for our three-year-old and newborn baby while my wife catches up.

‘Dad, can I have a banana?’

‘Aaaahhhh’. I wince slightly. ‘Yeah, hold on’. I juggle the milk in one hand and my daughter in another. Multi-tasking seems to be beyond me.

‘Aaaaahhh’. I put down the milk to focus on my youngest for a second.

‘Hey, hey, hey’, I say quietly, bouncing her up and down.

‘Daaaad’.

‘What is it?’ I snap. ‘Sorry, sweetheart’, I say when I see a startled reaction.

‘Banana?’

‘Oh sorry’. I place my baby in her bouncer and pick up a banana from the fruit bowl.

Thud. ‘Ohh, I’m sorry Dad’. I turn to see the milk container glugging its contents onto the kitchen floor.

‘It's alright, it's alright’. But my youngest doesn’t think so.

‘Ahhhhhhh’. The volume makes the pressure in my head feel like a balloon about to pop.

The next morning, the routine is similar, though this time I must go into work. If this is a two-day hangover, it's the worst I’ve ever experienced. I arrive at my office, but the screen of my computer makes the back of my eyes radiate with pain. I stare out the window, but it feels like the rays of the sun are being focused through a magnifying glass. I want to pack up my things and head straight home, but I feel a constant pressure to make progress with my PhD thesis. I turn back to my computer.

OK. Google scholar. Concussion affecting academic performance.

Hmmmmmmmmmm. A whirring noise begins inside my skull.

Headaches, difficulty concentrating, sensitivity to light, feeling slowed down (Holmes et al., 2020; McGrath, 2010).

Yeah, I’m familiar.

Hmmmmmmmmm.

Ttting, tttang. Someone rustles through the cutlery drawer in the kitchen area, but it feels like they’ve played it on a loudspeaker.

Arrrgh. I can’t concentrate.

I write best when I have quiet and calm. At the moment I feel like I’m trying to have a meaningful conversation at a rock concert.

I sit up from my desk and walk to the water cooler at the other end of the hallway.

Breathe. Inhale slowly…. exhale deeply.

I select a physical book from my shelf. It's easier on my eyes but I can only concentrate for 3 or 4 minutes before I drift. I persist for 3 hours, then I give in.

‘How’d your work go today?’ My wife, Ada (a pseudonym) asks me as I walk in the door.

‘Not flash’, I sigh. ‘I had to keep stopping for long breaks. It's taking me an age to write this section’.

‘Do you think …’ She pauses, trying to find a way to ease into a sensitive topic. ‘…that maybe it's time to stop playing?’

‘We’ll see’, I smile. Concussion is disrupting my life, but I still feel like I have plenty to give to the rugby field.

‘I think you need to take this seriously’. Ada looks at me and I can barely meet her gaze. She has become accustomed to these performances of masculinity – from me, from her father, from all the men in her life.

‘Its just…’ I start, immediately defensive, ready to trot out a line about how rugby is central to my identity, that I don’t want to feel like I gave up too soon. But she has left the room. After a few minutes on mine own, I start to think about what it would mean to not play rugby. What would it mean for Ada to have a husband that is not constantly broken, that does not have to be handled with care, that can contribute as a father?

2017

Six months later, I’m back playing. Conversations around retirement have progressed, but, feeling like the previous concussion symptoms are behind me, I convince Ada (and myself) that another season is a good idea. I play five good games but have just spent four weeks recovering from a minor knee injury. This is my first game back – the sun is out, the grass is cut short, and there is only a flicker of chill in the mid-winter air. I make a couple of nice passes, and a darting run, but it is the ability to run unencumbered that makes me smile.

The ball swings from the left and I pass wide to our winger who swerves past one player and is then felled by the second wave of defence. I follow. The tackler tries to stand but I am there quick enough to bump him out of the way. Two teammates join me, the first securing the ruck, the second passing the ball back towards midfield.

Whoooooh. I exhale as the moment of action ends and the play moves away. The tension in my body dissipates, the tight muscles that were clenched and ready for an onslaught relax and my mind refocuses on the next role – organise a pod of forwards in the midfield, get myself deep in behind and try to collate enough backs to…

Pow! If I was animating my experience, I’d use the graphics from the 1960s Batman series.

Out of nowhere, a player counter-rucks, driving hard into me to disrupt our ball. Upright, I am thrust backwards. My head clangs into the player behind me.

‘Ahh’, my teammate says, bringing his hand up to his temple.

‘Sorry mate’, I reply, and I offer him my hand to help clamber out of the piled bodies. There is a slight feeling of tenderness, but I am not worried about my head. As we jog off at halftime, I am thinking about how well my knee has withstood 40 minutes of contact.

The coach hands me a water bottle and says quietly, ‘Well done. We’ll give you a rest now’. I look at him, disappointment etched in my gaze. He notices and adds, ‘We don’t want to overdo your knee on its first run back’.

I nod. He's right. Still, I would rather be running back out there. Instead, when the halftime chat ends, I take a seat on the bench and watch.

That evening, I have a few beers as I watch the All Blacks match, so again, when I wake up the next morning with a slight headache, I blame the alcohol.

But the next day, it is worse. Tuesday is worse still.

I attend training, but only as an injured spectator. My plan is to watch – but almost immediately I am summoned to play a role.

‘Can you hold a tackle bag?’ the coach asks.

‘Umm…’ I stall, but I reach for the foam shield.

A player crashes into it moments later and I can feel my brain cry. I curse my stupidity as I excuse myself and make my way home.

The next morning, I attempt to work again. There is a relentless pressure in my head – like a brewing thunderstorm between my ears. If I look at a screen I feel dizzy and faint. My thesis stalls as I can only apply myself for short bursts before having to lie down. Guilt overwhelms me for not being productive.

I arrive home to my two daughters squealing at each other. ‘Eeeeeeeeeeeeeeeeee’.

‘Hey’, I get a big hug then an explanation of what's happening.

‘I’m the owner of a café and she's buying all my coffee…’

‘Sounds like serious stuff’, I comment before the room descends into a piercing pitch again. ‘Could you just do it a little bit quieter? Please?’

The last word comes out with a little too much impact. I see two little faces drop.

‘Why don’t you two go down to the bedroom for a little bit?’ Ada comes to my rescue, but I feel guilty for being ‘grumpy Dad’.

‘Thanks’.

‘They’re just excited you’re home. Anyway, what have you got on over the next few days? I was hoping to…’

‘Please, can I just sit down for a second?’ The words come out much sharper than I mean them to. ‘Sorry, it's just my head…’

‘It's fine’. I can see that it is not. ‘Why don’t you take a moment and lie down?’

I seem to be always ‘having a lie down’. I feel consistently tired – not overwhelmingly exhausted, just persistently in need of rest as the very basics of life bleed me of energy. I nod and leave the room, feeling more guilt for failing as a husband.

The next day is the same. The next week is the same. The next three months are the same with no sign of improvement. I am constantly annoyed, and my family must constantly walk on eggshells around me. I wonder if this is what the rest of my life will look like – am I going to be unable to hold conversations, concentrate or cope with light and noise? Is irritable my default setting? Will I become a burden on my family? Will I be able to finish my thesis? Will I be able to get a job? Will my symptoms get worse? Will I become a tragic example of CTE like Junior Seau or Mike Webster? ³

My wife sits on the edge of my bed while I cradle my cranium. ‘Hey’, she says softly. ‘It's ok…’

I interrupt with the news I should have delivered months ago. ‘I’m going to stop playing rugby’.

‘Do you mean completely? Not dropping down a grade or something?’

‘Done. For good’.

I had always imagined that retirement would be a monumental decision. I had pictured myself as the athlete who didn’t know how to hang up the boots, going from Premier to B team to Golden Oldies, clocking up 500 games for my club and slipping in the odd game in my late 40s. But now it is easy – as each concussion over the last 12 months has increased in severity, I don’t know what another one would bring. Six months of headaches? Years? Reduced brain function? Death?

While players often accept pain as a normal part of their sporting lives, they are not uncritical of corporeal damage with concern around injuries, pain and health a primary reason for retiring (Pringle and Markula, 2005). I just wish I’d been more critical sooner. Nevertheless, now I lean back and rest, content in the knowledge that I have concluded the final chapter in my rugby story.

2020

Except the concussion story is not complete. Two and a half years after my last concussion, I am largely symptom-free. Largely does not mean completely though, and there are still moments where my life is affected. Most noticeably, while going about my daily business, I have episodes where my mind seems to lose power like a battery and I semi-collapse. I will turn to see someone, look up, or sometimes I do nothing but sit, and for a moment I feel like my body is struggling to remain conscious.

I cannot do anything involving vertigo with my children. Swinging them around thrusts my head into a tailspin and I have to take several seated minutes to myself, waiting for the internal spinning to cease, waiting for the nausea to pass.

After a day's work in my office, despite self-promising to walk the stairs, I often take the elevator down to the bottom floor before walking to my car. At the ‘ding’, I step in, the doors close around me, and I descend.

The elevator reaches the bottom floor with another loud ‘ding’.

My head cannot cope with the change of momentum, and I grip the handles on the edge of the (apparently) stationary room. The doors slide shut, and I scramble to push the button to open them.

I stagger out like a drunk and clutch at a chair. It holds my weight for a minute until I am sure that I can move into a sitting position.

I spend 10 minutes waiting outside the elevator. Then I stand, slowly, make sure I have acclimatised, and I carry on with my day.

2024

‘You could make another mandarin cake’, my wife prompts as we discuss our youngest's birthday. She's eager for me to take the reins.

‘I haven’t made a mandarin cake before’, I reply matter-of-factly.

‘Yes, you have. Remember? Not that long ago either’.

‘What?’ I look at Ada, puzzled. This is probably just an example of my absent-mindedness. However, it's usually things I’m not paying full attention to – a cake would have required I plan and think – and this is becoming a more and more frequent trend. ⁴

I breathe deeply. I worry that these are the first signs of deterioration. What will I be like in 10 years? In 20 years? Will my family life, my work, my general well-being suffer? But I have no way of knowing whether this incident, or the others like it, are linked to my concussion history and I feel like worrying is only more likely to have a deleterious effect.

Persisting concussion symptoms are linked to increased symptoms of anxiety (Carlson et al., 2020), and these effects can also have economic implications such as diminished productivity, reduction in ability to work and increased healthcare costs (Doroszkiewicz et al., 2021). I make plans to stay as physically and mentally healthy as I can but there is so much unknown. Concussion has threatened my ontological security, disrupting that which can be taken for granted (Giddens, 1991).

I take another deep breath. My symptoms – while concerning – are (maybe were) mild, and pale in comparison to high-profile rugby players like Carl Hayman and Steve Thompson who live with ongoing consequences indefinitely with a paucity of definitive treatments (Doroszkiewicz et al., 2021). How do we support athletes so that we don’t continue to perpetuate this cycle? Consideration needs to be given to how many games athletes are being asked to play, and how much support there is for athletes who suffer concussion, particularly those who retire and are no longer immersed within team structures. In academia, we need to consider the support, both academically and in terms of pastoral care, that we provide to athletes at university.

In light of the fact that these athletes are engaging in litigation against World Rugby (Ingle, 2023), do we need to reconsider how athletes provide consent? Each year I registered as a player, but there was never any explicit consent process that dealt with my participation, what I experienced or what I continue to experience. Channon and Matthews (2022) explain that an assumption of consent is common in contact sport, and that attendance in training or competition is assumed to infer voluntary consent. However, they question whether athletes can freely opt out, and detailed how athletes in their study would often feel constrained by the cultural norms of the sport and deferred responsibility to coaches and medical staff. By stepping onto the field, do rugby players consent to the potential consequences of concussion? Can players ever really be informed of, and consent to, the risks without understanding exactly what living with neurodegeneration is like? Can they withdraw consent when they have suffered a concussion? Can children consent to these risks? Further research is needed on this topic.

Educational campaigns have had limited success thus far (Fraas and Burchiel, 2016) and sporting bodies continue to laud their proactive approaches which focus on the role of the individual. But we need to address the fundamental cultural dynamics such as the discourses of masculinity and adherence to the sport ethic, as well as the organisational, occupational and commercial aspects that contribute to the concussion crisis (Malcolm et al., 2023). The culture of rugby union is shifting, but more needs to be done to problematise masculine discourses which do not allow for vulnerability, that glorify those who play through pain and injury, and which controvert the authority of medical support.

How could this be done? Clacy et al. (2015) argue that more needs to be done to consider the ways in which athletes, coaches, parents and administrators engage with concussion guidelines – to implement context and sport-specific injury prevention interventions. Salmon et al. (2022) concur, arguing for ‘meaningful education programs that address underlying components of behaviour change’ (p.813). Specifically, they identify the discourses of ‘brotherhood’ and what it means to be a ‘warrior’ as themes that could be inverted to empower players to protect their teammates. Looking out for your ‘brother’ would support their long-term health and acknowledge that concussion will impact their (and subsequently the team's) performance. Emphasising long-term responsibility to one's family, or to the safety of younger players, Liston et al. (2018) argue, may encourage more sensible risk-taking. Yet while Salmon et al. (2022) assert that coaches and parents are ideally suited as mentors to ‘create and foster a culture of safety that does not support playing through an injury or winning at all costs’ (p. 814), they also acknowledge the ‘tug-of-war’ that these stakeholders face. While they care about the concussion management of players, discourses of competition simultaneously drive them to disregard protocols and downplay the severity of concussion. As highlighted in these vignettes (particularly 2009), coaches who feel they are valued only for their results are unlikely to foster a culture that minimises a win-at-all-costs mentality. At the amateur level in particular, interventions that allow coaches to see their roles as mentors, and not feel pressure to provide short-term results, may help to encourage this culture-building work. Autoethnography has an important role to play here – not only in the telling of concussion stories but also in interrogating them – to provide an accessible medium for engaging in critical debate about concussion to help shift cultural dynamics.

‘Did I?’ I look at my daughter who smiles and shrugs her shoulders. I pull a face as I shrug mine back and hope I don’t forget this moment.