Rowan Stringer was playing girl’s high school rugby in Ottawa and had suffered a concussion.

She had experienced a concussion four days before the day she died May 12 2013. However, according to the CBC, she ignored the symptoms, and played again only to suffer another head injury, which killed her.

17-years-old. 

After the incident, there was an investigation into her death. Charles Tator, a neurosurgeon at Toronto Western hospital who specializes in brain injury, was the expert advisor to the inquest into Stringer’s death.

“Rowan Stringer proved that the concussion field needs some rehabilitation. She was 17 when she died and she had a couple of concussions right after each other. The condition is known as the second impact syndrome. It’s one of the rare side effects of concussions, fortunately it is very rare, but unfortunately for her once it sets in, there’s very little that can be done to treat it,” he said.

“None of the people who were involved in the rugby league [at the time], were really up on the subject, nobody in Rugby Canada had a policy on concussions and nor did the league that she played in in Ottawa. None of the people had knowledge and training and as a result of all that ignorance, she died.”

“Back in the day it was a sign of toughness if you could just shake it off.”

Mismanagement of concussions is widespread, and does not stop when athletes become professionals. Jamie Cudmore, 39, who made 43 appearances for the Canadian men’s national rugby team, has experienced first hand the pressure athletes can come under to “shake off the grogginess” when a head injury occurs.

“Back in the day it was a sign of toughness if you could just shake it off. There’s this culture of ignoring it, and that comes down to education. I myself was the same probably five, six years ago.”

Concussions. 

With this increased attention comes more education, but the concussion field is ever evolving and changing, according to Matthew Holahan, associate professor of Neuroscience at Carleton University.

“Chronic Traumatic Encephalopathy (CTE) was discovered in boxers who showed dementia like symptoms when they were in there 30’s – 40’s. It is something that is present in athletes and not in the normal population,” he said.

CTE is similar to Alzheimer’s or dementia when analyzed under brain scans, and has a similar set of symptoms. The unique thing about it is there are very few cases where it shows up in people in the general population. It is nearly exclusive in professional athletes.

“Regular people can get concussions, they slip on the ice, they fall by skiing or snowboarding, or biking, but you increase your likeliness of major concussions and side effects by playing in high level sports,” said Holahan.

Sports have a big problem when it comes to dealing with concussions. However, the treatment and attempts to manage concussions have flaws. Holahan said there are also some common misconceptions about how a concussion happens, and what can be the cause of the problems.

“It’s more about how the head twists around and the way the brain wiggles around inside the skull,”

“People especially in sports are concerned with the force, they have force transducers in helmets to be able to measure that impact. It’s more about how the head twists around and the way the brain wiggles around inside the skull,” he said.

Misinformation can be a big issue when it comes to concussions. Baseline testing is an example of this problem. It has emerged as a possible solution for identifying and treating concussions. Tator has doubts, however.

Controversy.

“The controversy is whether or not it helps diagnose or manage concussions.” Tator said. He further asserts the community needs proof of baseline testing effectiveness.

Baseline testing involves taking a brain scan before a concussion takes place, so the patient can have a ‘baseline reading’ of their brain activity. Then, scans are taken when concussion occurs. In theory, scans help identify the problem areas after a comparison with the ‘before’ brain scans.

These procedures typically cost $60-$100 according to Tator, but are a waste of time and resources.

“For the vast majority of sports participants, baseline testing is unnecessary and wastes money and time.”

There are about 200,000 concussions annually in Canada

These questionable practices can prevent proper treatment, which can result in long term effects. There are about 200,000 concussions annually in Canada. Tator emphasized the importance of everyone “speaking the same language” when it comes to concussion policy.

This is why Parachute Canada created the Canadian Guideline for Concussions in sports, a report funded by the Public Health Agency of Canada.

Education.

After his retirement from rugby in 2016, Cudmore started Rugby Safety Network alongside his wife. Cudmore runs the organization out of France, where he spent much of his playing career. He plans to expand it into North America and beyond.

“We go to schools and kids are afraid to play rugby because they see players getting injured and not being treated properly.”

“I don’t want to change the sport, it’s a contact sport but there is a very fine line. We go to schools and kids are afraid to play rugby because they see players getting injured and not being treated properly. We have education programs and children’s books, to try and educate them and change the culture from the bottom up,” he said.

Even with these education programs and new guidelines introduced, there is a concern that the culture of “shaking it off” may not be changing fast enough.

Holahan’s opinion is that officials don’t always strictly adhere to guidelines. “There has to be a change in the culture, especially in university age kids; you don’t want them to have these long term effects for the short term gain,” Holahan said.

Treatment.

Annie Widdifield, 21, had to quit playing for the Carleton Ravens Women’s Varsity rugby team. She needed treatment for 6 concussions that occurred throughout her playing career. However she never felt hurried through the treatment process.

“The coaches’ attitude was very sympathetic and understanding, and they always wished me a speedy recovery but never rushed me. They always made sure with the doctors that I had been cleared and reviewed properly,” she said.

However, this is not always the case. Not managed properly, concussions put an athlete’s health and safety are put at risk. Holahan suggested a possibility for solving this problem.

“I think more objective criteria is needed, to say that somebody has recovered. Or independent evaluators who have no vested interest in the team in any way can come in and support the claim of the team doctor by this diagnostic, objective test. There’s still a bit of subjectivity that people can work with. Independent verification is the way forward.”