Why netball must learn from rugby when it comes to concussion

Telegraph

2 days ago

Gabby Marshall was watching the British and Irish Lions' squad announcement from her sofa earlier this summer when it dawned on her that her career was over.
She should have been preparing for the business end of the Netball Super League season, but instead Marshall was still coming to terms with having to retire from the sport on medical grounds after suffering two concussions in a matter of weeks.
'I watched Maro Itoje being named as captain and it hit me,' Marshall tells Telegraph Sport. 'I thought, 'They're preparing for a tour and I'll never be preparing for a game again'. It made it feel real for some reason.'
Marshall was making her debut for Birmingham Panthers on the opening day of the NSL's revamped season in March this year when she collided with Geva Mentor during the second quarter of the match.
The former England goal keeper's shoulder clipped Marshall's head in a mid-air challenge before she smacked her head on the court as she fell.
Incredibly, Marshall was deemed fit to continue after a SCAT test – the standardised tool to evaluate suspected concussions in athletes which includes assessing balance and asking questions to check memory. 'It wasn't until later on that I didn't feel quite right,' says Marshall, who was eventually substituted.
After completing return-to-play protocols, she lined up to face eventual NSL champions London Pulse on April 13, but another head collision ended her game and ultimately spelt the end of her 12 years as a top-flight netball player. She was left with a lip laceration and carried off court on a spinal board after clattering into the goalkeeper.
'It looked like I had fillers on this side for a little while,' says Marshall, who endured lingering, post-concussive symptoms. 'I didn't really move out of bed for 10 days. I couldn't really do too much at all. I was just exhausted. The fatigue was a big one, like I would come and sit downstairs for 10 to 15 minutes, and then could feel myself kind of spacing out. I would go back upstairs and then just fall asleep for two or three hours.'
Netball's new-look NSL has drawn higher crowds this season – London Pulse's 53-45 victory over Loughborough Lightning in the Grand Final on Sunday attracted a record number of fans to London's O2 Arena. But off the court, the pace of change feels slow. The NSL still relies heavily on volunteers, while physios attached to clubs are often not employed on a full-time basis.
'Quite a lot of teams will have sport therapists or physios who need to do their hours in training that might not pick up head injuries, so we're not getting to the top-tier level that we should,' says Rebekah Airey, another player who had to stop playing in the NSL after suffering five concussions in 20 months. One was so bad that she was hospitalised after being taken out in the air and hitting her head on the court. Severn Stars, her former club, were 'hugely supportive' and connected her with Professor Antonio Belli, an expert in acute brain injury at the University of Birmingham. 'The first thing he asked me was, 'Do you play rugby?' And I was like, 'No. I play netball,'' says Airey. 'He said that he would have told me to stop playing after three concussions.'
Like in elite rugby, head injury assessments (HIAs) can be carried out at NSL matches, but only if a doctor is present – otherwise players with suspected concussions undergo a SCAT test. Airey, as she puts it, 'learnt how to play the system'. She says: 'It's the same SCAT test. My cognitive function was fine, but my motor control was off. I cry at everything now and I never used to be like that. I do think there's a lot the sport can learn from rugby.'
England Netball already mandates all club staff in the NSL to complete the Rugby Football Union's 'Headcase' online learning module on concussion annually, but Airey believes the sport could do more. At present, it is not mandatory for match-day doctors to attend NSL games, meaning an HIA cannot be carried out straight away, while England Netball is yet to employ a chief medical officer.
'The sport doesn't have that infrastructure around concussion,' says Airey. 'It is getting better. People who take others out on court are getting sin-binned, which is an improvement, but the player in the sin-bin doesn't get to play [for two minutes] and the player who gets taken out might miss an entire season.'
It is a sentiment echoed by the Netball Players Association, which is calling for greater vigilance around head injuries in the NSL. 'As a sport we all need to ensure good injury surveillance, that HIAs are done consistently and that there is good care and follow-up for all players,' says Liz Bloor, the chief executive of the NPA. 'Recognition of the potential accumulation of minor head injuries needs to be considered.'
In netball, a player can receive a two-minute suspension for dangerous play – while players can be sent off for serious infringements – but do those rules go far enough? 'If there's ever a time to look at the policies, it's maybe [to] look at what we're doing to deter defenders from challenging for the ball or protecting players' heads,' says Marshall. 'The way in which netball is progressing in terms of the athleticism, the speed, the stakes as well, because I think that's a really important part of the game in terms of defenders going to try and win the ball.'
Head injuries might have become synonymous with sports such as rugby, but in netball, Marshall's and Airey's stories should serve as cautionary tales.
London Pulse beat Loughborough Lightning in the Grand Final at the O2 Arena to win their first Netball Super League title on Sunday.
Lightning had been chasing their third title in a row but fell to a 53-45 defeat against a side who had already beaten them twice this season.
Sam Bird's Pulse side, who had topped the NSL table, five points ahead of second-placed Lightning, established an early lead and never relinquished it, with Funmi Fadoju being named player of the match for her efforts in the heart of defence.
'I'm so happy for the club, the girls, our sponsors, our fans,' Bird told Sky Sports. 'It is such a great day. It was such a hard game. It was like a game of chess. The strategy involved was really tough and I'm just really proud we got across the line.'
Fadoju added: 'It feels so amazing. I am so proud of the girls. We went out there and did what we had to do.'