Alan Hubbard 1Being knocked unconscious is an unpleasant experience in any sport, whether it is in the ring, on the playing field, or, as that incredibly brave National Hunt champion jockey AP McCoy will testify, on the racetrack.

Here is a man whose body has suffered more bangs and bumps than an old dodgem car in a fairground.

By coincidence McCoy's announcement that he plans to quit at the end of another record-breaking season came on the weekend when rugby again became embroiled in a row over an international player who was ko'd on the pitch - twice in this case - but allowed to continue despite new rules being introduced to emphasise the sport's duty of care to prevent such potentially dangerous occurrences.

Understandably there has been an outcry after Wales permitted their star wing, 22-year-old George North, to carry on after TV pictures showed him slump motionless to the ground, suffering a 61st minute head injury in the Six Nations clash with England at Cardiff's Millennium Stadium.

North had already passed a now statutory Head Injury Assessment (HIA) after being accidentally kicked in the face in the first half.

Yet World Rugby guidelines say that any player even suspected of losing consciousness should be taken off to avoid risking potentially fatal "Second Impact Syndrome". The game's global governing body rightly has demanded a full report and said that North should not have stayed on the pitch, but they accepted the Welsh Rugby Union's explanation that neither the team medical staff nor the independent doctor had sight of the incident.

Their concern is justified. Concussion has become an increasingly vexed issue for rugby, which since the advent of full-scale professionalism is very much a game of muscle and macho.

The concussion debate reared its head once again after George North was knocked out twice during Wales' Six Nations defeat to England ©Getty ImagesThe concussion debate reared its head once again after George North was knocked out twice during Wales' Six Nations defeat to England ©Getty Images



A series of incidents involving concussion in British rugby union has been followed by a disturbing report which revealed that American footballers exposed to repeated head injuries showed significant levels of early onset dementia and were almost 20 times more likely to suffer long-term neurological problems than the wider population.

The decision to allow North to play on - which Wales coach Warren Gatland defended saying the "correct medical procedures" were followed - has drawn widespread criticism from outside and within the game.

The former England captain Lewis Moody tweeted: "Why was George North not taken off? A terrible decsion by the medics. Out cold."

And former Scotland international Rory Lamont asked: "Knocked out twice in one game and still on the pitch. How is this happening?"

How indeed. Or more pertinently, why?

Guidelines say players who have suffered a suspected concussion should be taken from the field for up to five minutes for an evaluation by a doctor before they are allowed to return. There have been calls for the period to be extended to 15 minutes but, if World Rugby makes a change, it is likely to be 10 minutes.

Instead doctors will be given a video of the incident which led to the injury to help them determine whether a player may have suffered concussion, and a review panel will be created to investigate if a player is allowed to return to play when it is later revealed that he was concussed. There used to be a minimum three-week rule but that was relaxed with each case being treated individually.

This is far too risky a scenario. Perhaps it is time rugby - and other contact sports – sought a meeting with the British Boxing Board of Control (BBBoC). They might learn something.

We have been hearing a lot recently about the effects of concussion on rugby players and I believe there is much to be gleaned from the way boxing deals with severe head injuries and the possible after-effects.

Rugby can take lessons from boxing where any boxer who is stopped in a fight is not free to return to action for 28 days ©Getty ImagesRugby can take lessons from boxing where any boxer who is stopped in a fight is not free to return to action for 28 days ©Getty Images



It may not be generally known that in this country any boxer who is stopped in a bout is suspended for at least 28 days, regardless of the circumstances. Should he actually be knocked out or has suffered excessive punishment to head or body, he would receive a minimum suspension of 45 days, which would include sparring, and in either case no boxer would be allowed to fight on until receiving medical clearance from a BBBoC doctor.

In extreme circumstances this would include a further brain scan, in addition to the scan and MRI that boxers must take annually.

Compare this to rugby - and football too - where there are growing worries about the alarming brevity of head-injured players returning to action, as North did, often only after a few minutes.

Over the years there has been an apparent lack of concern for this type of life-threatening injury and neither rugby nor football - as well as most other contact sports - have reached the levels of protection and after-care that have existed in British boxing for some time.

I bet there are more brain-damaged rugby players around these days than punchy ex-pugilists.

Curiously, too, you never see boxer now with cauliflower ears but in rugby they seem a badge of honour, an accepted occupational hazard for those in the scrum.

Of course in any sport there can always be a freak accident, as sadly there was with the death of Australian cricketer Phillip Hughes, and the tragic skiing incident that has left the seven-time formula one champion Michael Schumacher paralysed.

Equestrian sports, especially McCoy's National Hunt racing, see many more serious mishaps -and deaths - than you get in boxing.

AP McCoy's sport of horse racing often sees more accidents and injuries than boxing ©Getty ImagesAP McCoy's sport of horse racing often sees more accidents and injuries than boxing
©Getty Images



Of course, boxing will always be an inherently dangerous sport because of its very nature. Everyone in it accepts that. It has had its share of tragedies. But the BBBoC and licence holders have worked hard to make it safer than it has ever been.

Safety regulations have been upgraded since the unfortunate 1991 Michael Watson incident and advice from leading neuro-surgeons like Peter Hamlyn has been taken on board. The promoter Frank Warren also helped finance and set up a system whereby boxers get regular brain scans.

Now there are always two or three doctors at the ringside with paramedics and an ambulance on standby at the arena.

Warren tells insidethegames: "I am not knocking rugby. Like boxing, it is a game of hard knocks. I love the sport and was involved in the Nineties as owner and chairman of Bedford RFC.

"Three of my sons, Francis, George and Henry, played rugby, one for his university and the others for their school. I watched them often and was more concerned about them getting seriously hurt on the rugby pitch than had they been in the ring. One of them was knocked out cold and it worried me stiff.

"I have seen rugby players obviously badly concussed get a splash from a cold sponge, a whiff of smelling salts and be sent back into the fray. Very macho. But with what consequences?"

New concussion measures were brought into football after Hugo Lloris sustained a nasty head injury in Tottenham's match with Everton last season ©Getty ImagesNew concussion measures were brought into football after Hugo Lloris sustained a nasty head injury in Tottenham's match with Everton last season ©Getty Images



Football is not immune to the hazards of head injuries either. The family of the late England striker Jeff Astle fought a successful battle to prove that his death was caused by degenerative brain disease brought about by regular heading of the ball. Other footballers have been similarly affected.

And new guidelines about players suffering knockouts were only brought in after the Tottenham Hotspur goalkeeper Hugo Lloris was concussed in a match at Everton last season. Incredibly, like North, he was allowed to play on.

In British boxing, referees stop fights promptly if a fighter is in distress. Some say they often do so too quickly. George Groves still argues over Howard Foster's seemingly hasty intervention in the first world super-middleweight title fight with Carl Froch. But surely it is better to err on the side of safety - something which boxing does but other sports need to address more seriously than they appear to be doing at the moment.

With rugby sevens being introduced into the programme for the 2016 Olympic Games in Rio, there is a clear and present danger that the sport's Olympic debut may be mired in the sort of controversy witnessed last weekend unless rugby gets its head around concussion. Something it seems to be taking far too long to do.

Alan Hubbard is a sports columnist for the Independent on Sunday and a former sports editor of The Observer. He has covered a total of 16 Summer and Winter Games, 10 Commonwealth Games, several football World Cups and world title fights from Atlanta to Zaire.