Media interpretation of sports-related concussion in Irish rugby union: reinforcing or reshaping the sport ethic?

Abstract

Given that ‘sports injury reaches most people indirectly as a set of images transmitted by the mass media’, this article examines the role that the Irish media performs in promoting narratives surrounding sports-related concussion (SRC). Through a thematic analysis of the media coverage of two elite Irish rugby players’ concussion experiences, the article critiques whether the media’s presentation of SRC challenges the traditional norms of competitive team sport. A central dual narrative emanated out of the media’s framing of SRC, demonstrating both growing concern over the injury and a culture of risk continuing to exist. While concerns over SRC were emphasised, the narrative that playing through pain is a core ethos of sports participation was also reinforced. As such, the Irish media can be seen to simultaneously promote notions of caution towards SRC whilst solidifying the idea that certain ‘sport ethic’ dimensions remain significant to athletes themselves.

Keywords:

• Concussion
• sport
• Ireland
• media
• culture

Introduction

How athletes perceive injury, and react when it occurs, relates to the underlying socio-cultural norms of sport (Nixon 1993). As many modern competitive sports, and particularly contact team sports, emerged as a ‘male preserve’ (Dunning and Sheard 1973), cultural norms within these sports have had strong ties with hegemonic forms of masculinity (Connell 1995). Crucial, therefore, is the extent to which such masculinities – and the associated sporting norms – encourage a stoic, defiant approach to pain and injury, as reflected in the ‘sport ethic’ (Hughes and Coakley 1991). Social acceptance into sporting subcultures is premised on an acceptance of risk and denial of pain (Parry et al. 2022). However, given growing concerns over sports-related concussion (SRC) – which Malcolm (2019) labels a concussion ‘crisis’ – arguments have been made regarding the extent to which masculinities may be ‘softening’ as athletes become increasingly aware of neurodegenerative risks and the resultant need to adopt more cautious, self-preservational approaches to their participation, representing a fundamental challenge to traditional norms of sport (Anderson and Kian 2012). Given the role that the media has in shaping popular perceptions of sports injury (Kuhn et al. 2017), it is pertinent to critique this process, which this article does within the context of the Irish sports media landscape.

Concussion as a social issue

Wider social concerns regarding SRC have been evolving. Early scientific explorations into the injury, including Martland’s 1928 article in the Journal of the American Medical Association, failed to generate sufficient momentum to disrupt sporting institutions in a manner that would demand any serious scrutiny be put on the injury. However, as more compelling scientific evidence has been generated – stimulated in part by changing social perceptions surrounding concussion (Malcolm 2019) – this complex injury has demanded more thorough examination. Alongside the growing body of evidence pointing towards potential neurodegenerative consequences, the social construction of SRC intersects with traditional cultural norms of sport which prioritise sporting success and accomplishment over participant health and well-being (Nixon 1993). The nuances of this intersection are a matter which current research (including this article) seeks to address. This includes, for example, the query of where SRC is positioned amongst the ‘hierarchy of injuries’ that athletes consciously or subconsciously use to negotiate injury severity (Singer 2004), a hierarchy which informs interactions with their injuries and dictates appropriate responses. Initial forays into these issues appear to suggest that, for athletes themselves, SRC exists as another example of an injury which should be ignored, downplayed and disregarded as with any other (Liston et al. 2018). In fact, some high-profile athletes have publicly discussed the positive influence a concussion might have on athletic performance: see, for example, former NFL player Nate Jackson’s interview with Vice Sports Sitdown, where he describes seeking head impacts for their stimulating effects (VICE Sports 2015). Indeed, in the context of age-grade rugby union in Ireland, Baker et al. (2013) described how a quarter of athletes had reported that they continued participating after having sustained a concussion. Regarding the elite game in Ireland, Fraas et al. (2014) found that 46.6% of studied players reported suspected concussions to medical staff, suggesting that slightly more than half did not report. Perhaps the most thorough sociological examination of the lived experiences of concussion amongst rugby players was conducted by Liston et al. (2018): ‘On Being Head Strong’. Amongst the key findings were evidence of a functional interpretation of SRC, wherein players viewed injury severity in relation to time lost from participation. Athletes regarded concussion as transient in nature and thus less severe than other common rugby injuries which could result in more time lost (e.g. fractures or dislocations). Players were shown to downplay the injury and make efforts to conceal their symptoms. Despite growing concerns surrounding brain injury, the grasp which the ‘sport ethic’ has on athletic instincts appears to lead many athletes to interpret SRC in a largely similar fashion to other injuries; that is to say, as an obstacle that should be minimised and disregarded. Such is the power of these cultural norms that it has been suggested that sport’s concussion crisis is predominantly cultural in nature (Malcolm 2019), a point now increasingly reiterated by rugby’s administrators (Cummiskey 2016).

The ‘sport ethic’, pain and injury (and concussion)

Historian Paul Rouse wrote that ‘men walked on the moon before women played Gaelic football in Croke Park or rugby in Lansdowne Road’, such was ‘the secondary role that women fulfilled for so long’ (Rouse 2014, 8). These venues represent the principal stadiums of the Gaelic Athletic Association (GAA) and the Irish Rugby Football Union (IRFU) respectively (albeit the site at Lansdowne Road was rebuilt and now exists as the Aviva Stadium), demonstrating the legacy of how competitive team sports in Ireland, including rugby union, emerged largely as male domains (Dunning and Sheard 1973). These spaces were viewed to be resistant to impingements on certain iterations of masculinity, hence the proliferation of homophobic, transphobic and misogynistic attitudes in such spaces. This dynamic (alongside Victorian-inspired ideologies concerning ‘appropriate’ physical activities for women, which are often underpinned by restraint, finesse and a gentler approach) has stunted the development of women’s sports, and while change appears to be ongoing in terms of the inclusion of women and girls in some sports settings, scholars have noted that misogynistic perspectives continue to exist in many others (Pope, Williams, and Cleland 2022). Significant here is the notion of sport being linked not only with masculine identities, but rather certain types of masculinities, owing to the process which Connell refers to as hegemonic masculinity (1995), in which one form of masculinity is institutionalised and championed above others. As discussed previously, crucial to this study is the extent to which aforementioned forms of masculinity have been inextricably linked with defiant, stoic and resilient approaches to pain and injury.

Nixon argued that ‘competitive sport is inherently injurious’ (1993), and therefore athletes who wish to succeed in sport are required to learn to cope with pain and normalise certain levels of it. The ability to tolerate pain and conceal injury is a requirement of involvement (Safai 2003), and athletes are rarely criticised for this acceptance of pain as it has become intertwined with the cultural norms of sport, cultural norms which have been conceptualised as the ‘sport ethic’ (Hughes and Coakley 1991). Defining what it means to be a real athlete, the ‘sport ethic’ depicts the values and approaches that should be adopted if one is to embrace their identity as a competitive sportsperson, including making sacrifices for their sport, striving for distinction, refusing to accept limits, and playing through pain and injury. The ‘sport ethic’ conceptualises popular sporting mantras (‘win-at-all-costs’/’no pain, no gain’, etc.) and is a useful tool for our examination of cultural norms as they relate to SRC.

Media framing of SRC

As McGannon et al. argue, ‘one way to understanding concussion within a socio-cultural context is to focus on sport media narratives within the context of key sport media incidents surrounding recognisable athletes’ (McGannon, Cunningham, and Schinke 2013, 892). Although initial forays into this research space have largely emanated out of North America, this is progressing to a broader range of sports and geographical regions. As discussed previously, perceptions of sports injuries are shaped by the ways in which they are reported and presented (Kuhn et al. 2017). The Concussion Legacy Foundation’s Media Project delivers reporting workshops for journalists, encouraging what they deem to be ‘appropriate concussion reporting’, which centres around the utilisation of more accurate terminologies, emphasising the severity of the injury (i.e. referring to ‘brain injury’ as opposed to colloquialisms such as a ‘head knock’), as well as actively discouraging journalists from implying that athletes are ‘brave’ should they attempt to play through an injury (Concussion Legacy Foundation 2023). What the media chooses to cover, and how they do so (including who they quote and how these quotes are presented), becomes an important factor in the cultivation of its audiences’ perceptions on key issues being reported on (Carruthers 1998). While the notion of media framing demonstrates ‘the mechanism through which the media may highlight certain information and minimize others’ (Sanderson et al. 2016, 7), it is important to recognise the power that the sports media institution has to change perspectives through this process and, therefore, ‘sports journalists’ framing of injuries could potentially be a catalyst to shift cultural norms towards valuing players who put their health first’ (Sanderson et al. 2016, 3), particularly given the closeness that many sports journalists appear to have with the sports they are covering and with the athletes participating in them, as is demonstrated later in this article.

Methods

The following research questions guided the study design:

1. How have the concussions experienced by two elite Irish male international rugby union players been represented by the Irish media?

2. What implications might this have for the construction of the ‘sport ethic’ in this context?

In order to explore how Sexton and Marshall’s injuries were framed in the Irish print media, the study considered three nationally-dispersed daily publications: the two largest (by readership) national daily publications in the Republic of Ireland (The Irish Times and The Irish Independent) and the largest daily publication in Northern Ireland (The Belfast Telegraph), with readership figures determined as per the Audit Bureau of Circulation’s report (2018) and Ofcom’s 2020 survey. Articles were obtained from the Irish Newspaper Archives database as well as the online archives of the newspapers themselves. The two players were selected as both had highly publicised experiences of concussion, and the search terms utilised were ‘johnny sexton concussion’ and ‘luke marshall concussion’. In order to acquire a manageable and meaningful sample size, the search was narrowed down by limiting to a selected time-frame. Search dates were chosen which aligned with key moments of each player’s concussion history. For Sexton, two searches were conducted that covered two key periods of his concussion history. Firstly, from 22 November 2014 (Sexton suffered a concussion playing for Ireland v Australia on this date, which prompted a medical specialist to advise him to take 12 wk off) to 21 March 2015 (Sexton returned to play exactly 12 wk later in the 2^nd round of the Six Nations, starting against France on February 14 and subsequently starting all remaining games in a Championship-winning tournament, winning the title on this date). Secondly, from 9 February 2021 (the French doctor who advised Sexton in 2014 gave a high-profile radio interview on this date discussing Sexton’s concussion history, which sparked controversy) to 6 May 2021 (the British and Irish Lions touring squad was announced on this date, with Sexton omitted as concerns about his injury history were raised as potential reasons for his non-selection). The search dates for Sexton were 22 November 2014 to 21 March 2015 and 9 February 2021 to 6 May 2021. Marshall became newsworthy following three concussions in three consecutive starts in the Spring of 2013: in games involving Ireland v Scotland on February 24, Ireland v Italy on March 16 and Ulster v Saracens on April 6. As a result of these concussions, it was announced on May 7 that Marshall would be ruled out of the Ireland Summer tour. A second search was conducted that covered a month-long period of media discussion following Marshall’s next concussion (playing for Ulster v Dragons on 28 February 2014), with a third search conducted covering the period from which Marshall’s concussion history was discussed in an article published in the Sunday Independent (21 September 2014) to Marshall’s personal response, published in the form of an open letter in the same newspaper a week later (4 October 2014). The search dates for Marshall were 24 March 2013 to 7 May 2013, 28 February 2014 to 28 March 2014 and 21 September 2014 to 4 October 2014.

The study only included articles which referred specifically to concussions relating to one of the two named players, and the researcher discarded articles which were not substantially focused on the players’ concussions as a point of commentary. This sampling process allowed the researcher to obtain the most relevant examples of media framing of concussion in this context. In total, 25 articles were included in the final analysis: The Irish Times (n = 17), The Irish Independent (n = 6) and The Belfast Telegraph (n = 2). This figure was relatively comparable to Anderson and Kian (2012) limiting of focus to a well-defined selection of articles (10 in their case). It is important to note that the studied articles were weighted more towards content published in The Irish Times, largely because this newspaper contained a greater volume of rugby coverage and thus featured more relevant articles that met the search criteria. Furthermore, for similar reasons, the studied articles featured more content regarding Sexton’s injuries, as this was a more frequently newsworthy topic than discussions of Marshall’s injuries given Sexton’s more frequent inclusion in the senior Irish men’s national side and, arguably, higher status within the game across Ireland as a whole. Marshall was included in the study to maintain an all-island range of perspectives, reflecting the construction of rugby union in Ireland (hence, also, the inclusion of The Belfast Telegraph) which, despite the partition of the island, exists in an all-Ireland format. Indeed, the nuances of this format is also reflected in the Provincial administration, in which the Ulster branch of the IRFU oversees rugby activities in the Province of Ulster, which itself includes six counties from Northern Ireland and three counties from the Republic of Ireland.

The study drew upon the six phase process of thematic analysis outlined by Braun and Clarke (2006), which provided a useful framework through which analysis could take place. The approach was inductive in nature, utilising the research questions to guide the discovery of themes and subthemes. The data was analysed by the sole researcher, as per Nixon’s understanding that ‘using a single coder eliminates the problem of intercoder reliability’ (1993, 184). In order to mitigate against potential bias, the emerging themes and subthemes were continually re-evaluated in correspondence with the data set, and the inductive approach ensured that results were not inaccurately defaulting into any pre-existing theoretical perspectives. Following analysis and the establishment of themes and subthemes, the findings were examined against the current theoretical and conceptual landscape, including the burgeoning sociological literature on brain injury in sport, as well as frames outlined by Cassilo and Sanderson (2018), Sanderson et al. (2016) and Anderson and Kian (2012).

Findings

A central dual narrative emanated out of the data, demonstrating firstly, concern growing over SRC in rugby (framed as ‘caution’) and secondly, a ‘culture of risk’ continuing to exist (framed as ‘risk’). The complex and contradictory existence of SRC demonstrated a number of subthemes and, in total, ten frames were prominent within the two main thematic strands. The study found the media to emphasise concern over the emerging concussion crisis whilst highlighting the need for caution to be displayed towards the injury, particularly regarding players sustaining multiple SRCs, the long-term implications of the injury, and the importance of adhering to recovery protocols. However, the media also solidified the narrative that playing through pain is a core component of sports participation by highlighting players’ missed opportunities, the implications of non-availability, and the notion that the injury was transient in nature. The themes and subthemes were as follows (Table 1):

Table 1. Themes and subthemes.

1. ‘Caution’	(A) References to a concussion crisis (B) Concerns over accumulating multiple SRCs (C) Relevance of ‘expert’ judgement (D) Importance of effective protocols (E) Threat of long-term neurodegenerative consequences
2. ‘Risk’	(A) Transience of SRC (B) Missed opportunities (C) The ‘warrior narrative’ (D) Taking decisions out of players’ hands (E) Patient confidentiality

Primary theme 1. Caution

Subthemes in this category emphasised the severity of the issue, each of these being positioned under ‘caution’ as the discourse was largely raising concerns and demonstrating the fact that SRC was an issue that was increasingly newsworthy.

References to a concussion crisis

One of the most prominent themes to emerge from the data was concussion being framed as an issue of growing concern in the Irish media. The mere existence of articles which were substantively focused on SRC demonstrates that it is now an injury which warrants journalistic scrutiny in Ireland, a dynamic which was not always the case. One article noted that ‘Luke Marshall is another player with a concussion profile and Paddy Wallace, now retired, would have too had the word been used to describe head injury during much of his career’ (Watterson 2015a), reflecting the relatively recent shift in profile that SRC has experienced; Paddy Wallace was an Ulster and Ireland utility back whose professional career started in 2001 and ended with his retirement in 2014. This reinforces the shift in focus that ‘concussion’ has experienced in recent years within Ireland, with one article describing the following:

Head injuries were described as anything but concussion until Dr Eanna Falvey [Irish senior men’s team doctor] stepped over the white line in November 2013 and removed Brian O’Driscoll from the [New Zealand] All Blacks match… This past week the rugby narrative has refused to leave concussion alone.

(Cummiskey 2015b)

This is indicative of, as Malcolm suggests, ‘more than just an abnormal period in the development of sport’ (2019, 4), but rather a more substantial problem that sporting administrators are tasked with addressing, and here we can see the ramifications of this being felt in the Irish context. Of note here is the position of Brian O’Driscoll within the global game, in which the player was regarded as not only a key player for Ireland, but also a player with significant recognition from the rugby community worldwide. In this case, then, we may see some correlation between the magnitude of an incident in media coverage and its potential magnitude within the sport.

In the studied articles, concerns were evident over the concussions that both players received, with one article suggesting that ‘Sexton is still struggling with the effects of a concussion sustained almost a month ago… he continues to suffer headaches while running and passing in non-contact training’ (O’Sullivan 2014), whilst another article cited neuropathologist Dr Willie Stewart’s observation that ‘more players were removed with suspected concussion than tries scored last week’ (O’Connor 2021). This framing reflects a more contemporary trend towards valuing medical experts, providing such figures with a platform and voice to gain profile amongst non-scientific audiences. However, it has been noted elsewhere how the over-medicalisation of concussion may lead to weaker understandings from non-medical or ‘lay’ individuals (Malcolm 2019), who become alienated from increasingly-medicalised processes. This tension (between medical perspectives and non-medical understanding) is mirrored in the tension regarding the resistance towards the medicalisation of rugby. Players (and certain coaches) portray frustration with the impingement on their participation by precautious medical grounds. Included here alongside the introduction of the head injury assessment (HIA) for suspected concussed players is the greater scrutiny under which tacklers are regarded and an increased propensity for ‘high’ tackles (which result in contact with a ballcarrier’s head or neck) to result in penalties, red/yellow cards, and player suspensions. For example, former Ireland fullback and then-head coach of Leicester Tigers Geordan Murphy suggested that ‘I think the game’s gone a little bit too PC… It’s killed the game really’ (Kitson 2018) when Leicester player Will Spencer received a red card for contact to the head of an opponent. Despite the greater proportion of concussion-focused media content in the studied Irish sources, the cultural norms of the game might be seen here to resist inventions which are designed to protect player welfare. Indeed, the title of Kitson’s 2018 The Guardian article (‘Controversial Leicester red card spoils eight-try classic as Wasps prevail’) demonstrates the media’s contributing (this time in the broader UK and Ireland context) to resistance and frustration towards player welfare safeguards, if they impinge on competitive participation. Other recent examples of regulatory change being enacted in order to protect players and mitigate against the risk of long-term neurodegenerative illness amongst future participants have been met with mixed reaction. See, for example, the apology that the Rugby Football Union (RFU) - the governing body for rugby union in England - made in an official statement following public outcry at a previous statement announcing changes to the tackle height in the amateur club rugby game in England (Rugby Football Union 2023), despite such changes being made in an effort to reduce the risk of head injury.

Concerns over accumulating multiple SRCs

Concerns were demonstrated regarding the risk of players sustaining multiple concussions, as articles demonstrated the notion that players’ concussion histories are now newsworthy details for an Irish readership. For example, one article discussed how Sexton was ‘prepared to make his return to action having been stood down for 12 wk after suffering his fourth head injury of 2014 last November’ (O’Connor 2015b). This dynamic was also evident regarding Marshall, as one article described a scenario wherein ‘Ulster and Ireland centre Luke Marshall will see a specialist this week to determine the extent of his third concussion in four weeks’ (Cummiskey 2013), while another discussed how ‘Ulster are waiting anxiously for news on centre Luke Marshall following his latest injury… The 22-year-old midfielder suffered a third head injury in quick succession in Saturday night’s 27-16 Heineken Cup quarter-final defeat by Saracens’ (Crozier 2013b). Indeed, references to recurrent concussions were not always framed as a matter of ‘caution’, but were also evident within media presentations which erred more closely towards reflections of ‘risk’. For example, one article suggested that ‘it remains unclear what length of absence would be determined should Sexton receive another concussion this weekend’ (Thornley and Cummiskey 2015), a depiction which mirrors Liston et al. (2018) discussion of functional interpretations of SRC, as the media in this case was also shown to frame concussion primarily in light of the impact it has on continued participation. Here, concern is not generated due to the negative health and well-being implications of recurrent concussions, but rather the concern relates to the extent of time lost that the player in question would have to experience.

Relevance of ‘expert’ judgement

As referenced above, Irish media sources were increasingly seen to make reference to the ‘expert’ opinions of medical specialists or otherwise highlight the importance that medical professionals had in the treatment of SRC. For example, one article discussed how ‘Dr Cherman [the independent neurologist who treated Sexton during his time playing in the French Top 14] is regarded as an expert in this field’ (Thornley 2014), while another quoted Ireland assistant coach Greg Feek as claiming that ‘We’ve got brilliant medical staff’ (Thornley and Cummiskey 2015). When issues were raised about Luke Marshall’s concussion history in an article published by The Irish Independent, the newspaper published an open letter that the player himself had written:

My employer, Ulster Rugby, takes the best available advice in relation to head and other injuries, and ensures that its players receive top-class treatment from relevant specialists. I am properly educated and informed by the medical experts about what I should and shouldn’t do.

(Marshall 2014)

The importance of following the advice of medical specialists was prominent in the studied articles. However, articles also made reference to the controversy that emerged out of comments expressed by Dr Cherman, querying the validity of his views, with one article describing how ‘France have upped the ante ahead of Sunday’s Six Nations clash against Ireland after two French neurosurgeons specialising in concussion… warned the captain against the risks of returning too soon after his latest head injury’ (Tracey 2021). Indeed, the appropriateness of Dr Cherman’s comments were challenged and criticised by Sexton himself, particularly as these comments were made at a point at which Sexton was no longer a patient of the neurologist. Furthermore, Dr Cherman’s comments appear to have been framed as some form of ‘gamesmanship’ by the media coverage, particularly when such comments exist in the context of a major national sporting rivalry, a dynamic which illuminates the intersection between cultures of sport, media and national identity. The questioning of Dr. Cherman’s remarks could have quite serious implications for the broader acceptance of the severity of concussive injuries and the need for precaution.

Importance of effective protocols

The media were found to frame concussion as an injury for which effective treatment relied on the adherence to protocols, a notion which included scrutinising the protocols if they were deemed ineffective or inappropriate. For example, one article discussed the following:

In the last 12 months medical opinion in Ireland has hardened on the subject and at the end of last year the IRFU introduced a concussion guide aimed at amateur players, officials and parents… This season the Six Nations Championship, for the first time, adopted IRB protocols for professional players, which are still on a trial period.

(Watterson 2014)

However, with reference to Ireland scrum-half Conor Murray, it was discussed how, ‘underpinning Dr Barry O’Driscoll’s ongoing objection to the 10-minute injury bin that he calls meaningless, Murray passed the HIAs before the symptoms arose days later’ (Watterson 2015a), demonstrating how concussion protocols have been depicted as flawed by Irish journalists. Indeed, one article delved further into these nuances, describing the following:

Better policing and education, and the introduction of a pitch-side Head Injury Assessment, has actually led to the impression that there is more incidents of concussion or suspected concussion. If anything, it underlines how many incidents of concussion went undetected up until the not so recent past.

(Thornley 2015b)

Here, as discussed elsewhere in this article, the journalist goes beyond the point of reporting factual events. Critical journalism, as in this case, comments on the nature and construction of the institution being discussed, even so far as to suggest amendments to the regulations.

Threat of long-term neurodegenerative consequences

In this sub-theme, articles made reference to the threat of the long-term neurodegenerative damage that can be caused from SRC:

He’s [Sexton] making sure that he doesn’t fall into any of those traps of trying to return too early to play and cause long-term damage.

(O’Sullivan 2014)

There is no test available for anxiety, depression or dementia from CTE that may only become known in 10 or 20 years’ time. [CTE, or chronic traumatic encephalopathy, is a neurodegenerative disease that, at the time of writing, can only be diagnosed post-mortem].

(Watterson 2021)

The increasingly complex tensions that journalists have to navigate is demonstrated here, as journalists appear to feel required to both comment on the matter-of-fact sporting details and, simultaneously, discuss issues pertinent to the wider context of the sport. That is to say, they must be both interrogatively retrospective and speculatively prospective. The notion of long-term neurodegenerative consequences has fuelled much of the recent debate surrounding brain injury in rugby (Malcolm 2019), reinforced by the work of concussion advocacy group Progressive Rugby and the publication of former England men’s international (and Progressive Rugby affiliate) Steve Thompson’s autobiography (Thompson 2023). Furthermore, finding these issues being discussed in the Irish mainstream sports media demonstrates the growing nature of the concern rugby now has regarding the need to protect athletes’ health and well-being toward the threat of increasing neurological risks.

Despite a range of growing concerns which were becoming increasingly newsworthy in the Irish context, articles also framed SRC in a way which did not appear to unanimously align with a new kind of penchant for caution, and reflections of the ‘culture of risk’ continued to appear in the media’s framing of the injury.

Primary theme 2. Risk

Subthemes here were categorised under ‘risk’ as the presentation of SRC more clearly reinforced the notion that a culture of risk was still evident within the context of Irish sports media.

Transience of SRC

One of the most prominent themes to emerge from the data aligning with ‘risk’ was concussion being characterised as transient in nature. Concussive injuries have been described as relating to a ‘constellation’ of physical, cognitive, emotional and behavioural symptoms (McCrory et al. 2013), and each case is unique. However, in order to provide clear, distinct boundaries for treatment, governing bodies have attempted to create specific guidelines which aim to remain accurate within this ‘constellation’. Indeed, this is an inherently difficult (if not impossible) task. An example of such guidelines are the Return-To-Play (RTP) protocols, which seek to provide clarity on concussion recovery and reintegration into participation. However, RTP protocols, too, can be seen here to succumb to the pressures of athletic competition. One article suggested that, in reference to Sexton, ‘however his projected comeback is managed, if as is now anticipated, Sexton is given the all-clear to return in the second week of the Six Nations, he will be straining at the leash after 12 wk on the sidelines’ (Thornley 2015a), while another indicated that ‘Sexton hopes to play against France seven days after the head injury’ (Watterson 2021). These perspectives do not indicate that cautious recovery has occurred, but rather that the athletes involved have been eager to return to play as soon as is possible, and even make up for lost time with an additional impetus to their involvement. Likely in part to relate to Sexton’s position within the Irish game, rugby journalism in this context can be seen to support Sexton’s perspective that his participation is significant and, indeed, that his injuries may have been overstated in their severity.

Current Chief Medical Officer for World Rugby and former Munster, Ireland and British and Irish Lions team doctor Eanna Falvey contributed to an article which indicated that ‘players must complete World Rugby’s 6-stage graduated return to play protocol… contrary to some reporting, there is no set timeframe for its completion’ (Falvey 2021). Again, this perspective implies that an unpressured approach to rest and recovery should be given priority. However, an article one week previously in the same publication (Cummiskey 2021) quoted Ireland assistant coach Simon Easterby’s suggestion that ‘each stage lasts about 24 h’, with reference to Sexton’s RTP protocols. This directly contradicts Dr Falvey’s description of the process, again demonstrating a disconnect between expert medical guidance and those who are participating (or coaching). Furthermore, the journalistic framing of Easterby’s comments suggests a closer alignment between journalist and sportsperson than journalist and medic, again highlighting the degree of ‘closeness’ that many Irish sports journalists appear to have with the game. Although Easterby was also quoted as suggesting that ‘if a player… feels like they can’t complete the stage that they are in, then they obviously have to drop back a stage and that compromises their availability’ (Cummiskey 2021), this perspective puts an expectant onus on the player to recover, and as per the ‘sport ethic’, we know that athletes will attempt to overcome any barrier to their participation as quickly as possible.

Contemporary rugby at the elite level contains a crucial aspect relevant to this dynamic: professionalism. Players’ livelihoods depend on their participation, and there are economic consequences to their abilities to declare themselves fit following an injury (even a concussion). This professionalism, initiated to a large extent by the decision by World Rugby (previously the International Rugby Board) to declare rugby union ‘open’ in 1995 (thus permitting players to be paid and facilitating full-time rugby careers for senior players), has caused the sport to develop athletes who are physically bigger, stronger, and more athletic. The consequence of this process is that collisions are more impactful now than in the pre-professional era; a dynamic which may have ramifications on the severity of SRCs. Thus, players’ efforts to return to play (often prematurely) may be positioned alongside an increasingly injurious sporting landscape.

Missed opportunities

Discussions of the opportunities that players miss when they are unavailable for selection due to injury can fuel the perspective that athletes should tolerate pain and injury as much as is possible, with, again, the onus being placed on the athlete to ensure their own fitness and availability. Elite rugby players (especially in a relatively small setting such as Ireland) do not earn wealth at a level comparable to elite soccer, and players’ careers are often under more risk of premature curtailment due to the injury profile of the sport. As such, contracts and other monetary factors related to participation are significant factors for players in the Irish context. In the studied articles, media references did not frequently emphasise the benefits that an athlete would have in terms of recovery from brain injury, but rather there was a tendency to highlight the negative impact of players’ unavailability for certain games or competitions. For example, one article regarding Sexton discussed how ‘the Racing Metro 92 player suffered a concussion during Ireland’s autumn international victory over Australia… meaning he will miss the start of Ireland’s Six Nations championship’, with the same article quoting a Racing 92 coach as lamenting the ways in which the team would be ‘deprived of a player of [Sexton’s] class’ (Madden 2014). Similar sentiments were expressed by players themselves, for example, as one article quoted Sexton: ‘I’m feeling very disappointed for the club and my team-mates that I won’t be able to contribute to the team’ (O’Sullivan 2014). Athletic identity, as conceptualised by the ‘sport ethic’, can be impinged should players have enforced periods out of the game, and the ‘sport ethic’ implications are that they are required to strive to return as soon as possible, particularly if important games are upcoming and regardless of the implications of potential injury exacerbation:

The Racing Metro star [Sexton] misses tomorrow’s opening game along with Jamie Heaslip, Eoin Reddan and Cian Healy, but Joe Schmidt hopes to have all four available for round two.

(O’Connor 2015a)

He [Luke Marshall] is still sidelined, though Ulster’s expectation is that he will be fit to resume in the Heineken Cup quarter-final clash with Saracens.

(Crozier 2013a)

Framing injury in this way may fuel the perspective that pain and injury are routine, normalised components of sports participation, and the ability to conceal or disregard injury therefore becomes solidified. Furthermore, the discourse of ‘hope’ and ‘expectation’ is optimistic in nature, and inherent to sport. This demonstrates the alignment between Irish journalistic perspectives and the interests of the players/teams being reported on, and the contrast between these viewpoints and the perspectives of objective medical opinion (in which player safety/welfare is the priority, and thorough rest/recovery is prioritised over expedited return to participation).

The ‘warrior narrative’

Discussed previously, the notion of the implication that players are brave should they withstand injury with stoicism and defiance has been regarded by concussion awareness groups as a problematic concept, particularly regarding athletic negotiations with brain injuries. However, references to bravery/courage and metaphors relating to war/military/combat scenarios were evidenced in the studied articles. For example, one article depicted rugby as a ‘gladiator sport’ (Cummiskey 2015b) while another described how ‘by the end of the match Sexton had been tested and had been through the wars and had risen to it all’ (Watterson 2015b). Other articles reiterated the warrior narrative and linked it to the players and their approach to participation, as one article depicted with reference to Sexton: ‘many people feared for the wellbeing of Ireland’s best player and leader, they feared his own bravery and bloody-mindedness would lead to further injury’ (Cummiskey 2015b). Some journalists went even further and portrayed the positives that Sexton perceived through the intense physical nature of his experiences, with one article, for example, presenting a direct quote from Sexton in which he described a head impact which required him to have six stitches following a collision with French international Mathieu Bastareaud: ‘I was really happy. I was almost pleased to get a bang like that so it proves to myself there is no issue going forward’ (Cummiskey 2015a). Here, we see the athlete essentially demonstrating a preference for concussion being published and broadcast by the Irish media, with the media source facilitating this perspective without any opposing critical framing. Again, with the player holding such a senior position within Irish rugby, the influence of this perspective gains wider traction around the game in Ireland.

Another element of the ‘warrior narrative’ which was prominent in the media’s presentation of SRC was the notion of durability, which became used as a critical term to describe Sexton’s athletic profile in relation to his concussion history. One article described how there were ‘questions about the Irish captain’s durability’, before quoting Lions assistant coach Neil Jenkins: ‘obviously there is a little bit of concern about the concussions and stuff like that, there’s no doubting that’ (Thornley 2021). This comment was made in reference to Sexton’s non-selection for the 2021 British and Irish Lions tour, with the player’s injury profile implied to be a factor in his non-selection. Here, it is in the player’s interests to return to play prematurely and/or conceal injury in order to ‘prove’ their durability for fear of either missing prestigious playing opportunities or being regarded as a liability on such tours. The quadrennial nature of the Lions tours adds to the pressure that players face to gain selection, as well as the pressure that coaches face to select a suitable squad, plus the allegations of bias that coaches are often subjected to regarding preferential selections (Warren Gatland, a long-term head coach of the Welsh senior men’s team, has at times been alleged to have portrayed a bias towards Welsh players during his tours as Lions head coach).

Other articles reiterated the notion of durability with regards to Marshall: ‘Marshall, it is feared, is becoming less resilient as a result of repeated blows’ (Crozier 2013b). The promotion of such perspectives may reinforce the ‘sport ethic’ dimension that disclosing pain and injury symptoms or concerns should be avoided, underpinned by players’ desires to extend their careers and maximise earning potential (especially in the relatively small labour market that is Irish professional rugby).

Taking decisions out of players’ hands

Research is underway to determine the most accurate methods of detecting and diagnosing SRC, however until such mechanisms are widely available, much relies on athletes themselves making sensible decisions and providing honest, accurate depictions when they self-report symptoms. As per the ‘sport ethic’, we know this may be unlikely. This notion was demonstrated in the framing of Sexton’s comments, quoted in one article in reference to his 12-week enforced rest: ‘Probably around week four or five, I was starting to feel much better… I felt like I probably could have played after three weeks but I had some mild symptoms… in hindsight it was probably the right decision. It wasn’t easy to take’ (Cummiskey 2015a). One article discussed the involvement Sexton had during this enforced break, when then-Irish captain Paul O’Connell was quoted: ‘While he [Sexton] wasn’t able to train very hard in his earlier days of being out, he’s treated the break as a bit of a mini pre-season as well’ (Thornley and Cummiskey 2015). These issues fuel the notion that an athletic desire will constantly seek, as per the ‘sport ethic’, to strive for distinction, to refuse to accept limits, and to persevere through pain and injury (Hughes and Coakley 1991), intersecting with the work ethic with which senior Irish players define their approach to training and performance. The implication of such athletic desires often leads to the suggestion of the need to take decisions ‘out of players’ hands’, reinforcing the idea that players’ attitudes and actions will most likely continue to err on the side of risk-taking, as was demonstrated here in the Irish context.

Patient confidentiality

White et al. suggest that ‘media framing of these issues often utilises medical doctors as sources for stories’ and ‘the use of a medical professional strengthens a frame, making it more difficult for a typical, non-medical expert reader to disagree with’ (White et al. 2022, 546). However, in the studied articles, the Irish media portrayed the extent to which players challenged the views of medical specialists, particularly regarding Sexton’s former doctor, as discussed previously. In this example, one article noted how ‘the neurologist who recommended that Johnny Sexton be stood down from rugby for 12 wk in 2014, due to repeated brain injuries, believes that the Ireland captain has sustained “30 concussions”’ (Cummiskey 2021). However, Sexton publicly challenged the validity of the statements made and raised issues of confidentiality, with one article quoting the Irish Medical Organisation’s regulations on patient confidentiality alongside Sexton’s comments on the ‘improper’ contribution that Dr Cherman made (Watterson 2021). Whilst confidentiality is, of course, a legitimate concern, when the journalist in this case also raises confidentiality regulations, they are actively positioning themselves alongside Sexton’s ambition of querying Dr. Cherman’s actions, thus bolstering Sexton’s position and participating in this discreditation of medical opinion. The journalists’ ambitions of providing objective newsworthy detail are juxtaposed with their framing of Sexton as a key feature of Irish rugby, again highlighting the problematically close relationship that many Irish rugby journalists appear to have with their area of journalistic focus. This antagonism implies not only a further gulf between players and cautious approaches to health and well-being, but also that journalists are, in some way, participating within this dynamic. The media in this case could be seen to prioritise Sexton’s perspective over certain medical viewpoints, framing the discussion through the notion that the number of concussions Sexton had sustained (an accurate figure, or otherwise) was not worthy of further scrutiny.

Conclusion

In order to address the research questions (firstly, how has SRC been framed by the Irish media, and secondly, what are the implications of this for the construction of the ‘sport ethic’ in this context), this study analysed the media representation of concussion-related issues regarding two high-profile Irish rugby players. Media framing in this context emphasised concern over concussion, reflecting the emergence of a concussion ‘crisis’ and implying the need for cautious approaches towards the injury. However, the Irish media also reinforced the narrative that playing through pain is a fundamental component of sports participation by reiterating a transient interpretation of the injury, highlighting players’ missed opportunities and promoting the construct of a ‘warrior narrative’. Thus, media framing could be seen to simultaneously support notions of caution regarding SRC whilst also reinforcing the idea that ‘sport ethic’ dimensions relating to pain and injury remain significant to athletes themselves. Furthermore, this may in fact strengthen such cultural norms to a greater degree, as athletes can be viewed as desiring to display resilience and acceptance towards an injury for which an increasingly-compelling body of scientific work has begun to demonstrate neurodegenerative potential.

As this article has demonstrated, notions of ‘caution’ and ‘risk’ are themselves complex and interwoven. For example, one article depicted how ‘relentlessly driven and freakishly gifted, Johnny Sexton is a sporting icon – but health has to be the primary concern’ (Curtis 2021). A ‘relentless drive’ within sport and the pursuit of health as a primary concern do not often align. Indeed, as Anderson and Kian suggest, athletes continually engage in a process of ‘sacrificing tomorrow’s health for today’s glory, even in the face of debilitating injury or risk of death’ (2012, 166). In this study, while the Irish media presentation of SRC framed concussion as an injury that warrants attention, articles would mitigate these concerns by making references to the problematic implications of player unavailability, highlighting the loss of a crucial player for their respective teams whilst reinforcing the notion that players would continue to defy pain and injury as a core characteristic of their sporting identities. In some cases, the media presentation of SRC can be seen to actively contribute to cultural norms by emphasising certain interpretations of the injury that would be more adjacent with the ‘sport ethic’. For example, one article (in reference to Marshall’s concussion history) significantly downplayed concerns: ‘the recently turned 23-year-old can laugh about it now, but admit the situation is, well, far from ideal’ (Sadlier 2014). Many sports journalists have personal links within the sports that they cover (allowing them enhanced access to teams and players, beyond that which their journalistic credentials might otherwise grant them), and they are often former players themselves. As such, they may be as ‘compromised’ in their perceptions and attitudes as the athletes themselves. Further research might adopt this dynamic as a sole focus, examining how this closeness impacts Irish rugby journalists’ framing of events from ‘inside’ and ‘outside’ the Province in which they are based (i.e. The Irish Times/Leinster, The Belfast Telegraph/Ulster, The Irish Examiner/Munster, Connacht Tribune/Connacht). While individual journalists contribute articles, they all pass through the respective editorial boards of each newspaper, and thus the present study took these articles as exemplative of national print newspaper media rather than as personal contributions from individual journalists. Furthermore, the study analysed contributions made within these news publications during a specific time-frame that incorporated the playing careers of both players involved. The study did not specifically seek to examine changes over time. While perspectives on SRC have been in a state of evolution, the injury was newsworthy throughout the duration of the time-period studied here, thus allowing the article to consider all relevant media sources published during the selected time-frame within the same analysis, however further studies might analyse the nuances of how this framing may have changed over time.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.