Have you ever wondered why some players return to the field from a head knock, and some do not?
Regular followers are now well aware of rugby鈥檚 , first introduced in 2012.
While the notion of testing head knock incidents has long been prevalent, the specifics of the HIA assessment remain largely unknown beyond the changing room walls.
Does it involve , words, hopping on the spot while touching your nose?
The Herald took 鈥 and failed 鈥 the widely used test in the Eden Park medical room to pull back the curtain on the highly detailed, interconnected system designed to prioritise player welfare. And to save you the embarrassment.
Every professional player 鈥 from provincial to Super Rugby and the test scene 鈥 are closely watched in game by independent match day doctors who screen contact and collisions for suspected head injuries through the television director鈥檚 pitch side feed.
When a head knock is identified, these days with assistance from instrumented mouthguard alerts, the referee informs the affected player and they must leave the field to undergo the HIA test.
As soon as they depart, the 12-minute window to complete the test 鈥 17 minutes if it is blood related 鈥 begins.
At the elite level, some countries, such as France, insist their team doctor is present in the medical room for testing. Usually, though, the independent match day doctors perform the assessment with the player alone.
The neurological test is designed to challenge everything from balance to cognitive functions and memory. It is conducted through a specialised concussion management (SCRM) application, which standardises and logs assessments in World Rugby-approved competitions.
On this occasion, Rob Everitt, the most experienced match-day doctor, having overseen more than 300 professional games, performs my test.
鈥淢ost people doing their first one don鈥檛 pass it,鈥 Everitt says, as if he鈥檚 viewed my high school grades.
At the start of each season, all players undergo the HIA test to register a baseline that is then compared against results from their in-game score.
While the test has continually evolved in the past 13 years, a decade-long veteran would have experienced a version of it at least 10 times.
Coming in cold, taking the test for the first time, is not like-for-like compared to that familiarity, but it does provide a genuine insight as to exactly what鈥檚 involved.
Everitt begins with a set of 10 words 鈥 said to be scientifically selected 鈥 that can be recalled in any order.
鈥淛acket, arrow, pepper, cotton, movie, baby, monkey, perfume, sunset, iron,鈥 he says.
I recall five words.
Everitt repeats the same words twice more. I score five and six. Good start, then.
The next stage further probes memory.
鈥淲hat venue are we at? Which half is it? Who scored last in this match? What team did you last play? Did you win your last game?鈥
Then come the numbers, starting with a sequence of three, which must be repeated in reverse order.
Sounds simple enough, right?
I complete the first number sequence... and then start to stumble.
Everitt completes seven number sequences, increasing those by one each time I correctly recall all in reverse order.
Balance is next.
鈥淧lace your kicking foot in front with your heel to toe. Put your hands on your hips and close your eyes,鈥 Everitt says, starting his timer.
Questions about potential symptoms follow.
鈥淒o you have a headache, dizziness, pressure in your head? Are you nauseous or feel like vomiting? Do you have blurred vision? Does light or noise worry you? Do you feel as though you鈥檙e slowing down, in a fog or unwell?鈥
The final task is to recall as many of the 10 words used at the start in any order. I managed five, for a total of 18 of the 30 words, and duly fail the test.
Most top-level players score in the mid to high 20s with the words, and eight or above on the number recall.
鈥淚t鈥檚 a remarkably challenging test and very well proven scientifically,鈥 Everitt says. 鈥淭hey鈥檝e done a lot of testing. It鈥檚 a complicated system. It鈥檚 testing cognition, balance. It鈥檚 looking at symptoms. It鈥檚 testing immediate memory, near memory and remote memory.
鈥淧layers eat the numbers up. It鈥檚 really impressive. They鈥檙e doing that while playing professional rugby, deep into the second half, sometimes they come in here with respiratory rates in the 40s, blowing big time, and they鈥檒l still perform.鈥
Due to their familiarity and desperation to return to the pitch most players reach the last memory recall in under five minutes but are then held so it can be properly assessed.
鈥淲e are often sitting with a player for 40-50 seconds waiting for that five minutes to tick over. That鈥檚 all part of the scientific process, 鈥滶veritt says. 鈥淚t鈥檚 by far and away the best in sport, on the planet. World Rugby is clearly leading the way and a lot of other sports are looking at it.鈥
The HIA protocols don鈥檛 end there. Players must undergo a second post-match test and a third 36-48 hours after the incident to be cleared to play the following week.
Should players fail those tests, they are placed into a mandatory 12-day stand down and must tick several boxes before returning to contact.
Concussion remains a pressing issue confronting all contact sports but the real-time mouthguard collision alerts and the ever-evolving HIA test have vastly advanced safety measures in recent years 鈥 in many ways saving players from themselves.
The HIA test will never provide perfect detection but, the first time at least, it is difficult to pass.
The other takeaway from this experience is maybe I鈥檓 not cut out for the pressures of the pro game, after all.
Liam Napier has been a sports journalist since 2010, and his work has taken him to World Cups in rugby, netball and cricket, boxing world title fights and Commonwealth Games.
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