As we are all too aware concussion in sport, particularly Rugby Union is an extremely hot topic, with everyone having an opinion on whether George North should have been removed from play during the England match earlier this month where he collided heads with hooker Richard Hibbard.
In light of all the media attention English Rugby (RFU) announced last October that during the 2013-2014 season reported concussions in the Aviva Premiership rose by 59% on the previous year, with concussions also being the most common rugby injury for a third year in a row.
Rugby’s governing body ‘World Rugby’ (formerly IRB) believe this increase is due to an improved understanding of head injuries from both players and medical staff. However, this number more than likely far lower than the reality as highlighted by an Australian study into the compliance with return to play regulations following concussion, which found that many players do not follow the correct return to play protocols or even report concussions.
What is a concussion?
A concussion is an acute, temporary disturbance in brain function brought about by a trauma. It is thought that as a result, there is a disruption of cellular functioning within the brain, accompanied by a decrease in cerebral blood flow and increase in energy demands. In short, the brain’s not operating as it should be.
Although most commonly talked about in relation to competitive sport, concussions can happen in all sorts of non-contact sport, trips, falls, or motor vehicle accidents. It’s also commonly reported as a blow to the head, however any event or movement that incurs a linear or rotational force to the brain can result in a concussion. Lastly, it is a commonly held belief that to have a concussion you need to have lost consciousness. New research states that loss of consciousness was associated with only about 10% of concussions!
So what would I be looking for?
There are several signs and symptoms associated with concussions, the most common of which are headache and dizziness. Some other common symptoms are: nausea, vomiting, feeling foggy/ slowed down, feeling irritable/ more emotional, and change in sleeping habits. Obviously these symptoms can exist without a concussion, so it’s important to know what someone was like before the incident. People may also experience transient disturbances in balance.
Using an athlete as an example, you may be looking for someone that’s not playing up to their normal level (e.g. slow, not as reactive, missing passes…).
What to do when you find one?
If a concussion is identified, it is important to make sure the person is monitored by a friend, flat mate, or family member for any quick change in signs or symptoms, particularly over the first 24-48 hrs. If unsure, it doesn’t hurt to have them looked at by a health professional trained in managing concussions.
As the function of the brain has been disturbed and energy demand is at a high, it’s important not to expose the brain to too much mental or physical stress with concussions. This may mean restricting the individual to a minimally stimulating environment (dark, quiet room), avoiding mental (reading, homework) and physical (exercise) exertion.
There are no real hard and fast rules as to how long a concussion will take to recover, however the research has shown a correlation between increased number and severity of symptoms with increased time to recovery. Research has shown that 80-90% of concussions have historically resolved within 7-10 days.
Return to play
Return to play guidelines are pretty unanimous across sport. It is a six step process that begins when symptoms at rest disappear, and ends when the athlete can engage in a full contact practice without symptoms. Each step takes at least 1 day, so no athlete diagnosed with a concussion should return to match play within the first 5-6 days after a concussion. This process is normally monitored by a trained, educated health professional to ensure a safe return to sport.
So what’s the big deal if I go back early?
As the brain is already reeling and suffering from an energy imbalance, asking even more from the brain can put it at even more of a deficit. Some of the specific risks with returning too early are the possibility of cerebral swelling, increased susceptibility to another concussion due to poor reaction time/ coordination, or second impact syndrome (SIS). SIS occurs when an individual suffers another blow to the head before the initial injury has cleared and has been associated with cases of increased intracranial pressure, coma, or even death. So when side effects can be that serious, why even risk going back to play before symptoms have resolved!
All in all, concussions are a serious deal that athletes, trainers, family and friends should take serious and be aware of. Although not being able to participate in your sport or activity may seem devastating at the time, the risks associated with not taking a concussion seriously can last a lifetime so if you suspect you’ve suffered a concussion don’t hesitate to step aside for evaluation by a health professional. For further details on concussion and concussion management, check out this statement in the BJSM. If you’re interested in learning more, or have questions, don’t hesitate to book in or contact us at firstname.lastname@example.org.