Durban - While a bang on the head or even a blow to the body in a rugby match may not look serious to the onlooker, it can lead to concussion and ultimately result in brain damage, Dr Glen Hagemann, Discovery SharkSmart Programme head and former doctor to The Sharks, has warned.
He is not alone in his concern – the International Rugby Board (IRB) has recognised that concussion is sometimes missed, with serious consequences, and has issued a revised Graduated Return to Play (GRTP) protocol that aims to reduce long-term damage. It is urging doctors, physiotherapists, sports coaches, players and parents to be more aware of symptoms.
Speaking at a workshop on concussion at Growthpoint King’s Park, Durban, Hagemann said the IRB had become more conservative in its guidelines, particularly with regard to younger players.
“While 80 percent of concussion in adults is resolved within a week or two, the same is not true for younger players,” he said. “The younger the brain, the more prone it is to concussion.”
Concussion, he said, resulted from either a direct blow to the head or blows to other parts of the body resulting in force to the brain, like whiplash.
“It is a myth that you need to sustain a blow to the head to be concussed,” he said.
“Even a body blow can result in concussion as the brain is shaken and hits the skull. Another myth is that you can only be concussed if you are knocked out – loss of consciousness is present in fewer than 15 percent of cases of concussion.”
Don’t be misled by a normal scan result – MRI or CT scans are not sensitive enough to pick up the tiny, but dangerous, brain injuries caused by a concussion.
“Thousands of axons (brain cells) may be completely or partially torn and will not be seen on a conventional brain scan.”
Hagemann said the management of concussion was reviewed every four years and the recent Zurich Consensus Statement provided a summary of evidence related to its management.
Globally, management was the same and the new recommendations were more stringent.
“The IRB’s main message is: ‘Recognise and Remove’.
“Many concussions go unreported, especially at school level, so it is important to know the signs and remove the player. Even if there are no signs, the player should be removed after an injury as concussion can evolve over 48 hours,” said Hagemann.
“If in doubt, sit them out.”
Signs to look for are:
* Loss of consciousness and responsiveness;
* Lying motionless on the ground;
* Unsteadiness or balance problems;
* Grabbing or clutching the head;
* Dazed blank or vacant look;
* Confusion.
Doctors, physiotherapists, coaches and teachers have not only a duty of care towards players but also a legal obligation to recognise concussion and to remove the player from play until he or she has fully recovered.
The management of concussion is: Recognise, Remove, Medical Assessment, Rest, Recovery, Clearance to Play – all of which could take up to six months.
In players U15 and younger, there should be a minimum period of two weeks of total rest, after which the GRTP protocol can be resumed over the next nine days. The earliest a player in this age group should be back on the field is after 23 days.
In players in the U16-U19 age group, the mandatory rest period is one week with the GRTP protocol taking a further five days.
Concussion is sometimes missed, however. While symptoms usually occur within 24 hours of the injury and diminish over several days or weeks, they may remain for months.
Symptoms to watch for include:
* Headaches;
* Difficulty concentrating;
* Fatigue or feeling slowed down;
* Drowsiness and fogginess;
* Dizziness;
* Sensitivity to light and noise;
* Balance problems;
* Difficulty with memory;
* Sleep disturbance;
* Nausea.
Red flags include: neck pain, deteriorating consciousness, increased confusion or irritability, headache, repeated vomiting, unusual behaviour change, seizure or convulsion, double-vision, weakness or tingling/burning in arms or legs. Patients showing these signs need to be urgently reassessed by a medical professional.
The IRB’s Recognise and Remove message incorporates six Rs
* Recognise – Learn the signs and symptoms of a concussion so you understand when an athlete might have a suspected concussion.
* Remove – If an athlete has a concussion or even a suspected concussion he or she must be removed from play immediately.
* Refer – Once removed from play, the player should be referred immediately to a qualified health-care professional who is trained in evaluating and treating concussions.
* Rest – Players must rest from exercise until symptom-free and then start a graduated return to play. The IRB recommends a more conservative return to play for children and adolescents.
* Recover – Full recovery from the concussion is required before return to play is authorised. This includes being symptom-free. Rest and specific treatment options are critical for the health of the injured participant.
* Return – To facilitate the safe return to playing rugby, the athlete must be symptom-free and cleared, in writing, by a qualified health-care professional who is trsained in evaluating and treating concussions. The athlete then completes the GRTP protocol. - Daily News
Visit: www.irbplayerwelfare.com; www.sharksmart.co.za