Concussion on the school sports field

There is a growing perception, especially among parents of schoolboy players, that rugby is a dangerous game. Picture: Etienne Rothbart

There is a growing perception, especially among parents of schoolboy players, that rugby is a dangerous game. Picture: Etienne Rothbart

Published Mar 9, 2015

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London – Concussion isn’t just a risk for adults – experts are concerned about the high numbers of children and teenagers who are affected by it, too, often as a result of injuries sustained playing sports such as rugby.

In a typical nine-month rugby season, up to two players in every school or youth rugby team will suffer concussion, according to two recent studies published in the British Journal of Sports Medicine.

In rugby union (which has 15 players on each side), the probability of a child or adolescent player sustaining concussion over a season is 0.3 percent to 11.4 percent; in rugby league (where there are 13 players in a team and which has fewer stoppages and is played at a faster pace), the probability is between 7.7 percent and 22.7 percent.

The concern is the effects of concussion can be more serious and long-lasting in children because their brains are still developing.

Studies show children take longer to recover from concussion than adults, and some experts believe the response to the trauma involves a different mechanism in the young brain.

This means they are susceptible to so-called second-impact syndrome (SIS), when a second concussion is sustained before the symptoms of the first have resolved, causing the brain to swell rapidly.

Dr Willie Stewart, a consultant neuro-pathologist at Southern General Hospital, Glasgow, is a leading expert in the field.

The first blow to the head causes the blood vessels to become ‘a bit leaky’, he says.

‘The second one causes them to become much worse, and that leads to brain swelling.’

This has prompted campaigners to call for referees to be more vigilant with youngsters playing contact sports, and substituting them if they have suffered concussion. The issue was highlighted by the tragic death of 14-year-old Ben Robinson. He collapsed at the end of a rugby match at his school in Co. Antrim in 2011 and died two days later.

He’d taken several knocks to the head during the game and lost consciousness on at least one occasion, but after being checked each time, he was allowed to play on.

A coroner ruled Ben died as a result of repeated concussion, sustained in the match.

Cases such as Ben’s prompted a report, Concussion Can Kill, by a cross-party group of MPs, which was published last June.

The report called for sporting authorities to take action on the issue of concussion, and branded rugby union’s concussion assessment system ‘insubstantial’. It also said heading the ball should be limited in youth football, as this may damage the brain.

Professor Allyson M. Pollock, director of the global policy health unit at Queen Mary University of London, says ‘not enough is being done to protect boys from dangerous rugby injuries’. She says crucial to this is urgently collecting better data on concussion.

‘Concussion isn’t visible to the naked eye, unlike a fracture or a dislocation. It is under-reported because coaches have not seen it as a relevant problem, and children are encouraged not to report it for fear they lose time off play.’

The situation may be improving.

The Rugby Football union has begun a three-year study on injuries in children and teenagers and launched a campaign to raise awareness of concussion called Don’t Be A Headcase.

The campaign’s key message is to remember the four Rs:

* recognise the signs of concussion;

* remove the player if they are showing them;

* ensure they properly recover;

* and follow protocols on when they should return to play.

Yet while rugby authorities promote initiatives that focus on the management of injury after the event, there are concerns that we’re still failing to prevent concussion happening in the first place.

‘We know rugby is a changed and in many ways a more potentially traumatic game,’ says Dr Barry O’Driscoll, a former Irish rugby union international, who served on the International Rugby Board (IRB) Medical and Concussion Advisory Groups for many years.

‘There is a significant risk of concussion in children and adolescents. We must maintain the welfare of the player as a priority.’

Daily Mail

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