As the 2011 rugby season is upon us, I thought I’d share a few thoughts about concussion as this condition is often not acknowledged and even more commonly not managed optimally.
As rugby evolves, players are becoming generally bigger and faster and the game is being played at a greater and greater intensity.
Players are often urged to “win the collision” and the result of this is that more and more impact injuries are being seen at all levels of rugby.
It is believed that at least 15 percent of high school players will suffer a concussive episode in any one season and many of these are not recognised or diagnosed.
The first important point to note is that concussion is a functional injury to the brain, not a structural one.
This means that a brain scan (CT or MRI) is invariably normal and cannot be used to diagnose the condition.
Often I hear of players being declared fit to play after having had a scan that shows no abnormality - in the concussed brain you would not expect to see anything on scanning and so this is usually of no real value in determining whether a player can return to play or not.
The diagnosis of concussion is primarily a clinical one and brain scans are only requested by your doctor if more serious structural damage to the brain is suspected, in which case this is no longer classified as concussion.
It is also often mistakenly thought that one has to be knocked out to have suffered a concussion. This is not so and merely seeing stars after a knock may be diagnostic.
All concussed players should be seen by a doctor, primarily to determine whether referral to hospital is necessary or not, and secondarily for advice to be offered regarding the short- term care of the concussed individual.
As the brain is affected, patients are usually advised to rest completely until all symptoms of the concussion have resolved. This rest applies to both physical and mental activity and schoolwork, computer games, watching TV and similar activities must be discouraged for the initial few days.
Once the player has recovered completely in terms of any symptoms, a computerised neuropsychological test like Impact should be conducted to confirm the clinical decision.
Should this be normal, the player can then resume a stepwise return-to-play protocol involving increasing the intensity of training over a five-day period.
Should the player’s symptoms not recur during this time, then he/she will be declared fit to participate in contact sport again. The globally accepted clinical guidelines are actually quite simple, but often not followed.
There are no shortcuts to managing concussion and doctors often have to resist the persuasive efforts of some parents and coaches to allow their son or daughter to play again prematurely.
A concussive episode sensitises the brain to further damage both in the short term and in the long term, and it is certainly not in the player’s, parents’, coaches’ or team’s best interests to take this risk.
Fortunately 80-90 percent of concussions resolve within two to three weeks. This is a relatively short time to sit out considering the potential implications of returning to play too soon. - The Mercury
For more detailed information on concussion go to www.sharksmart.co.za