Sports Injuries: Concussion

Concussion is a significant injury and occurs quite commonly in the game of rugby, but can also occur in any sport of which contact comprises a component, such as hockey or soccer, amongst others.  It can be caused by either a direct blow to the head or in severe cases, a heavy blow to the body. 

 

South African rugby guidelines define concussion as a clinical syndrome with immediate and short-lived post traumatic impairment of neural function, as evidence by a change of consciousness and disturbance of vision and/or equilibrium, due to cerebral or brain stem involvement. 

 

As mentioned, the main causes for concussions are a direct blow to the head or jaw or a sudden deceleration of the head, such as a blow to the body or impact with the ground or another player but it is vitally important that one bears in mind that the mechanism of injury does not exclude a concussion and that any significant contact or impact can result in a concussion-type syndrome.

The exact effects and pathology of a concussion are still being debated; however it can be regarded as a diffuse form of brain injury and needs to be given the necessary attention based on this fact.

 

A very important aspect of concussion is that there are ways to attempt to prevent it from occurring. 

Preventative measures include:

• Strict application of rules of the game
• The wearing of mouth guards is definitely thought to reduce the incidence of concussion. 
• The wearing of a headgear does not seem to have any effect on the prevention of a concussion in rugby union but when in doubt, rather err on the side of caution.
• Neck strengthening
• Correct techniques (tackling/scrumaging etc)

 

The awareness and vigilance for the signs and symptoms of concussion, of coaches/parents and players, cannot be over-emphasised.

These include:

• Confusion(player is unaware of the time, score, date or place where he is),
• Memory loss
• Headaches
• Nausea
• Vomiting
• Dizziness
• Ringing in the ears
• Disturbances of vision
• Sleeplessness
• Excessive somnolence
• Sleepiness/Fatigue
• Irritability and/or depression

 

The physical symptoms include:

• In-coordination
• Loss of consciousness
• Seizures and speech abnormalities

 

If one considers the above signs and symptoms it becomes clear that they’re very vague and thus a high suspicion for the presence on a concussion in any player must be held. When in doubt, consult your Doctor/Sports physician.

 

When it comes to the initial managing a concussion, the following is important:

 

The player should not be moved if a concussion is suspected until he/she is examined by a paramedic or a doctor, as the possibility of a neck injury must ALWAYS be excluded first.  It is very important to realize that a player with a concussion does not always lose consciousness, so this is not an acceptable way of ascertaining the possibility of concussion.

 

The immediate management should consist of the following:

 

The player should be removed from play immediately and must not be allowed to return to play in that game, he/she should be examined by a medical doctor that is qualified to make decisions regarding concussion and where necessary a scan should be performed if indicated.  When in doubt, the patient can be admitted to hospital for monitoring over a 24 hour period and a neurosurgical opinion can be sought. 

 

There are computer tests that allow the effects of a concussion to be accurately monitored such as Cogsport or Impact; however these are mostly available to the professional level athletes.  There are significant efforts being made to make them more freely available to schools and club-level competitors.

 

Return To Sport

The problem of returning to sport is a very important one.

Until the player has been deemed to have fully recovered from the concussion, he/she should not take part in any activity whatsoever. Any symptoms (mentioned above) should be considered warning signs and it is paramount that coaches/trainers/parents and players heed them as warning signs.

A return to sport protocol is available on http://www.sportsconcussion.co.za but when in doubt, DO NOT hesitate to contact your sports physician or doctor.

 

The indication for MRI and CT scans are numerous, however they do not form part of the scope of this article. Ask your Sports Physician or doctor for assistance. The emergency number for any concussion related queries is SpineLine on 0800 678678

 

 

Should anyone require further information on the topic of concussion, they can use the following websites:  www.cogsport.com or www.sportsconcussion.co.za http://www.sarugby.co.za

 

Disclaimer:

 

This is a simplified report on a complex subject and is by no means intended to provide the reader with the skills or knowledge to diagnose any illness or injury. It is merely intended to create awareness of the conditions discussed.

The diagnosis and management of any injury or illness should remain the responsibility of a doctor or other qualified personnel.