Don’t underestimate a concussion
Posted on 5 March 2018
Whether it’s the result of a blow to the head, bad fall or hard tackle, concussion is an invisible injury. But if the sufferer isn’t given time to recover, they could experience long-term consequences.
‘It’s a myth that you need to lose consciousness to be diagnosed with concussion, says Dr Jannelene Killops, clinical head of the Mediclinic Events Department, which oversees pitch-side medical assistance services at the Cape Town Sevens. ‘If you have abnormal balance, confusion, disorientation, behavioural changes and abnormal eye movements after a head injury, you have suffered a concussion.’
Repeated concussions can result in dementia-like symptoms years after injury, a condition known as chronic traumatic encephalopathy (CTE). This is why concussion protocols need to be in place to protect players and ensure that they don’t suffer a major brain injury on the field.
‘Rugby’s governing bodies in South Africa have systems in place that make concussion safety a priority, and education resources are available to everyone,’ Dr Killops adds. ‘The Boksmart programme (www.boksmart.com/concussion) is a wonderful resource for athletes, coaches and anyone working with rugby players.’
Concussion cannot be detected via a medical scan, but it is still a serious condition with far-reaching effects. And knowing the signs and symptoms could save someone’s life.
‘Concussion assessment is best performed by healthcare practitioners who are experienced in managing the condition,’ Dr Killops says. ‘They need to take into account things like memory, balance and concentration, and examine for head and neck injuries. It is essential that players return to play in a graded approach only once they are free of symptoms. Children under the age of 19 are more susceptible to long-term complications. They should be removed from play if a concussion is suspected and then assessed by the appropriate experienced healthcare practitioner.’
Dr Killops adds that schools can have a major impact on the prevention of long-term injuries. ‘Parents should ensure that schools have systems in place to support children who play contact sports. The impact of concussion on learning and exams should also be addressed.’
Initially physical and cognitive rest is recommended until players are completely free of symptoms. Players under the age of 19 need to stay off the field for a minimum of two weeks; for older players, the minimum period of rest is one week. Players must be symptom-free before commencing graded return to play. Children should not return to sport until they are back at school and have returned to normal learning patterns without symptoms.
They should be allowed shorter days at school, more time for assignments, quieter learning spaces and regular breaks, and be given lots of reassurance from their teachers that symptoms will improve. Players can only progress to the following stages if they are symptom-free. At least 24 hours should pass before progression to the next stage.
Stage 1: Normal daily activities that don’t provoke symptoms.
Stage 2: Light aerobic exercise at a slow to medium pace to increase heart rate. The player must not do any resistance training.
Stage 3: Sport-specific exercise, such as running drills. Here players may increase their heart rate and add movement, but potential head impact activities must be avoided.
Stage 4: Non-contact, co-ordination and decision-making exercise. This could include passing drills and if no symptoms occur, progressive resistance training can be included
Stage 5: Normal training activities, including full contact practice and participation in normal training, this aims to restore the confidence of the athlete and allows the coach to do functional testing.
Stage 6: A medical doctor experienced in concussion needs to give the go-ahead before the player returns to normal game play.