Dubai, UAE – Concussion. The biggest buzz word in sports and the media right now and rightly so. More young people than ever are suffering the ill effects of head injury acquired on the field and with court cases in the U.S ending with hundreds of millions of dollars being paid out to retired professional athletes, there is clearly an issue in the identification and management of head injuries in sport.
A concussion is caused by trauma to the brain resulting from a direct impact to the head, or sudden acceleration/deceleration of the head, causing a movement of the brain within the skull. Symptoms can include but are not limited to loss of consciousness, confusion, aggression, loss of coordination, as well as sickness, nausea and vomiting. As with any injury, concussions can range from mild, to moderate, and severe, with symptoms changing accordingly.
Part of the issue with concussions, especially at grass roots level and in youth sports, is that they are incredibly difficult to identify and manage as symptoms may only present themselves hours after the incident that causes them. Furthermore, as diagnosis can rely on players reporting symptoms to the team doctor, physiotherapist, coach, or a parent, and the pressure to play on ‘for the team’ can often get the better of an athlete and lead them to continue play. All of this combined with a chronic lack of medically trained professionals working with youth and grass roots teams, identification of concussion is poor at best and players will often stay on the pitch following what is essentially a traumatic injury to the brain. Over time if the brain is not given sufficient time to heal, changes to the structure and chemicals of the brain occur and the brain becomes unable to function adequately. In the short term, consequences can be dire, a second impact to the head following a concussive episode can result in what is known as second impact syndrome: a cascade of chemicals within the brain known as neurotransmitters causes a rapid decrease in brain function, which in the most severe cases can be fatal.
With all this considered, what can we do to protect our young athletes from the dangers of concussion? The biggest factor in my mind is education: many young players do not realise when they have actually been concussed. Seeing stars, having their ‘bell rung’, wobbly legs, or even a simple headache are all cosidered concussion symptoms, yet many young players and parents will brush these off as a simple bump. If we can educate athletes as to the risks of concussion and help them to communicate to coaches and parents how they are feeling following a head impact, it is easy to remove the individual from play until it is safe for them to continue.
As a minimum, all players should be tested during preseason to establish a baseline of cognitive function as well as short, mid, and long term memory. To do this we can use a Sport Concussion Assessment Tool or “SCAT test”. A user friendly paper print out checklist of concussion symptoms and cognitive and vestibular test. Ideally this should be used in combination with CogState, a computerised cognitive assessment program. A trained professional such as a doctor, physiotherapist, or sports therapist can easily carry out this test in a few minutes and moving forward once a player has been identified as possibly having a concussion, the player can be tested again to ensure that the brain is functioning well enough to rule out concussion.
If on the other hand the player is found to have a confirmed concussion, a graduated return to play should be followed consisting of daily progressions from low intensity jogging, progressing to higher intensity running and building in sport specific skill training.
Once this has been completed with no recurrence of symptoms and a SCAT and CogState shows full cognitive function, a player can return to activity with the full knowledge that it is safe to do so.