Concussions have become a huge concern over the past few years within the sport of rugby. Following the unfortunate passing of a young high school rugby player in Ottawa, amateur rugby associations have begun to take this issue seriously, and with great reason. With the institution of new rules to allow for proper assessment off-field for head injuries, it’s important that both players and coaches understand what a concussion is and why it should be taken seriously.
A concussion is a brain injury that is caused when the brain accelerates or decelerates within the skull to a significant degree. This acceleration/deceleration impulse causes the brain tissue to stretch and deform briefly before being brought back to it’s original shape. This process happens very quickly and studies have found that the peak acceleration happens within the first 6 to 20 milliseconds following impact. Because concussion is an acceleration injury, players and coaches should be aware that this injury can happen even WITHOUT direct impact to the head! Hits to the body, or even falls, can cause the head to whip back and forth, and if the head accelerates/decelerates to a significant degree, the player can suffer a concussion.
As the brain tissue deforms, chemical signals are released within the brain that cause brain cells to discharge uncontrollably. This creates a kind of electrical storm within the brain, which can then display itself in a number of signs (can be seen by outside observers – Loss of consciousness, balance impairments, etc.) or symptoms (felt by the injured person – headache, dizziness, confusion, etc.). In fact, there are over 20 different signs and symptoms, which can indicate that a concussion may have taken place. Current recommendations suggest that there should be a high degree of suspicion for concussion and the player should be IMMEDIATELY removed from play for the duration of the game if they display even ONE of the following signs or symptoms following a significant blow to the head, neck, or elsewhere on the body:
· Headache or Pressure in the Head
· Neck Pain
· Nausea or Vomiting
· Dizziness, Balance Problems, Coordination Problems
· Blurred Vision or Ringing in the Ears
· Sensitivity to Light or Noise
· Feeling slowed down
· Feelings of being “in a fog”
· Not feeling right
· Confusion or difficulty concentrating on questions being asked
· Difficulty remembering
· Fatigue, Low Energy, Drowsiness
· Emotional (Tearful or Crying) or Sadness
· Irritable (Getting bothered by questioning)
· Nervous or Anxious
· Loss of Consciousness – It should be noted that more than 90% of concussions DO NOT result in a loss of consciousness!
Players suspected of suffering a concussion should be removed from play and not allowed to return prior to being cleared by a healthcare practitioner with advanced training and knowledge of concussion injuries and their management. In many cases, players may feel better in as little as 10 to 15 minutes following the initial injury. Coaches and athletic trainers should not be fooled by this sudden turn of events as there are actually TWO PHASES to a concussion injury, and the second phase is actually the most dangerous.
Following the initial electrical storm in the brain, the brain begins to burn energy at a rate faster than it can be produced. This causes energy stores within the brain to plummet, which is often why concussed players will begin to feel extremely tired within a couple hours of their injury and is also why the initial treatment for concussion is REST. These energy stores continue to fall for the next 3 to 5 days until they start to be gradually restored over the next few weeks and an initial period of rest allows the brain to conserve energy with the hope of speeding the recovery process. It is during this time of low energy that the brain is extremely vulnerable, where even smaller impacts can cause another concussion. These second concussions, which happen before full recovery from the first can lead to permanent brain damage, and in some cases, death. Please click here to watch a quick explanation of concussion (http://completeconcussions.com/for-parents-athletes/what-is-a-concussion/).
The biggest problem with these injuries is that symptoms (how someone feels) does not coincide with brain recovery. An injured person may feel 100% better, but in reality may be still within this dangerous period. This is where a properly conducted baseline test is extremely valuable.
There are no X-rays, MRI’s, or CAT scans which can tell you whether you’ve suffered from a concussion or whether or not your brain has fully recovered to the point where it is safe for you to return to your sport. Baseline tests are a battery of tests that examine every area of brain function, which could become affected during a concussion. These tests should be done by everyone involved in contact sport PRIOR to starting the season EVERY YEAR, because in order for clinicians to know when you have fully recovered from your concussion, we have to know how well you functioned prior to your injury. Without this information, it is impossible for doctors to know when the brain has fully recovered. Consider this as an insurance policy for your brain. You may never need it, but when you do, you are extremely thankful that you have it!
A good baseline assessment involves more than just computerized testing. Many clinics are coming out claiming that they offer concussion programs however they are simply conducting computerized tests, which have shown numerous problems on their own. If you are looking for a good concussion program, ensure that the practitioners involved have advanced training in this area and are testing numerous areas of brain function such as balance, reaction time, vision, memory, concentration, motor strength, physical capacity, as well as neurocognitive function.
Have fun and stay safe this rugby season! And remember, if you think you may have suffered a concussion, don’t hide it…REPORT IT! This could mean the difference between missing a few games and missing the rest of your season, or even worse.
About the Author
Dr. Cameron Marshall is a concussion researcher and the president of Complete Concussion Management Inc., a network of clinics across Canada with advanced training in the diagnosis, management, and rehabilitation of concussion injuries. These specialized clinics provide comprehensive, research-based baseline testing programs, concussion policy formation, coach & trainer education programs, as well as monitored return-to-learn and return-to-play programs for amateur sport programs and schools within their communities.