Mags GarganAnyone involved in sport should be aware of the dangers of concussion, writes Mags Gargan
Concussion has become a contentious topic recently, particularly in rugby, but all professional contact sports are coming under scrutiny such as hurling, football, soccer, American football and even horse riding.
In 2013, the American NFL (National Football League) agreed a $765m settlement (about €675m) after more than 4,500 former players sued them for concealing the risks of long-term brain damage. Other sports are now coming under increasing pressure to take the issue more seriously and to prevent players from continuing a game if concussion is suspected.
As part of the RCSI (Royal College of Surgeons in Ireland) MiniMed Lecture Series in Dublin, Prof. Michael Molloy, a specialist in sports medicine and a former international rugby player, gave a free public lecture last week on the management of concussion. He emphasised that concussion is not just an issue for professional sportspeople, but can happen at any level of sport and in everyday life.
“Players, parents, teachers, coaches, everyone needs to be educated in concussion,” Prof. Molloy said.
Traumatic brain injury
A concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head or a hit to the body that causes your brain to move rapidly back and forth.
This sudden movement can literally cause the brain to bounce or twist inside the skull stretching and damaging the brain cells and causing chemical changes in the brain. These changes make the brain more vulnerable to any
increase in stress or injury until the body recovers, so a second blow or shock can have severe consequences.
“If you get hit from the side rather than head on it rotates your brain, which causes greater risks,” Prof. Molloy explained. “So boxers that get hit on the jaw from the side will get knocked out faster than receiving a direct blow to the head. Anything that forces the soft brain tissue against the skull will damage your brain.
“The most important thing for anyone, trained medically or not, is that if you see a collision in a game and think that a player is concussed, then get them out. It can be difficult to make that decision, particularly at professional level, in the heat of battle, but the right decision is to always to take them off.”
In January 2011, 14 year-old son Benjamin Robson died on a rugby pitch in Carrickfergus, Co. Antrim. At an inquest into his death in Belfast the pathologist said he believed he had died from ‘second impact syndrome’, two heavy knocks close to each other which caused swelling in the brain.
His mother Karen Walton had wanted him taken off at half time after he was involved in a number of heavy tackles. She has criticised rugby bodies over the prevailing attitudes towards concussion and called for stricter measures to be introduced.
“Concussion is a brain injury,” she said in an interview after the inquest last September.
“There’s still that old schoolboy mentality of ‘suck it up; get on with it. After a hit you’re in a daze anyway.’ And that is wrong. If you suspect concussion, get that child off and don’t return him to the match.”
In 2013, Barry O’Driscoll, Brian O’Driscoll’s uncle, resigned as a leading IRB (International Rugby Board) medical advisor due to its introduction of the controversial five-minute concussion assessment. He insisted that if a player is recognised as showing concussion symptoms he should be taken off.
“There needs to be zero tolerance on this, not varying degrees if you show signs you are concussed. Pure and simple,’ he told the Irish Daily Mail. “Doing a five-minute or a 10-minute assessment, it becomes completely arbitrary.
“The experts still don’t know exactly the full significance of concussion but every bit of research that is coming out is really bad news.
“There can be no messing about with the brain,” he said.
Game is faster
Prof. Molloy explained that although dangerous tackles such as charges or spear tackles (where a player is dropped on their head) have been banned in rugby and safety has improved, the game is faster and the players are bigger so risks do remain.
“The thing to remember is that contact doesn’t have to be with your head to give you concussion – any part of the body can carry the impulse which shakes your brain. The question for all of us is, if you do it frequently what are the long-term consequences and at this point we don’t know the answer to that, but we have fears and worries about the future in that area,” he said.
Everyone responds differently to concussion, but it is known that women are more vulnerable to it than men. A man’s neck is generally bigger and stronger than a women’s, which provides him with added protection. Their neck muscles are more developed and are better at absorbing the shock of impact.
Children are at a higher risk of serious injury than adults, even from trivial head contact. They get brain swelling rapidly, their condition deteriorates quickly and they can face long-term brain damage.
Unlike cuts and breaks, concussion can de difficult to identify. The person does not necessarily lose consciousness, but if they do then a neck injury must also be considered.
Symptoms include headaches, distorted vision, lack of balance, nausea, strange behaviour, agitation, amnesia and slow reaction times. Symptomscan reveal themselves immediately or not show up for hours or days later.
Prof. Molloy recommends using a SCAT (Sport Concussion Assessment Tool) or Maddock questionnaire to evaluate on the side-line if a player is concussed. The questionnaire consists of a list of simple questions to assess their awareness and checks for symptoms and signs of concussion. They are available online and from most sporting bodies.
“A second impact is always more severe,” so the most important thing is to get a player out of a game. “They shouldn’t drink or drive afterwards, and should be observed for at least 24 hours. They can be unsteady on their feet for 72 hours. They must not returnto play the same day. If it seems serious and you are worried, they should be brought to hospital,” he said.
“In my opinion there should always be someone trained in first aid. No contact sport should go ahead without a first aider present.”
It is difficult to calculate, but it is estimated that between 1.6 and 3.8 million concussions occur annually in sport and that in soccer about 80% of players never seek medical help.
Prof. Molloy thinks that the culture of sport needs to change to stop any bravado or a sense of heroism at continuing to play when injured. He would also like to see referees getting tougher on dangerous tackles. He said mouth guards and helmets are not enough. They only protect the teeth from damage and the head from fractures and cuts, not concussion.
However, he said rule enforcement can prevent dangerous play. “In soccer there was a problem that when the ball was in the air a player might get an elbow in the head from a defender. They stopped that by giving out red cards. One suggestion made for rugby some years ago was a mark across the jersey at nipple level and anything above that was a dangerous tackle and should get a red card,” he said.
Contact will always be a part of sport, but that does not mean that players have to risk brain damage as part of the game. A player’s life and future is more important than the final score.
Players need to protect themselves, and people involved in all sports at all levels should be educated in the signs, symptoms and dangers of concussion, and should encourage a cultural shift in attitudes towards it.
For more information on sports concussions see http://www.abiireland.ie/sports_concussion.html