Concussions in Australian sport

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Head injuries in sports of any level (junior, amateur, professional) are the most dangerous kind of injuries that can occur in sport, and are becoming more common in Australian sport. Concussions are the most common side effect of a head injury and are defined as "temporary unconsciousness or confusion and other symptoms caused by a blow to the head." A concussion also falls under the category of Traumatic Brain Injury (TBI). [1] Especially in contact sports like Australian rules football and rugby, issues with concussions are prevalent, and methods to deal with, prevent and treat concussions are continuously being updated and researched to deal with the issue. Concussions pose a serious threat to the patients’ mental and physical health, as well as their playing career, and can result in lasting brain damage especially if left untreated. The signs that a player may have a concussion are: loss of consciousness or non-responsiveness, balance problems (unsteadiness on feet, poor co-ordination), a dazed, blank or vacant look and/or confusion and unawareness of their surroundings. [2] Of course the signs are relevant only after the player experiences a blow to the head.

Contents

Dangers of concussion

In the short term, concussions do not pose a serious problem and a player suffering may experience: headache, dizziness, loss of memory, blurred vision, confusion, disorientation and /or sensitiveness to bright light and loud noises. [3] However, the real danger occurs after repeated concussions suffered by the same player, if the player returns to play immediately after contracting a concussion or too soon after suffering one. If the player returns to play immediately or too soon after, there is an increased risk of another concussion (which is much more serious) as well as to the rest of the body due to a slower reaction time. The player can also suffer from a number of psychological issues like depression, as well as permanent brain damage and severe brain swelling. [2] A player, regardless of age or level of competition, should not return to play or training following a concussion, without a medical clearance from a registered medical doctors.

AFL

One of the all-time great AFL players, Jonathon Brown's career was cut short after a series of life-threatening head knocks. Jonathan Brown.jpg
One of the all-time great AFL players, Jonathon Brown's career was cut short after a series of life-threatening head knocks.

In a high-impact game like Australian Rules Football, head injuries and concussions have always been common, but public awareness has risen over the last decade towards the dangers of continuing to play while suffering from a concussion. It is estimated that there are 5–6 players who suffer a concussion for every 1000 hours spent on the field, meaning there are 6–7 concussions per team during one season. [4] Previously, players at the elite level, either realised they would be pulled out of the game if they were identified as concussed hid the fact from coaches and continued to play, but recently the AFL released new concussion management guidelines to combat the issue. Now, only a medical officer with previous experience in the subject may declare the player fit to play, also the coaches are warned against rushing their players back into the team after suffering a concussion. The guidelines also dictate that immediately, or as soon as possible, after a player suffers a concussion, or is suspected of suffering from one, they must be subjected to a medical assessment after which they may or may not be allowed to return to the field depending on the results. [5] Introduced in 2013 in the AFL, a player suspected of having a concussion must take a 20 minute concussion test. Introduced in 2021 in the AFL, after receiving a concussion, the player must not play in a match for 12 days, unless declared fit to play by an experienced doctor.

The occurrence of concussions in amateur leagues are less common because of the lower impact intensity.[ citation needed ] However, concussions suffered at amateur levels can at times be more dangerous than those suffered in the AFL because of the inferior resources possessed and in some cases the coaches are not willing to pull a player out of the game, or rest them if they are suffering from a concussion. [6] A study conducted by the Australian Football Injury Prevention Project (AFIPP) in 2002 showed that out of 301 players (who play for amateur clubs in the Melbourne metropolitan area), 14 suffered from a form of head knock, 7 of which resulted in concussion. [7] 18.9% of players participating in the test suffered from concussion, bearing in mind that the sample size is also small.

A separate study showed that out of 1015 Australian Rules Football players tested, 78 of them were concussed, 9 of which were concussed multiple times. The players mental functions were tested at controlled intervals with 38.6% of players still displaying symptoms at 48 hours after being concussed but after 96 hours, only 1.1% displayed any symptoms. [8]

Cricket

Cricket is classified differently to high intensity sports like Australian rules football and rugby, due to the stop-start nature of the game rather than continuous flowing play. However, due to the speed of fast bowlers and the hardness of cricket balls, cricket is still very much a high impact sport. Out of all Australian sporting codes, cricket requires the most protective gear to properly guard batsmen from a variety of injuries that can be afflicted all over the body. The most important piece of protective gear is the helmet, which includes a grill covering the face, to protect batsmen from head injuries. In the most recent Australian tour of the West Indies, now former Australian batsmen Chris Rogers suffered a concussion during training and was ruled out of the test series without playing a match. This has led Cricket Australia to plan out an updated concussion policy and guidelines [9] The principles are based on the International Consensus Conferences on Concussion in Sport (the Zurich Guidelines) and involve the player suspected of being concussed answering a set of questions to determine whether he has to leave the field. While concussion in cricket is considered quite rare due to increasingly safer helmets, the effects can be quite severe. NSW batsmen Ben Rohrer was struck in the head by a cricket ball during a Sheffield Shield match against Victoria in November last year, he recalls his legs feeling like jelly and falling over on the pitch. [10] The most widely known case is the death of NSW batsmen Phillip Hughes who died after being receiving a cricket ball to the head in 2014.

A study conducted with 542 junior cricket players revealed only 13% of injuries were limited to the facial region, and none of them suffered a concussion. [11]

Rugby

High intensity, high impact and played by men with big bodies, rugby is an extremely physical game where concussions are common. Brisbane Broncos vs Bulldogs 1.jpg
High intensity, high impact and played by men with big bodies, rugby is an extremely physical game where concussions are common.

Most popular in New South Wales and Queensland, rugby can be classified into two different codes, rugby union and rugby league. Both are played at a very high level of intensity with full contact allowed, and as such has one of the highest concussion rates in the world, let alone Australia. Studies conducted into the incidence of concussion in professional and amateur levels of rugby have revealed that approximately 3.9 concussions per 1000 hours of play occur in professional rugby (1 concussion in every 6 games). Playing at the amateur level, concussion rates are much lower measured at 1 in every 21 matches (1.2 per 1000 hours). This amounts to roughly 5–7 concussions per team per season. [12]

The National Rugby League released a 4 step set of guidelines, in 2012, for all coaches to follow in the case one of their players suffering a concussion during a game. The guidelines detail that the player be given basic first aid before being assessed by a medical officer, they also stress heavily that if the player is determined to be concussed there is no way the player should return to the field. if the concussion is serious, the player should be sent as soon as possible to hospital for medical treatment. [2]

Wearing protective gear, such as a helmet and mouthguard, can reduce the chances of sustaining a concussion.

Concussions in children

The occurrence of concussion in children during sport is significantly more likely compared to other levels of athletes. Roughly 20% of children playing sport are diagnosed with concussion. Despite the lower level of impact compared to the professional or amateur levels, children's neck muscles are quite weak and most lack the awareness and skill level to cushion or prepare themselves for a blow leading to a high concussion rate. [13] The guidelines and protocols for a child suffering a concussion are basically the same as if an adult received one.

For a child diagnosed with a concussion, the real issue is returning to school rather than the sporting field, as a concussion can affect a child's learning ability. A medical clearance is required before a return to school is possible and parents are recommended to properly manage their child through the first 72 hours after experiencing a concussion. [14]

See also

Related Research Articles

<span class="mw-page-title-main">Concussion</span> Medical condition

A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of consciousness; memory loss; headaches; difficulty with thinking, concentration, or balance; nausea; blurred vision; dizziness; sleep disturbances, and mood changes. Any of these symptoms may begin immediately, or appear days after the injury. Concussion should be suspected if a person indirectly or directly hits their head and experiences any of the symptoms of concussion. Symptoms of a concussion may be delayed by 1–2 days after the accident. It is not unusual for symptoms to last 2 weeks in adults and 4 weeks in children. Fewer than 10% of sports-related concussions among children are associated with loss of consciousness.

<span class="mw-page-title-main">Sports medicine</span> Branch of medicine for sports injuries

Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the late 20th century that sports medicine emerged as a distinct field of health care. In some countries, sports medicine is a recognized medical specialty. In the majority of countries where sports medicine is recognized and practiced, it is a physician (non-surgical) specialty, but in some, it can equally be a surgical or non-surgical medical specialty, and also a specialty field within primary care. In other contexts, the field of sports medicine encompasses the scope of both medical specialists as well as allied health practitioners who work in the field of sport, such as physiotherapists, athletic trainers, podiatrists and exercise physiologists.

A substitute in the sport of cricket is a replacement player that the umpires allow when a player has been injured or become ill, after the nomination of the players at the start of the game. The rules for substitutes appear in Law 24 of the Laws of Cricket.

Australian rules football is a sport known for its high level of physical body contact compared to other ball sports such as soccer and basketball. High-impact collisions can occur from any direction, although deliberate collisions sometimes occur from a front-on direction. In addition, players of the code typically wear no protective padding of any kind except for a mouthguard or, occasionally, a helmet. As such, injury rates tend to be high.

<span class="mw-page-title-main">Chronic traumatic encephalopathy</span> Neurodegenerative disease caused by head injury

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repeated trauma to the head. The encephalopathy symptoms can include behavioral problems, mood problems, and problems with thinking. The disease often gets worse over time and can result in dementia.

Second-impact syndrome (SIS) occurs when the brain swells rapidly, and catastrophically, after a person has a second concussion before symptoms from an earlier one have subsided. This second blow may occur minutes, days, or weeks after an initial concussion, and even the mildest grade of concussion can lead to second impact syndrome. The condition is often fatal, and almost everyone who is not killed is severely disabled. The cause of SIS is uncertain, but it is thought that the brain's arterioles lose their ability to regulate their diameter, and therefore lose control over cerebral blood flow, causing massive cerebral edema.

Concussion grading systems are sets of criteria used in sports medicine to determine the severity, or grade, of a concussion, the mildest form of traumatic brain injury. At least 16 such systems exist, and there is little agreement among professionals about which is the best to use. Several of the systems use loss of consciousness and amnesia as the primary determinants of the severity of the concussion.

The fencing response is an unnatural position of the arms following a concussion. Immediately after moderate forces have been applied to the brainstem, the forearms are held flexed or extended for a period lasting up to several seconds after the impact. The fencing response is often observed during athletic competition involving contact, such as combat sports, American football, Ice hockey, rugby union, rugby league and Australian rules football. It is used as an overt indicator of injury force magnitude and midbrain localization to aid in injury identification and classification for events including on-field and/or bystander observations of sports-related head injuries.

<span class="mw-page-title-main">Brad Sheppard</span> Australian rules footballer (born 1991)

Bradley Sheppard is a former Australian rules footballer who played for the West Coast Eagles in the Australian Football League (AFL). He was selected seventh overall in the 2009 National Draft.

<span class="mw-page-title-main">Health issues in youth sports</span>

The health issues of youth sports are concerns regarding the health and wellbeing of young people between the ages of 6 and 18 who participate in an organized sport. Given that these athletes are physically and mentally underdeveloped, they are particularly susceptible to heat illness, eating disorders and injury; sufficiently severe conditions can result in death. Awareness and prevention are key factors in preventing many health issues in youth sports.

Concussions and play-related head blows in American football have been shown to be the cause of chronic traumatic encephalopathy (CTE), which has led to player deaths and other debilitating symptoms after retirement, including memory loss, depression, anxiety, headaches, stress, and sleep disturbances.

Concussions, a type of mild traumatic brain injury, are a frequent concern for those playing sports, from children and teenagers to professional athletes. Repeated concussions are known to cause neurological disorders, particularly chronic traumatic encephalopathy (CTE), which in professional athletes has led to premature retirement, erratic behavior and even suicide. A sports-related concussion is defined as a "complex pathophysiological process affecting the brain, induced by biomechanical forces". Because concussions cannot be seen on X-rays or CT scans, attempts to prevent concussions have been difficult.

A sports-related traumatic brain injury is a serious accident which may lead to significant morbidity or mortality. Traumatic brain injury (TBI) in sports are usually a result of physical contact with another person or stationary object, These sports may include boxing, gridiron football, field/ice hockey, lacrosse, martial arts, rugby, soccer, wrestling, auto racing, cycling, equestrian, rollerblading, skateboarding, skiing or snowboarding.

A traumatic brain injury (TBI) is a blow, jolt or penetration to the head that disrupts the function of the brain. Most TBIs are caused by falls, jumps, motor vehicle traffic crashes, being struck by a person or a blunt object, and assault. Student-athletes may be put at risk in school sports, creating concern about concussions and brain injury. A concussion can be caused by a direct blow to the head, or an indirect blow to the body that causes reactions in the brain. The result of a concussion is neurological impairment that may resolve spontaneously but may also have long-term consequences.

<span class="mw-page-title-main">Concussions in rugby union</span> Risk of concussion from playing rugby union

Concussions in professional rugby union are the most common injury received. Concussion can occur where an individual experiences an impact to the head, and are also notable in high-contact sports, including American football, boxing, MMA and Hockey. Concussions can occur in recreational activities like horse riding, jumping, cycling, and skiing as a result of forceful rotational moment, resulting in injuries to the brain due to the contact with the skull, giving the skull not enough time to move with the body, causing the brain to press against the skull. With the development of equipment and training methods, further education on identifying concussion symptoms, aswell as adjustments to the terms of contact may allow players to make more informed decisions on their conduct on the pitch.

Head injuries in the Australian Football League (AFL) is a controversial topic with many players sustaining head related injuries during the AFL season, some of these being caused by the players themselves "ducking" their heads in order to receive high contact which warrants a free kick. One of the most common forms of head injury sustained in the AFL is concussion, which will affect about 6-7 players per team, per season. The reason head injuries are a big concern is that they relate to an increased probability to developing forms of cognitive impairment such as; depression and dementia later in life.

<span class="mw-page-title-main">James Calder (orthopaedic surgeon)</span> British orthopaedic surgeon

James David Forbes Calder is a British orthopaedic surgeon specialising in sporting injuries. He has built a reputation for treating foot and ankle injuries in top international athletes - soccer players from the English Premier League and European clubs including Paris St Germain, AC Milan, Barcelona FC, Real Madrid, Olympique de Marseille FC in addition to rugby players from England, Ireland, Scotland and Wales, GB Olympic teams, England and Indian cricket teams and UK Athletics.

Most documented cases of chronic traumatic encephalopathy have occurred in many athletes involved in contact sports such as boxing, American football, wrestling, ice hockey, mixed martial arts, rugby and soccer. Other risk factors include being in the military, prior domestic violence, and repeated banging of the head. The exact amount of trauma required for the condition to occur is unknown. Below is a list of notable cases of CTE in sports.

<span class="mw-page-title-main">Australasian College of Sport and Exercise Physicians</span>

The Australasian College of Sport and Exercise Physicians (ACSEP) is a not-for-profit professional organisation responsible for training, educating, and representing over 350 doctors in Australia and New Zealand. These doctors practise medicine in the specialty of sport and exercise medicine (SEM). The ACSEP is the smallest of the 15 recognised specialist medical Colleges in Australia with approximately 260 Fellows and Registrars in 2020. Australia and New Zealand, along with the UK, have been cited as pioneer countries in the establishment of SEM as a stand-alone specialty.

<span class="mw-page-title-main">John Orchard (doctor)</span> Australian sport and exercise medicine physician (born 1967)

John Orchard FACSEP is an Australian sport and exercise medicine physician, notable for advocating for rule changes in sport to improve player safety. In 2020 he was awarded a Member of the Order of the Order of Australia for significant service to sports medicine, particularly cricket. He was a member of the Australian government advisory group for sport responding to COVID, representing professional sport as the Chief Medical Officer for Cricket Australia and was instrumental in cricket's response to COVID. During 2023, he worked as the General Medical Officer for Australia at the FIFA Women's World Cup.

References

  1. ↑ Makdissi, Michael (2010). "Sports Related Concussion – Management in General Practice". Australian Family Physician. 39 (1–2): 12–17. PMID   20369128.
  2. 1 2 3 "Management of Concussion in Rugby League".{{cite journal}}: Cite journal requires |journal= (help)
  3. ↑ "What is concussion?". www.concussioninsportproject.com.au. Archived from the original on 4 March 2016. Retrieved 1 September 2015.
  4. ↑ Khurana, Vini G.; Kaye, Andrew H. (1 January 2012). "An overview of concussion in sport". Journal of Clinical Neuroscience. 19 (1): 1–11. doi:10.1016/j.jocn.2011.08.002. PMID   22153800. S2CID   6443393.
  5. ↑ "AFL Community: Concussion". www.aflcommunityclub.com.au. Retrieved 1 September 2015.
  6. ↑ Newton, Joshua D.; White, Peta E.; Ewing, Michael T.; Makdissi, Michael; Davis, Gavin A.; Donaldson, Alex; Sullivan, S. John; Seward, Hugh; Finch, Caroline F. (1 January 2014). "Intention to use sport concussion guidelines among community-level coaches and sports trainers". Journal of Science and Medicine in Sport. 17 (5): 469–473. doi:10.1016/j.jsams.2013.10.240. hdl:1959.17/42173. PMID   24252427.
  7. ↑ Braham, R; Finch, CF; McCrory, P (1 January 2004). "The incidence of head/neck/orofacial injuries in non-elite Australian Football". Journal of Science and Medicine in Sport. 7 (4): 451–453. doi:10.1016/s1440-2440(04)80263-9. PMID   15712501.
  8. ↑ Makdissi, Michael; Darby, David; Maruff, Paul; Ugoni, Antony; Brukner, Peter; McCrory, Paul R. (1 March 2010). "Natural History of Concussion in Sport Markers of Severity and Implications for Management". The American Journal of Sports Medicine. 38 (3): 464–471. doi:10.1177/0363546509349491. ISSN   0363-5465. PMID   20194953. S2CID   2667502.
  9. ↑ "Cricket Australia to roll out new concussion policy across country this summer" . Retrieved 2 September 2015.
  10. ↑ "Cricket Australia trialling 'very conservative' guidelines on concussion" . Retrieved 2 September 2015.
  11. ↑ Finch, Caroline F.; White, Peta; Dennis, Rebecca; Twomey, Dara; Hayen, Andrew (1 January 2010). "Fielders and batters are injured too: A prospective cohort study of injuries in junior club cricket". Journal of Science and Medicine in Sport. 13 (5): 489–495. doi:10.1016/j.jsams.2009.10.489. PMID   20031485.
  12. ↑ Gardner, Andrew J.; Iverson, Grant L.; Williams, W. Huw; Baker, Stephanie; Stanwell, Peter (20 August 2014). "A Systematic Review and Meta-Analysis of Concussion in Rugby Union". Sports Medicine. 44 (12): 1717–1731. doi:10.1007/s40279-014-0233-3. ISSN   0112-1642. PMID   25138311. S2CID   23808676.
  13. ↑ "Management of Concussion in Children". www.concussioninsportproject.com.au. Archived from the original on 4 March 2016. Retrieved 2 September 2015.
  14. ↑ McNamee, M.J.; Partridge, B. & Anderson, L (2015). "Concussion in Sport: Conceptual and Ethical Issues". Kinesiology Review (4 ed.). 4 (2): 190–202. doi:10.1123/kr.2015-0011.
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