Concussions in rugby union

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Example of what happens to one's brain inside their skull, when they are impacted by an outside force. Concussion Anatomy.png
Example of what happens to one's brain inside their skull, when they are impacted by an outside force.

Concussions in professional rugby union are the most common injury received. [1] 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. [2]

Contents

History of concussions

A concussion, a subset of traumatic brain injury (TBI), defined as a force comes in contact with the head, neck or face, or fast movement of the head, causes a functional injury to the brain. [3] The severity of any injury depends on the location & strength of the impact. Concussions may result in acute or prolonged impairment of neurological function, the brains ability to process information, which may be resolved in seven to ten days. [1] A loss of consciousness is not a prerequisite for a concussion diagnosis, with blackouts occurring in less than 10% of concussions. [3] Second-impact syndrome is when a player has obtained a second concussion when you either return to field the same day, or return to play before a complete recovery from a previous concussion. This is a result from brain swelling, from vascular congestion and increased intracranial pressure, this can be fatal to a player as it is a very difficult medical injury to control. [4] The brain is surrounded by cerebrospinal fluid, which protects it from light trauma. More severe impacts, or the forces associated with rapid acceleration, may not be absorbed by this cushion. Concussion may be caused by impact forces, in which the head strikes or is struck by something, or impulsive forces, in which the head moves without itself being subject to blunt trauma (for example, when the chest hits something and the head snaps forward). Chronic traumatic encephalopathy, or "CTE", is an example of the cumulative damage that can occur as the result of multiple concussions or less severe blows to the head. The condition was previously referred to as "dementia pugilistica", or "punch drunk" syndrome, as it was first noted in boxers. The disease can lead to cognitive and physical handicaps such as parkinsonism, speech and memory problems, slowed mental processing, tremor, depression, and inappropriate behavior. It shares features with Alzheimer's disease.

In a 2013 interview, recently retired Scotland international Rory Lamont was critical of the then-current protocols for handling concussions, notably the Pitchside Suspected Concussion Assessment (PSCA) employed at that time::

The problem with the PSCA is a concussed player can pass the assessment. I know from first hand experience it can be quite ineffective in deciding if a player is concussed. It is argued that allowing the five-minutes assessment is better than zero minutes but it is not as clear cut as one might hope. Concussion symptoms regularly take 10 minutes or longer to actually present. Consequently the five-minute PSCA may be giving concussed players a license to return to the field. [5]

Connection with rugby union

Rugby Union training session, learning tackling techniques. England rugby union training session DSC 0440 1.jpg
Rugby Union training session, learning tackling techniques.

Rugby union has been played since the early 19th century. Being a high contact sport it has the highest announced rates of concussions [6] and outside England also has the highest number of catastrophic injuries [7] out of any team sport. [8] [9] Research finding that during match play, concussion was reported at a higher level, and during training at a lower level, but still at a higher level than most players of another sport to receive. [9] With the game being both physically and mentally demanding, it varies from being at high intensities of sprinting, tackling and rucking, with small intensities of jogging and walking. The position of the forwards consists of them having to have a lot of physical strength to get the ball from the other team, or create gaps for their team to run through. Where as the backs are the players that make the play happen, making runs with the ball, with the protection of the forwards stopping attacks, the backs still do get tackled like any other player on the field, so they have to have physical strength as much as a forward. The Concussion bin was replaced by the head bin in 2012 with the players assessment taking 10 minutes. [10]

About a quarter of rugby players are injured in each season. [11]

In the US, college rugby has much higher injury rates than college football. Rugby union has similar injury types to American football but with more common injuries of arms. [12]

Causes and likelihood of concussion

Concussion was the most commonly reported Premiership Rugby match injury in 2015-16 (for the 5th consecutive season), constituting appropriately 25% of all match injuries, and the RFU medical officer said that the tackle is where the overwhelming majority of concussions occur. [13] A study found that playing more than 25 matches in the 2015/2016 season meant that sustaining concussion was more likely than not sustaining concussion. [14]

Signs of concussion

Some of the effects that concussion can cause to an individual's mind set can vary, depending on the circumstances and the severity of the impact. The common signs of concussion can be; blank look, slow to get up off of the ground, unsteady on their feet, grabbing their head, confused in where they are or what they are doing, and obviously if they are unconscious. [15] These are the things that a spectator, coach and medical assistant will notice in a player. Sometimes concussion can go unrecognised, so from a players point there can be these symptoms; continual headaches, dizziness, visual problems, feeling of fatigue and drowsiness. [15] These all can occur post game, so a player needs to have knowledge of what these signs could mean.

Saliva testing

Although not commonly used at present, novel experimental methods to rapidly diagnose concussion in the field have been developed by research laboratories in the US and UK, based on the detection of RNA biomarkers in saliva. [16] [17]

Treatment of the injury

Once taken off the field of play due to possible concussion, being unconscious, or showing the symptoms post game, getting medical advice as soon as possible is recommended. At the hospital or medical practice, the player will be under observation, if they are experiencing a headache, mild pain killers will be given. The medical professional will request that no food or drink is to be consumed until advised. [18] They will then assess whether the player needs an x-ray, to check for any possible cervical vertebrae damage, or a computerised axial tomography (CT Scan) to check for any brain or cranium damage. [18] With a mild head injury being sent home to take care and doing activities slower than usual, and maintaining painkillers. If symptoms of concussion do not disappear in the average of seven to ten days, then seek medical advice again as injury could be worse. In post-concussion syndrome, symptoms do not resolve for weeks, months, or years after a concussion, and may occasionally be permanent. About 10% to 20% of people have post concussion syndrome for more than a month.

Controlling concussions

In order to minimise the risk of concussion and repetitive head trauma, the method of the 6 R's is used. [15] Firstly Recognising and Removing a suspected player of concussion, to stop the injury from getting worse. Secondly Refer, whether the player is either recognised or suspected with concussion they must see a medical doctor as soon as possible. 90.8% of players knew they should not continue playing when concussed. 75% of players would continue an important game even if concussed. Of those concussed, 39.1% have tried to influence medical assessment with 78.2% stating it is possible or quite easy to do so. If the player is diagnosed with concussion, they then must Rest, until all signs of concussion are gone. The player must then Recover by just returning to general activities in life, then progressing back to playing. Returning to play, must follow the Graduated Return to Play (GRTP) protocol, by having clearance from a medical professional, and no symptoms of concussion. [15] Despite good knowledge of concussion complications, management players engage in unsafe behaviour with little difference between gender and competition grades. Information regarding symptoms and management should be available to all players, coaches, and parents. On-going education is needed to assist coaches in identifying concussion signs and symptoms. Provision of medical care should be mandatory at every level of competition.

Effect of concussions on brain functioning in later life

A 2017 study found that past participation in rugby or a history of concussion were associated with small to moderate neurocognitive deficits after retirement from competitive sport. [19]

See also

Related Research Articles

<span class="mw-page-title-main">Sports injury</span> Physical and emotional trauma

Sports injuries are injuries that occur during sport, athletic activities, or exercising. In the United States, there are approximately 30 million teenagers and children who participate in some form of organized sport. Of those, about three million athletes age 14 years and under experience a sports injury annually. According to a study performed at Stanford University, 21 percent of the injuries observed in elite college athletes caused the athlete to miss at least one day of sport, and approximately 77 percent of these injuries involved the knee, lower leg, ankle, or foot. In addition to those sport injuries, the leading cause of death related to sports injuries is traumatic head or neck occurrences.

<span class="mw-page-title-main">Concussion</span> Type of traumatic brain injury

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.

In medicine, a stinger, also called a burner or nerve pinch injury, is a neurological injury suffered by athletes, mostly in high-contact sports such as ice hockey, rugby, American football, and wrestling. The spine injury is characterized by a shooting or stinging pain that travels down one arm, followed by numbness and weakness in the parts of the arms, including the biceps, deltoid, and spinati muscles. Many athletes in contact sports have suffered stingers, but they are often unreported to medical professionals.

Post-concussion syndrome (PCS), also known as persisting symptoms after concussion, is a set of symptoms that may continue for weeks, months, years after a concussion. PCS is medically classified as a mild traumatic brain injury (TBI). About 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury. Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults.

<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.

<span class="mw-page-title-main">Coup contrecoup injury</span> Type of head injury

In head injury, a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was hit. Coup and contrecoup injuries are associated with cerebral contusions, a type of traumatic brain injury in which the brain is bruised. Coup and contrecoup injuries can occur individually or together. When a moving object impacts the stationary head, coup injuries are typical, while contrecoup injuries are produced when the moving head strikes a stationary object.

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 Rivermead Post-Concussion Symptoms Questionnaire, abbreviated RPQ, is a questionnaire that can be administered to someone who sustains a concussion or other form of traumatic brain injury to measure the severity of symptoms. The RPQ is used to determine the presence and severity of post-concussion syndrome (PCS), a set of somatic, cognitive, and emotional symptoms following traumatic brain injury that may persist anywhere from a week, to months, or even more than six months.

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">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.

<span class="mw-page-title-main">Prevention of concussions</span>

Prevention of mild traumatic brain injury involves taking general measures to prevent traumatic brain injury, such as wearing seat belts, using airbags in cars, securing heavy furnitures and objects before earthquake or covering and holding under the table during an earthquake. Older people are encouraged to try to prevent falls, for example by keeping floors free of clutter and wearing thin, flat, shoes with hard soles that do not interfere with balance.

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 Australian sport</span>

Head injuries in sports of any level 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). 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, a dazed, blank or vacant look and/or confusion and unawareness of their surroundings. Of course the signs are relevant only after the player experiences a blow to the head.

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.

Patria Anne Hume is a New Zealand sports biomechanics academic. She is currently a full-time Professor of Human Performance at the Auckland University of Technology Sport Performance Research Institute New Zealand (SPRINZ) at AUT Millennium.

A pediatric concussion, also known as pediatric mild traumatic brain injury (mTBI), is a head trauma that impacts the brain capacity. Concussion can affect functional, emotional, cognitive and physical factors and can occur in people of all ages. Symptoms following after the concussion vary and may include confusion, disorientation, lightheadedness, nausea, vomiting, blurred vision, loss of consciousness (LOC) and environment sensitivity. Concussion symptoms may vary based on the type, severity and location of the head injury. Concussion symptoms in infants, children, and adolescents often appear immediately after the injury, however, some symptoms may arise multiple days following the injury leading to a concussion. The majority of pediatric patients recover from the symptoms within one month following the injury. 10-30% of children and adolescents have a higher risk of a delayed recovery or of experiencing concussion symptoms that are persisting.

References

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  2. ↑ "American football or rugby: which is more dangerous? | Sport | The Guardian". TheGuardian.com . 28 January 2013.
  3. 1 2 "World Rugby Player Welfare – Putting Players First : World Rugby Concussion Guidance for the General Public". playerwelfare.worldrugby.org. Retrieved 2 September 2015.
  4. ↑ "Brain Injury in Sports". www.headinjury.com. Retrieved 2 September 2015.
  5. ↑ Lamont, Rory (19 December 2013). "Players are deliberately cheating concussion tests". ESPN Scrum. Retrieved 26 December 2013.
  6. ↑ "High school rugby cancelled across Nova Scotia due to safety concerns | CBC News".
  7. ↑ "Rugby Player Welfare, Part 2: 'Rugby Is Not the NFL'...Not Yet, Anyway | Bleacher Report | Latest News, Videos and Highlights". Bleacher Report .
  8. ↑ "What Sport Has The Most Concussions? | Concussion Rate". 6 December 2018.
  9. 1 2 Gardner, Andrew J; Iverson, Grant L; Williams, W. Huw; Baker, Stephanie; Stanwell, Peter (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. PMID   25138311. S2CID   23808676.
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  11. ↑ "Rugby Injuries".
  12. ↑ Willigenburg, Nienke W.; Borchers, James R.; Quincy, Richard; Kaeding, Christopher C.; Hewett, Timothy E. (March 2016). "Comparison of Injuries in American Collegiate Football and Club Rugby: A Prospective Cohort Study - Nienke W. Willigenburg, James R. Borchers, Richard Quincy, Christopher C. Kaeding, Timothy E. Hewett, 2016". The American Journal of Sports Medicine. 44 (3): 753–760. doi:10.1177/0363546515622389. PMID   26786902. S2CID   21829142.
  13. ↑ "Premiership Rugby |".
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  15. 1 2 3 4 "Concussion Guidelines". www.rugby.com.au. Retrieved 2 September 2015.
  16. ↑ "Saliva RNA Biomarkers Show Promise to Predict Concussion Duration and Detect Symptom Recovery". Cision PR Newswire. Retrieved 25 October 2021.
  17. ↑ Belli, Antonio; Pietro, Valentina Di. "Concussions in sport can now be rapidly diagnosed using spit – new research". The Conversation. Retrieved 25 October 2021.
  18. 1 2 "Head injury – home care tips – Better Health Channel" . Retrieved 2 September 2015.
  19. ↑ Hume, Patria A; Theadom, Alice; Lewis, Gwyn N; Quarrie, Kenneth L; Brown, Scott R; Hill, Rosamund; Marshall, Stephen W (2016). "A Comparison of Cognitive Function in Former Rugby Union Players Compared with Former Non-Contact-Sport Players and the Impact of Concussion History". Sports Medicine. 47 (6): 1209–1220. doi:10.1007/s40279-016-0608-8. PMID   27558141. S2CID   22837169.
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