Concussion in sport: a ticking time bomb?

One of the biggest cases in sport of late has been England Rugby Union international Mike Brown’s concussion. Following a bash to the head whilst playing for his country in last winter’s Six Nations Tournament, a recurrence of concussion signs meant the player was unable to take part in full-contact rugby for the rest of the season. Following a series of setbacks, Brown sensibly waited until he had been clear of symptoms for five weeks before resuming his playing career.

Shift in culture

Such a move would once have been unheard of in most contact sports, where the culture has always been to ‘play on’, with thoughts of sitting out a game seen as letting the side down. Mike Brown’s example suggests a shift in responsibility, with the player himself aware that playing in a less-than-100% state of physical fitness would let his teammates down far more, not to mention the potential damage he could be doing to himself.

The case of Brown’s fellow professional Ashley Smith – advised to retire at 28 due to concussion – and rugby league international Lance Hohaia – retired at 32 due to recurrent concussion symptoms – show that such head injuries in sport can end a career. Away from the professional game, such symptoms could easily result in job loss, with an individual unaware that their inability to perform at work is related to an earlier concussion in sport.

These examples of head injuries in rugby are from just one contact sport, but there are many others waking up to the reality of correctly-managing concussion in their game. In American Football, the game’s governing body recently made a pay-out to players following an estimate that 6,000 out of its 20,000 former competitors will develop a neurodegenerative problem as a result of on-field head collisions.

Difference at amateur level

The culture surrounding concussion in sport is certainly changing for the better from a professional perspective. In many sports, coaches are receiving concussion-training and strict guidelines are in place for any player receiving a bump to the head. However, it is hard to enforce recommended protocols at amateur level. With amateur teams rarely having medical staff close by, much depends on player discretion. In the time before proper worldwide regulations are made law, concussion incidents at present require responsibility from all involved, from player-level upwards.

The issue moving forward is to ensure that risks are minimised on the field, and any concussion in sport is dealt with correctly, both at the time of the incident and in the weeks/months following.

Concussion explained

Headway, the Brain Injury Charity, define concussion as a ‘minor brain injury…a temporary disturbance in the brain’s functioning as a result of a blow to the head’. It is important to note that having concussion does not necessarily mean that a person has been ‘knocked out’ or lost consciousness. Signs of a concussion can include headaches, changes in thought processes or changes in mood.

The real key to avoiding long-term damage is to be aware of such potential symptoms – even if one has been given the all-clear from a medical professional – and seek further help should they occur. As many concussion signs can mirror ‘everyday life’ feelings and emotions, it is easy to discount potential indicators as being down to tiredness and stress.

Getting a proper diagnosis at this point is essential. A secondary blow to the head at this stage will only exacerbate the existing problem. In terms of a contact sport such as rugby, the chances of a blow to the head are a distinct probability, and so risks of permanent damage high if the original concussion is not dealt with correctly.

Expert View

A single concussion as a result of a sporting or non-sporting injury such as a road traffic accident causes transient physiological changes within the brain and it is this which results in the symptoms experienced by the individual. Whilst there is still much to be learnt about concussive injuries it has become clear that:

• Certain individuals are at heightened risk of experiencing a concussion given an impact to the head. These include those under the age of 18 and above 50, women, people with a history of migraine and people with Attention Deficit Disorder or learning difficulties.
• Taking part in a variety of sports puts people at risk of experiencing concussion.
• Following a concussion there is a period of cerebral vulnerability which extends beyond the point at which the person reports being symptom free. During this time the brain is at heightened risk of experiencing another concussion which will result in more profound symptoms and which will take longer to recover.
• Symptoms of concussion include changes in thinking ability, behavioural and emotional problems as well as those associated with ocular (visual) and vestibular dysfunction (including balance). As a consequence of this Multidisciplinary assessment and rehabilitation is necessary.
• People can experience long lasting problems if they suffer repeated concussions that are poorly manged.

If managed appropriately the majority of people make a full and uncomplicated recovery from concussion. It is important, however, to identify the associated symptoms early and provide education and advice to maximise a positive outcome.

Between 20% to 40% of people can experience a complicated or prolonged recovery and treatment for these individuals should be offered according to their specific symptoms. Good management of concussive injuries reduces the severity and duration of symptoms and facilitates a timely return to normal activity.

Dr David Millar, Consultant Clinical Neuropsychologist

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