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Don’t Underestimate a Rugby Concussion

Whether it’s the result of a blow to the head, bad fall or hard tackle, a concussion is an invisible injury. But if the sufferer’s brain isn’t given time to recover, they could experience long-term consequences.

‘Repeated concussions can result in dementia-like symptoms years after injury, a condition known as chronic traumatic encephalopathy,’ says Dr Jannelene Killops,  Clinical head of the Mediclinic Events Department.

‘It’s a myth that you need to lose consciousness to be diagnosed with a concussion. If you have abnormal balance, confusion, disorientation, behavioural changes,  and abnormal eye movements, you  have suffered a concussion.’

Concussion protocols need to be in place to protect players and ensure that they safely return to sport. The rugby governing bodies in South Africa have systems in place that make concussion safety and education available to everyone. The BOKSMART programme, in particular, is a wonderful resource for athletes, coaches and anyone working with rugby players.

Although concussion cannot be detected via a medical scan, it is still a serious condition. Knowing the signs and symptoms could save someone’s life.

Concussion assessment is best performed by healthcare practitioners that are experienced in managing a concussion, and take into account memory, balance, concentration and examination for head and neck injury. It is essential that players return to play in a graded approach once they are symptom-free. Children (i.e. 19 and under) are more susceptible to long-term complications and should be removed from play if a concussion is suspected and then assessed by the appropriately experienced healthcare practitioner.

Schools can have an incredible impact on the prevention of long-term injuries. Parents should inquire at schools to ensure that children who play contact sports have systems in place to support them if they suffer a concussion. The impact of concussion on learning and exams should also be addressed.

Recovery consists of six stages.

Initially physical and cognitive rest is recommended until players are symptom-free. Players 19 years or younger need to rest for a minimum of two weeks. For players older than 19, a minimum of one week off the field is needed. Players must be symptom-free before commencing graded return to play. Children should not return to sport until they are back at school and have returned to normal learning without symptoms.

They should be allowed to attend shorter days at school, be given more time for assignments, quieter learning spaces, allowed more breaks and be given lots of reassurance from their teachers that symptoms will get better and that they will be supported.

Players can only progress to the following stage if they are symptom-free and at least 24 hours should pass before progression to the next stage.

Stage 1 is normal daily activities that don’t provoke symptoms.

Stage 2 is a light aerobic exercise for at a slow to medium pace to increase heart rate. The player must not do any resistance training.

Stage 3  The player is exposed to sport specific exercise such as running drills, here players increase heart rate and add movement but potential head impact activities must be avoided.

Stage 4 means the player can combine non-contact exercise, coordination and decision-making. This could be passing drills, should this not cause symptoms progressive resistance training can be included.

Stage 5 is normal training activities, including full contact practice and participation in normal training, this aims to restore the confidence of the athlete and allows the coach to do functional testing.

Stage 6 is returned to normal gameplay, and a medical doctor experienced in concussion needs to give the go-ahead prior to the player returning to the normal sport.