“For the first time, we have clear evidence that repeated head knocks in rugby league can have a devastating impact many years after the concussion occurs.” Dr. Alan Pearce, La Trobe University
Let’s talk about concussion management following the alarming results from a study conducted at La Trobe University in Melbourne. The study was led by concussion expert Dr Alan Pearce and involved 25 former NRL players who suffered concussions from the late 1980s to 1990s, including rugby league legend Ian Roberts. He had his first concussion at 13 years old and reports being heavily concussed over a dozen times throughout this 12-year rugby career. The study looked at how these players, now aged 40-65 years old have fared 20 years following their last concussion within competition compared to a control group of 25 similar aged men with no history of concussion or brain injury.
Tests in the study looked at memory, short-term learning and attention, reaction time and fine motor skills. Results found a significant difference in the brain function of the NRL players compared with the control group with the players showing a significantly large difference with:
- 40-50% worse on overall cognitive testing
- 122% worse in learning a new task
- 98% worse with memory skills (pattern recall skills)
- 14% slower with dexterity test (fine motor skills)
- 11% slower with reaction time
Dr Pearce also conducted a similar study in 2014, looking at retired AFL and amateur footballers who had suffered repeated concussions. Results of this study found notably worse performance with fine motor skills and reaction times compared to healthy controls who had never suffered from a concussion or brain injury.
Is recovery possible?
Dr Pearce hopes that his recent results could be used to start a rehabilitation program, using neuroplasticity (our brain’s ability to “rewire” and reorganise itself by forming new neural connections). “We have seen this in other areas, such as stroke and Parkinson’s. Where you do exercise therapy, we do get some improvement,” Dr Pearce has said.
The management of concussion has changed
It is recent findings like this that raise serious questions and awareness around concussion management in contact sports. Concussion management has come a long way since the 1980s/1990s. Back then it wasn’t considered an injury at all with many players and sportspeople even viewing concussion as a “badge of honor”. We now know that concussions need to be taken very very seriously, and it is important international best practice is adopted in their management.
All contact sports come with the potential risk of a concussion injury, and any player who sustains a concussion is at risk of short term and long term consequences. We have put together some information for coaches, players, parents and spectators about what to look for if you suspect a concussion and how to manage it. It is impossible to eliminate all of the risks associated with contact sport however with awareness and education the risk and potential effects of serious head injuries can be reduced.
What is concussion?
Concussion is a type of mild-traumatic brain injury that occurs as a result of a direct impact to the head or can even occur from an impact to anywhere else in the body that causes transmission of forces to the head and brain. A hard knock is not always required, it can even occur from a minor knock. It commonly causes short-lived disturbances in brain function, usually a temporary loss in skills such as memory and thinking.
This can be difficult as the symptoms and signs are variable, non-specific and may be subtle. It is important to know that concussions can be instant or delayed and gradual – even up to 72 hours after the impact! You do not have to be a trained health professional to recongise a person with a concussion. You simply need to able to:
- Recognise the signs and symptoms
- Remove the player from sport (immediately and no return to play on the same day)
- Refer them to medical care
The intentionally recommended Sport Concussion Assessment Tool (SCAT 3) identifies 22 possible symptoms to look for when suspecting concussion:
The Pocket Concussion Recognition Tool can be helpful to support an appropriate assessment. Take a look below.
The player is concussed – what next?
The next step is to refer the stable player to a doctor for a diagnosis and guidance in relation to appropriate management, rehabilitation and return to play. Any player with a suspected or confirmed concussion should remain in the company of a responsible adult at all times and should not be allowed to drive. Concussed players are advised to avoid alcohol and check medications with their doctor (especially avoiding aspirin, anti-inflammatories, sleeping tablets and sedating medications).
If the person with a suspected concussion shows of any of the following signs or symptoms:
- Loss of consciousness or seizures,
- Neck pain,
- Weakness, numbness or tingling down their arms or legs,
- Increasing confusion or irritability,
- Deterioration in symptoms (e.g. severe or increasing headache, drowsiness or repeated vomiting)
- Double vision
You should not move the player and call an ambulance immediately. These features suggest more serious injury that needs urgent medical attention.
In the first few hours to days after a concussion, the brain is in a vulnerable state. This is why there are strict rules when it comes to rest and gradual return to activities of daily living. Management will involve prescribed physical and cognitive rest.
Rest is vital during the recovery period
Rest means time off school/work and no cognitive activity – no reading, no TV, no computer and no hand held electronic devices. There must be complete cognitive and physical rest until symptoms have completely gone. The majority of concussion symptoms should resolve in 7-10 days. After a minimum of 24 hours without any symptoms, the concussed player is usually able to commence a gradual return program to cognitive and physical activity. This individualised program should be devised with your doctor to ensure a safe return to activities and eventually play and that recurrent symptoms do not occur.
Young brains are particularly susceptible to concussion and may take longer to recover with a more conservative (extended) return to activity program needed. For children and adolescents, a return to learn takes priority over return to sport. Even returning to school too soon can sometimes re-aggravate the concussion symptoms. A school program may be introduced with modified hours, more regular breaks and longer time to complete tasks for children following a concussion. It is recommended that a minimum of 14 days from the resolution of all symptoms is taken for any child returning to contact training, sport or play.
It is very important that all players with suspected concussions are managed appropriately, and remember
“if in doubt, sit them out”
You can read more about concussion management at:
- Sports Medicine Australia website: https://sportconcussion.com.au/
- Australian Institute of Sport and Australian Medical Association Concussion in Sport Position Statement: https://ama.com.au/sites/default/files/documents/AMA_AIS_Concussion%20in%20Sport%20Position%20Statement%202016.pdf
You can access and read the full study by Dr. Pearce at La Trobe University here: https://www.researchgate.net/publication/322590213_Neurophysiological_and_cognitive_impairment_following_repeated_sports_concussion_injuries_in_retired_professional_rugby_league_players