As the 2016 rugby and hockey seasons are upon us, I thought I’d share a few thoughts about concussion as this condition is often not always managed optimally. As these sports evolve, players are generally becoming bigger, fitter and faster, and games are played at a greater intensity. It is believed that at least 15% of high school rugby players will suffer a concussive episode in any one season, and many of these are not recognised or diagnosed.
The first important point to note is that concussion is a functional injury to the brain, not a structural one meaning that a brain scan (CT or MRI) is invariably normal. The diagnosis of concussion is primarily a clinical one, and brain scans are only requested by your doctor if more serious structural damage to the brain, like an intracerebral bleed, is suspected; in which case this is no longer classified as concussion. It is also often mistakenly thought that one has to be knocked out to have suffered a concussion. This is not so and merely seeing stars after a knock may be diagnostic.
All concussed players should be seen by a doctor, primarily to determine whether referral to hospital is necessary, and secondarily for advice to be offered regarding the short term care of the concussed individual. As the brain is affected, patients are usually advised to rest completely until all symptoms of the concussion have resolved. This rest applies to both physical and mental activity and schoolwork, computer games, watching TV and similar activities must be discouraged for the initial few days. For players 18 years old and younger, a minimum 2 week mandatory rest period is enforced. Thereafter, once the player has recovered completely in terms of any symptoms, a computerised neuropsychological test like Impact should be conducted to support the clinical decision. Should the results of this test be normal, the player can then resume a stepwise return to play protocol involving increasing the intensity of training over a 5 day period. Should the player’s symptoms not recur during this time, then he/she will be declared fit to participate in contact sport again. World Rugby encourages all concussed players to be cleared by an appropriately qualified doctor before returning to play.
There are no shortcuts to managing concussion and doctors often have to resist the persuasive efforts of some parents and coaches to allow their son or daughter to play again prematurely. A concussive episode sensitises the brain to further damage both in the short term and in the long term, and it is certainly not in the player’s, parents’, coaches or team’s best interests to take this risk.
Fortunately 80-90% of concussions resolve within three weeks – this is a relatively short time to sit out considering the potential implications of returning to play too soon. For more detailed information on concussion go to http://boksmart.co.za/content/concussion.
Dr Glen Hagemann
MBChB. Dip Anaes. MedSci
031 – 312 1136 or
031 – 312 7506