Tackling head, neck injuries
The SA Rugby Union's Boksmart department has issued an important statement on head and neck injuries. In it it says: To tackle concussion effectively, if in doubt, sit the player out!
Simply put, concussion is a minor traumatic injury to the brain. Concussion seldom results from a direct blow to the brain, but rather from a direct or indirect blow to the head which causes the brain to move within the skull. This movement results in the brain accelerating in a forward, backward or rotational direction. Although linear (forward, backward) acceleration has a role to play, it is mostly the rotational acceleration that causes the temporary disruption to the functioning of the nerves (neurons) of the brain; this is known as a concussion. The brain therefore does not have to strike the skull for a player to suffer a concussion.
Where a player undergoes a ‘whiplash’ action, there might be no indication of a direct blow to the head at all, but the player may still show signs and symptoms of concussion. For example where a player is running forward and is suddenly stopped in a collision or driven backwards in a direct high-impact front-on tackle, it is possible that this player can also be concussed. This can damage some of the tiny blood vessels and nerve fibers, thereby temporarily stopping the brain from working properly.
When the brain does strike the skull or where the forward, backward or rotational forces aregreat enough to cause damage to the membranes surrounding the brain, or the blood vessels supplying blood to the brain; it can lead to a more serious situation. Here the brain can swell, and being in a confined space inside the bony skull, this situation, if left unmanaged can become serious, and therefore the need to see a medical doctor as soon as possible after the event.
These, however are very seldom found in rugby!
Time-loss injuries are when the player had to miss either a match or at least one day of normal or planned rugby activities. Time-loss injuries due to concussion, in the South African Rugby Union Youth weeks last year, ranged from 13 – 38% of all Time-loss injuries reported at these tournaments, depending on the level of the game. The higher 38% value positively reflects the strict application of the current management protocols applied at these Youth weeks, and also the BokSmart education on removing players from the field of play and from the remainder of the tournament following a suspected concussion. When looking at all medical attention injuries, i.e. when a doctor was required to assess the player, concussionsranged from 8 – 19% of all the injuries recorded at these same tournaments.
Because it is not an obvious and visible injury such as a hamstring injury, coaches, referees, players and spectators do not always give it the necessary respect that it is due. For if not managed properly, some concussion injuries can have devastating consequences. The majority of concussion injuries however, are minor injuries, and if managed correctly, should never end up in a severe or catastrophic outcome.
If managed correctly and conservatively and according to international evidence-based best practice principles the player can have a long rugby career with no more risk of catastrophic outcome than any other player on the field.
A suspected concussed player should be managed according to the international consensus guidelines available in the scientific research literature. Each case should be managed individually, as there is no blanket management approach that fits all.
How to identify, suspect and manage a suspected concussion, forms an integral part of the BokSmart programme’s educational content on the Rugby Safety Course DVD’s provided to all rugby coaches and referees around the country for free, and each coach and referee in attendance receives a pocket BokSmart Concussion Guide to use at practices and matches.
Extensive evidence-based information on this topic is also available on the BokSmart website at www.boksmart.com, and is promulgated via the BokSmart programme’s social pages i.e. www.facebook.com/boksmart, www.youtube.com/boksmartsa and Twitter @BokSmart.
The referee and coach are often the first people who come into contact with a head or neck injured player, and decisive action may prevent further serious injury.