Concussion

The incidence of concussion in rugby has been gradually increasing in the last two years. Whether it is the fact that the game has become faster and more physical or whether the competitiveness has increased does not in fact alter the management and outcome of the condition.

What is concussion?

The most widely cited medical definition "clinical syndrome characterized by an immediate or transient post-traumatic disturbance in neural function, such as alteration of consciousness, disturbance of vision or equilibrium" - (Committee on Head Injury Nomenclature of the Congress of neurological surgeons, 1966). Often the loss of consciousness is accompanied by a period of amnesia and the duration of these two symptoms in cases determines the classification of the degree of severity.

The mildest form of concussion is often called the "Dinger" in which the player has received a blow to his head and momentarily is "dazed" with no real "loss of consciousness".There is no amnesia.

In moderate cases of concussion there is loss of consciousness from a few seconds for up to five minutes and/or amnesia for up to thirty minutes. This player is almost always confused and simple questions like the time of day, the score, etc he will be unable to answer.

In the more severe cases of concussion there is a loss of consciousness for more than five minutes and the amnesia often lasts more than 24 hours.

The cumulative effect of repeated episodes of concussion has been well documented and cannot be over-emphasised. In addition, by allowing players to resume playing when they still have symptoms eg headaches, dizziness, lack of co-ordination one will be guilty of contributing towards a potentially fatal added episode of concussion.

There are numerous other forms of exercise which are non-contact with which the player can maintain his level of fitness without compromising his health, eg swimming, cycling. At all costs participation even in practices should be avoided until the player is symptom free.

Specific match training on the field is not advisable because co-ordination is often impaired for a time and the risk of injury is higher, and there may be some temptation to tackle or invite the risk of contact injury.

Keypoints in evaluating someone who has received a blow to the head are:

Error on the side of caution. Rugby is only a game, if there is any question of the player's fitness to play. He should not be allowed to continue.

An unconscious player on the ground has a neck injury until proven otherwise. Do not attempt to move him until qualified medical personnel have properly evaluated him. Any player with prolonged unconsciousness or does not respond to questions (>15 seconds) should be sent to an emergency room via ambulance for a complete evaluation to handle possible spinal cord injuries.

Players, coaches and official should recognize that leaving a game is not a sign of weakness, especially when the player is not playing to his full capacity. Help your team-mates by assisting officials in convincing injured players to leave the game.

Return to play after a concussion is based on the amount of time it takes to assure healing of the brain and the ability to protect the head/brain from further injury during a practice or contest.

"CONCUSSION OFTEN DESTROYS JUDGEMENT. DO NOT ALLOW THE PLAYER TO INFLUENCE YOU. THE PLAYERS' HEALTH AND THE REPUTATION OF THE GAME IS AT STAKE."

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