Concussion in sport: what you need to know

Contact sports are great for fun and fitness, but our heads sometimes get in the way. Make sure you know about concussion, warns Fiona Adams

September is back-to-school month, but for sporty types it’s also time to return to the pitch. Yet for all the fantastic highs of team sport, there are also a few lows – and one, the risk of injury, is a factor to be carefully considered.If you or your child plays a contact sport, then it’s likely you’ve seen your fair share of broken limbs, which (usually) heal fairly quickly. But what of concussion? This enigmatic condition can manifest itself within minutes or hours of the knock, with a plethora of symptoms. Yet its seriousness is not always obvious. Most concussions are minor and resolved within seven to ten days, but successive untreated concussions can lead to brain injury and even death.

Recently the condition has hit the headlines. In the US, there are investigations into whether or not there is a link between suffering repeated concussion (like American footballers) and the onset of dementia. In the UK, the Football Association has introduced new guidelines for the 2014-15 season and is promoting a film featuring players such as Steven Gerrard to get its message across. The Rugby Football Union, meanwhile, has also released updated guidance (see RFU website for its Don’t be a Headcase campaign).

Indeed, rugby has come under much scrutiny. Most notably last year, when Australian George Smith was allowed to resume playing against a British and Irish Lions team despite clashing heads with Richard Hibbard. He was helped from the field, clearly dazed and unbalanced, yet passed a PSCA (pitch side concussion assessment) test within the recommended five minutes and went back on.

Naturally, this invited widespread condemnation. However, it is not the norm. Safety has long been of paramount importance in rugby. The PSCA is still in place, but the RFU has revised it and there are strict rules for players at risk.Michelle Cuthbert, senior physio at Richmond Rugby Football Club with 20 years’ experience, thinks that the assessment itself is generally a good idea.

“Yes, it has been misused, but I think the point of it was to give medical professionals time to assess the player if they weren’t sure.

“However, if a player is wobbly, they shouldn’t even get to pitchside assessment – they should be off at once. From September, the assessment window will be10 minutes – five is simply not long enough – and for Premiership and international games this must be done by a doctor,” she explains.

In addition to the PSCA, there are other checks such as Maddocks questions (see right), commonly used in children’s and youth games. But the key, says Michelle, is simply “to know your players”. While a doctor must attend Premiership games, at most youth games the responsibility for first aid commonly falls to coaches, teachers and parents.

“Understanding the signs of concussion can be difficult, but it’s important that laypeople learn to recognize them. If someone’s staggering, then they’re probably not very well. But there are so many symptoms, which can be especially varied and changeable in children, that it’s nigh on impossible to be certain every single time.”

I know this from experience, as my 16-year-old son was concussed last season, having been hit in the face by a ball. He wasn’t unconscious, but according to Michelle, that is rather beside the point.

“Knocking out is just another symptom and not one that tells you much about the severity of the injury. It’s a bit of a red herring, actually.”

Luckily, he was immediately subject to the three Rs: recognize, remove, refer. Obviously shaken, he was taken off and saw Michelle two days later for SCAT3 (sport concussion assessment tool) testing, which assesses wellbeing, balance, memory and so on. This is done as many times as necessary (usually at weekly intervals). My son returned to play after two tests and three weeks’ rest.

In truth, most young players of contact sport will rarely see a concussion, let alone experience one. But it’s key to remember that, while medical staff may be on hand at official events, on a freezing Sunday in November it’s down to parents, teachers and coaches to be prepared. Keep your players safe: it’s a no-brainer.

Concussion: what to look for...

Know your players and their usual behaviour. Are they different to normal?
Typical symptoms: headache, dizziness, nausea
Physical signs: unsteadiness, loss of balance, personality changes, slurred speech, short-term memory loss
Remember: a player does not have to lose consciousness to be concussed
Recognise, remove, refer: if in doubt take your player out and get him/ her to a doctor or physio

Maddocks questions: