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Safety in Sport

Dr Karen IrwinThere has been so much in the media recently about head injuries and concussions.

A lot of this is around direct contact sports such as rugby union and rugby league but it is important to remember that head injuries can occur in any sport (especially given the fast, competitive nature with which most sports are played these days). Concussion is the most common head injury in sport and is caused by a temporary disturbance to brain function due to trauma (the reason why people are often unable to later remember the events causing the concussion).

The term head injury refers to both visible injuries to the scalp and internal injuries to the brain.

Traumatic brain injury (TBI) is the medical term for internal injuries to the brain itself. Mild TBI is sometimes referred to as a concussion. A concussion is caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain. Concussion may occur with or without loss of consciousness.

Concussions are usually not life-threatening but the effects can be serious.

Concussion Signs Observed:

• Can’t recall events prior to or after the impact
• Appears dazed or stunned, has a vacant stare
Disorientated – forgets an instruction, is confused or is unsure of the game, score, or opponent
• Uncoordinated, moves clumsily
• Answers questions slowly
• Slurred or incoherent speech
• Loses consciousness (even briefly)
• Emotionally confused
• Unable to focus attention.

Concussion Symptoms Reported:

• Loss of consciousness
• Headache or ‘pressure’ in head
• Nausea or vomiting (feeling sick)
• Balance problems or dizziness, or double or blurry vision
• Sensitive to light or noise
• Feeling sluggish, hazy, foggy, dizzy or groggy
• Just not ‘feeling right’ or ‘feeling down’
• Double or fuzzy vision
• Ringing in the ears
• Confusion or concentration or memory problems.

Signs and symptoms usually show up soon after the injury but may not show up for hours or days. For example, in the first few minutes the person might be a little confused or a bit dazed, but an hour later they might not be able to remember how they got hurt.

Concussion Guidelines

Recognise and remove from play. If concussion is suspected, remove from play/activity immediately and seek urgent assessment by a medical doctor. When in doubt, sit them out! (If the person is unconscious always assume there may be a spinal injury and manage them accordingly).

Concussions often occur without loss of consciousness (only 10-20% lose consciousness).

Do not return to play/activity for the remainder of that day.

Seek medical attention for initial assessment and for advice and monitoring of return to normal activity.

Recovering From a Concussion

Rest is very important after a concussion because it helps the brain heal. Unfortunately complete brain rest is impossible given that every bodily function requires the input of the brain but it is important to minimise conscious activities such as reading, studying and physical activities or activities. Doing too much may cause concussion symptoms (such as headache or tiredness) to come back or get worse. After a concussion, physical and cognitive activities—such as concentration and learning—should be carefully monitored by a medical provider.

It is important to remember that a concussion is a body injury (of the brain) and in the same way that people must manage other sporting injuries (ankle sprain, fracture of the wrist) to enable return of full function, the injury of the brain must be managed just as carefully (or more so).

Reducing the Risk of a Concussion

Safe techniques should be practiced at all times in high contact sports. Wearing a custom made mouth guard may reduce the risk of concussion.

Further Information

The following brochures are available from ACC and can be downloaded from their website:

Caring for yourself after a head injury (2007)
Caring for a child after head injury (2011)
Knowing about your mild traumatic brain injury. (2006)

Sport Concussion in New Zealand – ACC National Guidelines here.

Dr Karen Irwin, School Doctor

References
Sport Concussion in NZ. (2014). ACC National Guidelines. Retrieved from http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_communications/documents/reference_tools/wpc136118.pdf
Concussion. (2015). ACC. Retrieved from http://www.acc.co.nz/preventing-injuries/playing-sport/common-sports-injuries/pi00105
Heads Up. (2015). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/headsup/basics/concussion_whatis.html