As the governing organisations for our sport, World Rugby and Rugby Netherlands have made Player Welfare a major priority. In particular, any type of head injury leading to concussion must be taken very seriously.
Over the past few years, there has been a lot of research carried out into the nature of head trauma in many sports. As a result, important guidelines and protocols have been produced to support coaches, managers, players, parents and medical staff in the safe management of concussion related injuries. These guidelines are meant to ensure that players who suffer concussion are managed effectively to protect their long-term health and welfare.
As a reminder, all of us at HRC have an obligation to follow the concussion guidelines and protocols to help ensure the well-being of all our players. Helping to effectively identify and manage concussion is the responsibility of us all.
What is concussion?
Concussion is a traumatic brain injury resulting in a disturbance of brain function. There are many symptoms and signs of concussion, common ones being headache, dizziness, memory disturbance or balance problems. Loss of consciousness (being knocked out), occurs in less than 10% of concussions. Loss of consciousness is not a requirement for diagnosing concussion but is a clear indication that a concussion has been sustained.
What causes concussion?
Concussion can be caused by a direct blow to the head, but can also occur when blows to other parts of the body result in rapid movement of the head, e.g. ‘whiplash’ type injuries.
Who is at risk?
Concussions can happen to any player of any gender and at any age. However, children and adolescent athletes:
- are more susceptible to concussion
- take longer to recover
- are reported to have more significant memory and mental processing issues
- are more susceptible to rare and dangerous neurological complications.
Onset of symptoms
It should be noted that the symptoms of concussion often present immediately post injury but they may be delayed, becoming evident within the first 48 hours following a head injury.
How to recognise concussion or suspected concussion
Recognition of concussion may occur immediately, identified from the side-line, while attending a player on the field of play or within the 48 hour period after the game. If any of the following signs or symptoms are present following a head injury, the player should be suspected of having concussion and be immediately removed from play or training.
What you may see or hear immediately
Any one or more of the following clearly indicate a concussion:
- Seizure (fits)
- Loss of consciousness (LOC) – confirmed or suspected – visible signs suggesting LOC – lying motionless on the ground for more than 5 seconds, slow to get up off the ground
- Unsteady on feet or balance problems or falling over or poor coordination
- Confused
- Disorientated – not aware of where they are or who they are or the time of day
- Dazed, blank or vacant look
- Grabbing or clutching of head
- Behavioural changes eg. more emotional or more irritable
Symptoms of concussion / suspected concussion – what the player tells you
Presence of any one or more of the following signs and symptoms may suggest a concussion:
- Headache
- Dizziness
- Mental clouding, confusion, or feeling slowed down
- Visual problems
- Nausea or vomiting
- Fatigue
- Drowsiness/feeling like “in a fog“/difficulty concentrating
- “Pressure in head”
- Sensitivity to light or noise
Immediate management of concussion or suspected concussion
Any player with concussion or suspected concussion should be immediately and permanently removed from training or play. Remember: “If in doubt,… take them out”
Appropriate emergency management procedures must be followed especially if a neck injury is also suspected. In this instance the player should only be removed by emergency healthcare professionals with appropriate spinal care training.
Once safely removed, the injured player must not return to any activity that day and should be medically assessed. Staff, coaches, referees, players or parents and guardians who suspect that a player may have concussion must ensure that the player is removed from the field of play in a safe manner.
Recurrent or multiple concussions
Players with a history of two or more concussions within the past year maybe at greater risk of further brain injury and slower recovery and should seek professional medical attention before returning to train/play. In addition to a history of multiple concussions, players with unusual presentations or prolonged recovery should be assessed and managed by health care professional with experience in sports-related concussions.
Graduated Return to Play (GRTP) programme
The Graduated Return to Play (GRTP) programme incorporates a progressive exercise programme that introduces a player back to Rugby in a step-by-step fashion. This should only be started once the player has completed the requisite physical rest period and is symptom free and off treatments and/or medication that may modify or supress concussion symptoms – for example drugs for headaches or sleeping tablets.
*The link below provides access to Rugby Netherlands Concussion Protocol (Hersenschuddingprotocol) and the Pocket Concussion Recognition Tool (Pocket Hersenschudding Herkenning Tool).
www.rugby.nl/rugby/player-welfare/hersenschuddingprotocol/
Please remember, concussion is a very serious condition and needs to be carefully identified and managed responsibly. We all have a role to play in helping look after our players’ welfare and well-being.
If you have further questions or concerns about concussion, please raise them initially with the respective Head Coach of your age group or to the HRC Director of Rugby.
Matt Roper
Director of Rugby
