Heading towards Concussion
There are always risks associated with playing sports, especially so with contact sports such as football, rugby and hockey. Fortunately, the majority of sporting injuries are relatively minor and can be remedied with bandages, spray and a friendly handshake from the opposition. However, in some instances, the injuries sustained are a lot more severe and can be difficult to spot.
The nature of concussion means that the symptoms may not be immediately apparent and sometimes occur much later after the injury has been sustained. Symptoms include: confusion, nausea, dizziness, blurred vision, headache, loss of balance and memory loss. This can ultimately result in it being very difficult for an individual or team to decide whether it is safe for the player to continue or to seek immediate medical assistance.
In the Premier League alone, we have seen several incidences involving high profile players who have sustained serious head injuries during play, for example:
- Petr Cech of Chelsea FC fractured his skull in October 2006
- Hugo Lloris of Tottenham Hotspur was knocked unconscious in November 2013, and
- Anthony Martial of Manchester United suffered a concussion in September 2016
Both Lloris and Martial continued to play, despite suffering concussion.
These incidences have helped to increase awareness of the risk of head injuries in sport and have raised some important questions as to who should be making decisions relating to the care of the player and whether better protocols need to be in place when these situations arise.
Grassroots decisions – enough awareness about brain injury risks?
At a professional and semi-professional level, players will often be supported by a team of medics who are best placed to exercise their judgement as to whether the player should continue.
At grass roots or amateur level, these important decisions are often made by someone who has no medical background, such as a parent, coach or first aider (who only has basic knowledge of emergency care but no extensive medical training). Sadly, those decision making procedures can often lead to devastating outcomes for those with otherwise bright futures ahead of them:
Nic O’Leary‘s story is a timely example of exactly what can go wrong despite good intentions and showing a fighting team spirit: in 2008, 16 year old Nic suffered a blow to the head whilst playing rugby in London. Determined to play on, Nic sustained a further head injury and subsequently suffered a concussion and stopped breathing. Nic was left with a brain injury which now affects his cognitive abilities, motivation and personality.
Ben Robinson’s story is another incredibly tragic example: In 2011, 14 year old Ben participated in a rugby union match for his school. Ben was treated on three separate occasions for head injuries and was sent back on to the field on each occasion. Ben subsequently collapsed on the pitch and later passed away in hospital. In his report, the Coroner found that the cause of death was Secondary Impact Syndrome. Peter Robinson, Ben’s father, commented that there should have been a chain of health and safety procedures in place, including players, coaches, referees and parents and that Ben may have had a chance at survival if one link in the chain had removed Ben from the pitch earlier.
Concussion is a brain injury and every brain injury suffered by a child must be taken seriously because it is likely to impact the child for life. As a child’s brain is still developing, an injury to the brain during childhood can interrupt development and make it difficult for the child to learn new skills. The examples above show that child head injury can lead to devastating consequences, despite the appearance in the immediate aftermath of an accident being seemingly innocuous.
Sports’ governing bodies need to take the lead on protecting players’ heads
These tragic stories serve as important reminders of the need for better awareness of the subtlety of head injuries, and the need for safer practices when these situations arise. All sports clubs, especially those involving contact sports, should be adopting injury-prevention strategies to minimise the risk to players of head injuries. Below are some examples of strategies which could help:
- Playing by the rules: teaching players to respect the rules of their sport and to practice good sportsmanship with a view to reducing on-field aggression
- Teaching players the correct techniques relevant to their sports
- Wearing the appropriate safety equipment e.g. helmets, gum shields
- Making sure that posts are padded sufficiently
- Reducing contact drills/practices
World Rugby issued a directive which came into force in January 2017 and applies at all levels of the game, clamping down on high tackles with a view to protecting the ball-carrier from suffering concussive blows to the head. They have a zero-tolerance approach to reckless and accidental head contact in the sport and said they:
“aim to change culture in the sport to ensure that the head is a no-go area.”
The effectiveness of this directive has been called into question but I feel that this is a really positive step towards ultimately changing the sport’s mentality in respect of high tackles and consequent concussion injuries. Whilst some commentators think that injuries may increase before the figures fall, I hope that the players, coaches and teams are all educated as to the devastating life-changing effect a brain injury can have, even in the most seemingly innocent or ordinary of situations.
Inevitably, given the often unpredictable nature of sport, head injuries will still occur despite putting in place injury-prevention strategies. Concussions are not always easily identified and often players are reluctant to admit that they have suffered injury themselves. Fortunately, sporting bodies such as the FA and England Rugby have released very clear guidance as to how best to deal with scenarios where players are concussed or there is a suspicion of concussion:
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- The FA Guidance: “If in doubt, sit them out” i.e. anyone with a suspected concussion must be immediately removed from play. Once safely removed from play, they must not be returned to activity that day. In all cases of suspected concussion, it is recommended that the player is referred to a medical/healthcare professional for diagnosis and advice.
- England Rugby guidance: “Don’t be a head case” i.e. if a player is suspected of having concussion after a blow to the head, they must be removed from play immediately.
The FA Guidance is particularly clear that everyone involved in the sport, from team mates, coaches, match officials, team managers, administrators to parents, have a role to play in doing their best to ensure that players are removed from play safely if concussion is suspected.
The recent decision not to impose sanctions on Northampton Saints after they allowed George North to continue playing despite appearing to lose consciousness when he landed heavily on his neck, raises questions as to how seriously the guidance is being taken.