While participants in the school sports enjoy the action and wins, they must also be wary of concussions.

Sports Physician in Bedfordview, Dr Peter Baxter, defines a concussion as a minor traumatic brain injury caused by an acceleration (blow to the head) or deceleration (head landing on the ground) force to the head.

These can be either linear or rotational and result in shearing forces on the brain, which, in turn, cause a complex disturbance in the metabolic function of brain cells or neurons, he adds. Ultimately, this results in decreased energy production and, therefore, compromised nerve function, as evidenced by the symptoms and signs observed after injury.

Baxter notes that concussions are most commonly seen in high-impact and collision sports like rugby, boxing, and football (although in football, it is often underdiagnosed), where direct blows to the head are commonplace. In sports such as cricket, hockey, and baseball, where balls travel at high speed, a direct blow to the head from a ball can result in a head injury. Other sports where athletes may fall and land awkwardly on their heads, such as cycling, horse riding, gymnastics and dancing, may also result in concussions, Baxter warns.

“One must also be aware that concussions may result from normal accidents – tripping at home, childhood activities and motor vehicle accidents! Concussions are not always the result of a direct blow to the head, however. Indirect whiplash-type injuries are also involved in the sudden movement of the brain inside the skull and may cause the sequence of events resulting in a concussion,” said Baxter.

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Common signs and symptoms of concussion include: headache, dizziness, balance problems, nausea/vomiting, light/noise sensitivity, loss of memory / poor memory, fatigue/low energy, drowsiness/confusion, loss of consciousness, irritability / more emotional, difficulty concentrating and seizures.

Dr Baxter says that these may be seen almost immediately or develop over time and worsen for up to 72 hours post-injury. The physician adds that it is not uncommon for a rugby player to suffer a blow to the head, have little or no symptoms at the time, only for them to develop over the next two or three days.

He advises, “It is vital for coaches, parents, teammates and the officials to be aware of the fact that head injuries are common, especially in high-contact sports, and to have a high index of suspicion during games and practices.

“This involves watching the players and being aware of how long players get up after an impact and if they are unbalanced, whether they hold their heads, and thereafter how they participate in the game.” Warning signs include running aimlessly, missing tackles that would normally be made, not playing as well as usual, generally being slow, appearing dazed and/or unbalanced, etc.

Should there be any concern or doubt about a head injury, Baxter suggests a conservative approach: the player should be removed from the field of play until properly assessed by experienced medical personnel.

Diagnoses are made when there is a collection of typical signs and symptoms, together with a high index of suspicion. If the symptoms are mild or absent, no incident has been noted, or the individual assessing the player is inexperienced in concussion management, players may slip through the cracks, Baxter warns. He said it is therefore always important that such players be followed up on at roughly 72 hours to be reassessed.

Concussion red flags:

It is essential for parents, coaches, and healthcare professionals to take steps to prevent and properly manage concussions in young athletes so that they are not at risk of the long-term effects of concussion.

These long-term effects include the following:
• Post-Concussion Syndrome – persistence of symptoms for a prolonged period of time due to poor initial management. This has ramifications, most importantly in the classroom, where learning is compromised, and on the sports field, where performance is below par.

Furthermore, the presence of depression, irritability, etc., may have an impact on the adolescent’s social interactions.
• Chronic Traumatic Encephalopathy (CTE) – this is the progressive deterioration of the brain due to numerous repeated blows to the brain.

This affects the ability to think and mentally process, causes neurodegenerative disorders, and affects emotional well-being. It is not curable and may result in disorders such as dementia and Parkinson’s.

Return to play (RTP)
According to Dr Baxter, head injuries and concussions invoke much discussion and controversy, and none more so than the RTP protocols. He said SA Rugby has a mandatory 21-day sit-out period for concussion, but this is a minimum time, as the player may not have fully recovered by then.

To RTP, the player should have no symptoms or signs of concussion, a normal neurological examination (if present), a computerised neurocognitive test that has returned to baseline, and passed a sport-specific RTP program.

After the player has been assessed for his head injury, Dr Baxter said the standard protocol is to rest for 48-72 hours, depending on symptoms. “Thereafter, we encourage light exercise with no contact and to a level that does not exacerbate any symptoms that may be present. Once the above steps have been passed, a more comprehensive RTP is prescribed.

“I encourage my injured athletes to ‘respect their injuries’. There are no shortcuts! Follow the advice given, do the rehab well, and usually the injury will settle, and the player will return strong.”

He added that shortcuts invariably result in chronic injuries, poor performance, further injuries, and ultimately an unhappy, underperforming athlete. In terms of preventing head injuries and their effects, Dr

Baxter believes that one of the biggest factors is educating players, parents, coaches, and schools/clubs.

He adds that good sport-specific conditioning is also a cornerstone to decreasing the incidence and severity of injuries. For example, a stronger core improves stability, which in turn allows the player to be stronger in the contact area and potentially reduce the effects of an impact.

Dispelling myths around concussion

“There is no doubt in my mind that concussions are under-reported, and I think the reasons are varied. In many instances, a lack of education is a major factor and probably underlies most of the reasons. There is unfortunately still the mentality of ‘in my day’, ‘don’t be soft’, and ‘it was just the on/off switch, he is ok now’,” says Dr Baxter.

In some cases, he observes that the pressure to win, together with a relatively small squad, puts unnecessary pressure on coaches and players not to miss out on games; admitting to a concussion may result in missing at least three games.

Unfortunately, the doctor reveals that there are no blood tests or imaging tests that clearly show the injury or its progress in healing, which makes the condition even more frustrating. The presence of adequately trained medical personnel at the field side, and the trust placed in their expertise by all the role players, according to Baxter, would go a long way toward helping to look after the players’ well-being.

“Unfortunately, many events do not have this in place, and so many injuries are not detected or managed adequately. The key here is adequately trained and experienced medical personnel!

“Too often, through no fault of their own, medics (and, for that matter, officials) are missing significant injuries which could have significant sequelae,” observed Baxter.

He added, “If a player is worried after taking a ‘hit’, I would suggest they sit down on the field so that they can be attended to. If, even after being assessed by whoever may be at the side of the field, the player is still not feeling ok, ask to be substituted.”

Baxter said, “The single most important message I would like to pass on, apart from the importance of education, is that we only have one brain! By looking after our brains, we will look after our lives and futures!”