Lindsay and I were the physiotherapists for Greerton Marists Premier and Development rugby teams this season. We had an awesome season which has just finished with an intense game in the premier semi-finals against Te Puna. Throughout the season we had a variety of injuries across both teams however, one that stood out to me due to its severity and also frequency, was concussions. I feel like concussion on a number of levels is misunderstood and we often have many questions directed at us around this injury.
WHAT IS CONCUSSION?
A concussion is a type of brain injury and can occur with a knock to the head or a jolt/impact to the body that transmits force to the head. This can cause the brain to move inside your skull. The damage affects the way the brain functions as it causes a disturbance in the brain cells.
– A fairly common misconception is that concussion only occurs with loss of consciousness, which isn’t true.
– Concussion can affect people short term, from a few hours to a number of days or weeks, and in more severe cases months and years.
– Any concussion is serious, and all concussions need to be identified and managed correctly in an attempt to avoid long term health consequences. (1,2)
WHAT ARE THE POSSIBLE SYMPTOMS?
Some of the many symptoms of concussion include: (2,3)
– Sensitivity to light or noise
– Feeling not quite right
– Feeling nervous or anxious
– Feeling emotional
– Blurred vision
– Balance problems
– Difficulty concentrating
– Difficulty remembering
– Feeling slowed down
WHEN SHOULD YOU SEEK IMMEDIATE MEDICAL HELP?
According to Sport Concussion in New Zealand: ACC National Guidelines recommend the signs to seek immediate medical help are:
– A headache that gets worse
– Repeated vomiting
– Unusual behaviour
– Unsteadiness standing/walking
– Slurring of speech
– Very drowsy and cannot be awakened
– Have seizures
– Weakness in arms or legs
– If you are deteriorating
WHAT DO YOU DO IF YOU SUSPECT SOMEONE HAS A CONCUSSION?
If you suspect someone has a concussion but does not have the above symptoms, the following may help with immediate management:
– If they are playing sport, immediate removal from play is required. If you are unsure, it is best to be more cautious and take them off.
– Ensure they are not left alone for the first 1-2 hours post-injury. This is important as they could deteriorate and need immediate medical help.
– Encourage physical and mental rest. Mental rest includes avoiding the use of phones or other devices.
– Get them to their GP. Only medical doctors are qualified to diagnose and manage a concussion. (2,3)
DOES WEARING HEADGEAR HELP PREVENT CONCUSSION?
Unfortunately, a systematic review and meta-analysis found that wearing protective equipment, such as headgear, did not help in reducing the number of concussions. (4) Headgear was shown to lower the risk of superficial injuries, such as fractures, especially in sports where there is a possibility of falling onto hard surfaces. (2)
HOW LONG DOES IT TAKE TO RECOVER FROM A CONCUSSION?
There is no clear answer to this question. The NZ Rugby guidelines have a mandatory stand down after diagnosed concussion. Players must then follow a specific return to play protocol and be cleared by a certified sports medical professional to take the field again.
We see people after concussions almost every day in our clinic, from a wide range of impacts such as car accidents, falling from heights, etc.
As physiotherapists, we feel we have an important role in identifying how much impact the neck is having on the symptoms the patient is presenting with. We predominantly work to mobilise and optimise the neck joint range, muscle tension and normalise movement integrated with the rest of the body. Research has shown that in most cases (80%) there is some involvement of the neck contributing to ongoing concussion symptoms. From our experience, the complete resolution of symptoms is varied from person to person. The ones that follow advice including complete rest and a gradual return to function have the best outcomes and return to play quicker.
The main message of this blog (and this one) is that all concussions are serious and if you or a teammate, family member or friend, has any of these symptoms after a head knock or blow to their body, make sure they visit there GP or seek immediate help where appropriate. If you are unsure if someone is concussed, it is better to be more cautious and remove them from play.
For more information or to get a concussion or neck assessment, call our clinic on 021438825 and book in with one of our physiotherapists today.
1. Sport Concussion in New Zealand: ACC National Guidelines [Internet]. 2019 [cited 23 July 2019]. Available from: https://accsportsmart.co.nz/assets/assets-final/resources-final/ACC7555-ACCSportSmart-concussion-national-guidelines.pdf
2. McCrory P, Meeuwisse WH, Aubry M et al. Consensus Statement on Concussion in Sport, 3rd International Conference on Concussion in Sport, Held in Zurich, November 2008: Erratum. Clinical Journal of Sports Medicine. 2010;20(4):332.
3. SCAT3 Sport Concussion Assessment Tool [Internet]. 3rd ed. 2019 [cited 23 July 2019]. Available from: https://bjsm.bmj.com/content/bjsports/47/5/259.full.pdf
4. Schneider D, Grandhi R, Bansal P, Kuntz G, Webster K, Logan K et al. Current state of concussion prevention strategies: a systematic review and meta-analysis of prospective, controlled studies. British Journal of Sports Medicine. 2016;51(20):1473-1482.