Understanding Concussion Enhancing Rugby Safety Through Sports Science

Two decades ago, the diagnosis of a concussion relied on just two criteria. Dr. Jon Patricios, a specialist in sports and exercise medicine and a co-author of the most recent international consensus statement on concussions in sports, sheds light on the science of head injuries and the protocols embraced by World Rugby to enhance player safety.

What Constitutes a Concussion?

Concussion is a traumatic brain injury stemming from a force transmitted to the brain, resulting in a functional change in brain operation. Most concussions are transient and can resolve fully with proper recognition and management.

Notably, concussions do not typically present structural changes visible on brain scans; instead, they manifest as alterations in brain function. This is the key focus for medical professionals when evaluating, assessing, and managing concussions.

Recognizing Concussion Signs Conspicuous indicators of a concussion include loss of consciousness, seizures, clear disorientation, an inability to walk, or poor coordination. Two decades ago, only two criteria existed for diagnosing a concussion: loss of consciousness and amnesia. Today, over 20 criteria, such as irritability, nausea, concentration difficulties, poor balance, emotional changes, and heart rate variations, are considered.

The absence of biomarkers, like a blood or saliva test or a suitable brain scan, remains a challenge in concussion diagnosis. However, ongoing research in this field is rapidly expanding, with expectations of commercial availability within the next five years.

Subtle Signs of Concussion Many times, concussion signs are subtle and may rely on patient self-reporting. These symptoms and signs are categorized into domains, assessing various aspects of brain and body function, encompassing physical symptoms like headaches and nausea, changes in balance, emotional shifts, anxiety, and concentration difficulties.

Cognitive changes, such as an inability to concentrate, and autonomic functions, like irregular heart rate and blood pressure changes, are also considered. A systematic approach is crucial to avoid missing these subtle changes.

Understanding the player’s baseline condition before an injury is equally important. Evaluating athletes before the season starts provides a better understanding of their normal functioning.

Immediate Response to a Knocked-Out Player When a player is knocked out on the field, the initial response should follow standard procedures for serious injuries. This includes ensuring physiological functions, protecting the airway, and addressing any other potential serious injuries, such as neck injuries.

The player should be removed from the field to assess and monitor their recovery in a controlled medical environment. A systematic evaluation is then conducted, repeated within an hour or two and again within a day to track improvements or worsening symptoms.

The Role of Rest in Recovery Rest periods are prescribed based on the severity and nature of the concussion. In some cases, long rest periods may not be necessary. Instead, a period of relative rest is recommended, allowing the player to engage in daily activities while gradually reintroducing exercise within 72 hours. This approach has been shown to expedite recovery.

Impact of Rule Changes Changes in the rules of the game have improved concussion identification and player safety. Most collision sports now require players to undergo a specific process before returning to the field, which must be documented and submitted in professional games. These rule changes are driven by the evolving science behind concussions, aligning with evidence-based and robust protocols.

The Safety Outlook While complete elimination of concussions from collision sports is challenging, heightened safety awareness and evidence-based protocols have significantly improved player safety. The game is safer than ever before, but it remains important to stay vigilant and continue research in this field.




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