No 'one size fits all' approach to concussion injuries

A sports medicine conference at DCU hears of the need for greater awareness of concussion in sport

A GREATER awareness of concussion in sport could protect affected athletes against further injury. Furthermore, a concussed player should not be returned to play on the same day unless given the all-clear by a doctor.

Those were the take-home messages from a panel of speakers at Dublin City University on Friday night at a conference on sports-related concussion.

A person who develops concussion following a blow to the head will have a change in their awareness or attention and possibly a range of other immediate or delayed symptoms including headache, dizziness, foggy thinking, difficulty concentrating, drowsiness and balance difficulty.

However, concussion is not one size fits all and every case is different, according to Prof Mike Ferrara, director of St Mary’s hospital athletic research laboratory at the University of Georgia, who said that more than 300,000 sport-related concussions occurred in the United States each year.

He dispelled a myth that concussion always involved a loss of consciousness – often it doesn’t – and he stressed the importance of raising awareness about the condition.

“We have to educate about the dangers of concussion, the signs and symptoms, and reporting it to the appropriate healthcare providers. No player should return to play the same day following a concussion unless cleared by a doctor.”

When diagnosed and managed properly, athletes who suffer concussion generally recover well through rest and a gradual return to play, according to Prof Ferrara, who has analysed concussion in American football for more than decade and has been on a Fulbright scholarship at DCU since January working on projects relating to the GAA.

One of the risks associated with returning to play too soon after concussion is an increased likelihood of getting another injury. Many regulating bodies in sport have set concussion guidelines whereby athletes are rested for a defined number of days unless they receive the all-clear from a physician.

However, the potential of being kept from play can make players cagey when they are being assessed by a doctor for concussion, according to consultant neurologist Prof Tim Lynch, who directs the Dublin Neurological Institute at the Mater hospital.

In addition, Prof Lynch said the condition could be hard to recognise because symptoms vary and there was no definitive blood or imaging test for it.

“Sometimes you don’t get a straight answer, you have to pin them. But you have to be sure the patient is well. And there’s no point in putting a player back if they are not functioning well – a concussed player plays poorly.”

Repeated concussion may cause some cumulative brain injury over months and years, but the jury is out on whether concussive injuries contribute to dementia-associated physical changes in the brain over time, according to Prof Lynch.

And he emphasised the importance of minding the brain, which can be directly impacted by a wallop on the skull: “The brain is like blancmange, it’s gooey stuff inside a box and it gets a heck of a rocking if it gets a knock.”

The conference winced its way through a number of videos highlighting collisions during play – many repeated from different angles to see exactly what had happened to the player now left lying motionless on the pitch.

“The key thing is the first response – try to witness the injury and gauge and assess the seriousness, and look at treatment options and transportation,” said Stephen Mutch, head physiotherapist with the Scottish rugby team.

“You have to exclude spinal injury, then move on to . A player should not be left alone after an injury and a diagnostic concussive event should be enough that the player should not be allowed to play on.”

Concussion symptoms may be delayed, and players and coaches should be on the lookout for signals that someone is behaving oddly even some time after a collision, said Mr Mutch.

“We had one guy who took two showers after a match,” he recalled. “That told us something was up.”

Mark Mulrooney, senior clinical neuropsychologist at Beaumont Hospital, echoed the importance of tuning into changes if a player was “not themselves” after a collision where concussion could arise.

It could be a change in humour – perhaps they were irritable during the usual post-match slagging, or they were not answering questions like they normally do, he suggested.

“The best thing you bring to this is your familiarity with the person,” he said.

“If you find you are still thinking about after a while, then there could be something wrong.”