May 2, 2019, by brzmjb1
Heads Up | It’s time to discuss concussion in sport
Following the incident this week at White Hart lane which saw Tottenham Hotspur defender Jan Vertonghen sustain a serious head injury in the Champions League Semi-Final, it is a good time to talk about concussions.
We spoke to University of Nottingham Sport Physiotheraspist, Desi Gillespie, for her insight into the protocol of assessment and to learn what the team at David Ross Sports Village are doing to support its student-athletes and members of the local community with concussion.
“Firstly as a fellow medical personnel who has covered many pitchside interventions it is a high pressured situation assessing and making decisions on the field with many people watching and awaiting your decision. I cannot comment why he was initially able to return to play, however it was clear that he was assessed for an appropriate amount of time to assess for initial concussion signs.”
“It has been well documented in research that players can withhold information to be able to continue to play i.e. denying headaches, visual disturbances or dizziness. Concussions are not always instantly apparent and can take up to 48 hours for symptoms to prevail as swelling occurs within the brain. However as medical personnel we all have a clear protocol to follow, i.e. the questions we ask, signs and symptoms we look out for, and even on return to play we are constantly watching to ensure players are reacting appropriately e.g. how quickly they stand up after tackles etc.”
“To go back to basics, a concussion is defined as a “ a traumatic brain injury induced by biomechanical forces”1. This can be caused by any blow to the head, face or neck, or a blow to the body. An important factor to note is a player does not need to be ‘knocked out’ to be concussed, only 10% of cases have a loss of consciousness2. This normally causes short term symptoms such as headaches, dizziness or visual disturbance and with appropriate rest and a graduated return to play will settle the symptoms. As a coach or fellow player you may notice that your team mate isn’t acting normally, they may be dazed in a team huddle or not remembering common plays, or indeed where they are.”
“The best course of action to take is to recognise and remove the athlete from the pitch to further assess any concerns, to establish if there are medical personnel present, and certainly to prevent the risk of further injury. The current topics following the Spurs case is if football needs to have a Head Injury Assessment (HIA) substitution for ten minutes, as in Rugby Union, to give the athlete time to get effectively assessed and an appropriate decision made with the aid of footage analysis. This allows the athlete to be removed, but offers the opportunity to return to play should be no obvious symptoms of concern to a medical practitioner.”
“Everyone has a responsibility to look out for head injuries, not just the medical team, but as a player, coach or parent we can all notice symptom changes especially if they occur away from the field of play. If you have had a suspected head injury and you are experiencing ongoing symptoms, such as a severe headache, multiple episodes of nausea or loss of feeling and sensation in your limbs, then seek immediate medical attention at an A&E. If you have mild symptoms and unsure on how to manage it, the University if Nottingham have set up a concussion clinic at the state-of-the-art Sports Injury Clinic at David Ross Sports Village.”
“After confirmed or suspected concussions, players should follow the appropriate ‘Graduated Return to Play’ protocols, if the athlete has remained symptom free for 14 days, the athlete can gradually increase physical activity and can return to playing 19 days after the original incident if they are an adult, or after 23 days if in they are in the U19 age group or younger3.”
“Concussion is a common brain injury that can occur during sporting participation and from injuries in every day life. People with a concussion injury can described various symptoms but the common complaints are headache, difficulty with concentration, irritability and insomnia. The majority of concussion cases usually resolve within 7-10 days but in 10-15% of cases, symptoms can persist for longer than this.”
How can we help?
Our Concussion Clinic can help support you during your concussion injury and help you to return to learning and daily life activities and to return to your sporting activities.
During your clinic appointment you will undergo a sport concussion assessment (SCAT-5) and you will be assessed by Dr Mary O’Hanlon who will give you advice if you are ready to return to sporting participation.
We can see you in our clinic just after your concussion to give you advice during your rest period and when to start the graduated return to play (GRTP). If you have already started your return to play, we can provide the final clearance to resume full sporting activities which can only be undertaken by a Doctor.
So if you’re worried about a concussion, make sure you head to our concussion clinic Thursday’s 5-8pm at the Sports Injury Clinic at David Ross Sports Village.
- Ellenbogen RG, Batjer H, Cardenas J, Berger M, Bailes J, Pieroth E, Heyer R, Theodore N, Hsu W, Nabel E, Maroon J. National football league head, neck and spine committee’s concussion diagnosis and management protocol: 2017-18 season. Br J Sports Med. 2018 Jul 1;52(14):894-902.
- Headcase – General Information [Internet]. RFU. 2019 [cited 1 May 2019]. Available from: https://www.englandrugby.com/my-rugby/players/player-health/concussion-headcase/general-information/
- Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, Makdissi M, Sullivan SJ, Broglio SP, Raftery M, Schneider K. The sport concussion assessment tool 5th edition (SCAT5): background and rationale. Br J Sports Med. 2017 Jun 1;51(11):848-50.