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Dr Ameer Ibrahim attending to Seb Ryall of Sydney FC

Concussion – Just Another Head Knock?

By Dr Donald Kuah, NRL Medical and Player Safety Advisory Group
and
Dr Thomas Longworth, Medical Officer for Wests Tigers NSW Cup

As Australians we love our contact sports over the winter months, but is this love affair coming with a cost to our long term health and that of our children?

Concussion has in recent years become a major talking point in the football codes around the world. It is becoming apparent that repetitive head trauma through a players’ career, at any level, can lead to serious health consequences in the future. This new information has led to changes in rules across our sporting codes, major litigation cases in the USA and even a recent Hollywood movie “Concussion” featuring Will Smith.

Common Myths on Concussion


  • If a player feels fine after a coming off for a concussion, they can return to play without risk.
    FALSE. If no medical assessment is available, the best advice is not to return to play. Signs of concussion can be quite subtle.

  • Wearing headgear will prevent or protect players from concussions.
    FALSE. Headgear may help protect against lacerations and skull impact injuries, however some studies have shown that headgear can also give false a sense of security, encouraging more aggressive play that could lead to a higher chance of concussion.

  • The number of concussions during a season doesn’t matter as long as the symptoms resolve each time.
    FALSE. There appears to be a cumulative, negative impact of repeated concussions.

  • If there has been no direct knock to the head then it cannot be concussion.
    FALSE. Concussion can occur just by sudden deceleration of the skull.


    What is concussion?


    Concussion is defined as: A Complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. In everyday language, this refers to an immediate change in the way the brain functions after a direct or indirect blow. Concussion relates to functional rather than structural changes in brain function which resolve over time, it may or may not be associated with a loss of consciousness or ‘being knocked out’. Children and adolescents (developing brains) are more susceptible to these injuries and they can take a longer time to recover.

    What are the symptoms?


    Symptoms can be wide ranging from on field seizures to confusion, headaches, dizziness, change in behaviour, anxiety or vomiting. These symptoms generally last for a short time following the injury – days to weeks. However, in severe cases, they can last many months and affect day to day life such as school or work.


    What are the risks?


    The immediate risks of concussion are the changes in the function of the brain. A player who continues to play while concussed is more likely to have a second head injury or other major injury while their balance and brain function is altered. Secondly, players, especially junior players, need close supervision following a head injury as occasionally they can deteriorate and need hospital medical care.

    The long term risks of concussion and repetitive head trauma are of a greater concern. Recent studies have shown that repetitive head knocks are possibly related to the onset of a form of dementia known as chronic traumatic encephalopathy (CTE) and also higher rates of mental health issues in retired athletes. More research is needed in these areas to be certain, but at this stage it is much better to be safe than sorry.

    What steps should be taken?


    All players who have a suspected concussion, or major head knock, need to be taken from the field and assessed by a qualified medical officer. The NRL, rugby union and AFL have all implemented new rules which allow for this process without using an important interchange. If a player is diagnosed as having a concussive injury, then they are unable to return to play that day.

    We recommend that all people with diagnosed concussion should be seen by a doctor within the next couple of days where they can be re-assessed and undergo concussion testing. If appropriate, the player may be guided through a return to play protocol. The return to play protocol followed by most contact sports will require 6 steps over at least 6 days for a safe return to play.
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Appointments from 7am for some services