Concussion and the Young AthleteCaroline White

Physiotherapist, Northampton Saints Rugby Club

Aims

• What Concussion is• How can Concussion be diagnosised• The long term impact of poor management• The new management guidelines

"Concussion is considered to be among the most

complex injuries in sports medicine to diagnose, assess and manage”

Elite Rugby Contacts

• 456 contacts per game in total

• 95 contacts per game – Forwards

• 25 contacts per game – Backs

• 1 concussion every 5-6 games on average across the whole premiership

Concussion

• Direct or In- Direct force causing “Injury” to the brain

• Injury now thought to be structural • The result is dysfunction to the brain related to

unknown pathology with poor management• Symptoms can be delayed or develop over a

period of time• They can still be concussed with no LOC

Symptoms

–Symptoms (Dizzy, headaches)–Physical (LOC, Ataxia, Vomit)–Behaviour (Emotion, irritability, anxious)–Cognitive (Confusion, memory, poor

concentration, reaction time)–Sleep (difficulty falling asleep, insomnia,

drowsiness)

IRB GuidelinesREGULATION 10. MEDICAL

• The IRB Concussion Guidelines (available on www.irbplayerwelfare.com) shall be updated from time to time in accordance with best medical practice.

• 10.1.2 All Players diagnosed with concussion during a Game or training must: – (i) be removed from the field of play and not return to play or train on the

same day; and – (ii) complete the graduated return to play protocol described in the IRB

Concussion Guidelines.

• 10.1.3 All Players who are suspected of having concussion during a Game or training at which there is no appropriately qualified person (as applicable in the relevant jurisdiction) present to diagnose concussion: – (i) must be removed from the field of play and not return

to play or train on the same day; and – (ii) should be reviewed by an appropriately qualified

person (as applicable in the relevant jurisdiction) and diagnosed as having concussion or not; and

– (iii) in any case must complete the graduated return to play protocol described in the IRB Concussion Guidelines.

• Whenever there is a head injury think NECK

• No perfect clinical or diagnostic tool

• Sideline view can be difficult to see the injury- ?use of video in retrospect

Axonal Damage

Neurotransmitter release + hyperexcitation

Cell death

Concussion

Chronic Traumatic Encephalopahy (CTE)

Second Impact Syndrome• Rare and still a lot of ongoing research• The brain swells rapidly, and catastrophically, after a person suffers a

second concussion before symptoms from an earlier one have subsided.• The second blow may occur minutes, days or weeks after an initial

concussion, with even the mildest grade of concussion can lead to SIS.• The condition is often fatal, almost everyone who is not killed is severely

disabled. It is thought the brain’s arterioles lose their ability to regulate their diameter, therefore lose control over cerebral blood flow, causing massive cerebral oedema

• Young Athletes are thought to be particularly vulnerable and to help prevent the risk of SIS using the graded return to play help to minimise the risk of a player returning to play before it is safe to do so

How can we manage Concussions….

If in Doubt Sit Out• Never leave a player on their own- inc

showering

• Not allowed to return to play on the same day

• Must be checked by a Health Professional with experience in SRC

Maddocks

5 Questions1) What Venue are we at?2) What half are we in?3) Who scored last?4) Who did we play last week?5) Who won that match?

Sport Concussion Recognition Tool

SCAT 3 • Child SCAT 3 • SCAT 3• Baselines• Pocket or i-Pad versions

• No set ranges for average, can vary gender and previous Sports Related Concussion history

• Symptom checklist before start GRTP• Do they feel 100%, if not why??

Graded Return To Play• U8s-U15s

– 2 weeks rest– GRTP with 48hours in between each stage

• U16s-U19s– 1 week rest– GRTP with 24hours in between each stage

• U20s- – 24hours symptom free– GRTP with 24hours in between each stage

• All of them must be seen by a Medical Professional

GRTP

• Physical rest– No training, no playing, exercise, weights– Be careful of exertion of daily life

• Cognitive Rest– No TV, computers, phones, reading, video games– ?School – ?Daytime sleep

Questions????