In rugby league there is a high incidence of concussion, as it is a highly physical contact team sport played in Australia and internationally, at various levels. The Australian Sports Commission’s 2006 survey showed an estimated 209,800 Australians aged 15 years and older played rugby league in the 12 months prior to being surveyed. The majority of players were male (88%), aged 15 to 24 years (73%) who played in New South Wales and Queensland (87%) as part of organised sporting activity (75%).
Concussion injuries account for around 7% of all injuries in rugby league. Over time it has been found that repeated concussions can lead to permanent brain injury. In Australia, guidelines have now been developed to help manage concussion and head injury. The guidelines are based on a Consensus Statement produced from the 5th International Conference on Concussion in Sport to ensure that first responders, medical practitioners, coaches and parents have an awareness on how to manage concussion in rugby league.
What is concussion?
A concussion is a type of traumatic brain injury (TBI) that occurs when a blow, jolt, or impact to the head causes the brain to move rapidly within the skull. This sudden movement can lead to various symptoms, including headaches, confusion, dizziness, nausea, and sometimes loss of consciousness. Concussion is a milder traumatic head injury and involves a disturbance of brain function with no structural damage and no probable permanent injury to the brain.
Concussions can happen from various activities, such as sports injuries, falls, or car accidents. Concussion is caused by either direct or non-direct trauma to the brain. Direct trauma could involve a clash of heads, whilst indirect could be a shoulder charge to another part of the body being transferred up through the brain.
When the force is transmitted to the brain it can stun the nerve tissue and affect nerve function. This can result in various symptoms depending on which part of the brain is traumatised. It must be remembered a player does not have to lose consciousness to suffer a concussion injury. A concussion injury is a functional disturbance of the brain rather than structural damage.
It is essential to recognise and properly manage concussions because repeat concussions, especially before the brain has fully healed from the initial injury, can lead to more severe and long-term consequences. If managed appropriately the changes are believed to be temporary and usually spontaneously recover.
Recognise the signs and symptoms of concussion:
Recognising the signs and symptoms of a concussion is crucial for prompt and appropriate management. In concussion injuries complications are not common, however, the risk of complications increases if a player is allowed to return to play (or training) before they have fully recovered from their initial concussion.
It is therefore essential to recognise concussion and take appropriate steps to diagnose head injury and keep the player out of play until fully recovered. Here are some common signs and symptoms to look out for:
Physical Symptoms:
Headache or pressure in the head
Nausea or vomiting
Dizziness or balance problems
Sensitivity to light or noise
Blurred or double vision
Fatigue or drowsiness
Slurred speech
Difficulty sleeping or sleeping more than usual
Loss of consciousness (not always present)
Cognitive Symptoms:
Confusion or feeling mentally foggy
Difficulty concentrating or remembering new information
Feeling slowed down
Difficulty with decision-making or problem-solving
Emotional and behavioural symptoms:
Irritability or mood swings
Anxiety or nervousness
Depression or sadness
Easily angered or frustrated
Other symptoms:
Ringing in the ears (tinnitus)
Changes in taste or smell
Brief loss of consciousness (even for a few seconds)
Feeling “not quite right” or “off”
It’s important to note that symptoms may not always appear immediately after the injury and can develop over time. Additionally, individuals may experience a combination of these symptoms to varying degrees. If you suspect someone has a concussion, it’s essential to seek medical attention promptly. Concussions can have serious consequences if not managed properly, and a healthcare professional can provide guidance on treatment and recovery.
What to do if you suspect concussion in a player:
If you suspect a player has a concussion, it is crucial to prioritize their health and safety above all else. Here are the steps you should take:
Remove them from play: Immediately remove the player from the game or practice. Continuing to participate in physical activity with a suspected concussion can lead to further injury or complications.
Assess the player: Observe the player for signs and symptoms of a concussion. These may include headache, dizziness, confusion, nausea, sensitivity to light or noise, blurred vision, balance problems, difficulty concentrating, or memory problems.
Seek medical attention: If there is any doubt about whether the player has sustained a concussion, it’s essential to have them evaluated by a qualified healthcare professional. This could be an athletic trainer, team physician, or emergency medical personnel.
Follow concussion protocols: If the player is diagnosed with a concussion, follow the appropriate concussion management protocols established by the relevant sports organization, such as guidelines from the CDC, NCAA, or other governing bodies. This may involve rest, gradual return to activity, academic accommodations, and monitoring for symptoms.
Inform the player and their family: Communicate with the player and their family about the suspected concussion, the steps being taken for evaluation and treatment, and any recommendations for recovery. It is essential to keep everyone informed and involved in the process.
Document the incident: Keep detailed records of the suspected concussion, including the circumstances surrounding the injury, any symptoms observed, medical evaluations, and follow-up care. This documentation may be necessary for future reference or reporting requirements.
Emphasize safety and prevention: Use the incident as an opportunity to reinforce the importance of concussion awareness, proper techniques to reduce the risk of injury, and the need for players to report any symptoms they experience promptly.
Remember, when it comes to concussions, it is always better to err on the side of caution. Prompt recognition and appropriate management of concussions are essential for the well-being of athletes and can help prevent long-term complications associated with head injuries.
Return to play process:
When considering management of concussion, the welfare of the player both in the short and long term must always remain paramount. This is a vital process where concussion management has been thorough to ensure that a made a full recovery has been made by the player before return to play. As repeated concussion on a previous concussion can lead to further brain injury and long-term trauma.
Community rugby league now encourages coaches and medical professionals to undertake courses run by the professional rugby league association to understand protocols involving concussion or head injuries. The following are keys to management of concussion:
Rest and recovery:
Returning to play after a concussion should be approached cautiously to ensure the safety and well-being of the individual. This means adequate time away from both training and playing to avoid subsequent injury. The brain needs time to recover, however there is no mandatory period on return to play. However, an adult player wanting to return to play earlier than an eleven day period must get clearance from a specialist concussion Doctor. The decision on return to play must always be made by a medical practitioner such as a Doctor, Neurologist, Neurosurgeon or Sports and Exercise Physician with a documented strong interest in concussion management.
Medical evaluation:
Before considering a return to play, the individual should undergo a thorough evaluation by a medical practitioner experienced in managing concussions. This evaluation may include a physical exam, cognitive assessment, and possibly neurological imaging studies to assess the severity of the injury and track recovery of the brain injury.
Returning to physical activity should be a gradual process that is closely monitored by medical professionals. This typically involves a step-wise progression where the individual gradually increases their level of exertion while closely monitoring symptoms. The specific protocol for return to play may vary depending on the individual’s age, severity of the concussion, and other factors.
Symptom-limited progression:
Progression through the return-to-play protocol should be guided by symptoms. If symptoms worsen or return during any stage of the protocol, the individual should return to the previous stage and allow more time for recovery before attempting to progress again.
Medical clearance:
Before returning to full contact or high-risk activities, the individual should obtain medical clearance from a healthcare professional experienced in managing concussions. This clearance should be based on the individual’s symptom resolution, cognitive function, and completion of the return-to-play protocol.
Close Monitoring:
Even after returning to play, it is essential to monitor the individual closely for any recurrence of symptoms or signs of delayed recovery. If symptoms return or worsen, the individual should immediately stop activity and seek further evaluation from a healthcare professional.
Overall, the goal of returning to play after a concussion is to ensure a safe and gradual return while minimizing the risk of re-injury or exacerbating symptoms. It’s essential to prioritise the individual’s long-term health and well-being throughout the recovery process.
Play Safe:
Playing safe rugby league involves a combination of proper technique, adherence to rules and regulations, and prioritizing player welfare. Here are some key tips for playing rugby league safely:
Learn and practice proper techniques: Proper tackling, passing, catching, and tackling techniques can help reduce the risk of injury. Coaches should emphasize safe techniques during training sessions and ensure players understand and can execute them correctly.
Wear appropriate protective gear: Protective gear such as mouthguards, headgear, shoulder pads, and appropriate footwear can help reduce the risk of injury during play. Make sure all equipment fits properly and is worn according to the manufacturer’s recommendations.
Follow the rules: Rugby league has specific rules and regulations designed to promote safety and fair play. Players should familiarize themselves with the rules of the game and adhere to them at all times. This includes rules related to tackling, dangerous play, and foul play.
Respect your opponents: Rugby league is a physical sport, but players should always respect their opponents and play within the spirit of the game. Avoid unnecessary aggression, foul play, and dangerous tackles that could cause injury to yourself or others.
Stay hydrated and properly conditioned: Proper hydration and conditioning are essential for preventing injuries and maintaining performance on the field. Players should stay hydrated before, during, and after games and maintain a level of fitness appropriate for the demands of the sport.
Report injuries promptly: If you sustain an injury during play, report it to your coach, team medical staff, or other appropriate personnel immediately. Ignoring or downplaying injuries can lead to further complications and prolonged recovery times.
Receive proper medical attention: If you suspect a concussion or any other serious injury, seek medical attention from a qualified healthcare professional as soon as possible. Follow their recommendations for treatment and recovery to ensure a safe return to play.
Communicate with your team: Open communication among teammates, coaches, and medical staff is essential for promoting safety and wellness within the team. Encourage teammates to speak up if they’re feeling unwell or have concerns about their health.
Focus on sportsmanship and teamwork: Emphasize the importance of sportsmanship, teamwork, and camaraderie both on and off the field. Supporting and looking out for each other can help create a safer and more enjoyable playing environment for everyone.
By following these guidelines and prioritising safety, players can enjoy the physical and competitive aspects of rugby league while minimising the risk of injury. Injury is unavoidable in rugby league but by taking safe measures hopefully we can minimise and reduce the severity of injuries and the safety of players. The main message in this article on concussion, is recognise and manage concussion immediately and delay return to play until a full recovery of the player is achieved.
