South African experts have played a leading role in developing new world guidelines on how to prevent and reduce the risk of concussion in sport, which turn on their head previous advice on recovery and treatment.
This “mild traumatic brain injury” doesn’t just affect elite and schoolboy rugby players, but also women slammed into the wall by abusive partners, car crash victims, cyclists, children tumbling off jungle gyms and pensioners tripping down steps.
Sports medicine doctor and Wits professor Jon Patricios says concussion is often missed, yet unrecognised, unmanaged and repeated concussions can compromise people’s cognitive, physical and emotional well-being, reports TimesLIVE.
Patricios, head of Wits sport and health, jointly led the process of developing new world guidelines on how to prevent and reduce the risk of concussion in sport, diagnose it and treat it.
“SA has played a leading role in this,” says the first author of the updated consensus statement, published in the British Journal of Sports Medicine in June.
The guidelines include changes to old practices, for example, replacing the practice of cocooning in a dark room after a concussion with light physical activity, like walking.
“We are treating concussion in a very different way,” says Patricios, calling for greater awareness and an end to scaremongering. “If we identify and manage concussions properly, they can be resolved with good outcomes. We are in a different era from even a decade ago.”
The sport guidelines overlap with how to manage concussion from recreational or daily activities, like falling off a ladder or a horse. “Concussions in equestrian sports are very underestimated.”
Concussed patients typically underestimate the injury to their brain, says Dr Leigh Gordon, a director of the Cape Sports Medicine Clinic.
“’They say, ‘I wasn’t knocked out, mine wasn’t a bad concussion.’ But 90% of the time people are not knocked out and after a blow to the head there is lot going on invisibly, at a cellular level in the brain.”
School sports
In school rugby, concussions occur at the rate of about 16 per 1 000 player hours, says Gordon, who was the Springbok 7s team doctor for years.
“In a big school rugby derby with 1 000 players on a weekend, we can expect about 16 concussions.
“After multiple concussions, very little force can (trigger) lots of symptoms. The more concussions you have, the more vulnerable you are.”
A major risk with concussions is that it is easily overlooked in busy hospital casualty wards, says Patricios. “Emergency rooms are concerned with gross damage and (not all) doctors have the skills or the tools to evaluate concussion. Unless there is bleeding or a fracture, standard imaging is almost useless in detecting concussions.”
That advice “to go home and rest” has been updated by the “return-to-learn and return-to-sport” strategies noted in the Amsterdam International Consensus Statement on Concussion in Sport.
Gordon says: “We want people to exercise, lightly but not to the extent that they aggravate their symptoms. We want people to use their brain, but not to overuse it.”
“We now have better clinical tools to identify concussion, though the technology is not quite at the threshold we need,” says Patricios, who was lead author on a paper about later-in-life health risks associated with sport-related concussions and repetitive head impacts.
The team reviewed 28 studies for this, but most were not designed to provide the right information.
“Some studies in former professional athletes suggest an increased risk of neurological disorders such as ALS (suffered by former Springbok Joost van der Westhuizen) and dementia,” they concluded, noting, however, that higher quality studies were needed.
Embracing safety
“SA has been a key player in implementing protocols in the field, not just at a professional level but in schools with the BokSmart programme,” says Patricios.
“The message is to recognise and remove: recognise the concussion and remove the player. In collision sports, any abnormal change of behaviour must be treated as suspicious.”
See more from MedicalBrief archives:
Systematic review confirms concussion brain injury risk for athletes
New UK concussion guidelines make players ‘sit it out’
Even one, moderate concussion can lead to cognitive deterioration – large study