Concussion and the Young Athlete
Caroline 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 Guidelines
REGULATION 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
Chronic Traumatic Encephalopahy
(CTE)
Axonal Damage
Concussion
Neurotransmitter release +
hyperexcitation
Cell death
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 Questions
1) 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????