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Sports concussion: top of the injury list at the Rugby World Cup?
Latest news | September 1, 2015
The 2015 Rugby World Cup kicks off this month right on our doorstep, setting us up for the prospect of watching two months of fast and hard-hitting rugby. Rugby medics tend not to watch much of the game itself, but rather concentrate on the players left on the ground, because along with the tackles and tries will inevitably come injuries. Knee ligament injuries caused the greatest time off from rugby at the last RWC (held in South Africa 2010), but the most commonly occurring injury was a hamstring strain, closely followed by concussion.

Undoubtedly concussion will again be close to the top of the list this year, however this will be accompanied by a greater awareness as well as improved diagnosis and management. RWC 2015 promises that the rules and regulations surrounding concussion will be among “the strictest and most transparently enforceable” ever seen.

Concussion occurs in many sports, including football, gymnastics and cycling. In the USA, concussion is synonymous with American football (and cheerleading incidentally), but – in the UK – concussions in rugby receive the most scrutiny. It is the most commonly reported rugby match injury in the amateur game, and in school and adolescent club rugby concussions account for up to 24% of all injuries sustained.

What is concussion?
Concussion is a traumatic brain injury which results in a temporary disturbance of brain function, usually caused by a direct blow to the head, although it can also occur in whiplash-type injuries which cause rapid movements of the head. Contrary to popular belief, concussion usually occurs without being knocked out.

 Concussion can mimic more severe brain injuries and, therefore, caution is imperative. World Rugby (previously the International Rugby Board) teaches referees, coaches, players and parents to ‘Recognise and Remove’: removing any player with suspected concussion immediately and seeking medical attention. The symptoms of concussion can present at any time but typically show themselves within the first 24-48 hours after a head injury. These symptoms can be vague, including headache, dizziness, difficulty concentrating, or memory and balance problems.

How is concussion treated?
Rest, both physical and mental, is the cornerstone of managing concussion. This means avoiding physical exertion (including running, cycling, and of course training) as well as resting the brain until symptoms settle. World Rugby stipulates that players should have complete rest for at least 24 hours, whilst children and adolescents should not train or play for a minimum of two weeks following the cessation of symptoms.
Once a player is symptom-free at rest and has completed the minimum rest period, he or she can move through the Graduated Return to Play (GRTP) protocol which is designed to slowly and progressively challenge the body and brain to establish if any subtle or residual signs of concussion still exist. World Rugby recommends that players receive medical clearance before starting the GRTP protocol and again before the player can participate in full contact training.

In rugby, concussions which have been managed correctly and have fully resolved do not make future concussions any more likely. However, when a player returns to playing too soon, he or she runs a significant risk of prolonging their symptoms (“post-concussion syndrome”) and exposing themselves to the rare but serious second-impact syndrome. The potential risks of developing long-term brain disorders as a result of multiple concussions is under intense scrutiny by sports medics and scientists around the world. A recent study from New Zealand of 500 former players found no firm evidence of a link between playing rugby and any serious decline in brain function. A link is certainly possible but this remains elusive. In the meantime, we should remember that there are numerous benefits of playing sports, including rugby, and keeping active.  In many cases these benefits, particularly to health, far outweigh the risks, as long as those risks are taken seriously and injuries are managed properly. 

(a version of this article appeared in the Putney Clinic newsletter in September 2015)
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