Headcases – the improvement in dealing with concussion in Irish sport.

The identification and treatment of concussion in contact-related team sports has improved dramatically over the last decade. The day of the coach running onto the pitch and asking a player “how many fingers am I holding up?” are thankfully long gone. However, progress and education of coaches and medical staff involved with both professional and amateur teams continues to be a work in progress for the main sporting bodies in this country. 

The Headway association in the UK that deals with various brain injuries have been to the forefront of creating awareness around the topic, while the 2015 movie starring Will Smith ‘Concussion’ dealt with the topic from the perspective of the risk of repeated undiagnosed traumas to the head area and leading to long-term effects know as chronic traumatic encephalopathy (CTE). Irish doctor and former rugby International Dr. Barry O’Driscoll has also been a vocal campaigner on the topic “What has become increasingly indisputable over this period has been the potential short, medium and long-term brain damage from concussive episodes, most of which present with mild/moderate transient symptoms or signs.”

The approach to Concussion among the major sporting bodies in this country is now in line with best international practice and medical advice on how to try to identify and deal with suspected concussion incidents. 

By its very nature the sport of rugby has a higher frequency of physical contact than most other team sports. The number of hits a player makes and receives in a  game means that the risk of trauma to the head is greater than in other team sports.  The IRFU have been leading the way on the topic and have a stringent HIA (Head Injury Assessment) protocols to identify if an injury has occurred and a stringent procedure before a player can return to action. This return to play is governed by a graduated return to play plan. The IRFU have developed separate plans for the professional and amateur games.

In recent seasons there has been an increasing awareness of how to identify and treat any potential injuries as soon as they happen. The IRFU and their medical experts have put a system in place to check players as soon as there is any suspicion that they may need medical intervention. If a head impact is spotted by the pitch side doctor or the team physio or the match doctor then the player is removed from the pitch for a minimum of ten minutes while a HIA assessment is carried out. 

At a professional level, this assessment requires the establishment of a baseline performance level for each player. This measures the player’s ability to recall information under normal conditions. These measures are then used as a benchmark to check a player against when there is a suspicion of the player being concussed. The normal balance and fitness levels are also established at this stage to measure performance during the return to play procedure. This is a five stage process which goes from complete rest from all activities via gradual steps before a full-contact session. A player cannot progress to the next step until they a symptom-free at the current stage. 

The amateur game has a similar plan over six stages and they have produced video guides and handouts for clubs and players to follow in order to prepare a player for return to action. 

There also has been a cultural change among players. No so long ago players would proudly re-tell anecdotes of not remembering scoring an important match-winning score after an earlier bang on the head. Perhaps the most well know of these is Moss Finn’s post-game testimony of Ireland’s 1982 win over the Welsh at Lansdowne road. “I scored two tries, but can’t remember them. I finished the match, was taken away to St. Vincent’s hospital and spent the night there. The highlights come on the tv in the room. I sat there watching myself score two tries I had no memory of scoring.”

It was an era when players ‘heroically’ would have refused to come off after staggering around for a few minutes because they couldn’t be seen to let their team-mates down. Concern for their own personal safety was often placed a distant second to the good of the team. Now there is an acceptance amongst players that if they tried to remain on the pitch they would be letting their teammates down as they would be slower to react, and more likely to have poorer positional awareness. 

Campaigns such as Headway’s “If in doubt, sit it out” fronted by former English captain Lewis Moody have helped change the mindset of players in rugby. 

Soccer is another sport that has become increasingly aware of its responsibility to its players in protecting them from the risks of concussion.

According to the FAI on their website “Concussion can be defined as a brain injury that arises from trauma to the head, neck or through an impulsive force to the head from elsewhere in the body.” 

The FAI’s website states that any player with a concussion or suspected concussion should be removed from the field of play immediately and safely, and should not return to play, training or other physical activity on the same day.

The GAA have an upcoming Symposium on Concussion at Croke Park in November, and this is their third annual event dealing with the topic. 

In the words of their own press release  on the topic from their first event in 2016: “Leading concussion experts from UPMC in the United States, Bon Secours Health System in Ireland and sporting figures from the GAA will join together for a ground breaking symposium which will share nationally for the first time the best practices, protocols and treatment of concussion today.”

It’s not just team sports that have concussion risks associated with them. Boxing has long been linking with repetitive head trauma’s and has stringent guidelines for return to fighting after a knockout blow to the head. Irish Boxing follows AIBA protocols for all fighters.

Thankfully modern sportsmen and women are offered far better protection from their governing bodies than was the case even a decade ago and awareness amongst the general public is vastly greater too.

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