We frequently hear these words on the sideline of sports fields, in our clinic rooms or even in social settings. It’s a statement that makes me cringe every time.
To set the record straight from the beginning – concussion is a traumatic brain injury. Though formally classed as a mild brain injury, the short and long term effects on the brain can vary wildly. For some it may be a simple headache. For others there may be visual disturbance, inability to concentrate, memory loss, difficulty with movement, inability to tolerate loud noises or bright lights. The list goes on. The duration that these symptoms may last is equally varied. Even more troubling still are the list of consequences if there is a subsequent concussion within a 3-4 week period. Second impact syndrome has, in severe cases, led to sudden death.
Over the years concussion has come and gone in the public spotlight. At times this has been due to the premature retirement of an elite athlete; or perhaps the threat of legal action against sporting bodies due to player welfare. Contact sports in particular have been under pressure to balance the risk of concussion with the demand of the game.
There have been widespread policy changes to help assist with early assessment and intervention following a suspected concussion. Rugby players are required to leave the field if the referee, sideline physio or video referee suspect a head knock. The doctor then conducts a “head impact assessment” (HIA) following which the player may be prevented from returning to the field. Similar approaches are taken in other sports including cricket, hockey and football.
Otago University and AUT University have developed and tested a new framework for the management of concussions in our youth. The FRAmework for MaNaging Concussion in New Zealand Secondary School, (FRANCS) has been developed to coordinate the physical, mental and emotional recovery. In a school setting this can mean a gradual return to learning with less hours per day, less screen time, changes to homework demands or more. The physical recovery pathway includes a 4-week stand-down with a gradual increase in effort, ensuring not to reproduce their symptoms. Ongoing resources are being developed and in time these will be provided to a wider range of schools beyond the pilot group.
The key message is that a concussion is a serious injury to the most important organ of the human body. Simply referring to a concussion as a brain injury can change our thinking about how to best recover. Finally, if the concussion has been in one of our young people I would urge you to take the diagnosis seriously and ensure they are fully recovered before returning to sport.
Nb. Written as Health columnist for the Hibiscus Matters.
