Head injury: Concussion in rugby

Definitions of concussion abound and vary widely. A good working definition of concussion is that it is “a clinical syndrome characterised by immediate and transient post traumatic impairment of neural function, such as alteration of consciousness, disturbance of vision and/or equilibrium due to cerebral or brain stem involvement” (SARugby.Net).

Mechanism of injury
Concussion may be sustained through a variety of mechanisms. These include:

• A direct blow to the head
• A blow to the jaw
• Sudden twisting or shearing force on the head
• Sudden deceleration of the head

It is important to bear in mind that it is not necessary for a player suffering concussion to fall to the ground. Also important is the fact that loss of consciousness is not a necessary sign of concussion, but may indicate its severity.

Symptoms
Symptoms and signs of concussion vary widely. Common among these are:

A) Cognitive features

• Unaware of the period, opposition, score of the game
• Confusion
• Amnesia
• Unaware of time, date, place. This may in some instances remain intact.

B) Typical symptoms

• Headache
• Dizziness
• Giddiness
• Nausea
• Unsteadiness/loss of balance
• Feeling stunned or dazed
• Seeing stars or flashing lights
• Ringing in the ears
• Loss of field of vision
• Double vision
• Sleepiness, sleep disturbance
• Feeling slowed down
• Fatigue

C) Physical signs

• Loss of consciousness/impaired conscious states
• Poor coordination and balance
• Seizure
• Slowness in processing information – e.g. answering questions or following directions
• Easily distracted or poor concentration
• Inappropriate emotions – such as laughing or crying
• Nausea or vomiting
• Vacant stare/glassy eyed
• Slurred speech
• Personality changes
• Inappropriate behaviour – e.g. running in the wrong direction
• Significantly decrease playing ability

Time out of action
Concussion is classified into three grades i.e.: mild, moderate and severe. Depending on the classification and grade of the concussion the athlete may be out of the game from one week to as long as the rest of the season. Due to the nature of this injury it is advisable that return to activity be primarily determined by the lack of the above-mentioned symptoms as well as scans or whatever other methods the treating doctors use in their determination. – (Conrad Booysen, Biokineticist)