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Rugby head injuries

 One in four rugby injuries are to the head. There are two types of head injury, namely external (usually scalp injuries) and internal (which may involve the skull, the blood vessels within the skull, or the brain). Concussion is a typical internal head injury.

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

  • A direct blow to the head or 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. Symptoms and signs of concussion vary widely. Common among these are:

The most prominent symptoms are:

  • Headache
  • Dizziness and giddiness
  • Nausea
  • Unsteadiness/loss of balance
  • Feeling stunned or dazed
  • Seeing stars or flashing lights
  • Loss of field of vision or double vision
  • Ringing in the ears
  • Sleepiness, sleep disturbance
  • Feeling slowed down or feeling fatigued

Look out for these signs:  

  • Loss of consciousness or an impaired conscious state
  • Being unaware of the opposition’s team name, the period or the score of the game
  • Slowness in processing information – e.g. answering questions or following directions
  • Inappropriate behaviour – e.g. running in the wrong direction
  • Inappropriate emotions – such as laughing or crying – or personality changes
  • Poor coordination and balance
  • Nausea or vomiting
  • Vacant stare/glassy-eyed
  • Slurred speech
  • Significantly decreased playing ability
  • Seizure

Concussion is classified into three grades i.e.: mild, moderate and severe. Depending on the classification and grade of the concussion the player may be out of the game from one week to as long as the rest of the season.

The wing Chris Ashton of England took a heavy blow to the head in a match against South Africa in November last year. He passed the on-field tests and was allowed to continue playing, despite the fact that the referee felt that he should be replaced because of the groggy look in his eyes. Ashton later admitted to have little recollection of the match.

Due to the nature of the game, head injuries and concussion are inevitable and short of wearing helmets, very little can be done to prevent this injury. That said, there is strong evidence that stricter application of the rules, along with strengthening of the neck, could have certain preventative value. Scrum caps and mouth guards have been helpful in reducing the risk of head injuries.

Cauliflower ears are common amongst forwards and are due to chronic damage to the cartilage of the ear lobe. This happens because blood clots or other collection fluid separates the cartilage from the sheath around it (pericondrium) from which it derives its nutrients. The cartilage dies and fibrous tissue then forms, resulting in the deformity.

Scrum caps can prevent or minimise damage. However, some players regard a cartilage ear as a badge of honour or experience.

(Health24, September 2011)

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