Get Your Head In the Game

Sean Morgan takes a look at traumatic brain injuries in sport
Irish Fly Half Jonathan Sexton Giving English Rugby Fans Just Another Thing To Feel Bad About, Weeks After Returning From A Break Following 4 Concussions.

Irish Fly Half Jonathan Sexton Giving English Rugby Fans Just Another Thing To Feel Bad About, Weeks After Returning From A Break Following 4 Concussions.

When you think of injury in sport, the musculoskeletal system first comes to mind. A fractured clavicle, torn hamstring or ACL injury are injuries which you may be familiar with seeing on the sporting stage, whether you follow football, rugby, cycling or just about any sport. You may even fancy your chances of diagnosing one of these injuries when your player goes down in a heated game of FIFA with your housemates. However, in recent years there has been increased attention on sporting related traumatic brain injuries (TBIs), with a number of high profile incidents owing to the increase publicity.

It is estimated that around 60,000 sporting related TBIs occur each year in athletes partaking in American high school and college sport programs. Typically injury is the result of an external force causing trauma to the brain, resulting in a range of symptoms including neurological, psychological and physical impairment.  The most common form of TBI is concussion. Concussion is the result of a traumatic force impacting the brain, resulting in transient loss of cerebral function, presenting in a range of manners, such as loss of consciousness, retrograde amnesia, headache, irritability and issues with ability to co-ordinate or speak. A recent high profile example of concussion in sport comes from the world of motor racing. Two weeks ago Formula One driver Fernando Alonso crashed heavily at 130mph following the loss of control of his Mclaren-Honda race car during winter testing at Circuit de Cataluña, Barcelona. On arrival of the circuit’s medical team, Alonso was conscious and talking. After being removed from the car, he briefly lost consciousness and once regained it became evident he was suffering retrograde amnesia, reportedly having no recollection of the incident or the events which had proceeded. Alonso was medically sedated at the circuit, before being airlifted to hospital for a CT scan to rule out other forms of TBI, such as contusion or haematoma.

Of the 60,000 sporting related TBIs in American high school and college sport programs, 62% were seen in American football, so while the example of Fernando Alonso is illustrative of concussion, contact sports such as rugby and American football are where concussion is more commonly seen. One issue with concussion in sports, which is not as pressing a factor in normal episodes of concussion, which had side lined Irish rugby outhalf Jonathan Sexton for the 12 weeks leading up to the first weekend of this year’s Six Nations Championship and will see Fernando Alonso miss next weekend’s Australian Grand Prix, is the risk of Second Impact Syndrome (SIS). SIS is the result of a second concussion suffered before full recovery from the first. It may lead to catastrophic brain swelling, increased intracranial pressure and critical damage to the brain. Coma may result and it is not unheard of a vegetative state to result. Aside from the risk of SIS, a break from participation is recommended on the basis of increased understanding of repeat concussion resulting in the neurodegenerative condition Dementia Pugilistica, characterised by features of dementia and Parkinsonism. Psychological problems also characterise the condition, with many sufferers dealing with depression and addiction.  The condition was first described in boxers, but is commonly seen amongst retired American football players, with Seattle Seahawks wide receiver Sidney Rice and Steve Weatherford of the New York Giants announcing this week that they will be donating their brains to research in to the condition.

While the element of contact remains in sport, the risk of concussion and TBI will never be removed, but steps have been taken to increase awareness of concussion and protocol has been introduced in order to prevent the risk of an athlete suffering concussion and putting themselves at risk by continuing to partake in their sport before they have recovered. Sporting bodies such as the International Rugby Board, Fédération Internationale de l’Automobile (Governing body of Formula One), FIFA, the International Olympic Committee, amongst others, have introduced standardised protocol for the assessment of concussion, both in the immediate aftermath of the incident and in the days to weeks which follow. A current example of protocol used is the SCAT3 (Sports Concussion Assessment Tool- 3rd Edition), a pitch side assessment which incorporates potential signs of concussion, neurology, physical ability, Glasgow Coma Scale, and cognitive ability through modified Maddock’s questioning, a series of questions relating to the current sporting event.  Upon completion of the assessment, the attending medic must make the decision if the athlete can be reintroduced to the event. If the athlete is refused from taking further part, further protocol is followed which will stagger the reintroduction of exercise and competitive behaviour to the athlete in correlation with the reduction of symptoms.

Though we may be more aware of sporting related TBI through the attention it has received from the media, when playing BUCS or UH matches, the incidents we see on the big screen in the biggest of sporting events may appear foreign to us, but we are equally at risk. Be responsible and take precautions to limit your chances of sustaining a TBI and be aware of what signs to look out for in the event of an impact.

Sean Morgan, Sports Editor

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