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Head knocks in Rugby, Rugby Injuries
Head injury in sport has progressed enormously in its understanding, particularly over the last 5 years. Initially road trauma, boxing then American football attracted the majority of attention to head injuries. The long held view was that if there was no loss of consciousness (LOC) then the injury was not severe, but this is not so. Also, medicos were sometimes puzzled as to why an athlete could be so sick even though his “scans” were normal. Read on…….
The term concussion has a broad definition. In the 1960’s the American College of Neurosurgeons offered a definition which included symptoms and wording such as temporary unsteadiness, dizziness and giddiness. Symptoms which all of you have experienced both playing and training for rugby, sometimes on a regular basis.
We know that the brain is protected in the vault of the skull, and it is bathed in a chemically rich fluid (CSF). Sudden trauma can jolt the brain; some authors have compared a violent head injury to throwing a pile of jelly against a brick wall. The key to the degree of damage though appears to be the position of the head.
Human and animal studies have shown that rotational forces (eg blow across the chin) cause more severe damage than front-on blows. In addition blows to the temporo-parietal region (above the temple) are more likely to cause concussion. Obviously some of these may be accidental but poor tackling technique is now implicated following studies where video-analysis of concussion injury was used.
Now with a better understanding of injury through Neuro-Psychometric Testing (NPT) the pathophysiology (injury and mechanism) of head injury and possible long term problems are appreciated. NPT are a series of tests to assess cognitive function. This includes speed of thinking, assimilation of information, memory recall and concentration under pressure. Computerised testing is more common with elite teams, but a common simple ‘pen and paper” test is the Digital Symbol Substitution Test (DSST). Pre-seasonal “normal” values provide a baseline measurement.
Three final points as you consider taking any future head injuries seriously:
- If you are regularly getting dazed when you are the tackler, then seek to have this addressed. A video of those episodes may be helpful. Nobody is beyond improving their technique.
- Perform your pre-season Neuro-Psychometric tests and keep a record for yourself. Many players will play for 3 or 4 teams in a year and these tests are a helpful part of your assessment.
- Headgear has not been shown to protect against concussion, but new research may in fact show that if headgear is reinforced in certain areas, it may provide better protection and hence may be an advancement. This possibility is being analysed at present.
Dr John P Best
B.Med., Dip. Sports Medicine (London), FACSP
Sports Physician
References available on request