Concussion
Concussion refers to a 'reversible injury affecting the function of the brain'. These injuries are common in rugby league, rugby union and Australian football. Although they are extremely common, the majority of professional football players who show a degree of concussion do not miss a single match, and many return to play in the same game as they were concussed. This rapid return to play is controversial, as many observers (both expert and amateur) consider that this management is too risky.
Model of brain
Why is the 'return is safe when symptoms have recovered' approach taken? : In Australia, the majority of sports physicians and team doctors believe in the philosophy that it is safe to return to play once all symptoms of the concussion have reversed, irrespective of the time taken for this to happen. Therefore, even if a player is unconscious for say 30 seconds during a game, if later in a game he is fully orientated, is processing information and has no headache or dizziness or other residual symptoms, then the doctor may consider that he is OK to return to play. The leading Australian specialist responsible for promoting this guideline is Dr Paul McCrory, of the University of Melbourne, who has duel training as a neurologist and sports physician. The lack of incidents of catastrophic head injury where doctors are involved at football matches in Australia supports the viewpoint that this philosophy is safe. Whilst there have been deaths and other catastrophic head injuries in Australia, these have either occurred from a single major incident or in circumstances where a doctor was not present and it is unclear whether the player was previously symptom free. Doctors in Australia will often use a test such as the Digit Symbol Substitution Test (DSST) or objective testing using CogSport tests in order to test a player's alertness if they have any doubt that the player is giving them correct information regarding their mental state.
What is the alternative approach? Many medical authorities internationally have set guidelines on compulsory stand-down periods following concussive episodes. In theory this sounds like better practice as it appears to be more conservative practice, which sounds 'safer'. However, a lack of credibility surrounds concussion guidelines as there are at least 20 different sets of guidelines regarding mandatory stand-down periods based on the presenting symptoms, and none of the guidelines are based on anything other than an arbitrary 'best guess'
analysis. Typical criticism of these guidelines (click for more)
Brain MRI
Respected Melbourne journalist Mike Sheahan has highlighted the difficult football club doctors have in managing concussion, illustrating recent cases from the AFL where players have been returned to play after apparently significant injuries. Writing in the Herald-Sun on 22/7/03, he almost suggested that doctors were not always acting in the players' best interest but stopped short, saying instead: "We don't question the integrity of club doctors, yet there is implied pressure to keep the better players on the ground". Even if doctors were doing the right thing by players, Sheahan argued that the game has a duty of care to avoid the image of a disorientated player staying on the field, or returning shortly after an obviously significant injury.
A recent article in the Clinical Journal of Sport Medicine has shown that memory loss (amnesia) is much more important than loss of consciousness time in predicting the severity of a concussive episode. Click here to read the abstract .
To post a comment or ask a question about these injuries, visit the cricketinjuries Forum, click here .
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