Thursday 17 October 2019

Dear Dr Nina: 'My son (13) is an avid rugby player and he has been concussed twice in the last year'

Contact sport should not occur for a full week after a concussive event
Contact sport should not occur for a full week after a concussive event

Nina Byrnes

Question: My 13-year-old son is an avid rugby player. He goes to a rugby school and is by all accounts, very good. He has been concussed twice in the last year, and I am really worried about him. My husband is very keen for my son to continue playing as he feels it will open a lot of doors for him but I am not so sure. Can you explain to me what impact this could have on my son long-term? How serious is repeated concussion?

Dr Nina replies:  Concussions occur as the result of a traumatic blow to the head that causes the head and brain to move rapidly back and forth in a whiplash-like fashion. Concussion can cause physical and chemical changes in the brain that affect how it functions.

It is important to note that you do not need to lose consciousness to suffer from concussion. Dizziness is one of the most common. Headache, confusion, delayed reaction times, ringing in the ears; nausea and vomiting, blurred vision and fatigue are also common symptoms. Repeated episodes of concussion can have a cumulative effect and may increase the risk of chronic brain damage.

Long-term effects of concussion include memory problems, trouble concentrating, depression, irritability and other mood and personality changes, sensitivity to light and noise, disorders of smell and taste, and sleep disturbance.

The outcome of multiple brain injuries is the subject of much study and debate and there is no clear consensus as to what the critical number or level of injury is. It is however, generally agreed that recurrent injuries of this kind can lead to brain damage and may lead to cognitive and behavioural change in those affected. Most of the evidence in repeated concussion has been collected from studies and reviews of those competing in sports such as boxing, soccer, hockey and American football. Repeated concussions can result in dementia-like symptoms many years after injury, a condition labelled chronic traumatic encephalopathy (CTE). This was initially thought only to occur in boxers but a high-profile investigation in the USA also linked it to American Football.

The consequence of recurrent concussion in rugby is hotly debated. Countries vary in the age at which they allow full rugby tackles from eight in New Zealand to 11 in Canada. Some experts have called for no full tackles till age 18. It is unlikely a definitive decision can be made about whether these tackles are safe for teens until science shows a clear pathway to brain damage and there is a firm consensus on what constitutes too many head injuries.

Anyone who suffers a concussion should be taken off the pitch. The evidence is strong supporting allowing enough time for the brain to recover before exposing oneself to risk again. Resting brain and body is extremely important. Reading, computer games etc should be avoided for 24 hours. Once this 24-hour period has passed a return to light activity is okay. Contact sport should not occur for a full week after a concussive event.

It is important that your son's coaches take all steps to ensure play remains as safe as possible for all involved. It is good to be aware of risks and take all steps involved to ensure recovery if injury occurs. Rugby is not the only situation where head injury can occur. Safety is essential in all walks of life.

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