Advice on when to return to play after a concussion.

First topic message reminder :

Folks, in the light of a few rugby-related concussions I've become aware of recently, including one to RDW_Scotland I figure it's worth having the IRB quidelines available as a ready reference, so I'm resurrecting MrsP's thread (below) and making it a "sticky". -KRD


http://irbplayerwelfare.com/concussion



This is a subject very close to my heart and a chat on another thread has just lead me to ask.

How many players/coaches/parents are aware of the most recent guidelines?

This is about protecting not just your rugby career but your quality of life and even, for youngsters, your life itself.

Summary Principles

Concussion must be taken extremely seriously to safeguard the long term welfare of Players.

Players suspected of having concussion must be removed from play and must not resume play in the match.

Players suspected of having concussion must be medically assessed.

Players suspected of having concussion or diagnosed with concussion must go through a graduated return to play protocol (GRTP).

Players must receive medical clearance before returning to play.

The new Guidelines are summarised below.

The IRB Recognise and Remove message incorporates 6 Rs[size=38]

Recognise -

Learn the signs and symptoms of a concussion so you understand when an athlete might have a suspected concussion.


Remove -

If an athlete has a concussion or even a suspected concussion he or she must be removed from play immediately.


Refer -

Once removed from play, the player should be referred immediately to a qualified healthcare professional who is trained in evaluating and treating concussions.


Rest -

Players must rest from exercise until symptom-free and then start a Graduated Return to Play. The IRB recommends a more conservative return to play for children and adolescents.


Recover -

Full recovery from the concussion is required before return to play is authorized. This includes being symptom-free. Rest and specific treatment options are critical for the health of the injured participant.


Return -

In order for safe return to play in Rugby, the athlete must be symptom-free and cleared in writing by a qualified healthcare professional who is trained in evaluating and treating concussions. The athlete completes the GRTP (Graduated Return to Play) protocol.[/size]


Who has read them or been made aware of their contents?


For anyone who has suffered a recent head injury, here is some excellent advice c/o Doctor Grey.


http://www.morrisrugby.org/images/pdf/2010parent-head-injury-instructions.pdf

And another video (about 10 mins) this time from the NFL giving some general advice about concussion.

http://www.nata.org/health-issues/concussion



For anyone who may be unaware of the extent or severity of the problem, this is an interesting Aussie TV program on the subject which aired just last week or so.

http://www.abc.net.au/4corners/stories/2012/05/10/3499950.htm

And this is why I am so animated about concussion!

http://www.theguardian.com/sport/2013/dec/13/death-of-a-schoolboy-ben-robinson-concussion-rugby-union

I know any time I see a lad who I coach dazed or anything like that, he is hauled off be it training or a match.

As Mrs. P said, it took a tragic death to raise the issue. Should never have gotten to that, but sometimes something awful brings things to light for more people.

When I heard about the poor Ben Robinson, both from Mrs. P on old 606 and well as through the medical and Rugby grapevines I was shocked. I looked at my older son, who was just about to turn 14 and swore never. Never here. Never mine. And I consider 'my kids' as not just my lads, but also every kid I ever coached. This from a Dad who has had a few big concussions on the pitch and a few others elsewhwere.

As summer moves into autumn, and the season resumes again, I cannot stop thinking about the kids playing. The professionals and top level players are generally well taken care of, but so much does not move down to the grass roots. These kids at the grass roots, whether they advance to higher honours or not are the future of our sport. The players active at all the adult and old bays club levels are the present.

Whenever Her Majesty's handlers dismiss me from service once again (punishment for considering orders to be suggestions, don't you know) which should be soon, I will going to the NFL and a few universities to see thir latest data and initiatives. Then to USA Rugby, which will seem like going from visiting the White House to the Outhouse. But someone in USA Rugby must have good information. I now need to know. Once the differences are known then a proper game plan of public awareness, whether in the US, UK, Ireland France down south or out east.

I believe the Rugby Unions I have spoken with are of two distinct minds about how to seal with Concussion/SIS:
One one hand they truly do care for their players and want no one with any permanent disability, from concussion or any injury. None.
This excludes a few who won't listen

The other side of this is they don't want the negative publicity associated with implementing new test methods, evaluative methods and restrictions. So their preference we start the new tighter criteria by almost by stealth.

So the next step is to craft a hard hitting, short, concise, to the point information dossier covering the dangers AND the danger of serious injury combined with the required medical and evaluative steps. This sport is too great, too good for kids to learn the positive life lessons, that it needs to sometimes be protected from itself.

Thus endeth the sermon.

I would like to add this artcle to the growing body of knowledge about concussions we have here. The link directs to an article about a certain form of head trauma monitoring in American Football where data has been built for a number of years.

Specificaly, accelerometers attached to the inside of football helmets measure the force and direction(s) of every hit in both practises and matches. It covers three American universities over a number of years so the data has a unique significance. Its a study I have been following, but I have never seen it described as well as here. Also, it mentions conclusions are due after this current season which will inevitably have an impact on Rugby.

Grey

http://www.nj.com/collegefootball/index.ssf/2012/12/virginia_tech_using_data-colle.html

Concussion is now being treated correctly as a major and sometimes career if not life threatening injury.
It is now being treated VERY seriously in the Game we love and it should be the Doctors decision.
He alone is qualified to tell,a couple of seasons ago Ritchie McCaws career was in jeopardy after a series of concussions.
Thankfully he recovered from them to his current status,BUT a promising AllBlack
10.Nicky Allen tragically died after head injuries sustained in a club match.

Here is an update about the death of Junior Seau, a former NFL star Linebacker for 20 years who suffered a lot of concussions. He recently committed suicide amid concerns about severe mood swings, depression, memory loss, and pain.

His brain was evaluated post-mortem and showed clear evidance of CTE. Clearly highlights the need for further investigation to long term impact and ways to make our sports safer. The peculiar part of this is despite his anguish, he still wanted to help people - he shot himself in the chest to preserve his brain for autopsy.

"he loved the game, but didn't love the end of his life"

http://espn.go.com/espn/otl/story/_/id/8830344/study-junior-seau-brain-shows-chronic-brain-damage-found-other-nfl-football-players

This is one example, but I think that Connacht's example of getting balance into their players is to be admired. There are too many crocked players due to over emphasis on upper body.

Another story from Australia about concussions. Headaches, mood swings, memory loss, and in some cases early death.

Just another warning about being careful and treating them properly.

http://www.smh.com.au/opinion/society-and-culture/concussion-a-concern-from-elite-to-schools-20130227-2f6c2.html

Clearly the message is NOT getting through.

http://www.bbc.co.uk/sport/0/rugby-union/22621893

Dr Barry O'Driscoll has resigned from the IRB over the new "5 minute rule" used to assess concussed players.

http://www.scotsman.com/scotland-on-sunday/sport/tom-english-rugby-concussion-rule-causes-alarm-1-2868497

Thanks to Ozzy for pointing me to the article.

MrsP - "IRB reaffirms concussion commitment"

LINK

Thanks Penfro,

I have serious concerns that some teams are using the Pitchside Suspected Concussion Assessment (PSCA) protocols as justification to put clearly concussed players back on the pitch. We have all seen players helped from the pitch looking like they don't know who, let alone where they are only to see them return after 5 mins.

There are 2 parts of that piece by the IRB which are vital but too often ignored.

(1): "IRB Chief Medical Officer Martin Raftery said: "The PSCA is intended to be a supportive tool for physicians in the elite Game. If a player is clearly displaying the signs of concussion, that player must be removed from the field of play and should not return to play."

and

(2): "If a medic is suspicious that a player has concussion at any stage, regardless of the outcome of a PSCA test, then he must be removed from the field of play and not return. This would include displaying symptoms of concussion as the player is treated on field, or as the player is escorted from the field."

Does anyone think that George Smith was not displaying signs of concussion?

http://m.scotsman.com/sport/rugby/latest/rugby-players-are-cheating-concussion-protocols-1-3017722

http://www.bbc.co.uk/news/uk-scotland-23545796

http://www.bbc.co.uk/news/uk-northern-ireland-23943642

This is the incident which really got me determined to get the word out on how important it is to take head injury seriously.

Ben's death seems to have been the first reported case of SIS in the UK. Let's all try to make sure we do all we can to ensure he is the last too!

 

Another article which mentions both the resignation of Barry O'Driscoll and Ben Robinson.

http://www.bbc.co.uk/news/uk-wales-24554550

Yet more info.

http://www.bbc.co.uk/sport/0/rugby-union/24765650

It was good to see a report about this issue on the main BBC news tonight. Hopefully the subject is now attracting broader attention.

2 years and 10 months after the tragic death of Ben Robinson the Education Minister has written to schools about head injury in sport.

http://www.bbc.co.uk/news/uk-northern-ireland-24908267

The IRFU seem to be making some moves towards educating all involved on the importance of proper care of potentially concussed players.

http://www.ulsterrugby.com/news/latest/2013/12/irfu-issues-new-concussion-guidelines.aspx

http://www.theguardian.com/sport/2013/dec/13/death-of-a-schoolboy-ben-robinson-concussion-rugby-union

Another player retiring because of concussion.

http://www.bbc.co.uk/sport/0/rugby-union/26019840

If anyone is looking for something to watch on this subject, I highly recommend watching the documentary Head Games!

It's primarily focusing on American sports, but it's obvious that the same issues affect us all in Rugby, and as it explains, even those who play soccer.

It's available on Netflix at the moment, and probably found elsewhere online. Below is a link to the trailer and official website.

https://www.youtube.com/watch?v=1qhWHejYFY0
http://headgamesthefilm.com/

http://www.nzherald.co.nz/sport/news/article.cfm?c_id=4&objectid=11208087

It won't be as big an issue in rugby, but they do need some neuropathological experts willing to examine brains of deceased players (amateur era would differ greatly from current one though I imagine) looking at patterns of Tau in the brain which are linked to CTE and other disorders. I would hope the IRB are lookign into.

The problem for rugby will be that the numbers of pro players in any one country will be small compared to the numbers of pro footballers in America both because of the numbers playing and because of the short time frame since professionalisation. That will make research much more difficult. I suspect we will have to produce something which shows that the results from the USA can be applied to rugby.

One of the original NFL concussion surveys (they were a bit of a joke but anyway) had about 1000 players involved. Would agree with you MrsP, it would have to be done between all pro rugby playing countries and their respective leagues to work effectively.

Anyone interested in the concussion debate. I recommend reading League of Denial, By Mark Fainaru Wada and Steve Fainaru. Great look into the NFL coverup and the medical science behind the whole thing. You'll learn a lot!

Chris Paterson lends his support to further research into the long term effects of concussion in rugby players.

http://www.bbc.co.uk/sport/0/rugby-union/26369388

An interview with Dr Barry O'Driscoll following the terrible incident of Florian Fritz being put back on the pitch despite being KO'd , aggressive and unable to stagger to the touchline before he collapsed again.

http://www.newstalk.ie/player/podcasts/The_Right_Hook/Highlights_from_The_Right_Hook/53047/2/my_advice_to_parents_is_to_get_their_kids_out_now

Will this be the final straw?

If the death of a child didn't change hearts and minds then I don't hold out much hope!

Another player whose life may have been ruined by concussion.

http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11264856

http://www.bbc.co.uk/sport/0/rugby-union/27655550

Has anyone read this?

http://www.espn.co.uk/scrum/rugby/story/230309.html

This man is ridiculous and nothing short of dangerous!

I think I missed this one. Yet another concussion related retirement.

http://www.irishexaminer.com/breakingnews/sport/connacht-captain-clarke-retires-after-suffering-10th-concussion-in-22-months-632402.html#.U5DjOCzh0dI.facebook

Sort of related - http://www.thesundaytimes.co.uk/sto/news/uk_news/Health/article1450553.ece

http://www.planetrugby.com/story/0,25883,3551_9462663,00.html

Sooooo....we can't punish you for completely disregarding our protocol and endangering the health of a player because lots of other clubs have done it too but it wasn't on TV world wide????

Newsflash!!!

How about you punish them all!!!!

Disgraceful!

Unbelievable decision not to punish them, It barely looks like they have condoned what they have done either!

In other news, does anyone follow the like of Rugby Banter Page on Facebook or Twitter?

They put a link up of a player who they described as the 'hardest man in rugby', and listed all the injuries he has had and called him an absolute legend for playing on.

Anyway one of the things listed was 10 concussions. The fact that people are congratulating this guy and saying how much of a legend he is - that's exactly what is wrong with the sport and why we keep hearing incidents like this when it comes to concussion.

There is no way that guy should still be playing rugby. I have had 2 serious concussions (well only 1 kept me in hospital overnight!) and am probably being reckless carrying on playing.

A note home from school today - a head knock experienced in any sport will see kids removed from that sport for 14 days minimum before being reassessed - 23 days for a rugby concussion in addition.

Asbo,

Were you given advice to seek medical attention?

MrsP wrote:Asbo,

Were you given advice to seek medical attention?

Yes, MrsP, the advice was to take any child that suffers a blow to the head in any sport straight to A&E.

Great!

I would say that is a good starting point but it is important to rest from lots of other activities too. TV, computer and school work. And to reintroduce activity gradually and only as tolerated.

I would say the 23 days should apply to all sports, not just rugby, and should be a minimum rest before even contemplating any return to physical activity in kids.

It would be interesting to hear Grey's take on this.

MrsP wrote:Great!

I would say that is a good starting point but it is important to rest from lots of other activities too. TV, computer and school work. And to reintroduce activity gradually and only as tolerated.

I would say the 23 days should apply to all sports, not just rugby, and should be a minimum rest before even contemplating any return to physical activity in kids.

It would be interesting to hear Grey's take on this.

Can see a lot of kids pretending they are concussed!

It is a fair point though - I might have 'physically' recovered from my head knock but when I came back to work having had a week off I definitely wasn't right mentally. Found it hard to concentrate and work things out that I would usually have no problem with. Got better over time obviously.

RDW_Scotland wrote:

MrsP wrote:Great!

I would say that is a good starting point but it is important to rest from lots of other activities too. TV, computer and school work. And to reintroduce activity gradually and only as tolerated.

I would say the 23 days should apply to all sports, not just rugby, and should be a minimum rest before even contemplating any return to physical activity in kids.

It would be interesting to hear Grey's take on this.

Can see a lot of kids pretending they are concussed!

It is a fair point though - I might have 'physically' recovered from my head knock but when I came back to work having had a week off I definitely wasn't right mentally. Found it hard to concentrate and work things out that I would usually have no problem with.  Got better over time obviously.

It did?

http://www.bbc.co.uk/news/uk-northern-ireland-29427914

Good to see.

http://www.telegraph.co.uk/sport/rugbyunion/news/11150094/Headguards-in-rugby-would-add-to-the-concussion-problem-not-solve-it-says-doctor.html

Interesting reading, especially as someone who started wearing a head guard after a serious concussion.

I know that it doesn't do anything to stop concussions, but it certainly gives me a lot more confidence going into contact. I'd feel naked without it now to be honest!

RDW_Scotland wrote:Interesting reading, especially as someone who started wearing a head guard after a serious concussion.

I know that it doesn't do anything to stop concussions, but it certainly gives me a lot more confidence going into contact. I'd feel naked without it now to be honest!

And that is part of the problem. I'm sure you're careful and aware of the problems but how many of these kids (a lot of the younger backs seem to be wearing them these days) are relying on them for protection?

Head guards give nothing but false confidence for serious injuries (although if you want to avoid the hole in the head (well scalp) that Charlie Hodgson got then they're more useful).

It's entirely a mental thing for me - I'm a ponsy back so avoid rucks as much as possible, but as I said it has given me the confidence to take contact on my own terms again, which in itself should make me less likely to get injured than if I was subconsciously backing out of it.

http://www.bbc.co.uk/sport/0/rugby-union/29638234

All players, coaches and officials will now need to pass an online module, or risk a fine or even a suspension.

I wish it were a human delivered module - but glad we are seeing an attempt to educate.

http://www.bbc.co.uk/sport/0/rugby-union/30036056

Very scary.

http://www.medicalnewstoday.com/articles/249912.php

http://www.bbc.co.uk/news/uk-wales-30086898

Edit: just to say it's currently unpublished. I do wish the media would look at the quality of these studies so that we had some faith in what they broadcast (they have put some Poopie out there). Is more research being done or is it just getting in the media more now?