A Guide To Concussions
Note: This article, though informative in nature, is not a substitute for professional medical advice. In the event of a concussion please seek professional medical treatment. For further information regarding concussion refer to Brain Injury Australia.
As women begin to take their place in contact sports previously dominated by men, we have an opportunity and responsibility to establish safe pathways and practices to protect athletes from concussions.
Concussions and their consequences are currently front and centre for many sports both nationally and across the globe. With a growing number of athletes and their families coming forward to highlight the long-term impacts of repeated head trauma experienced during their playing careers, it has become incumbent on sporting organisations to provide policies and protocols to safeguard athletes. “We didn’t know” is no longer an acceptable response to players who present with neurological deficits secondary to historical concussions. The World Health Organisation classifies traumatic brain injury as a “critical public health issue”.
While high-contact professional and semi-professional sports for women, like rugby and AFL, are in their infancy, the amateur game has been growing exponentially with almost one million women and girls participating in contact sports in 2022. As participation grows, so does the number of athletes at risk of acquiring temporary or lasting head injuries.
These foundation years of professional women's competition present a unique opportunity to establish new practices and norms in the elite game which protect current players and can be reflected back into grassroots competition thereby protecting the athletes of the future!
What Is A Concussion?
A concussion is a traumatic brain injury caused by an impact or sudden deceleration of the head that causes the brain to move at a rate greater than the cerebrospinal fluid can absorb, this results in the brain colliding with the bones of the skull. In worst-case scenarios, this impact may result in sometimes fatal bleeding. Commonly, the impact causes brain cells to stretch and tear. Cerebral blood flow changes, mitochondrial function becomes impaired, glucose metabolism is altered and neuron pathways are interrupted.
Who Experiences Concussions?
We commonly associate concussions with athletes, particularly those involved in high-contact sports. While athletes comprise a large proportion of concussions, mild traumatic brain injury is common in both the elderly and children. It can be particularly problematic in children where the initial incident may not have been witnessed and the symptoms can be difficult to detect.
The statistics related to concussion rates are inconclusive and largely unhelpful. Over 3,000 Australians are hospitalised with concussions each year. It is suspected, however, that there are three times this number that go unreported and still more that go unrecognised.
Symptoms of Concussions
Symptoms of a concussion may not be immediate. They are often subtle and can last hours, days or even weeks. Common symptoms include:
Headache
Ringing in the ears
Nausea
Vomiting
Blurred Vision
Fatigue or drowsiness
Confusion
Amnesia or forgetfulness
Dizziness “seeing stars”
Slurred speech
Ataxia (incoordination)
Seizure
Altered cognition - Dazed and confused
Recovery
90% of patients recover fully within a few days or weeks, however, a small proportion of victims unfortunately suffer Persistent Post Concussion Symptoms, formerly known as Post Concussion Syndrome. As with the immediate symptoms of concussion, the symptoms of persistent concussion vary between individuals. All of the symptoms listed above may persist. Sufferers may also experience ongoing balance problems, light and sound sensitivity, irritability and mood changes, and mental illness such as anxiety and depression.
Another variant of concussion is a secondary concussion. This occurs when a victim suffers a second head injury prior to the initial injury being resolved. Though rare, secondary concussion may result in Second Impact Syndrome whereby the brain swells rapidly almost immediately after the second impact. SIS is usually fatal within minutes of the injury occurring. It is for this reason that athletes should never take the field if still experiencing symptoms of concussion and ideally should seek professional medical clearance not less than 24hrs after the initial injury.
Concussion, persistent concussion, and long-term impacts of concussion are all current areas of medical research. Breakthroughs and advancements are being made frequently, despite research still being in its infancy. There is a growing amount of anecdotal evidence which strongly suggests changes to practices and protocols need to be immediate in order to protect current and future athletes from debilitating and potentially fatal long-term effects of mild brain injury.
What is Chronic Traumatic Encephalopathy?
Chronic Traumatic Encephalopathy is a rare and currently not well-understood disorder of the brain caused by repeated head trauma. CTE causes degeneration of the nerve cells in the brain. This degeneration results in symptoms including cognitive, behavioural, mood, and motor changes. CTE may be suspected in people displaying degenerative symptoms who have a history of repeated head trauma but definitive diagnosis can only be made via autopsy after death. CTE has been confirmed in several now-deceased persons involved in high-contact sports and also in military personnel who have been exposed to explosive blasts.
First Case of CTE Diagnosed in a Female Australian Athlete
Australian Rules footballer Heather Anderson tragically took her own life in November 2022. 28-year-old Heather was a medic in the Australian Defence Force, she was a talented AFL and Rugby League player and had enjoyed a decorated playing career since the age of five. After her passing, her family, determined to understand more about her death, donated her brain to research. Heather was found to have multiple degenerative lesions in her brain commensurate with the current diagnostic criteria of CTE. Her degree of degeneration was consistent with and indistinguishable from, cases of CTE previously found in male athletes.
CTE was also found in the brains of AFL legends Danny Frawley and Shane Tuck. Both men were loved and respected as players, coaches, and family men. They were known as “hard men” of the game and both took many a knock to the head which at the time, may or may not have seen them leave the ground. Both men struggled with mental illness late in their careers and into retirement. Both men took their own lives.
While it is important to note that there is insufficient evidence to draw any conclusions between CTE and the manner in which these athletes sadly died, it is equally important to recognise that suicide is not uncommon in cohorts where CTE is diagnosed post-mortem. This is just one area of important ongoing research that aims to prevent negative outcomes for athletes in the future.
What to Do After a Head Injury
Diagnosis of concussion should always be made by a medical professional but there are tools available to help you assess someone’s condition immediately after impact.
We have long been told not to let the patient sleep, in actual fact, rest has been identified as vital to concussion recovery. After an initial assessment, unless the patient is vomiting (in which case seek urgent medical attention) it is safe to let them sleep. Gently wake them every so often to ensure that they are rousable and not unconscious. It is important to monitor the patient closely for at least four hours after a head injury and reassess as new symptoms present or existing symptoms change. If in any doubt, seek emergency medical advice.
Though the above tool may be helpful, it is always best to seek medical clearance before returning to sport. Some codes and associations have their own guidelines pertaining to returning to play after a concussion, this is a hotly debated topic as some stakeholders argue that enforcing a time frame that a player must sit out post-injury, may actually be deterring players from reporting symptoms.
The Future of Contact Sport
It is crucial to the future well-being of athletes and to the exciting ongoing growth of many sports, those organisational bodies invest in the research and development of best practices and policies designed to protect players from head trauma.
This goes further than just concussion management. It is suspected that repeated small knocks to the head or even the body, that reverberate through the brain, may be having a cumulative effect on brain deterioration. Rule amendments that protect players within the spirit of the game should be adopted and enforced and the addition of protective wear seriously considered. It is up to all sports participants and enthusiasts to demand that governing bodies fully invest in player well-being.