Concussion is a temporary impairment of brain function usually caused by a blow that has shaken the brain within the skull. Failure to assess, evaluate and manage a player with a concussion can have serious adverse consequences, particularly if a player with concussion is allowed to continue playing, or returns too early to training or playing.
There is a need for medical assessment in cases and before return to play, details can be found in the regulations section of this website.
The IRB Council approved a revised Concussion regulation effective from May 26th 2011
The Regulation is at http://www.irb.com/mm/document/lawsregs/regulations/04/23/26/100518gfirbhandbook2010freg10english.pdf
And the accompanying guidelines at http://www.irbplayerwelfare.com/concussion
The IRB will roll out a formal education programme later this year.
The RFU has produced a series of resources to help with the recognition and management of concussion:
- A wallet-sized pitch-side concussion assistant card has been sent out with previous issues of Touchline. Contact the RFU if you would like additional copies for your club
- Training is available for coaches and volunteers through the one day RFU Sports First Aid Course (many standard courses do not contain this information). Ask your local RDO about courses in your area
- Concussion guidance is also included in the RFU's Start Rugby Coach resource pack, available from www.communityrugbyshop.com
In addition, the RFU has produced a poster to help highlight the signs and symptoms of concussion (PDF 1.6MB) and the procedures to follow in the event of a suspected injury.
If the player has any of these symptoms, they should not return to play:
- Headache, feeling dazed or "in a fog”
- Balance problems, dizziness
- Hearing problems/ringing in ears
- Vision problems
- Nausea or vomiting
- Feeling slowed down, low energy
- More emotional/irritable than usual
- Difficulty concentrating and/or remembering
If the player has any of these signs, they should not return to play:
- Loss of consciousness or unresponsiveness (even temporarily)
- Seizure/convulsion (uncontrolled jerking of arms and legs)
- Balance problems, unsteadiness, clumsiness, slurred speech
- Appears dazed, stunned or confused
- Poor memory (of score, moves, opposition, events)
- Odd behaviour
- Significantly impaired playing ability
If a player has suspected concussion, ask these questions:
- Which ground are we at?
- Which team are we playing today?
- Which half is it?
- Who are you marking? (if appropriate)
- Which team scored last?
- Which team did we play last week?
- Did we win last week?
An incorrect answer should be considered abnormal and the player should not return to play. The player should be seen by a doctor and the following guidelines should be adhered to.
Post-head injury and returning to play guidance
Following a head injury or concussion, further serious problems can arise over the first 24 hours.
- The player should not be left alone during this time and should be monitored regularly
- Players must always consult their doctor following a suspected concussion
- Symptoms may worsen with exertion
- Players with suspected concussion must be removed from the field of play (and not return)
- Players with suspected concussion must go through a graded Return to Play Protocol with medical practitioner clearance before a return to play
- The mandatory three week stand down for the age group player is replaced by advice around a more circumspect individualised Return to Play
For youth players, this applies to all club/school sides a player belongs to and it is his or her/parents responsibility to advise clubs/schools of the concussion.
Dealing With Concussion
After a knock to the head, It is quite common for the person (especially children) to want to sleep for a short while. This is normal and if they want to sleep, let them.
If you are concerned at the level of drowsiness displayed, wake them up after an hour or so. They may be grumpy about being woken up, but that is reassuring. You can then let them go back off to sleep again. You can do this a few times during the night if there is particular concern.
When asleep, check to see that he or she appears to be breathing normally and is sleeping in a normal position.
It is normal after a knock to the head to have a mild headache. Sometimes there is also tenderness, bruising or mild swelling of the scalp. Some paracetamol will help (such as Calpol or Disprol for children). Do not take tablets containing aspirin.
If the headache becomes worse, consult your doctor or a health professional immediately.