Rugby Union to Install New Concussion Rule

As part of the new rules in Premiership Rugby the installation of a “concussion bin” will begin September 1st.  Union and the sport of rugby took some criticism when recently played matches included some players that seemed to be dazed or even incapacitated after a hard knock.  Because of this the new rule was created;

If a team doctor or referee suspects that a player may have suffered concussion during an Aviva Premiership match, that player will be required to leave the field for five minutes to undergo cognitive tests.

If that initial suspicion is confirmed in a pitch-side assessment, the concussed player will not be allowed to return and the temporary substitution will be made a permanent one.

Not only does the team medical official have the ability to have the player removed the referee can be more aggressive in getting a player off the field.  The hope is that this will catch more players that have suffered a concussion and make sure they are removed, but if you remember the NHL tried this at the end of the 10-11 season and it was basically abandoned the following year.

Not only do I think this is a productive idea, but it is one that should be adopted by the sports that have limited substitutions, such as soccer and Aussie Rules.  Five minutes are sufficient to get the job done, but more time would be better.  Alas, this is a step in the right direction.

Published Article in CJoSM Supports ‘Hit Count’

I was forwarded this information from a very astute and prominent concussion researcher for my take and information.  The Clinical Journal of Sports Medicine published an article regarding the under-reporting of concussions.  The authors are: Greenwald, Richard M. PhD; Chu, Jeffrey J. MS; Beckwith, Jonathan G. MS; Crisco, Joseph J. PhD.

It is important to note that the authors (as it is disclosed) have an interest in the Head Impact Telemetry System created by Simbex and limited currently to Riddell helmets.  With that out-of-the-way the article exposes the bigger problem with concussions with competitive athlete; the subjective nature of the injury and the self-reporting;

We typically cannot “see” a brain injury, and even with increased public and medical awareness about the serious nature of any brain injury, a “warrior mentality” inspires many athletes to continue to play. Contemporary, more stringent guidelines proscribing a same-day return to play may actually fuel underreporting of symptoms by some athletes. It is therefore critical that improved techniques for identifying athletes at increased risk of developing brain injury be implemented at all levels of play.

Prevention of brain injury should be a priority. Athletes in contact sports are exposed to head impacts, Continue reading

Now This is a Possible Game Changer

There have been many attempts to create a concussion “game changer”, something that will bring the assessment and/or recovery into better focus and provide more concrete answers for all of us.  One thing many people keep forgetting is that the human brain is not only very complex but it is also very individual.  Creating blanket statements, guidelines, and recommendations are very difficult; unless of course you use a multidisciplinary approach that touches on every part of the concussion sequale.

If you have read long enough and seen the comment section you will know that we have been clamoring for a more comprehensive, evidence-based, set of recommendations that broach all four parts of a concussion: physical, cognitive, sleep, and social/behavioral.  Perhaps the Ontario Neurotrauma Foundation has done just that (.pdf at end of post and in “Current Concussion Management Page” or you can go to the ONF website);

ONF is pleased to publicly release the Guidelines for Mild Traumatic Brain Injury (MTBI) and Persistent Symptoms.  The Guidelines were generated through a consensus process using existing evidence and clinical expertise. 10 to 15% of people who sustain MTBI do not recover well or as expected. The guidelines are therefore aimed at treating and reducing the impact of persistent symptoms following MTBI in adults.  On behalf of the project team that oversaw this work, ONF welcomes feedback on the Guidelines to info@onf.org

There have been other guidelines, one we hold as the standard (note not gold standard) Continue reading