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CONCUSSION

Concussion is serious and we outline the steps to be taken by those involved in the game.

Concussion is serious.

Concussion is a disturbance of the normal working of the brain but without there being any structural damage. Most people who sustain a concussion do not require any treatment as they normally get better by themselves and recover quickly, but for some the symptoms may last for days, weeks or in rare cases even longer.

Is concussion different in young players?

In young players we do need to be more cautious. Because the child or adolescent brain is still developing, there is particular concern that concussion can have more of an impact on the brain, and a second concussion occurring before recovery of the first results in prolonged symptoms that can have a significant impact on the child.

What about repeated concussions?

Because there is considerable variation in the initial effects of concussion, and spontaneous recovery is often rapid, this can increase the potential for players to ignore concussion symptoms at the time of injury or return to play before they’ve fully recovered.

There are therefore concerns that repeated concussion – particularly before full recovery – could shorten a player's career, significantly interfere with their academic performance, and may have some potential to result in permanent neurological impairment or death.

COACHES AND TEACHERS


Coaches can play a vital role in diagnosing concussion.

Coaches probably have the most important role in the prevention and management of concussion.

Research has shown that young players in particular rely on their coach to provide information on concussion and are influenced most in their behaviour towards concussion by their coach.

All coaches should be able to recognise suspected concussion and are in the best position to remove the player from play.

WHAT IS A CONCUSSION?

A concussion is an injury to the brain that cannot be seen on routine x-rays or scans. It affects the way a person may think and remember things for a short time, and can cause a variety of symptoms.

WHAT CAUSES A CONCUSSION?

Any blow to the head, face or neck, or a blow to the body which causes a sudden jarring of the head may cause a concussion.

RECOGNISE THE SYMPTOMS AND SIGNS OF CONCUSSION

A player does not need to be knocked out (lose consciousness) to have had a concussion.

Thinking problems the player may experience:

  • Does not know time, date, place, period of game, opposing team, or the score in the game. 
  • General confusion
  • Cannot remember things that happened before and/or after the injury
  • Seems slow to answer questions or follow directions
  • Seems easily distracted
  • Not playing as well as expected
  • A blank stare/glassy eyed, 'the lights are on but nobody's home'

A concussion may have taken place if the player is unable to answer these questions:

  • “What venue are we at today?”
  • “Which half is it now?”
  • “Who scored last in this game?”
  • “What team did you play last week / game?”
  • “Did your team win the last game?”

THINGS THE PLAYER MAY COMPLAIN OF OR WHAT YOU MAY SEE

  • Knocked out
  • Headache
  • Dizziness
  • Feel dazed, 'dinged' or stunned
  • Loss of vision, seeing double or blurred, seeing stars or flashing lights
  • Ringing in the ears
  • Sleepiness
  • Stomach ache, stomach pain, nausea, vomiting
  • Poor coordination or balance, staggering around or unsteady on feet
  • Slurred speech
  • Poor concentration
  • Strange or inappropriate emotions (i.e. laughing, crying, getting angry easily)
  • Feeling generally unwell

WHEN CAN A CONCUSSED PLAYER RETURN TO PLAY OR TRAIN?

It is very important that the player does not go back to Rugby League or any other sport if they have any concussion symptoms or signs.

Return to sport and activity must follow a step-wise Graduated Return to Play (GRTP).

They should not go back to Rugby League/sport until they have been cleared to do so by a doctor.

HOW LONG WILL IT TAKE TO GET BETTER?

The signs and symptoms of a concussion often last for 7-10 days in adults but may last much longer, especially in younger players and children.

In some cases, players may take many weeks or months to recover. Suffering previous concussions may increase the chance that the person may take longer to recover.

REMEMBER 'THE 4 RS'

  • Recognise the signs and symptoms
  • Remove the player from play
  • Recover fully before returning to sport
  • Return - only after following a Graduated Return to Play

WHAT TO DO IF YOU SUSPECT CONCUSSION IN A PLAYER

You must remove them from play right away. Continuing to play increases their risk of more severe, longer lasting concussion symptoms, as well as increases their risk of other injury:

  • You should not let them return to play that day
  • You should not allow them to be left alone
  • You should make sure they are seen by a health care practitioner as soon as possible that day
  • You should not let them drive

HOW IS A CONCUSSION TREATED?

Concussion symptoms are made worse by exertion, both physical and mental. The most important treatment for a concussion is:

  • The player should not exercise or do any activities that may make them worse, like driving a car, reading, working on the computer or playing video games
  • If mental activities (e.g. reading, concentrating, using the computer) worsen their symptoms, they may have to stay home from work, college or school
  • If they return to activities before they are completely better, they are more likely to get worse, and to have their symptoms last longer

Once they are recovered, and cleared to do so by a healthcare practitioner they can start a step-wise increase in activities – see When can a concussed player return to rugby? . If possible, they should be seen by a doctor with experience in treating concussions.

CAN IT BE ANYTHING MORE SERIOUS?

Anyone with a suspected concussion should be seen by a healthcare professional as soon as possible.

They will usually give instructions to the injured person to return to them or go to hospital immediately if they have a worsening of symptoms such as:

  • Drowsiness when normally awake or cannot be awoken
  • A headache that is getting worse
  • Weakness, numbness or decreases in coordination and balance
  • Repeated vomiting or prolonged nausea
  • Slurred speech, difficulty speaking or understanding
  • Increasing confusion, restlessness or agitation
  • Loss of consciousness
  • Convulsions
  • Clear fluid coming out of ears or nose
  • Deafness in one or both ears

PLAY WELL

Although it may not be possible to stop all concussions happening, there are some measures players can take that have the potential to reduce the number of concussions we see:

  • Ensure the playing or training area is safe, and the risk of serious head injury occurring is reduced.
  • Check ground conditions - do not play or train if the ground is frozen solid or rock hard due to drought.
  • Ensure all posts and barriers on or close to the pitch are protected with appropriate padding. Ensure correct tackle technique is performed consistently. If the head of the tackler hits the ball carrier there is a significant risk of concussion and/or neck injury. You should therefore ensure that you are able to perform correct tackle technique consistently.
  • Do not engage in dangerous play such as high, tip and spear tackles. Similarly do not tackle players in the air i.e. when jumping to catch the ball from kicks - falling from height increases the risk of concussion and neck injuries.

The information contained in this site is intended for educational purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion we strongly recommend that you contact a qualified health care professional for appropriate diagnosis and treatment. The authors have made responsible efforts to include accurate and timely information. However they make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.

MATCH OFFICIALS


Match officials are important when it comes to concussion.

Match Officials have an important role in the prevention and management of concussion.

Through the correct and consistent application of the laws of the game, they are able to influence players and their coaches' behaviour towards concussion.

If you suspect concussion, you should ask for the player to be removed from play right away. Continuing to play increases their risk of more severe, longer-lasting concussion symptoms, as well as increasing their risk of other injury.

Even if a player is cleared to play by a team doctor and you are concerned that they continue to show signs or symptoms of concussion, you should remind the doctor of their responsibilities to the player.

REMEMBER 'THE 4 RS'

  • Recognise the signs and symptoms
  • Remove the player from play
  • Recover fully before returning to sport
  • Return only after following a Graduated Return to Play

The information contained in this site is intended for educational purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion we strongly recommend that you contact a qualified health care professional for appropriate diagnosis and treatment. The authors have made responsible efforts to include accurate and timely information. However they make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.

PLAYERS AND PARENTS


Players must take concussion seriously.

Failing to manage concussion sensibly can have significant and sometimes serious consequences:

  • Your playing career and enjoyment of the game may be affected
  • Your long term health may be affected
  • Your work and/or academic studies may be affected

PLAY WELL

Although it may not be possible to stop all concussions happening, there are some measures players can take that have the potential to reduce the number of concussions we see:

  • Ensure the playing or training area is safe, and the risk of serious head injury occurring is reduced.
  • Check ground conditions - do not play or train if the ground is frozen solid or rock hard due to drought.
  • Ensure all posts and barriers on or close to the pitch are protected with appropriate padding.
  • Ensure correct tackle technique is performed consistently. If the head of the tackler hits the ball carrier there is a significant risk of concussion and/or neck injury. You should therefore ensure that you are able to perform correct tackle technique consistently.
  • Do not engage in dangerous play such as high, tip and spear tackles. Similarly do not tackle players in the air i.e. when jumping to catch the ball from kicks - falling from height increases the risk of concussion and neck injuries.

PROTECTIVE EQUIPMENT

Head guards do not protect against concussion.

They do protect against superficial injuries to the head such as cuts and grazes though - this has been demonstrated in a number of research studies.

There is also however some evidence to suggest that head guards may increase risk taking behaviours in some players.

Mouth guards/gum shields do not protect against concussion either, although they are strongly recommended for all players as they do protect against dental and facial injuries.

REMEMBER 'THE 4 RS'

  • Recognise the signs and symptoms
  • Remove the player from play
  • Recover fully before returning to sport
  • Return - only after following a Graduated Return to Play

The information contained in this site is intended for educational purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion we strongly recommend that you contact a qualified health care professional for appropriate diagnosis and treatment. The authors have made responsible efforts to include accurate and timely information. However they make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.

PREVENTION


Concussion can't be eradicated.

Rugby League is a full contact sport, with players running around in a confined area, and it is unrealistic that concussion will be removed completely from the game.

In the same way, concussions can occur on our streets and in school playgrounds every day.

Ideally, we all want to prevent concussions occurring in the first place and there are some measures that can be taken during rugby training and games that have the potential to reduce the number of concussions that we see.

RECOMMENDATIONS INCLUDE

1. Ensure the playing or training area is safe

2. Ensure correct techniques are coached and performed consistently by all players

WHAT ABOUT CONCUSSIONS SUSTAINED ELSEWHERE?

To prevent recurrent concussions and the rare but potential risk of prolonged or severe injury, coaches, teachers and parents must encourage players to report concussions that occur during games and training sessions, and to report concussions that occur out of Rugby League. It is also essential that school and club coaches communicate between themselves if a player is concussed, and involve parents in these discussions.

The information contained in this site is intended for educational purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion we strongly recommend that you contact a qualified health care professional for appropriate diagnosis and treatment. The authors have made responsible efforts to include accurate and timely information. However they make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.

RECOGNITION & MANAGEMENT


Information on symptoms and treatment.

A player does not need to be knocked out (lose consciousness) to have had a concussion.

Players might experience a number of problems after a blow to the head, or you might notice certain things that arouse your suspicion.

If a player is suspected of having concussion after a blow to the head, they must be removed from play immediately.

Read more about how to recognise the signs and symptoms of concussion.

MANAGEMENT OF CONCUSSION

How should concussion be managed?

If a player sustains a concussion they should be managed in accordance with best practice guidelines.

It is recognised that the medical/first aid cover at training and matches varies, but the universal principles are encompassed in 'The 4 Rs', which are listed below.

REMEMBER 'THE 4 RS'

  • Recognise the signs and symptoms Remove the player from play
  • Remove the player from play
  • Recover fully before returning to sport
  • Return - only after following a Graduated Return to Play

HOW IS CONCUSSION TREATED?

There is no specific treatment for concussion and no medication that can be taken to speed up recovery.

The mainstay of treatment is rest; it is not practical to have complete rest but there are some things that should be avoided to aid recovery if they make symptoms worse:

  • Alcohol – avoid
  • TV and cinema – limit as guided by symptoms
  • Computer or computer games – limit as guided by symptoms
  • Sport and physical exertion. Walking is fine and graduated use of exertion may be used under medical supervision if symptoms are prolonged
  • Reading or writing for long periods. Break up what needs to be done into short periods

The information contained in this site is intended for educational purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion we strongly recommend that you contact a qualified health care professional for appropriate diagnosis and treatment. The authors have made responsible efforts to include accurate and timely information. However they make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.

Positional Statement

The RFL takes concussion and player welfare very seriously and follows the guidelines from the International Consensus on Concussion in Sport when drawing up its Concussion Regulations.   The Medical Standards follow the principles agreed at the 2016 Berlin Conference and include a number of significant quotes from the text of the Consensus Statement on Concussion in Sport published by the 2017 Concussion in Sport Group (CISG).  It is recommended that all Club Medical Staff read the full Consensus Statement. The RFL Medical Standards will be reviewed following the 2021 Paris Conference.

The information contained in this site is intended for educational purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion we strongly recommend that you contact a qualified health care professional for appropriate diagnosis and treatment. The authors have made responsible efforts to include accurate and timely information. However they make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.