Concussion and the AFL

Concussion is emerging as a major health issue particularly in sport. There is an increase  in research  into  the  area  which is  having a positive  impact  on  public  awareness and recognition. Concussion is common in the normal population after a fall or car accident and is well known in contact sports. In AFL the  incidence  rate  is  5-6  concussions per  1000  player  hours  (6-7  injuries/team). High risk sports include Rugby, boxing and AFL. This blog will discuss concussion in AFL.

Years gone by in the AFL it was seen as heroic if a player returned to sport immediately following a concussion and ‘played out’ the game. Nowadays in the AFL, if a player is returned to play after being deemed to have suffered a concussion, the club will have to pay a hefty fine. This was recently the case when Carlton returned a young player to the field after a suspected concussion and coped a $20k fine. (Read about it here: http://www.afl.com.au/news/2018-06-29/blues-cop-sanction-for-concussion-breach). This is a great advance in the recognition of the importance of correct management of concussions as every sportsperson who sustains a concussion is at risk of having a structural brain injury (e.g. brain contusion). A player’s welfare should always come first, especially if symptoms worsen later on as has recently happened.

Two cases of structural brain injury in the AFL and VFL have received media attention. Harris Andrews, an AFL player from the Brisbane Lions, recently suffered bleeding on the brain following a head knock with GWS forward Jeremy Cameron. Doctors assessed him as having a concussion at the time of play but after the match his condition worsened. He was admitted to hospital and underwent a series of tests, he is now making a slow recovery (click here for more information- http://www.afl.com.au/news/2018-06-25/andrews-in-hospital-after-condition-worsens). This was also the case when Complete Sports Care physiotherapist, Zuzana Machotka, together with club doctor James Maclaren attended to North Melbourne’s FC VFL co-captain Michael Close. He was also assessed and diagnosed to have sustained a concussion and later experienced worsening symptoms (click here to listen to a recent interview with Michael Close about his experience- http://www.nmfc.com.au/video/2018-06-28/close-interview-june-28-2018). Michael also was admitted to hospital and after a period of careful monitoring was discharged home, still under close supervision from Dr Maclaren. Education is key in these cases for player, team, staff and coaches as well as family. This is true for all levels of footy, whether at AFL level or grass roots community level.

So what is concussion?

Concussion, defined by the Concussion in Sport Group (CISG) international Consensus Statement is “… a  complex  pathophysiological  process affecting  the  brain,  induced  by biomechanical  forces …” It is often seen after a head knock and leads to short-term impairment of brain function. Symptoms may be immediate or delayed, such that a player can report symptoms the next day. In adults, most cases, symptoms resolved in ten to 14 days post injury but in a few symptoms can be more prolonged e.g. up to 6 months to a year.

https://qbi.uq.edu.au/concussion

What are the features of a concussion to be aware of?

Concussion involves disturbance to the brain function rather than structural change. It is important to understand that symptoms, which there are many including headache, visual disturbances, memory impairments, are transient and should resolve in a relatively quick period of time. The player may not necessarily experience a loss of consciousness but may be slow to get up and appear confused. Recognition of a concussion is the first step and a quick assessment on the field can help. More detailed assessments are utilised by medical professionals but the Concussion in Sport Group (CISG) have developed a great resource for trainers, coaches and parents involved in game day. The concussion recognition tool 5 is a quick and easy assessment. Step 4, memory assessment (refer to picture), provides some simple questions that a player should be able to answer immediately. Failure to do so can suggest a concussion and further assessment should be made. The golden rule for those with minimal medical coverage/resources is ‘if in doubt, sit them out.’

Red flags are signs to look out for that suggest a much more severe presentation and require immediate attention. These include:

  • Player complains of neck pain
  • Increasing confusion/irritability
  • Repeated vomiting, seizure, convulsion
  • Weakness or tingling/burning in arms or legs
  • Deteriorating conscious state
  • Severe or increasing headache
  • Double vision
  • Unusual behaviour change
Management

Management of concussion involves an individual based approach. Initially there is a period of rest both physically and mentally. There is ongoing assessment of signs and symptoms as well as cognitive tests which help monitor recovery and guide gradual return to sport. A medical professional should have the final say in regards to return to play. Children should not return to  play/sport  until they  have  successfully  returned  to school/learning  without  worsening  symptoms. Often children (ages between 5 to 12 years) will miss a day or two of school.

For more information on concussion, please refer to the two excellent resources listed below.

Resources:

https://qbi.uq.edu.au/files/32337/Brain-Series-Concussion-Digital-PDF-web_QBI-UQ.pdf

http://www.aflcommunityclub.com.au/fileadmin/user_upload/Coach_AFL/Injury_Management/1211_AFL_Concussion_Management_2013_LowRes_1_.pdf