Head Injuries and Sport

In this article, Emma Hammett from First Aid For Life addresses the critical issue of head injuries and concussions in sports, highlighting the alarming link to long-term neurological conditions like dementia. It offers essential insights into symptom recognition, management, and the crucial steps for ensuring athlete safety.

The Correlation Between Head Injuries in Football and Dementia

There is increasing evidence demonstrating the proven correlation between repeated head injuries in football and dementia: former professional footballers are 3.5 times more likely to die of dementia and other serious neurological diseases. As such, coaches and parents must be aware of the risks surrounding head injuries and what to do if a player experiences one. Multiple concussions risk cognitive impairment and mental health problems. There is a growing body of evidence to suggest the link between multiple concussions and neurodegenerative disease (Dr Willie Stewart et al.)

When most people bang their heads, it can be difficult to tell whether they have done any serious damage. Most head injuries are not serious, but severe or repeated injuries can cause damage to the brain.

Understanding Concussion: Symptoms and Diagnosis

Dr Marwan Al Dawoud in his recent presentation at a Sterosport Injury Rehab Network Event, described concussion as a disturbance in brain function caused by direct or indirect force to the head, resulting in a variety of vague signs and symptoms. He noted that concussion most often does not involve loss of consciousness. This is reinforced by statistics that show that only 10% of head injuries result in loss of consciousness. There are many other symptoms you should keep an eye out for, as detailed below.

Dr Al Dawoud described how symptoms usually start shortly after the incident and get better with time, appropriate rest and recovery but can be delayed. Concussion does not show up on any scans. The majority of cases (80-90%) resolve in around 7-10 days but may take longer. The primary symptom is headache, which is present in 95% of concussion injuries. Dizziness occurs in 74% of concussions, with difficulty concentrating in 56% of cases. Marwan considered symptoms that may be more difficult to identify, and athletes may be less willing to disclose or be aware of, including being more emotional, nervous/ anxious and having trouble falling asleep. Dr Al Dawoud explained that concussion accounts for 25% of all rugby injuries and is important because of the potential for structural brain injury.

If athletes return to sports too soon, symptoms can be prolonged and more troublesome (second impact syndrome). He also described how an athlete’s performance before full recovery is likely to be poor, with a 60% increased risk of other injuries after a concussion. There can be a possible long-term change in brain function and mental health. Repeated concussions place athletes at higher risk of long-term problems.

Head Examination

Symptoms Following a Concussion

A significant blow to the head: Symptoms or physical signs

Impaired brain function
Abnormal behaviour
Incorrect/ struggling with Maddock’s Questions (specific questions designed to assess the impact of head injuries)

Concussion Assessment Tools: SCAT5 and Maddocks Questions

The SCAT5 (Sport Concussion Assessment Tool – 5th edition (1)) includes the following modified Maddocks questions in the assessment of possible concussion at the pitchside. When asking the Maddocks questions then, the questions should be preceded with the preface:

“I am going to ask you a few questions; please listen carefully and give your best effort.”

The modified Maddocks questions are:

At what venue are we today?
Which half is it now?
Who scored last in this match?
What did you play last week?
Did your team win the last game?

Recognising a Concussion

The poster below describes the signs and symptoms of a concussion and what should happen with someone who has a suspected concussion

First Aid For Life Check for Concussion

Download poster here

Care for Children After Head Injuries

In a child, look for loss of consciousness, intense crying, trouble walking, and complaints of head and neck pain. If your child experiences these, call 999 or 111.

Following a head injury during sports, players may experience:

Loss of consciousness
Difficulty with coordination
Delayed reactions
Heightened emotions
Changes in personality

If any of the above occurs, call the emergency services immediately. If they are unconscious, ensure you roll them into the recovery position to ensure their airway remains open whilst protecting their spine. If they are unconscious and not breathing, you would need to start CPR.

Symptoms to Monitor Post-Injury

There will be some symptoms that you will need to ask them about:

Headache
Blurred vision
Difficulty remembering things
Feeling dizzy
Being more sensitive to light/ sound

Coach

Guidelines for Coaches and Parents

Coaches and parents should be confident in removing any player who has experienced even a minor head injury. They should stop playing straight away and sit off the pitch somewhere warm and dry and be monitored closely for anything unusual. New UK Concussion Guidelines for Grassroots Sport were launched in 2023 with a clear message ‘If in doubt, sit them out’.

Repeated head injuries can increase the risk of brain injury. Call an ambulance if you see any of the following:

Abnormal breathing
Unconsciousness
Bleeding/ clear fluid from the nose, ear, or mouth
Unequal pupils
Vomiting more than two or three times
Loss of consciousness (knocked out)
Traumatic convulsion (fit/ seizure)
Tonic posturing (stiff limbs/ jerks)
Ataxia (unsteady/ off balance)
Disorientation or confusion

If the casualty is not an infant, has not lost consciousness, and is alert and behaving normally after, talk to them and check they know where they are. Continue to monitor them for the next 48 hours. Keep observing them and checking their symptoms.

To relieve any superficial swelling or pain, you can periodically apply a wrapped ice pack to the area for up to ten minutes.

If they are unusually drowsy or can’t be woken, call an ambulance.

The most important step following an injury is rest. A player must have at least 24 hours of complete rest for an adult and 48 for a child or adolescent. No one should go home to an empty house: an adult must always be observing the casualty, conscious of the symptoms of a brain injury.

Medical Room Assessment

(Part of SCAT5) once an athlete has been removed from the pitch for assessment. Athletes undergo an initial 5-minute rest period followed by testing, which takes around 10 minutes. Tests focus on and may include:

Symptoms
Orientation
Balance
Memory
Concentration
Coordination
Computer-based neurocognitive tools
Management – immediate

Marwan described the immediate steps for the management of concussion as follows:

Rest (body and brain) for 24 – 48 hours – including exercise, use of devices/ screens and thinking in general
Remain supervised by a responsible adult
Avoid dehydration
If headache take paracetamol (not aspirin or ibuprofen)

Do not

Drink alcohol
Take sleeping tablets
Drive

Marwan described how the Buffalo Concussion Treadmill Test could also be used where the relevant equipment is available. Vestibular exercises are also increasingly being used to manage concussions (with the support of clinicians with appropriate knowledge).

Following a head injury, a player must follow the gradual return to activity or sport (GRAS) guide to ensure a safe recovery. This is further detailed below, and a free copy of this can be found at www.firstaidforlife.org.uk, or by emailing emma@firstaidforlife.org.uk

More information can also be found on England Rugby’s website and on the England Football website

Following a concussion: children and adolescents must abstain from playing sports for 23 days; this is 19 days for an adult.

Written by Emma Hammett for First Aid for Life

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