“Independent medical opinion is required ‘pitch-side’ to decide whether or not a player is fit to carry on following a blow to the head in contact sports” said Professor Michael Barnes, UKABIF Chair, speaking on BBC World News last week.
Professor Barnes was commenting on the issue of concussion which occurs in all sports, but has a high incidence in football, hockey, rugby, soccer and basketball.
Concussion is a mild traumatic brain injury which is generally self-limited and at the less-severe end of the brain injury spectrum. However, It is defined as a traumatically-induced transient disturbance of brain function and involves a complex pathophysiological process. Animal and human studies support the concept of post-concussive vulnerability, showing that a second blow, before the brain has recovered, results in worsening metabolic changes within the cell. Repeated mild traumatic brain injuries, occurring over an extended period of time i.e. months or years, can result in cumulative neurological and cognitive deficits.
Professor Barnes continued: “Every case of concussion is different but I don’t think the player, team manager or even the team doctor is in a position to comment on whether the player can continue playing. An independent doctor is in a much better position to make that decision. Although the currently used sideline tests are useful for examining a player, they fall short in terms of sensitivity, specificity, validity and reliability. Sporting organisations need to be doing a great deal more to change their policies on the management of concussion.”
The medical consensus is that any athlete suspected of having a concussion should be stopped from playing and assessed by a licenced healthcare provider trained in the evaluation and management of concussions. The recognition and initial assessment of a concussion should be guided by a symptoms checklist, cognitive evaluation including orientation, past and immediate memory, new learning and concentration, balance tests and further neurological physical examination. There should be no ‘return to play’ within a day for any player diagnosed with concussion.