That’s according to CQUniversity’s Physiotherapy Discipline Leader Professor Tony Schneiders, who says that all athletes should be removed from play after receiving a head injury on the sporting field.
Professor Schneiders concedes that diagnosing a brain injury is not usually considered within a physiotherapy scope of practice.
“But identifying the signs and symptoms associated with a head injury in a sporting situation is really important for physiotherapists,” he said.
“It’s also important to be able to quickly identify if someone does have a more serious injury such as a subdural haematoma or swelling in the brain which could be catastrophic and fatal, as opposed to saying it’s just a head knock, and treating it as a concussion.
“They need to be able to identify where perhaps that suspected minor concussion can transgress and actually get worse, resulting in more serious consequences for the athlete.
“That’s a difficult area because the trouble is that the signs and symptoms that are associated with concussion are, if not exact, very similar to the signs and symptoms of a subdural haematoma…until the symptoms get so bad and the athlete loses consciousness, and obviously you realise that you are dealing with something more serious.”
Professor Schneiders will speak about concussion in sport during the Physiotherapy New Zealand (PNZ) conference from September 19-21.
He said initial signs are varied but are usually both cognitive and physical; from poor memory to slurred speech, loss of balance and coordination.
“It’s vital physiotherapists take a conservative approach to head injuries, particularly when it comes to children’s and adolescent sport.”
“Their brains are much more susceptible to damage and to ongoing problems than an adult brain, so even if we’ve had the inkling of a thought that they might have sustained a concussion they should be removed from play and not returned to play until they have been checked over by a doctor,” he said.
“With the adult athlete, perhaps not as conservative, but certainly the consensus concussion guideline document at the moment advises that the player is removed from play despite what level of concussion they have, because the symptoms they have after concussion will change from person to person.”
Professor Schneiders said there has also been much hype and misconception around second-impact syndrome, where it’s believed that two concussions in quick succession can result in serious and sometimes fatal consequences.
“Probably, what this really is, is a slow swelling of the brain which takes a while to manifest in signs and symptoms, so with the first knock they’ve had significant structural damage to the brain, which has caused it to swell or bleed, and depending on how that progresses it can be quite catastrophic,” he said.
“In a lot of cases with brain injuries that bleed or swell, this actually takes a period of time to start giving you symptoms because it needs to build up pressure in the brain, and that can take anything from minutes to hours in some cases.
“That’s why with concussion we always say if someone’s had a head knock or a head injury we must monitor them over a 24-hour period because there is the possibility, even though it’s quite slim, that it may not be a concussion; it can actually be a more serious brain injury.”
Professor Schneiders said while the current conception of second-impact syndrome is likely wrong, it had worked positively to make athletes more aware about head injuries and their potential serious consequences.
“I guess we have got a culture in this country, and particularly in collision sport culture, where there’s a bravado that athletes will continue to play…. and this syndrome actually puts a little bit more fear in them,” he said.
“You’ve got to debunk the myth in some respects but also still keep the football playing public aware that a injury to the brain can be a very serious condition.”
More than 500 delegates are expected to attend PNZ’s Linking the Chain conference in Auckland.