A positive approach to concussion management

(IRB.COM) Saturday 14 September 2013
 A positive approach to concussion management
The concussion policies operating in rugby are based on the Zurich Consensus Statement on Concussion in Sport

Concussion is a complex and emotive topic and the IRB works tirelessly in collaboration with its Unions, the International Rugby Players’ Association (IRPA) and leading neurologists to ensure its policies are in line with recommended best-practice and put players first at all levels.

The policies operating in Rugby worldwide are based on the Zurich Consensus Statement on Concussion in Sport, widely recognised as a leader in its field.

The 2012 statement determines that athletes should not be allowed to return to play after a diagnosed concussion and should not return to play or train on the same day. It also outlines an approach to help physicians determine when an athlete might be safe to return to sport.

The IRB’s strategy, developed under the guidance of the IRB Medical Commission, which comprises top sports physicians, independent neurologists and risk management experts, is entirely consistent with these recommendations. The general principles are:

1. All players with a diagnosed concussion must be removed from the field of play and not return to play or train on the same day.  
2. All players with a suspected concussion where no appropriately trained personnel are present must be assumed to have a diagnosed concussion and must be removed from the field of play and not return to play or train on the same day.  
3. Players with a suspected concussion at the elite level must be removed from play and assessed by an experienced doctor assisted by the Pitch-side Suspected Concussion Assessment (PSCA).

All players should be reviewed by an appropriately qualified person and then complete the graduated return to play protocol described in the IRB Concussion Guidelines and overseen by a medical practitioner.

Brett Gosper, IRB Chief Executive, said: “Concussion management is at the very heart of our player welfare strategy. The IRB Medical Commission has driven the development of concussion management and return to play protocol guidelines and importantly education best-practice for elite and community Rugby, all designed to further protect players at every level. Our message to players, coaches and officials at all levels is very clear: Recognise the symptoms and remove the player. Symptoms should not be ignored.”

“An additional layer of protection for elite athletes is the Pitch-side Suspected Concussion Assessment which is designed to standardise the assessment of players in an elite match environment and support team medics to assess suspected concussion in a situation where otherwise a player may have been left on the field. Contrary to media reports, the PSCA is not a tool to clear a player nor a tool to diagnose concussion.”

The PSCA is an important advancement for the care of elite players as it gives medics five minutes to assess players following a head knock and remove those with suspected concussion, rather than trying to assess on the field and on the run. Results from the first year of the PSCA trial show 25 per cent more players in elite Rugby now leaving the field after head knocks than under the previous procedure.

Education is key and the IRB, working with its Member Unions, has prioritised education at all levels. The IRB Rugby Ready initiative has become the standard bearer for promoting best-practice techniques in playing, coaching and administering Rugby worldwide.
Alongside this initiative, the IRB has a dedicated player welfare website which includes interactive and easy to follow concussion education for players, coaches and parents (www.irbplayerwelfare.com) and hosts an annual Medical Commission Conference for the International Rugby community (the 2013 Conference is in November).
The IRB continues to promote education in collaboration with Unions and IRPA to further educate players at all levels. A key element is the Match Day Doctor accreditation programme, which includes a significant component on managing head injuries.

Gosper continued: “The work on concussion is vital for everyone involved in our sport. Education is key and if there is any doubt, a player must understand that they should leave the field permanently as per IRB Regulations. It is vital players understand and listen to their bodies.”
Rugby has also taken a proactive approach to research and has commissioned a study into the long-term health effects of a career in Rugby. The study, in partnership with the New Zealand Rugby Union and Auckland University of Technology, will compare how head impacts affect the long-term health of players at elite and community level.

Without this research, comparisons to other sports are inaccurate owing to differences in technique, laws and equipment.  

For more information on the IRB’s player welfare initiatives, including its six simple steps designed for players, coaches and parents at all levels, please visit www.irbplayerwelfare.com.