Kazuyuki Kanosue, Tetsuya Ogawa, Mako Fukano and Toru Fukubayashi (eds.)Sports Injuries and Prevention10.1007/978-4-431-55318-2_4

4. Concussions in Junior Rugby Football Athletes and Their Prevention

Mana Otomo¹ and Toru Fukubayashi²

(1)

Graduate School of Sport Sciences, Waseda University, Saitama, Japan

(2)

Faculty of Sport Sciences, Waseda University, Saitama, Japan

Mana Otomo

Email: mana1325@gmail.com

Abstract

Sports are second only to motor vehicle crashes as a cause of traumatic brain injury among 15–24 year olds. A wide range of head and neck injury risks are incurred in sports, and some involve serious injury. Among other head injury in sports, Concussions have recently attracted much attention, and are a hot topic in sports medicine. Concussions are caused by a direct impact to the head and face or other part of the body that includes the transfer of an impact force to the brain. Full-contact sports are known for their high incidence of such injuries. Although rugby athletes can sustain injuries to all body parts, concussions are the most common. Tackling is the phase of play that produces the highest proportion of injuries in rugby union football. Helmets and headgear have been shown to reduce the risk of severe head and facial injury, but have been of littie or no help in reducing the rate of concussions. Concussion injury prevention must be multifaceted, addressing relevant factors of the environment as well as those of training and supervision.

Keywords

ConcussionsRugy footballInjury prevention

4.1 Introduction

In recent years, concussions occurring during in sports activities have become recognized as a central issue in sports medicine in Europe and the United States and the development of concussion awareness and management programs is underway in many sports medicine institutions. The first conference of the International Consensus Conference on Concussion (ICC) was held in Vienna, Austria in 2001, the second in 2004, the third in 2008, and the fourth in 2012. An important function of the ICC has been to increase the worldwide awareness of concussions in sports McCrory et al. (2013). A particularly dangerous aspect of concussions incurred in sports is the high likelihood of repeat injury. A repeat injury during the acute stage of a concussion can result in second impact syndrome, which may result in fatal brain damage. In addition, acute subdural hematoma can be a complication that occurs immediately after a concussion, and repeated concussions may result in chronic brain injury which negatively impacts cognitive function. It was stated in the ICC that junior athletes who incur a concussion should be managed particularly carefully. Sports concussions in junior athletes are particularly dangerous, and involve, a long recovery time (Gary S. Solomon et al. 2011) as well as a large number of symptoms and signs after the concussion (Alexis Chiang Clovin et al. 2009). Unfortunately, a standard method for preventing sports-related concussions has yet to be developed. Therefore, the ICC has stated that all people working with junior athletes must learn about the signs of concussions. Athletes, referees, parents, coaches, and healthcare providers must be educated about concussions, their clinical features and assessment techniques, and the principles to be followed in order to have a safe return to play.

4.1.1 Definition of Concussion

The ICC (2013) officially identified concussion as a brain injury and defined it as a complex pathophysiological process induced by biomechanical forces that affects the brain. Concussion is caused by a direct impact to the head and face or other part of the body that includes the transfer of an impact force to the brain. Concussion is included among a handful of short-term disorders of neurological function that resolve naturally. Their symptoms and signs evolve over the course of a few minutes to a few hours. Acute clinical symptoms mainly reflect functional disability and abnormal findings such as anatomical disorders that are not always seen on magnetic resonance imaging or computed tomography. Concussion severity results in correspondingly serious clinical symptoms. Loss of consciousness is one clear mark of a more severe concussion.

4.2 Injury Incidence

Sports are second only to motor vehicle crashes as a cause of traumatic brain injury among people aged 15–24 years. Stephanie J. Hollis et al. (2009) studied 26 nonprofessional rugby clubs and eight schools in Australia. A total of 3,207 male players with a mean age of 22.7 (5.5) years (range, 15–49) were recruited for the study. Of the players, 36 % (n = 1,034) reported wearing protective headgear and 80 % (n = 1,816) reported wearing a mouth guard during the game. Almost 15 % (n = 326) of the players had sustained a concussion in the 12 months prior to recruitment, and 25 % (n = 81) of these players had sustained a concussion in the previous 3 months. Interestingly, 64 % of the recent concussions occurred in players with >8 years of playing experience. This study concluded that nonprofessional rugby has a high incidence of mild traumatic brain injury (mTBI) and that the absence of headgear and a recent history of mTBI are associated with an increased risk of subsequent mTBI. These findings highlight the fact that the use of headgear and the proper management of prior mTBI would likely be beneficial in reducing the likelihood of mTBI among nonprofessional rugby players, who comprise >99 % of the rugby union players in Australia.

Gessel et al. (2007) compared the rates of concussion among high school and collegiate athletes in a variety of sports and found that concussions represented 8.9 % (n = 396) of all high school injuries and 5.8 % (n = 482) of all collegiate injuries. Bleakley et al. (2011) calculated that the incidence of concussion in adolescent rugby ranged from 0.1920 to 1.4523/1,000 playing hours and from 3.826 to 5.728/1,000 athlete exposures.

4.2.1 mTBI

The reported incidence of mTBI in rugby varies, partially because studies do not always evaluate the players’ exposure but also because of variations in injury definition and study design. Rugby studies that have evaluated exposure and, more specifically, performed systematic reviews of the incidence of mTBI in a number of contact sport studies report that rugby has a high incidence of mTBI (0.62–9.05 per 1,000 player game hours). The level of competition affects mTBI. For professional rugby players, it is 2.9–9.1 per 1,000 player game hours, whereas mTBI is lower in nonprofessional players, at 0.6–5.0 per 1,000 player game hours. Hollis et al. (2009) found that for school-aged players, the incidence of mTBI was approximately 1.03 per 1,000 player game hours, but found no conclusive evidence which indicated that prior concussion was a precursor to future mTBI. While many studies have indicated that prior concussions are not a precursor to mTBI, other studies have found that high school and collegiate athletes experiencing ≥3 concussions are more vulnerable to a subsequent concussion note. The literature highlighting recent mTBI as a precursor to subsequent mTBI indicates that incomplete recovery from a prior injury may be responsible for this phenomenon. For example, it has been postulated that an increase in lactate production after brain injury leads to secondary ischemic injury, which may predispose the brain to a repeat injury (Hollis et al. 2009) ***document?***. Unfortunately, in this study, we were unable to determine whether an inadequate recovery contributed to the repeat incidence of concussion. A recent study of mTBI found no relationship between initial and subsequent concussions on mTBI (Hollis et al. 2009) ***document?***.

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