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How do you solve a problem like concussion?

Harry Black explores the unique set of difficulties which put university students at risk of repeated injuries

Posted by Rebecca Paddick | August 30, 2016 | Sports & leisure

Concussion is a major topic of concern across world sport. With clear guidelines on how these injuries should be managed, all organisations providing sport need to be aware of what their responsibilities are.

Harry Black, Universities Business Manager for Return2Play - a web based concussion management system that handles the entire return to play process - explores the unique set of difficulties which put university students at risk of repeated injuries and prevents them from receiving the best care. 

What is concussion? 

Concussion is simply the result of the brain hitting the inside of the skull. In other words: the very thing that’s there to protect your grey matter, injures it.

But, of course, it’s a bit more complex than that. Any combination of numerous physical, cognitive or mood-related symptoms can point to a concussion having taken place. These include dizziness, headaches, memory problems, difficulty concentrating, depression, anxiety, motor impairment and more. The appearance of symptoms can also be delayed by hours or even days from the moment of injury making concussion one of the hardest injuries to diagnose. A player doesn’t even have to have taken a knock to the head to sustain a concussion. And the cherry on top? Loss of consciousness (widely considered to be synonymous with concussion) occurs in fewer than 10% of concussions.

Given all these uncertainties it’s little wonder that people are a bit hazy about how to handle concussion.

How should the injury be managed? 

The first step in the management of any injury is recognition which, given the above, is not always easy. Outside of elite sport there is no place for pitch-side assessments and decisions should be underpinned by the mantra “if in doubt, sit them out”. All players and coaches should feel empowered to act upon this rule and, if concerned, get medical attention for the player. 

There are now clear, cross-sport, guidelines about how a player returning to sport after a concussive injury should be managed. The key objective is to remove the risk of re-injury while the brain is still recovering – something that can have serious, and even fatal, consequences. The pathway starts with a period of complete rest from sport, before a medical assessment is recommended to check a player is safe to move onto the next stage – the Graduated Return to Play (GRTP). GRTP progressively introduced a player back into sport, with the player only advancing if they remain symptom free. At the end of the process medical clearance from a doctor is required before the player should return to full play.

What factors make following the guidelines difficult at Universities?

Universities have arguably the toughest job in managing the concussions of their students. For many students their years at university are the first in which they are required to take full responsibility for their own health and welfare. On top of this many university sports clubs rely on student volunteers to run their teams, and as such ask students to be responsible for the welfare of others, as well as themselves. It is therefore feasible that within the space of a year a student can go from having no responsibility, to being entrusted with the welfare of a whole squad of their peers.

With these factors considered, it is all too predictable that the clear post-concussion return to play pathways are likely to be poorly followed in university sport. 

Universities have arguably the toughest job in managing the concussions of their students. For many students their years at university are the first in which they are required to take full responsibility for their own health and welfare

“Every club for themselves”

A lot of students play multiple sports at University, both competitively and recreationally and the vast majority of involvement is managed at “club level” rather than centrally. The independent running of clubs means that the reporting of injuries, and therefore the prevention of possible consequences, can easily be missed. Unfortunately, this means that students may be receiving concussions, and nobody knows about them. Nobody knows that the symptoms they experience over the following weeks are as a result of a head injury, nobody knows that they shouldn’t be walking out onto a pitch again, nobody knows about the danger they are in when they do so, and nobody knows about the effect it may have on their academic studies. 

“It’s all too much effort…”

There is no doubt that a key to running a “Gold Standard” return to play pathway is good administration and communication between multiple parties – something which may just be too much work for students with busy academic and social lives.

The other factor which prevents best care being provided is lack of access to doctors for medical clearance. It is often difficult to get appointments in the desired time-frame, potentially keeping well players out of action for longer than they would like, and even then it may be that the doctor doesn’t feel they are appropriately experienced to make a decision on whether a player is safe to play a particular sport. Engaging with private doctors is expensive and unlikely to be an option for the majority of students.

If either, or both, of these factors is encountered, the easy option is to take the risk and not follow the guidelines – something which clearly has a potential health risk to the player but also raises the argument that the duty of care the club should provide is being neglected.

And finally…

Concussion isn’t going to go away. With greater awareness of the injury there are already more reported cases and more people demanding that sport does more to look after its players. But it also isn’t a death sentence: the clear guidelines mean “Gold Standard” care can be provided to players and, some might argue, make sport safer than ever. The key is to make sure all the required resources are available to allow the guidelines to actually be followed. 

Harry Black is the Universities Business Manager for Return2Play – a fully-automated concussion management system that handles the entire return to play process. As a student at the University of Bath, Harry was a 1XI sportsmen in both Hockey and Cricket. He was Chairman of the Hockey Club, working closely with, and piloting projects for both BUCS and England Hockey.

W: www.return2play.org.uk

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