Concussions are one of the most commonly reported rugby-related injuries.
Young rugby players have a higher risk of prolonged recovery following a concussion. Preventing concussions in schoolboy rugby is therefore very important.
As part of a global concussion prevention strategy, World Rugby, the body that manages rugby internationally, has introduced guidelines on how to manage concussions. These include regulations and return-to-play protocols. One of these guidelines require that concussed players are assessed by a medical doctor before returning to play.
Despite these international guidelines, many players ignore this warning and return to play prematurely. We looked at this defiance in South Africa and tried to understand why young South African rugby players failed to comply with the requirement of medical clearance.
We found that many did not seek medical clearance because their parents or legal guardians deemed it unnecessary. This is concerning because returning to play before complete healing could have long-lasting effects, particularly in younger boy’s brains. In rare cases, it could even be fatal.
There are several rugby injury-prevention programmes in the world. These mainly target coaches and referees with their injury prevention education. But our study shows that there is a gap – and unless parents of young rugby players are given concussion education, they won’t manage the injury properly.
What happens during a concussion
A concussion is a brain injury induced by a heavy blow on the head that results in a temporary loss of consciousness. Previously loss of consciousness or being “knocked out” were considered the only signs of a concussion. But there are many other signs. This includes being confused or dazed days later.
More recently, concussions have been recognised as more of a chemical than a structural disruption. For example, in contrast to an injury such as a hamstring muscle tear, most concussions are not visible – even with highly sophisticated scans.
This chemical underpinning also might explain why this injury can evolve over time. For example, a concussed child might have no signs of their injury during their match, but develop some confusion after they return home.
These signs of concussion should all need to be considered with the same level of seriousness. A “knock-out” is not necessarily more severe than a player presenting with confusion six hours after their match.
The delayed effect is critical in schoolboy rugby – and needs parents to be aware of the symptoms and how to treat it.
Our study showed that parents were not particularly involved in the management of concussions. To gather evidence, we interviewed teenagers who participated in schoolboy rugby in South Africa.
There were three reasons they didn’t get medical clearance from a doctor before returning to play.
First, there was the perception that it “was not necessary”. In most of the cases it was the parent or player that decided it was unnecessary. This was the most commonly mentioned barrier.
Second, some players were unaware of the requirement to seek medical clearance before returning to play.
Third, others said it took too much time to see a medical doctor.
In contrast, most sought medical clearance because they had been instructed to do so –- either by the tournament doctor or their school coach. Another reason for seeking medical clearance was because there was a concern for their wellbeing as they were still symptomatic.
The challenge arises when a concussed player who has still not recovered properly chooses not to seek medical clearance because they are mainly asymptomatic. They may not have completely recovered and may still be at risk if returned to full contact rugby too early. For example, when players are subjected to physical exertion, symptoms might re-emerge that were not there at rest.
Schoolboy rugby is governed by South African Rugby, the sport’s official regulator. The regulator has a national rugby safety program: BokSmart.
Despite numerous efforts in the past, BokSmart have had difficulty in filling a classroom with parents to discuss concussion management. This is in stark contrast to talks on nutritional supplements or player selection, where often the entire school hall has been filled.
If parents were more educated on the importance of managing a concussion, players would seek treatment more regularly. Therefore, they should be involved from the time of initial injury through to the safe return of their child to playing rugby.
Parents should educate themselves on concussion management, both at home, in the child’s classroom environment and on the field. They can also access a freely available pocket concussion recognition tool that World Rugby endorses.
If a parent even suspects that their child has sustained a concussion, they should be removed from play immediately and be assessed by a medical doctor as soon as possible.
If concussed, the player will need to be guided through a clearly defined return-to-play protocol by a medical doctor with experience in sport-related concussion management.