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Concussion

Are you taking it seriously?

For decades, getting up after a hard knock was regarded as testament to your physical toughness, but these days every blow is coming under scrutiny. Sports culture is beginning to change, even forcing some athletes into early retirement.

Concussion is now being taken seriously in sports, particularly where there is physical contact. Although sailing may not be regarded as a contact sport, we all know that a hit on the head is all too common. Concussion, therefore, deserves our full attention and should be taken equally seriously in all forms of competitive sailing and when training and cruising.

Numerous studies show a connection between brain trauma and problematic futures; consider these troubling illustrations pulled from the internet:

• Almost half of homeless men have had traumatic brain injuries.
• Teenagers who have had concussion have a higher rate of attempted suicide.
• Head injury can affect social competence and make children loners.
• There is an association between concussion and depression particularly in teenagers.

Whether these examples are factual or not, they have probably got your attention! What is a fact is that concussion is not normally a visible injury and it is therefore important that we all take any blow to the head seriously and ensure that it is treated appropriately.

What is concussion?

Concussion - also known as minor head injury - is commonly caused by falls, road crashes, assaults and sports accidents. It is estimated that over a million people each year attend A&E departments in the UK after a head injury although the majority of these injuries are classed as minor. Concussion usually only lasts for a short time, although it sometimes needs emergency treatment and some people can have longer-lasting problems.

Although head injuries in sport are commonly associated with football, rugby, hockey and boxing, they can occur when sailing, particularly in racing where aggressive jibing and tacking is taught and widely practiced. They can even occur from accidental and unexpected strikes to the head in relatively calm cruising conditions; an accidental jibe is always a potential danger.

What happens in concussion?

The skull helps protect the brain from injury. Spinal fluid cushions the brain inside the skull. A blow or jolt to the head can hurt the brain directly or make the brain move around and bang up against the hard bone of your skull. This can change the signals between nerves, which causes concussion symptoms.

From this you might naturally conclude that you should be wearing a helmet for sailing to protect you if you bang your head; indeed the RYA provides guidance on things to think about if you are considering the use of a helmet which you can read here. But there is a “but”, and it is a big one - there is no data to confirm that a helmet can prevent concussion.

Helmets can help to reduce the incidence and severity of facial and skull fractures, contusions and lacerations, but they do not prevent the brain from banging up against your skull. Although anyone can suffer from concussion and research shows that it occurs more easily in pre-teen and teen years.

Concussion in sport

Sport plays a key role in keeping us fit and healthy, it also provides a host of additional benefits including enjoyment through social interaction, improved self-esteem and it helps to instil discipline and teamwork particularly in young people.

As with life in general, however, accidents and collisions can occur and it is vital that all who participate in or watch sport are aware of the risks of concussion – particularly those involved at club or junior level, where ambulances and medics may not be on standby should something go wrong.

The effects of concussion can leave people with symptoms including dizziness, nausea, confusion, an inability to process or retain information and vision distortion. In extreme cases, an individual may lose consciousness as a result of the head injury. However, only around 10% of reported concussions involve a loss of consciousness so it’s important that you do not rely on this as an indicator. Furthermore, there are considerable risks with continuing to compete or continue what you are doing once a concussion has been sustained, heed the HEADWAY message:

If in doubt, sit it out

The bottom line in sport is: never ignore concussion. Even with the suspicion of a possible concussion, it is essential that the sailor leaves the water immediately and does not return until rested and medical advice has been sought. If managed properly, the vast majority of people are fine within a few days of a concussion. If you ignore it, there is a much higher risk of long-term problems and occasionally, even serious damage.

How do I identify concussion?

Concussion is notoriously difficult to identify, particularly in the midst of a sporting event. It can be a progressive condition, with the symptoms taking time to display themselves and many of the symptoms require honesty from the sailor to tell you if they think something is wrong. Do not carry on regardless thinking that you are doing the right thing and not letting your team or crew down; critically you may be exacerbating the damage to your brain.

What can sailors do?

As a sailor it is vital that you take concussion seriously. Your health is important and you have a responsibility to look after yourself and other teammates. Ignoring any signs or symptoms of concussion could have significant and sometimes serious consequences:

• Your sailing career and enjoyment of the sport may be affected;
• Your long-term health may be affected;
• Your work and/or academic studies may be affected.

If during training, a competition or in any other situation, you think you may have a concussion it’s critical that you speak up and talk to your coach, parent/guardian, or an official, etc. Similarly, if you see any signs of concussion in one of your teammates, or even a fellow competitor, make sure you tell someone appropriate.

What can coaches and officials do?

Coaches and officials must encourage sailors to report concussions that occur during competition and training sessions. Coaches probably have the most important role in the prevention and management of concussion. Sailors rely on their coach to provide information on concussion and their coach’s behaviour will influence a sailor’s attitude towards concussion. Coaches should be able to recognise suspected concussion and are in the best position to remove the sailor from the water. Safety boat crew and other officials should also be able to recognise the symptoms of concussion and should not hesitate in taking similar action.

What can parents and guardians do?

Parents and guardians also play a vital role in the prevention and management of concussion. It is important that they are also able to recognise suspected concussion, which may develop after their children have left the water, and support them appropriately. Ignoring the signs or symptoms of concussion could have significant and sometimes serious consequences; potentially affecting academic studies, long-term health and enjoyment of the sport.

No matter whether you are a sailor, a coach, an official or a parent/guardian, it is important to be able to recognise the symptoms and remove yourself or the suspected casualty to a safe place for observation.

What are the common signs of concussion?

Concussion commonly produces a mixture of physical, cognitive and emotional symptoms, which can vary greatly between individuals. Some key signs of concussion to look out for include:

Physical signs
• Headaches
• Dizziness
• Light sensitivity
• Insomnia and sleep problems
• Balance problems
• Fatigue

Cognitive signs
• Poor concentration
• Forgetfulness
• Difficulty with processing information

Emotional signs
• Irritability
• Low mood
• Anxiety
• Feeling more emotional than usual

Failure to answer a few simple questions correctly, such as these for example, may also suggest a concussion:
• What venue are we at today?
• Who is your crew?
• Who won the last race?
• What is your sail number?
• Where did you finish in the last race?

In most cases, the symptoms will improve by themselves within a couple of weeks. Usually the physical symptoms improve first, followed by the cognitive and emotional symptoms.

Any sailor with a suspected concussion should be removed from the water immediately, and should not return to activity until they are assessed as fit to do so. Sailors with a suspected concussion should be kept under observation, not left alone for at least 48 hours and should not drive a motor vehicle until cleared to do so.

It is recommended that, in all cases of suspected concussion, the sailor is referred to a medical professional for diagnosis and guidance on when to “return to play”, even if the symptoms disappear.

In the majority of cases, there will be no long-term damage caused by a concussion if treated appropriately with medical assessment and rest. Occasionally, however, complications can arise from seemingly minor blows to the head, which is why it is vital that people seek medical attention following a concussion.

The British Journal of Sports Medicine Pocket CONCUSSION RECOGNITION TOOL™  (Appendix A) may also be useful to help identify concussion in children, teenagers and adults if you are not a health care professional.

What are the risks of ignoring concussion?

While injuries to external parts of the body can be readily identified, it is impossible to know what damage has occurred in the immediate aftermath of a bang on the head and the symptoms may be delayed before presenting themselves.

We know that in the majority of cases, there will be no long-term damage caused by concussion if treated properly. However, occasionally, complications can arise from seemingly minor blows to the head, which is why it is vital that people seek medical attention following a concussion.

There are also significant risks in returning to the water soon after sustaining a concussion. If you sustain another blow to your head before your brain has had a chance to recover from the initial concussion, the damage can be exacerbated to the point that it can be – on rare occasions – fatal. This is known as Second Impact Syndrome and it is believed to be more common among children and young adults.

What to do and what not to do following a concussion

The following DOs and DON’Ts are provided by HEADWAY and are worth heeding if you have concussion or are caring for someone else who has:

• DO stay within reach of a telephone and have medical numbers at hand if you need them
• DO have plenty of rest and avoid stressful situations
• DO share this information with a friend or a family member who can keep an eye on your condition
• DO take painkillers such as paracetamol for headaches;
• DON’T stay at home alone for 48 hours after the injury has taken place
• DON’T drink alcohol until you feel better
• DON’T take sleeping tablets without consulting a doctor;
• DON’T do anything active (play or train) for at least three weeks without consulting your doctor
• DON’T return to driving until you have recovered; if in doubt, consult your doctor
• DON’T isolate yourself, but avoid meeting too many friends all at once, and avoid loud, busy, over-stimulating social situations

The prognosis for concussion is usually good and most will feel back to normal within weeks.

And finally….

If you or someone you know is struggling with the ongoing effects of concussion, consult a doctor. Not only can they recommend medication or therapies that can help, but it may also prevent the condition becoming more serious.

Sources of information:

NHS Choices
Headway
Child Brain Injury Trust
Supporting Head Injured pupils in Schools
Brain and Spine
Brain Injury Rehabilitation Trust
Headinjurysymptoms.org

This guidance has been prepared with help from the Headway Concussion Aware campaign, visit www.headway.org.uk/get-involved/campaigns/concussion-aware

The contents of this article is the RYA’s interpretation of information available at the date of publication. However, the article is intended for educational purposes only and it not a substitute for medical advice. Before taking any action based on the contents of this article, readers are advised to confirm the up to date position and to take appropriate professional advice specific to their individual circumstances. In particular if you believe that you or someone under your care has sustained a concussion, we strongly recommend that you contact a qualified health care professional for appropriate diagnosis and treatment. The RYA makes no representation or warranties regarding the accuracy of the information contained in the article, and so far as it is able disclaims any liability in connection with it.

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