Concussion in Sport

The Faculty welcomes the new Concussion Guidance for Grassroots Sport produced by the Department of Culture, Media and Sport https://www.gov.uk/government/news/landmark-concussion-guidance-for-grassroots-sport-published

The guidance has been generated through a working group led by Professor James Calder, the Sport and Recreation Alliance and supported by Laurence Geller, the Government’s Adviser on Concussion in Sport.

The guidance will undoubtedly help all those actively involved in recreational and community sport including, players, coaches, parents, teachers and National Governing Bodies.

It takes an appropriate precautionary approach – ‘If in doubt, sit them out’ and builds on Sport Scotland’s earlier excellent publication[i]

Players, parents, coaches, teachers and administrators are asked to familiarise themselves with the following steps to:

• RECOGNISE the signs of concussion;
• REMOVE anyone suspected of being concussed immediately and;
• RETURN safely to daily activity, education/work and, ultimately, sport.

The guidelines include a recommendation to call NHS 111 within 24 hours of a potential concussion, to rest and sleep as much as needed for the first 24 to 48 hours and avoid using devices which involve screen time.

A graduated return to activity such as work, education and sport is advised – to reduce the risks of slow recovery, further brain injury and longer-term complications. Individuals should be assessed by an appropriate healthcare professional if symptoms persist for more than four weeks.

This guidance follows the report of the House of Commons Digital, Culture, Media and Sport Committee on Concussion in Sport[ii]. There were significant contributions from Members and Fellows of this Faculty, many of which positively influenced the report.

At the launch there was the recognition of the importance of expert management of concussion – particularly in those individuals which do not rapidly return to full health. The provision of funded regional centres for the management of concussion was alluded to but details are yet to be released.

If these centres are developed then it is important that the Faculty is involved in the planning, organisation and delivery of these centres – as much of the clinical expertise involved in the management of sport-related concussion rests with our Members and Fellows. Furthermore, the Faculty has developed considerable expertise in online education, evidence review and policy development through its Moving Medicine initiative – which could equally be applied to concussion management, at all levels of sport.

The guidance is a welcome contribution to grass-roots sport but does not address concussion in elite or professional sport, where the issues may be more complex and often more emotive. The adverse neurological consequence of sport is a complex area. The evidence is incomplete, the terminology is confusing and the conditions, understandably, cause considerable distress for players, family members and those trying to do their best for their sport. There can be a confusion of terms with concussion, post-concussion syndromes, dementia and Chronic Traumatic Encephalopathy often used interchangeably.

The Faculty believes that the treatment of patients with cognitive, affective and behavioural symptoms arising from concussion and other neurological injury has not been properly addressed. There is considerable evidence to be derived, from the literature arising from traumatic brain injury, that rehabilitation is effective. However, this evidence is not being consistently applied to the form of brain injury seen in sport. An important determinant of outcome in brain injury is the mental health of the patient, if this is ignored or the brain injury managed inappropriately, then there is likely to be a detrimental effect on patient well-being.

The Faculty would strongly advocate that this is an area which should be addressed in any future research or treatment guidance.

Conclusion

The Faculty believes there are real opportunities arising from this guidance and that of the DCMS Select committee – and it is keen to work with the DCMS and other agencies to help improve the prevention and management of concussion in sport. We welcome future collaboration with DCMS and the Devolved Assemblies to reduce the incidence and consequences of concussion in sport.

The Faculty supports:

• The clarity brought to the management of concussion in grass-roots sports by the current guidelines.
• The need to take reasonable precautions to reduce the consequences of repetitive head trauma, e.g., reducing the exposure to heading in football. In most cases this should be directed by the NGB’s – with reference to the best evidence medical evidence and advice – which the Faculty is happy to support.
• The requirement for further research into the epidemiology, pathogenesis and mitigation of concussion in sport at all levels of participation
• The development of treatment centres to manage those with the long-term consequences of concussion.

Author: Dr John Etherington, Past President of Faculty of Sport and Exercise Medicine 2018-2021

©Faculty of Sport and Exercise Medicine UK –  Published 2nd May 2023.

References:

[i] If in Doubt Sit them Out. Scottish Sports Concussion Guidance: grassroots sport and general public. 2018 version.

[ii] House of Commons -Digital, Culture, Media and Sport Select Committee. Concussion in Sport. Third Report of Session 2021-22