DERMOT SIMPSON discusses the dangers of concussion, an injury he saw up close during his time as Donegal’s All-Ireland winning physiotherapist – especially in 2013.
Although the journey from Qatar to Ireland is eight hours and requires two flights, the trips to Europe over the past year have at least allowed me to see a lot of movies. One recent and very topical movie I watched was Concussion starring Will Smith.
It tells the story of a Nigerian doctor, Bennet Omalu, whose altruistic research into the effects of repeated concussion in American Football in the early 2000’s, led to significant rule changes in the NFL.Error, group does not exist! Check your syntax! (ID: 81)
His in depth autopsy and self-financed tissue analysis on ex Pittsburgh Steelers player Mike Webster led to the discovery of what is now termed chronic traumatic encephalopathy (CTE). At that stage concussion and its long term effects were only associated with boxing and other combat sports.
Omalu found increased tau protein in the brain, which leads to contrasting moods, emotions and cognitive functions. Incidentally the NFL didn’t acknowledge the findings of Omalu’s work until 2009, seven years after his initial work. They’ve now come full circle, probably in fear of future lawsuits. With the new NFL season just underway, new rules for this season can penalise clubs hundreds of thousands of dollars for not removing a concussed player from play.
A recent rule change in English Rugby League is also a step in the right direction. It requires a medical professional to analyse in-game replays of tackles in which injuries may have been incurred.
Hopefully, something similar will happen soon in Gaelic football and soccer. Presently, those watching the game in far flung places like Australia can see the dangerous collisions a lot more clearly than those pitch-side. They can see an incident replayed many times and in slow motion whereas the pitch-side medical team might be up to 80 metres away with no chance of a replay!
An incident that generated a lot of discussion occurred during the Mayo v Cork Allianz League game in February. Lee Keegan and Eoin Cadogan collided in the centre of the pitch. Cadogan was immediately withdrawn, whereas Keegan stayed on pitch (Mayo were 14 points down with 20 minutes left to play).
He suffered a second collision not long after and was in visible distress as he was removed from field. It’s very easy to criticise the medical team for not taking him off initially as it’s quite possible to have delayed concussion symptoms and to have passed the on-field test despite being ‘concussed’.
It was much easier for those watching at home to say ‘he should have been taken off’ after seeing numerous replays. Only the medical team will know the exact situation. Obviously a mistake was made in not withdrawing him in the initial collision. They’ve admitted later that an error was made in not taking off the player.
But there are many other factors that would make it easier to do so. A 10 minute ‘concussion – sub’ to allow further time to assess a head injury, pitch side replays on iPads (which Liverpool FC used last year) or a medical professional in the stands analysing these incidents.
During an Ulster Championship semi-final with Down in 2013, we had two players withdrawn before half time due to concussion, Ryan Bradley and Frank McGlynn. Ryan Bradley’s concussion probably remains the one I remember most due to the mid-air contact, the height he fell from and the way he landed.
Ryan and Frank were both taken to Letterkenny hospital that evening for a precautionary CT scan and stayed in overnight. Ryan took a couple of days off work but with Gaelic being an amateur sport, that’s all he could afford to take. In the following two weeks at training, I can vividly remember Ryan coming into the changing rooms in Ballybofey.
Ryan was always one of the first to arrive and the minute he walked into the door, I would say “you’re not able to train”. Each time he looked like he hadn’t slept in a week. As well as being visibly tired, he said himself he just ‘‘wasn’t feeling right’’.
He was kept out of play until he passed all ‘return to play’ criteria. Fortunately he hasn’t had any serious incidents since however he does lose his head if things aren’t going his way out here with Qatar GAA!
In the very next match, the Ulster final, Mark McHugh sat in the dugout after been taken off the field after 15 minutes following a heavy hit by a Monaghan player, with Donegal 0-4 to 0-0 down. Two minutes later, he asked me “how do Monaghan have four points? When did they score them?”
Notwithstanding the seriousness of the injury, it is still not as common in Gaelic Football as is in other sports. Despite playing a high intensity game with lots of contact for nine months of the year, we’d expect to see three to four concussions every year in a squad of 30 to 35 players.
That number is replicated in other inter-county teams in injury epidemiology studies. The number may of course be higher as players may want to hide symptoms with fear of losing a starting spot or the concussion may simply go undetected.
A concussion doesn’t have to be a direct blow to the head. Many times it can be a heavy blow to the chest or shoulder which causes the coup contrecoup affect in the brain. The brain for a split second, is like a piece of jelly, moving inside the skull after a heavy impact.
I attended a very interesting talk in Aspetar recently by Mr Paul Maurer, chief of neurosurgery at Rochester Hospital, New York. Having seen thousands of head injuries over his career, he emphasises that the worst thing that can happen is to get a re-injury within the first seven to 10 days of initial injury; damaged cells take that long to recover from initial impact.
It’s important to know that children and adolescents take a longer time to heal. Current guidelines advise under 18’s with concussion symptoms, to remain out of sport for three weeks.Error, group does not exist! Check your syntax! (ID: 81)
A headache on its own is a very common symptom of concussion but headache and vomiting together can be much more serious and should be referred to a medical professional. Mr Maurer finishes by saying “A single head impact doesn’t generate much long term injury however repetitive mild events lead to a chronic inflammatory reaction that can give you a CTE from inflammatory brain death”.
Mr Kevin Moran, the Donegal GAA team doctor has become highly involved with the GAA medical committee on the management of concussion in recent years. They have developed an excellent online resource at http://learning.gaa.ie/Concussion – Information on concussion guidelines, assessment/recognition can be found here.
Dermot Simpson (pictured above) is a physiotherapist currently working at Aspetar, a world renowned sports medicine clinic in Doha, Qatar. Dermot has been team physiotherapist for Donegal senior football team from the 2012 to 2015 seasons.
He holds an undergraduate degree in physiotherapy and as well as a Masters in Sports Physiotherapy from UCD, Dublin. Dermot is the owner of Donegal Physiotherapy & Sports Injury Clinic in Letterkenny and Inishowen Physiotherapy & Sports Injury Clinic in Carndonagh.
He will write articles on sporting injuries, injury prevention and rehabilitation for Donegal Sports Hub.