In perspective: David Herdman on concussion in sport

Nineteen minutes into the World Cup Final, Christopher Kramer suffered a blow to the head. He was replaced 14 minutes later only after he asked the referee where he was. The pitch-side assessment had excluded any blood or broken bones, but his injury was potentially more serious. He was concussed.

This is just one case in a series of incidents that illustrate we have a long way to go in recognising the risks of concussion. Concussion is a trauma-induced alteration in mental status that may or may not involve loss of consciousness. The International Symposium of Concussion recommends that players are removed from the field of play for that day, even if the visible symptoms are only brief.

The FA’s recent guidance on head injury will give more power to medical staff to remove players (Frontline, page 10, 3 September). This is a positive step, but is necessarily dependent on them being able to identify concussion in the first place.

The International Rugby Board produced in-match concussion protocols last year, which allowed players to be removed from the field of play for 10 minutes to allow for assessment. The intention was admirable but it has become clear that these guidelines are poorly interpreted due to a lack of expertise by many match day doctors and physios.

It has led to many high-profile cases of players returning to play only minutes after being escorted off, presumably because the overt signs of concussion appear to have abated. However, research shows that early signs of apparent recovery may be misleading.

Around 15 to 30 per cent of athletes will experience prolonged symptoms following a concussion. Concussion is taken far more seriously in America, perhaps due to high-profile lawsuits settlements received by retired NFL players this year.

It may be that tightening protocols in the UK now may be too late for some players, but it is essential that we take steps to prevent further long-term damage to athletes. We need to educate the general public about concussion, but before we can do that we need to educate ourselves.

Clear guidelines are a positive step forward, but present the profession with certain challenges. Physiotherapists must now take greater responsibility to identify signs of concussion, act appropriately and recommend a timely assessment to a specialist.

Vestibular rehabilitation is a safe and effective treatment for post- concussion symptoms, although is entirely dependent on healthcare professionals routinely referring patients. Any physio not adhering to international guidelines risks the reputation of our profession and the wellbeing of the athletes they are supposed to be protecting.

How long until we see a case of malpractice brought forward?

Author

David Herdman is a specialist vestibular physiotherapist at Guy’s Hospital, London