22 May 2019

South Africa: Concussion in Football

Photo: @SasolLeague/Twitter
Banyana Banyana team members at the send-off event in Johannesburg.

Concussion is one of the most common head injuries in football. It is therefore critical to give our football family some insight on concussion. Concussion is also a specialised topic so I will try and give a very basic overview for the benefit of everyone regardless of medical background. It is defined as a traumatic brain injury that is caused by a direct or indirect blow to the head thus shaking up the brain forcefully inside the skull.

A brain is a soft organ surrounded by fluid and is protected by a hard structure called skull. This fluid around the brain cushions the brain from crashing against the rigid skull. But if the head is hit hard, the brain can crash against the skull and be injured. Concussion in football is most likely caused by player's head colliding with an opponent's head, elbow, arm, knee or boot or a head clashing with the ground or goal post.

The player who has suffered from concussion can present with physical, mental and emotional symptoms & signs. It must be noted that any of these could be a sign of traumatic brain injury. Here are some few yet important symptoms & signs to look out for:-Confusion, Balance problems or dizziness, Clumsiness, Slurred speech, Headache, Nausea or Vomiting, Sensitivity to light, Sensitivity to noise, Ringing ears, Sluggishness, Behaviour or personality changes, Concentration difficulties, Memory loss, Sleep disturbances , Irritability or sadness.

Players suspected of suffering a concussion should be immediately removed from the field of play and the medical personnel should do a quick pitch side neurological evaluation performed using the specially developed Sports Concussion Assessment Tool (Version 5) - SCAT5. For more information on SCAT5 please consult the medical column on the SAFA website.

If there is no medical personnel the player should be immediately removed and sent straight to the Hospital Emergency Unit for thorough neurological evaluation.

The evaluating Doctor will determine the management however I've listed few things that are essential in management of concussion which are:

Stop playing immediately

Thorough formal medical evaluation

Analgesia e.g. paracetamol for headache

Avoid reading or television

Avoid physical activity

Stay in a quiet and dark environment (room)as possible.

Because football is a free-flowing game with no dedicated timeouts apart from halftime, clinicians, referees, coaches and players need to be particularly vigilant for players who may show signs of concussion. All players suspected to have suffered from concussion must be immediately removed from the field of play and stop playing until a formal medical evaluation is made by a Doctor, who will then determine when the player will be fit to play again.

This is particularly important because there are many things that can go wrong in a head injury that will need to be ruled out by a Doctor. It is also important to note that fitness to play is not a decision of a player or Coach but only the Doctor.

Dr Thulani Ngwenya - SAFA Medical Doctor

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