New Concussion report

[Puja]

League finally changing their tackle rules, and leapfrogging top-level union by going down to armpit height: https://www.theguardian.com/sport/2023/ ... ssion-risk

Puja

[Which Tyler]

https://www.planetrugby.com/news/super- ... -criticism

“Players will continue to wear the iMGs this weekend but will not be required to immediately leave the field for an HIA when their mouthguard triggers an alert to pitch-side doctors,” a statement read.

“Instead, players will be checked by an on-field doctor after a trigger alert has been received. If the doctor has any concerns the player will then leave the field for an HIA.

“If the player passes an on-field check, they will still be subject to a full HIA, either at half-time or full-time.”

I'd need to see what the onfield check is - the HIA was introduced because onfield checks of the time were simply terrible.
Since then, or course, attitudes have changed, and we know a lot more about concussion, so it's entirely possible that a better onfield check has been developed - but if so, it's passed me by.


My instinct of course, is that the whole point of an HIA is as an evidence based Assessment of a potential Head Injury; not to confirm / rule out the findings of a test that's known to be useless.

[Puja]

https://www.planetrugby.com/news/super- ... -criticism

“Players will continue to wear the iMGs this weekend but will not be required to immediately leave the field for an HIA when their mouthguard triggers an alert to pitch-side doctors,” a statement read.

“Instead, players will be checked by an on-field doctor after a trigger alert has been received. If the doctor has any concerns the player will then leave the field for an HIA.

“If the player passes an on-field check, they will still be subject to a full HIA, either at half-time or full-time.”

I'd need to see what the onfield check is - the HIA was introduced because onfield checks of the time were simply terrible.
Since then, or course, attitudes have changed, and we know a lot more about concussion, so it's entirely possible that a better onfield check has been developed - but if so, it's passed me by.


My instinct of course, is that the whole point of an HIA is as an evidence based Assessment of a potential Head Injury; not to confirm / rule out the findings of a test that's known to be useless.

Zander Fagerson and Scotland complained about his gumshield-related HIA at the weekend, but I noted in the m-b-m that, as soon as he came back on, he carried the ball with his head down like a charging ram and nutted Underhill who was trying to tackle him, which made me lose sympathy for him complaining about being checked for head injuries. Although weirdly, that one didn't trigger the gumshield (or he'd switched his status to refusing to use it, which they can do).

The sooner World Rugby bring in the community level laws of "No tackles above the sternum, no leading with your head into contact" into the professional game, the better. Need one unified set of laws.

Puja

[morepork]

https://www.planetrugby.com/news/super- ... -criticism

“Players will continue to wear the iMGs this weekend but will not be required to immediately leave the field for an HIA when their mouthguard triggers an alert to pitch-side doctors,” a statement read.

“Instead, players will be checked by an on-field doctor after a trigger alert has been received. If the doctor has any concerns the player will then leave the field for an HIA.

“If the player passes an on-field check, they will still be subject to a full HIA, either at half-time or full-time.”

I'd need to see what the onfield check is - the HIA was introduced because onfield checks of the time were simply terrible.
Since then, or course, attitudes have changed, and we know a lot more about concussion, so it's entirely possible that a better onfield check has been developed - but if so, it's passed me by.


My instinct of course, is that the whole point of an HIA is as an evidence based Assessment of a potential Head Injury; not to confirm / rule out the findings of a test that's known to be useless.

Real-time Telemedicine in the middle of a fight...

[Which Tyler]

Real-time Telemedicine in the middle of a fight...

Don't forget, this is Brexit Britain - your 1 minute phone consultation with a GP who can't access your medical notes, is a 4 week wait away.

[Mellsblue]

More confusion as to which (no pun intended) board this sort of thing should be posted on.

[morepork]

More confusion as to which (no pun intended) board this sort of thing should be posted on.

We've all had a blow to the head.

[Puja]

https://www.bbc.co.uk/sport/rugby-union ... 0lknlv2ylo

This is to be taken with the usual oversized pinch of salt about medical claims made by anyone selling a product, but this is interesting and I'm curious to see the results of the research. It seems to make a basic sense to my amateur brain - one of the major problems is swelling in the brain, icing reduces swelling, so therefore cooling the head should reduce swelling? Who knows whether it'll have a noticeable effect in real life though.

Puja

[Which Tyler]

FTR - the use of ice to reduce swelling is very controversial amongst those in the know (short term gains vs longer term harms - I have opinions, but this isn't really the place).

Either way, I await the results of the research with interest.

[Puja]

FTR - the use of ice to reduce swelling is very controversial amongst those in the know (short term gains vs longer term harms - I have opinions, but this isn't really the place).

Either way, I await the results of the research with interest.

I would be interested in those opinions, as I know precious little about the matter.

Puja

[Which Tyler]

I've kept this as short as I realistically can - which isn't very.

► Show Spoiler

Essentially, applying ice starts up a hunting reaction, as the blood vessels in the area respond to the change in temperature.
Initially this starts with vasoconstriction (narrowing of the vessels) as the body panics a bit that it's going to lose core temperature; then it over-reacts the other way into vasodilation (expansion of the vessels); and hunts around for a bit until it finds a new level it's happy with and settles down.
The time frames of this hunting reaction depend on a LOT of different factors (temperature of the ice pack, size of ice pack, temperature of the tissue, size of the tissue [eg. finger versus torso], quantity of subcutaneous fat, vascular & neurological health etc etc).
Another effect of cryotherapy is to slow nerve conduction => less pain (impaired mental function and repairing nerves are already relative contraindications to cryotherapy [amongst many others] - I'll be really interested in how this study squares that circle - but I'll also admit that neurology/neurophysiology is ridiculously complex, and I struggled with them 25 years ago).

Vasoconstriction has an anti-inflammatory effect (starving the tissue of blood, oxygen, and the various building blocks it wants to heal the injury) - it's what you want on the sports pitch, where you want to minimise bleeding / bruising, and deal with the injury properly later (and why pitch-side, you should never use the ice for more than a couple of minutes).
Vasodilation has a pro-inflammatory effect (flushing the tissue with blood, oxygen, and the various building blocks it wants to heal the injury) - this is where the advice used to be to use the ice pack for 10-15 minutes on, and leave it off for 60-90 minutes before re-applying.

These effects have been seen in a really small way, at the level of inflammatory markers.

Inflammation is the first stage of tissue healing, so we really don't want anti-inflammatories unless it's actually indicated by an excessive inflammatory reaction (as opposed to as standard, just because).

We also know that patients are frankly terrible at taking advice (especially if it's given by people who are terrible at giving advice, don't explain the advice, and often, don't understand the rationale behind the advice); and therapists are currently running scared of inflammation - "first do no harm".

In my opinion:
A] Yes, patients are idiots, but so are therapists. Explain the rationale, and treat the patient like a grown-arse adult (or their parent/guardian as a grown-arse adult), then even if they forget the time-frames, they've a far better chance of using the stuff appropriately.
B] Appropriate use of ice is appropriate, inappropriate use of ice is inappropriate.
Whilst we have evidence of cryotherapy effecting inflammatory markers; as far as I've seen, we've not seen that that effect is actually relevant to patient healing times.
C] I've been doing this shit long enough to see various other babies being thrown out with the bathwater based on "common sense when you think about it" rather than actual evidence (or simply poor evidence), only to be rediscovered as useful a decade or two later.

My practice:
I still recommend ice; but way less often than I used to (doing my accounts - I sold 3 ice packs last year; 18 years ago when I opened my own practice, I got through a box of 50, and into a second box). When I do, I explain the what and why to the patient, along with the potential adverse effects, and follow up by email. The ice packs I sell have the time frames written on them.

[morepork]

I thought the head cooling thing was more for ischemic episodes, particularly for newborn babies.

[Which Tyler]

Gabe Goss retiring due to concussions

[Mellsblue]

Head injuries ‘wake dormant viruses’
Kaya Burgess - Science Reporter
Dormant viruses “lurking” in the brain could be awakened by head injuries and contribute to the development of dementia, scientists have suggested.

Doctors should consider prescribing anti-viral drugs to those who have suffered a blow to the head in case the injury activated a “latent viruses” in the brain, according to a new study.

The mechanism by which head injuries can increase the risk of dementia is not fully understood, but the link has been highlighted by campaigners calling for greater protection for athletes.

More than 80 per cent of people are thought to carry the herpes simplex virus (HSV-1), which causes cold sores, while 95 per cent of people carry the varicella-zoster virus, which causes chickenpox and shingles.

These viruses can exist in the body without causing harm and are “known to make their way into the brain and sleep within our neurons and glial cells”, scientists have said.

Researchers at Tufts University, in Massachusetts, and Oxford University “have uncovered mechanisms that may connect the dots between trauma events and the emergence of disease, pointing to latent viruses lurking in most of our brains that may be activated by the jolt”, according to the study, published in the journal Science Advances.

The study has been conducted only in laboratory settings so has not been assessed in human subjects. Researchers took protein tissue filled with neurons, some of which had the herpes virus dormant within them. The tissue was put in a cylinder and given a jolt.

Professor Ruth Itzhaki, a visiting fellow at the University of Oxford’s Institute of Population Ageing, discovered that many older people carry HSV-1 in their brains and that it can be reactivated from a dormant state. She observed a “reactivation of the virus” in the cells that had been subjected to a concussion-like jolt.

Dr Dana Cairns, from the department of biomedical engineering at Tufts, said: “This opens the question as to whether antiviral drugs might be useful as early preventive treatments after head trauma to stop HSV-1 activation in its tracks, and lower the risk of Alzheimer’s disease.”

[Which Tyler]

This is aimed at clinicians, but should be useful for anyone who's interested - benefit of being completely free
Course covers assessment, prognosis and management of concussion

https://www.ccgi-research.com/ce-concussion

[Puja]

https://www.planetrugby.com/news/concus ... l-decision

Finn Russell apparently passed his HIA but was kept off the pitch because the Scotland staff “sensed he wasn’t totally aware of what was going on" and "there were a couple of things he wasn’t remembering about plays". First off, full marks to Scotland, cause the temptation really would've been to let him continue considering how important he is (especially with them having 6:2 and losing Graham in the same incident), but it's kinda worrying that he wasn't compus enough to pass muster in general conversation but was still able to pass the HIA.

Puja