From tackle to trauma: Managing brain injuries in rugby

The rugby season is kicking off in schools across South Africa and players, parents, coaches and referees are preparing for exciting and physically demanding matches.

In many sports, injuries are an unfortunate, common occurrence. Rugby, a contact sport, also carries the inevitable risk of head injuries, ranging from minor concussions to severe traumatic brain injuries (TBIs).

The early detection of head injuries is essential for effective treatment and preventing further complications.

The symptoms of a concussion or TBIs may not be immediately apparent and athletes may continue playing which can lead to more damage.

Accurate diagnosis and management of head injuries require a combination of clinical evaluation and advanced imaging techniques.

There are several types of head injuries common in rugby. The most frequent is concussion, a mild traumatic brain injury occurring when the brain is jolted inside the skull from an impact or violent movement.

Occasionally, with more severe injuries, we see skull fractures, contusions and haemorrhage surrounding the brain. These require urgent diagnosis and management.

Concussion symptoms include headaches, dizziness, nausea, confusion, memory problems, sensitivity to light and difficulty concentrating. Immediate recognition is vital.

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A player with any of these symptoms must stop playing immediately to prevent further injury.

What to look out for

Radiology plays an essential part in accurately diagnosing the extent of head injuries. Computed tomography (CT) scans are always the first imaging method used in emergencies.

Although patients with concussion do not have significant imaging findings, it is crucial to image patients with severe concussion or atypical symptoms.

CT scans rapidly detect serious issues like fractures, brain swelling and bleeding.

Magnetic resonance imaging (MRI) is used in situations needing more detailed evaluation, particularly when concussion symptoms persist or worsen.

MRI excels in identifying subtle injuries, such as microbleeds and brain swelling.

Emerging imaging techniques, such as diffusion tensor imaging (DTI), show promise for better understanding and management of head injuries, especially the subtle effects of concussions.

DTI helps identify damage to the brain’s white matter.

Second impact syndrome (SIS) is a rare but extremely serious condition that occurs when a person sustains a second concussion before fully recovering from an initial concussion.

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It causes rapid and severe brain swelling, or cerebral oedema. Symptoms can escalate quickly, often within minutes, including loss of consciousness, severe headache, dilated pupils, respiratory failure and even death.

SIS is considered a medical emergency.

Chronic traumatic encephalopathy (CTE) is a long-term degenerative brain condition linked to repeated head impacts. CTE can currently only be definitively diagnosed after death.

Common causes of head injuries in rugby primarily arise from the high-impact nature of the sport, with tackling identified as a significant risk factor.

Rugby’s dynamic play often results in players being brought down forcefully or falling awkwardly. The impact of the head striking the playing surface can lead to concussions or more severe trauma.

Due to the speed and intensity of the game, unintended impacts between players are inevitable.

These include clashes of heads or impacts from knees and elbows, which can result in mild concussions to more severe brain injuries.

Preventative strategies and safer playing practices can reduce all these risks.

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