Concussions: Why a football match has to stop after a head injury

Since the 2014/15 season, fans supporting the top teams have been treated to a new rule in football. The game has to stop if a player got a head injury.

According to the English Football Association, procedures and guidelines surrounding the management of concussions and head injuries were based on an accord in Zurich in 2012.

Concussions are mild traumatic brain injuries caused by either a slight knock or a violent blow to the head.

What causes concussions:

It happens when a person's brain moves rapidly, twists or bounces inside the skull and experiences a back and forth type of movement, causing it to collide with the insides of the skull.

Symptoms of concussions:

- Headaches

- Vomiting, Nausea

- Sleep deprivation/disturbance

- Loss of Consciousness

- Tiredness/Drowsiness

- Memory Loss

- Confusion

- Dizziness/Lightheadedness

- Fog feeling

Following the publication of the consensus agreement in 2013 and harmonisation with the guidelines for management of head injuries and concussions, the following had to be adhered to:

Emergency Action Plan (EAP)

An EAP (Emergency Action Plan) was installed for management of injuries in every stadium and training ground. A map of the facility should be available, showing all ambulance arrival points and emergency exit points. This material should also be available to visiting teams, preferably given to a medical professional.

All local hospital phone numbers and hosting club staff contacts should be available, along with a clear communication route for summoning emergency services.

Screening

During pre-season, professional footballers are required to undergo baseline neuro-psychological testing, that forms part of the normal screening accepted during the conditioning period. It is recommended a medical professional use a web testing programme to profile players.

Tests done during this period act as a baseline in case a player gets a head injury. The impact of the injury and the recovery process can be observed by regular re-testing using the same method, which forms part of the 'return to play' advice.

What happens immediately after a head injury on the pitch?

The medical team is required to immediately enter the field to attend to the injured player upon the assent of the referee. In the event of a confirmed or assumed loss of consciousness period, the player must be taken off the pitch, and not to be allowed to play further.

Suppose there's a head injury but no loss of consciousness, a Pocket Concussion Recognition Tool (Pocket CRT) is used to carry out a touchline or on-field assessment. The decision to take the player off the field rests with the attending doctor.

Should the player be taken off the pitch in case of a suspected or established concussion, they should be observed until believed fit to leave the venue. If he/she is allowed to go home, it is advisable they do not drive themselves, and should not be alone, but with an adult bearing instructions on how to respond should the player's condition worsen. Medical attention must be sought in the event of this. The medical attendant ensures that the responsible adult has their contact details.

Suppose there is a head injury on the pitch with no medical professionals in sight, the injured player must be taken off the pitch on any suspicion of concussion. They should then be taken to a medical centre or an emergency department.

'Return to play' protocols after concussions and head injuries:

As with any other injury in sport, athletes who sustain concussions and head injuries are required to rest, before steadily returning back to action, with close supervision by a medical professional.

After a head injury, to recover fully, a player is required to go through a period of mental and physical rest (at least 24 hours recommended).

Physical exercises and training can recommence once there are no recurrent symptoms of concussion.

The procedure should incorporate the use of (SCAT 3 assessments), standardised tools used for evaluating injured athletes for concussions.

The chosen type of assessment should be done every 48 hours after the injury until the player is deemed fit to return to play. A daily basement from the clinic is also required while conforming to the following rehabilitation programme:

- If there persist concussion symptoms such as headache, fog feeling, blurred vision, uncommon emotional behaviour or sleep disturbance, the player should not be allowed to proceed to the next step.

- If the assessments show clinical and neuro-psychological improvements, as the player's load is increased, this is a clear indication they are ready for the next step.

Rehabilitation protocols physical activity:

- No activity at first

- Aerobic exercises (light)

- Exercises specific to different sports

- Non-contact training workouts

- Contact practice (maximum)

- Returns to action

Other protocols:

After a head injury or confirmed concussion, a player should not be allowed to return to the field of play for six days (often longer), and should follow the guidelines above.