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Is the enjoyment of school sport worth the risk of concussion?

School sport and physical activity have always played a central part of my life. But activity has also caused four episodes of concussion: two sustained from school sport matches and training; two non-sporting episodes - one playfighting with siblings and the other from falling down a cliff whilst on holiday. So, with such high risks present, how should the huge enjoyment from school sports be balanced against these great risks?

 

Canford School’s definition of concussion is “Sports Concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces” (3rd International Conference on Concussion in Sport, Zurich 2008).  This means damage to the brain caused by contact to the head, body or neck. Symptoms are listed in Appendix 1.   The real danger comes from both secondary or repeated concussions which can cause serious life-long effects.  In a Year 10 rugby match I was concussed while carrying the ball and being tackled.  I completed the SCAT5 test (ref 6) and experienced symptoms confusion, headache, balance problems, difficulty concentrating and remembering which continued for a few days.  These restricted my ability to attend school, to properly function intellectually and to play sport.  Although these symptoms affected me severely, they were short term but much larger risks appear to come later in life according to a study in Sweden, which found that Traumatic Brain Injury “ consistently predicted later risk of premature mortality, psychiatric inpatient admission, psychiatric outpatient visits, disability pension, welfare recipiency, and low educational attainment in the sibling-comparison analyses, and the effects were stronger for those with greater injury severity, recurrence, and older age at first injury.”(ref 1)  This shows that head injuries to children, adolescents and young adults must be taken seriously and carry very large risks. 

 

The adrenalin kick of a competitive rugby or hockey match where I was able to let off steam in a controlled manner, or the elation after perfecting a new routine in trampolining have always been highlights of my week. In particular, school sport brings the benefits of both discipline and competitivity in a fun, safe environment where students can bond as a team and recharge after an intensive day of study.  Sport in school seems to be a manageable way to give students this outdoor opportunity which, I believe, cannot be replicated in non-sporting activities. Teenagers are known for their innate risk seeking behaviour particularly among peers and “No Life can (or should) be made entirely safe” from Nicola Morgan (ref 2). So by providing sport as a controlled outlet for this behaviour schools can actually help prevent teenagers doing much worse activities and learn measure and react better to risk situations.  Sport for England research shows that playing sport also increased numeracy rates by 8% on average; reduced risk of illness such as cardiovascular disease and some cancers; and sport, through its natural highs, can lead to an increase in self-esteem (ref 3).  There is undeniable evidence that sport brings enormous benefits.

 

A key element to risk of concussions is whether the sport being played is a contact or non-contact sport, and the amount of contact involved.  I have used Canford School’s Health Centre records for the years 2018 and 2019 as a case study (Appendix II) and personally interpreted the results.  Although not a thorough investigation, rugby accounts for the most concussions by far (31 of the 50 sporting concussions in two years).  Lacrosse (5 of 50 occurrences) and hockey (8 of 50 occurrences) also appear to produce head injuries due, perhaps, to the risk of the ball and stick elements involved but it remains rugby, as the only contact sport, which stands out. It’s noticeable that concussions in rugby steadily decrease as students become both more experienced and rise through the school.

 

Shells

4ths

5ths

L6th

U6th

12

7

5

4

3

In the two years sampled:

 

 

This suggests that that fitter students in the higher-level teams who, through expert coaching, learn how to remain safe and have built more neck strength are at reduced risk of concussion while playing the game. Although a similar number of concussions to rugby came from non-sporting activities (32 of 82 total concussions), the nature of these is not recorded, so no reliable conclusions can be drawn.  Like my own non-sporting concussions, accidents are often unavoidable in this age group. 

 

Can this clear risk of concussion be reduced to allow the enjoyment to outweigh the risk?  Well-informed and well-trained coaches as well as referees can help to identify concussions when they occur and therefore remove students from play and refer them to medical assistance without which, secondary or repeated concussions can occur.  Coaches can also educate their students about the risks and techniques to play in a safe way, and why they must flag up any symptoms they experience, despite temptation to continue to play.  Students who are more physically fit, particularly with neck strength, appear to be less susceptible to head injuries so coaches can encourage this through strength and conditioning sessions and training programmes such as the Bath University Warm Up, which is in place at Canford, to physically protect students. A final key protection comes from correctly following protocols such as RFU Headcase General Guidance for Concussions which helps to prevent both risk of concussion and any early return to play. Other protocols can be used to identify concussions and their severity, such as the SCAT5 test used by Canford Health Centre.  I believe these factors can both reduce risk of concussion without affecting a student’s enjoyment and ensure that any student that does experience a concussion is dealt with in a way that reduces the chance of long-term damage.

 

Risk is always present in life whether it be on the rugby pitch or climbing a cliff, but I personally feel that if all measures are taken to reduce risk that the enjoyable competition and adrenalin rush of sport is worth the risk that remains. But the protection of players must be the priority. Therefore I believe any student who does not wish to engage in high risk head injury sports must be allowed not to do so and even players who still wish to continue to play but play in an unsafe manner or have had many prior concussions should not be allowed to continue their sports.

 

References

 

  1. Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes

    Amir Sariaslan, David J. Sharp, Brian M. D’Onofrio, Henrik Larsson, Seena Fazel

    Published: 23 August 2016

  2. Teenage brains and risks

    Nicola Morgan

    Published: 15 December 2017

  3. What are the benefits of sport to individuals, society and the economy?

    https://www.sportengland.org/research/benefits-of-sport/

  4. RFU Headcase – Return to play after concussion

  5. RFU Headcase – Players and Parents General information

  6. BJSM SCAT5 Sport Concussion Assessment tool

  7. Canford Head Injury Policy

    https://gateway.canford.com/Resources/Policies%20%5BF3dy%5D/Policies%20(NEW)%20%5BFew9%5D/Medical%20-%20Master%20List%20%5BFfj3%5D/HeadInjuryPolicy.pdf

  8. Do concussions have long term side effects? Article

    https://www.piedmont.org/living-better/do-concussions-have-long-term-side-effects

  9. Effects of concussions Article, Elizabeth Quin, 3 October 2019

    https://www.verywellhealth.com/serious-effects-of-mild-concussions-3119218

  10. Sport Collision Injury Collective

    https://www.sportcic.com/

  11. Allyson Pollock Tackling rugby

    https://www.allysonpollock.com/?page_id=1964

  12. Guardian UK Health experts call for ban on tackling in school rugby, 2 March 2016

    https://www.theguardian.com/education/2016/mar/02/uk-health-experts-call-for-ban-on-tackling-in-school-rugby

  13. Return to play following a Concussion

    https://www.gpnotebook.co.uk/simplepage.cfm?ID=x20150308193826256537

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