by Tom Billups, C.S.C.S.

Over the last several years, identifying concussions and determining when it is safe to return to play have been white-hot topics in contact sports. Although the media attention surrounding concussions has helped to increase awareness of them, it is more important to have protocols in place to accurately identify a concussion. Medical professionals and sport governing bodies have established numerous procedures on how to best look after players when a concussion is suspected. Shortly, rugby’s international governing body, the International Rugby Board (IRB), will release a new set of concussion guidelines. In this offering, let’s discuss what a concussion is and how to assess whether a player has incurred one. In early March, I will follow up further on this topic by offering examples from Cal’s concussion management program. I believe all rugby programs should work toward implementing some variation of a concussion management program for their team.

What is a concussion? A concussion is a mild brain injury that is caused by the impact of an “impulsive” force transmitted to the head. The injury can be the result of hitting the head against a hard surface or colliding with a player or piece of equipment. All possible concussions should be treated seriously as the symptoms often vary dramatically. Because an athlete does not have to lose consciousness to have a concussion, referencing a list of signs and symptoms can prove very helpful. Personal experience is not enough to work off of in assessing a player’s condition. Coaches must be careful to not be deceived by a player who tries to bluff their way through a few questions in order to stay in a match. To assist coaches in the process of identifying a concussion, I offer the University of Pittsburgh’s “Concussion Signs and Symptoms Evaluation.”

Signs observed by staff

• Appears to be dazed or stunned
• Is confused about assignment
• Forgets plays
• Is unsure of match, score, or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness (even temporarily)
• Shows behavior or personality changes
• Forgets event prior to hit (retrograde)
• Forgets events after hit (anterograde)

Symptoms reported by athlete

Headache
Nausea
Balance problems/dizziness
Double or fuzzy vision
Sensitivity to light or noise
Feeling sluggish or foggy

Additionally, the sports medicine department at the University of Pittsburgh offers a brief battery of cognitive testing protocols that a coach or staff person can administer when assessing a concussion. There are five separate categories of tests:

Orientation – ask the player the following questions. Where are we playing today? What city are we in? Who are we playing? What month is it? What day is it?

Anterograde amnesia – ask the player to repeat the following words: girl, dog, green.

Retrograde amnesia – what happened in the prior half of the match? What do you remember just prior to the hit? What was the score of the match prior to the hit? Do you remember the hit?

Concentration – Ask the player to repeat the days of the week backwards (starting with today). Repeat these numbers backwards: 63 (36 is correct), 419 (914 is correct).

Word list memory – Ask the player to repeat the three words from earlier (Girl, dog, green).

Any failure is considered abnormal and sports medicine professionals should be consulted prior to further participation.

Increased awareness and education of what is a concussion (and what isn’t) will make our game safer to play. As coaches, we have a dual responsibility in this regard.

We must ensure baseline testing is completed prior to participation (to be discussed in my next piece) while having assessment protocols in place when a concussion is suspected. Additionally, I humbly suggest that it is our obligation to teach safe and effective technique that will minimize a player’s exposure to a concussion.

Tom Billups began his rugby career in 1984 and has spent time as a player in New Zealand (Bay of Plenty), the U.S. (The Old Blues), England (London Harlequins), and Wales (Pontypridd) for domestic teams as well as representing the U.S.A. at international tournaments with the Eagles. After hanging up his boots, Billups got into coaching leading the Eagles and now with University of California – Berkeley. Read the entire bio of Tom Billups as well as Billups first column My Rugby Path and then check out what Billups is saying about the game of rugby in The Billups Column on Rugby Rugby.