The rugby season is officially underway across schools in South Africa, with enthusiastic players, dedicated parents, coaching staff, and vigilant referees gearing up for a series of matches that promise both excitement and physical challenges. While the sport fosters teamwork and resilience, the inherent nature of rugby—being a contact sport—introduces a significant risk of head injuries. Symptoms can range from mild concussions to severe Traumatic Brain Injuries (TBIs), and the urgency for effective management and prevention has never been greater.
Importance of early detection
Dr Hofmeyr Viljoen, a radiologist at SCP Radiology, underscores the necessity of recognising and understanding head injuries in rugby. “Immediate recognition of these symptoms is crucial,” he explained.
Many concussion symptoms may not be immediately evident, leading players to continue in the game without realising the potential consequences of further aggression to the brain. “Appropriate diagnosis requires a blend of clinical evaluation and advanced imaging techniques,” he added, highlighting the essential role that radiology plays in ensuring athletes’ safety.
Common head injuries in rugby
Concussions stand as the most frequent head injury in rugby, characterised as a mild traumatic brain injury where the brain is jolted inside the skull following a blow or sudden movement. Symptoms can vary widely, comprising headaches, dizziness, confusion, memory issues, sensitivity to light, and difficulty concentrating. Dr Viljoen stresses, “Immediate recognitions of these symptoms are crucial. A player showing any of these signs should be removed from play immediately to prevent further injury.”
In instances of more severe injuries, there may be occurrences of skull fractures, contusions, and bleeding around the brain, all requiring urgent assessment and management.
Radiology in diagnosis
CT scans are the default imaging tool in many emergency situations. Dr Viljoen points out, “While patients with concussions may not show significant findings, those with severe concussion or exceptional symptoms must be imaged quickly.” A CT scan can swiftly identify serious conditions like fractures, brain swelling, and bleeding, which inform critical treatment paths.
Conversely, Magnetic Resonance Imaging (MRI) is applied when detailed evaluations are necessary, especially when symptoms persist or worsen. “MRI excels at spotting subtle injuries overlooked by CT scans,” explains Dr Viljoen. Notably, MRI does not employ radiation, rendering it a safer option for long-term monitoring and assessment of head injuries.
Advanced imaging techniques
The advent of innovative imaging techniques, including Diffusion Tensor Imaging (DTI), is paving the way for a better understanding and management of head injuries stemming from rugby. “DTI can identify damage to the brain's white matter, which may inform return-to-play decisions and treatment strategies,” shares Dr Viljoen.
Potential complications
One possible complication, Second Impact Syndrome (SIS), poses significant risks. SIS materialises when a player sustains a second concussion before fully recovering from an initial one. This secondary injury need not be severe; even a minor blow can lead to rapid and serious brain swelling. “Symptoms can develop quickly, turning dire—loss of consciousness, severe headaches, and respiratory failure may ensue,” warns Dr Viljoen, who underscores the importance of adherence to concussion protocols to mitigate these risks.
Chronic Traumatic Encephalopathy
Chronic Traumatic Encephalopathy (CTE), a long-term degenerative brain condition linked to repeated head impacts, remains a challenge as it can only be definitively diagnosed post-mortem. “Ongoing research strives for methods to identify CTE in living individuals, potentially through advanced imaging techniques like Positron Emission Tomography (PET),” asserts Dr Viljoen.
Causes and preventative strategies
The high-impact nature of rugby significantly heightens the risk of head injuries, with tackling seen as a major risk factor. Young players, whose tackling skills may still be developing, face heightened vulnerability. “Educating young players on safe tackling techniques and enforcing protective protocols are pivotal in reducing injury risks,” Dr Viljoen advocates. While protective gear like headguards can lessen superficial injuries, they do not prevent concussions.
Dr Viljoen also calls for strict adherence to concussion management protocols by coaches. “The culture of under-reporting incidents must change,” he states, “Players must be fully assessed and cleared by medical professionals before returning to play.”
As the rugby season unfolds, ensuring player safety is paramount. Dr Viljoen asserts, “Rugby is a fantastic sport, but prioritising player wellbeing is essential. Through awareness, timely medical intervention, and appropriate preventative measures, we can significantly decrease the severity of head injuries and allow young athletes to relish the game they love.”