Unifying Pathophysiological Explanations for Sports-Related Concussion and Concussion Protocol Management: Literature Review

The balancing act - Physiotherapists' experiences of managing rugby-related concussion in the community

BACKGROUND

New Zealand Rugby (NZR) implemented a concussion management pathway (CMP) to improve management at the community level. Physiotherapists play an important role in the CMP.

OBJECTIVE

This study explored physiotherapists' experiences in the management of community rugby-related concussion as part of the CMP.

METHODS

We adopted a pragmatic, descriptive qualitative approach to explore perceptions of twenty-four physiotherapists involved in the CMP. Thematic analysis was used to analyze data.

RESULTS

Four themes represented participants' experiences: 1) 'walking the tight rope between player welfare and performance' described the balancing act between different attitudes and priorities of the various rugby stakeholders; 2) empowering physiotherapists' authority and responsibilities, described the influence of physiotherapists' authority within the team and concussion management responsibilities; 3) multi-directional communication, described the role of communication between multiple stakeholders; and 4) the influence of context, which included the complexity of concussion, concussion knowledge of the physiotherapists and team, resource support for the physiotherapist, and access to a medical doctor.

CONCLUSION

Physiotherapists had positive attitudes toward the CMP and are well-positioned to play an active role in the pathway. Priorities of other stakeholders, authority of the physiotherapist and the communication flow influences physiotherapists' ability to optimally manage players with concussion.

Head impact exposures in women's collegiate rugby

Objectives: To describe the incidence, magnitude, and distribution of head impacts and track concussions sustained in a collegiate level women's rugby season. Methods: Data on head impact incidence and magnitude were collected via Smart Impact Monitors (SIM) (Triax Technologies, Inc., Norwalk, CT) within fitted headbands during practices and games of one competitive season. Magnitude data included peak linear acceleration (PLA) and peak rotational velocity (PRV) measurements and were reported as median [IQR]. Results: Players sustained 120 head impacts ≥15 g (18.1 g - 78.9 g) with 1199 total athlete exposures. In eight games, 67 head impacts were recorded with a mean rate of 0.40 ± 0.22 hits per-player per-match, median PLA of 32.2 g, and PRV of 13.5 rad^.sec^-1. There were 53 head impacts in 47 practices with a mean rate of 0.05 ± 0.04 hits per-player per-practice, median PLA of 29.8 g and PRV of 15.7 rad^.sec^-1. Four concussions were reported and monitored. Conclusion: The incidence and magnitude of head impacts in collegiate level women's rugby over one season of practices and games were fewer than those reported in other comparable studies. These findings give insight into the impact burden that female collegiate rugby athletes withstand throughout a competitive season.

Radiographic and neurobehavioral profile of sports-related concussion associated with scholastic wrestling: a case report

Sports-related concussions (SRCs) are typically characterized by transient neurologic deficits due to physiologic and metabolic brain injury. However, following an SRC, subsequent insults may lead to severe and permanent injury in the affected brain cells. We present the case of a 15-year-old female scholastic wrestler who developed acute encephalopathy, macroscopic white matter injury on imaging, and chronic behavioral changes from inadequate neuro-recovery after a documented SRC. We also compare her case with established SRC data, demonstrating that wrestling-related concussions and repetitive head impacts can produce similar degrees of diffuse neuroinflammation, myelinated axonopathy, blood-brain barrier disruption, and post-concussive symptoms.