Concussed stars need medical clearance before playing again. TERRY MADDAFORD reports.
Tama Umaga should be counting rather than seeing his lucky stars thanks to the checks and balances system now adopted by the main sporting codes.
Hurricanes centre Umaga was concussed by a clash of heads with Waratahs fullback Matt Burke in the first minute of last week's Super 12 game in New Plymouth.
The Hurricanes initially hoped Umaga would return for last night's game against the Chiefs.
Medical opinion - with the full backing of coach Graham Mourie and team management - scuttled those hopes.
Thankfully, it is now virtually impossible for a concussed sportsman or woman, especially at the higher level, to return to action without a full medical clearance.
Such clearances follow a simple rather than complicated test.
The fear by some medics, however, is that while those at the highest level come under almost instant scrutiny, players away from the spotlight - that is, in lower grades - might not get the same attention and treatment.
Before, say, a Super 12 or NPC rugby season, or before the New Zealand Warriors kick a ball in the NRL, players undergo a psychometric evaluation or digit symbol substitution test.
This, in its varied forms, measures cognitive function or skills - the brain's ability to react.
A simple test may ask a player to quickly reel off the months of the year in reverse order or, in the digit symbol test, to relate numbers between 1-12 and co-relate them with symbols such as circles, squares, dollar signs, triangles and so on.
These tests, often done among team-mates to create a competitive edge and thus eliminate any thought of deliberately producing a "poor result," are timed.
This evaluation is recorded and becomes the benchmark for any subsequent test when a player is recovering from a knockout blow or concussion.
"It is simple but effective," Auckland NPC doctor Graham Paterson said yesterday.
"Having this pre-injury data makes life simple. We can put the concussed player through the same test and quickly ascertain whether there remains some [brain] damage.
"But someone like me or other team doctors, who can spend up to 16 hours a day, six or seven days a week with the players, can usually tell whether or not a player is fully recovered.
"It is easier for me to draw on that knowledge and understand how fit a player is than if someone walked in off the street."
Paterson said he would want five key questions answered before agreeing to a player returning to action.
He would want to know: (a) are you tired and your energy levels low? (b) do you have headaches? (c) how is your concentration level? (d) have your had any dizziness? and (e) any blurred vision?
Three affirmative answers would leave a player on the sideline - told to try again next week. A pass mark would see the testing procedure continue.
"If I'm in any doubt, I would call for formal psychometric testing by professional people who are very skilful in conducting these tests," said Paterson.
"Even then, I would want to see a player doing non-contact training like grids and drills before allowing them to step up to full-on training."
Andrew Beattie, managing director of Ranworth Healthcare which works mainly with serious brain injury but retains a close association with the Warriors, said the problem was often not with the first but subsequent concussions.
"Not too long ago a rugby player was concussed but played again the following week, and was concussed again," said Beattie.
"When I saw him later he was in a wheelchair, his career over."
Sportsmen who have succumbed to multiple concussions include All Black Jock Hobbs and gridiron star quarterbacks Steve Young and Troy Aikman.
Others, such as league players Matthew Ridge and Ken Stirling, also suffered.
Young, 15 years in the NFL and a regular for the San Francisco 49ers from 1987 to 1998, was eventually forced to retire because of ongoing concussion.
His plight forced changes in the rules as NFL administrators sought to provide more protection for the quarter-back.
The severity of concussion - or brain damage - can depend on the speed the brain is travelling at the time of impact.
The 320 km/h-plus crash which killed Nascar ace Dale Earnhardt would clearly have done far more damage than the clash of heads at maybe 40 km/h between Umaga and Burke.
Beattie uses a pear-in-a-jar analogy to explain.
"If you shake the pear in the bottle and then sit it down, the jar stops but the fluid and the pear don't.
"In human terms, the skull is the jar, the cerebro spinal fluid is the water and the pear the brain. When heads clash the skull stops but the brain keeps thumping against it. This causes the brain to bruise [bleed]."
Concussion, often accompanied by short-term memory loss, as Umaga experienced this week, is not the domain of sporting types alone.
Beattie tells of someone falling while working in a kitchen. He hit his head, which started internal bleeding. Without diagnosis or treatment the bleeding continued. He died within hours.
While rugby, rugby league and American football are at the top of the list of sports in which concussion can be an issue, others, too, have taken steps to ensure the fitness of their players.
The New Zealand Hockey Federation have a "head policy" which insists that players whacked on the head - often by a ball - must be checked at the ground before being allowed to return.
They have also made the wearing of mouthguards mandatory at all levels.
"With our rolling subs rule, there is no need for a player to return unless fully fit," said federation chief executive Ramesh Patel.
"Any player suspected to have suffered concussion must produce a medical certificate before being allowed to play again."
New Zealand Soccer follows the standard New Zealand Federation of Sports Medicine decree which provides for a three-week stand-down often followed by a neurological assessment.
Amateur boxers face a compulsory 28-day stand-down - including sparring - after being stopped. A second knockout in the first bout back is followed by a mandatory three months away from the ring.
"Our system in which all bouts and the results are recorded in the boxer's medical book is fairly foolproof now," said Boxing Association chairman Keith Walker.
"In a case like the Tama Umaga incident, our sport would insist on a compulsory stand-down."
While no system will ever be perfect, medical opinion now says sufficient checks are in place and hopes enough qualified experts can guarantee the safety and health of our sporting people - from the youngest to the oldest, novice or international.
Codes have system to protect players
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