As the rugby season gets underway in schools across South Africa, players, parents, coaches and referees are gearing up for thrilling, yet physically intense matches.
In many sports, injuries are an unfortunate reality—and rugby, by its very nature as a contact sport, carries a higher risk of head injuries, ranging from mild concussions to severe trauma.
The importance of early detection
Early identification of head injuries is essential for effective treatment and preventing further complications. Often, the symptoms of concussion or TBIs may not appear immediately, and athletes might continue playing—risking more serious damage.
Proper diagnosis and management of head injuries require a combination of clinical evaluation and advanced imaging techniques.
Dr Hofmeyr Viljoen, radiologist at SCP Radiology, discusses the nature of these injuries, the critical role radiology plays in diagnosis and treatment, and what preventative measures can be taken.
Understanding head injuries in rugby
Dr Viljoen explains that several types of head injuries are common in rugby. "The most frequent is concussion, a mild traumatic brain injury occurring when the brain is jolted inside the skull from an impact or violent movement.
"Concussions can be mild or lead to significant short and long-term issues. Occasionally, with more severe injuries we see skull fractures, contusions and haemorrhage surrounding the brain. These injuries require urgent diagnosis and management."
Recognising the symptoms
He highlights the importance of recognising concussion symptoms, including headaches, dizziness, nausea, confusion, memory issues, sensitivity to light and difficulty concentrating. "Immediate recognition is vital," he explains. "A player with any of these symptoms must be removed from play immediately to prevent further injury."
The role of radiology
Radiology plays a crucial role in accurately diagnosing the severity of head injuries. According to Dr Viljoen, Computed Tomography (CT) scans are the first line of imaging in emergency settings.
While concussions often don’t produce significant findings on imaging, it’s essential to scan players with severe or unusual symptoms. "CT scans rapidly detect serious issues like fractures, brain swelling and bleeding, providing crucial information for urgent treatment decisions," he explains.
Magnetic Resonance Imaging (MRI) is used when symptoms persist or worsen and more detailed evaluation is needed. "MRI excels in identifying subtle injuries, such as microbleeds and brain swelling, often missed by CT scans," says Dr Viljoen. Unlike CT scans, MRI doesn’t use radiation, making it safer for repeated use.
Advanced imaging methods
Newer imaging techniques, like Diffusion Tensor Imaging (DTI), offer promise for improving understanding and management of head injuries, particularly subtle effects of concussions. "DTI helps identify damage to the brain's white matter, potentially guiding return-to-play
Understanding possible complications – Second Impact Syndrome (SIS)
Second Impact Syndrome (SIS) is rare but extremely serious. It occurs when a person sustains a second concussion before fully recovering from an initial one. This second injury doesn’t need to be severe—it can be minor—but it can lead to rapid and severe brain swelling (cerebral oedema).
After the initial concussion, the brain’s ability to regulate blood flow and pressure is compromised, making it highly vulnerable. Symptoms can escalate quickly, often within minutes: unconsciousness, severe headaches, dilated pupils, respiratory failure, and even death. Young athletes are especially at risk.
Due to its swift progression and severity, SIS is considered a medical emergency requiring immediate treatment.
Preventing SIS relies on strict adherence to concussion protocols, ensuring full recovery before returning to play, and monitoring symptoms carefully.
Addressing Chronic Traumatic Encephalopathy (CTE)
Dr Viljoen explains that CTE is a long-term degenerative brain condition linked to repeated head impacts. "CTE is challenging because currently, it can only be definitively diagnosed after death. However, ongoing research aims to develop methods to detect CTE in living patients, potentially using advanced imaging techniques like Positron Emission Tomography (PET)."
Current research is focused on non-invasive ways to assess the living brain and track changes over time.
Common causes of head injuries in rugby
Head injuries in rugby usually stem from the sport’s high-impact nature. Tackling is a major contributor, especially when performed incorrectly or at a dangerous height. Young players are particularly at risk due to undeveloped tackling techniques. Teaching safe methods from an early age is key to reducing injuries.
The game’s dynamic nature often results in players being brought down forcefully or landing awkwardly. Even with protective gear, the impact of the head hitting the ground can cause concussions or more serious trauma.
Unintentional collisions are also common—clashes of heads, or contact with knees and elbows, can lead to anything from mild concussions to serious brain injuries. Safer playing practices and preventative strategies can help reduce these risks.
Prevention remains critical
Dr Viljoen stresses the importance of training: "Educating young players on safe tackling techniques and enforcing protective protocols significantly reduces injury risks. Protective gear like headguards can minimise superficial injuries, though it does not prevent concussions."
He also underscores the need for proper concussion management. "Coaches at schools and clubs must rigorously apply concussion management strategies, ensuring players are adequately assessed and cleared by medical professionals before returning to the field."
Under-reporting of head injuries is common in school rugby, often because players either want to stay in the game or don’t recognise the signs of concussion.
Dr Viljoen concludes: "Rugby is a fantastic sport for building teamwork and resilience but player safety must always come first. Through awareness, timely medical intervention and proper preventative strategies, we can significantly reduce the risk and severity of head injuries, allowing young athletes to safely enjoy the game they love."
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