There are 3 aspects to this debate that particularly interested me (although I'm so any of these issues are being discussed in a knowledgeable forum)
1. The research that was quoted in the program stated that even in the absence of a concussive event neuropathologies were being seen as a result of repeated "low level" collisions. In other words, a player didn't necessarily need to be concussed (as we understand the symptoms) to develop neurological impairment.
2. The clinical diagnosis of concussion is actually incredibly complex, and many of the mechanisms are poorly understood (primarily because detailed study of the brain tissue itself is only possible post-mortem. We can look at MRIs and CTs etc, but actual tissue examination isn't possible, but I digress). Diagnosis of the severity of a concussion isn't something a GP has any specialist training or experience in, so people who present at their usual doctor are usually diagnosed on the mechanics of the incident rather than the residual effects (if any) of the incident. To make matters worse, research is now saying that on-the-field amnesia, not loss of consciousness, is a better predictor of after-injury symptom severity and possible residual damage. In other words, the player who gets a knock early that doesn't "look" concussed but who avoids the trainer & coaches that game because they can't remember the game and don't want to come off if they are found out, can actually be a bigger problem than a knocked-out player! Loss of consciousness (LOC) is actually only seen in 10% of all concussion cases.
There are some Sports GPs & other doctors trained to use the imPACT (a "computerized neurocognitive assessment tool"), or other similar tool in conjunction with a detailed physical examination to assist in determining a player's ability to return to training. This is basically a computer program that can monitor actualcognitive recovery from a concussion rather than a standard 3 weeks. The player progresses through a series of steps to first resume non-contact training, then contact training, and finally return to play. Because every player is different, standard guidelines of 3 weeks out may be more than enough for some (who only need a week or 2 weeks) and not enough for others (as seems to be the case with Barnes' last one)
3. When the ARU had a head injury policy that stipulated that a concussive event required a mandatory 3 weeks out of the game I know of many instances where the player who had a head knock was taken from the field limping: because they left the field with an ankle/knee injury they didn't have to report the concussion and therefore didn't have to miss any games. Or even though it was clear to all and sundry they couldn't walk in a straight line, it would come out in the post-match press conference that Player A twinged his hammy or something - complete crap, but it meant he would be available the next week. Remember, Elton Flatley was playing in the time of the mandatory 3 weeks out after a concussion. As a trainer, I would prefer we didn't go back to having players feel like they need to cover up their injuries or hide from trainers - it's our job (and the referees) to do what we can to make the game safer, and when players fear missing 3 week's play (which is a long time, especially in short schoolboy seasons) I fear that is exactly what would happen.
Combine that with the pressure (silent or otherwise) that would be exerted on a trainer (or other decision-maker) to not say someone was concussed in the last round game of the season where missing 3 weeks means missing all finals and the GF.
My ideal?
Every player find a doctor who has further training in the head-injury field, and use their expertise to determine a protocol for return-to-play. It is so individual and the consequences for getting it wrong are potentially catastrophic! I don't want to this post to talk about what to do with a player who copped a head-knock (message me if you want more info). Rather I wanted to put the 4 corners program in a rugby union context.
Thanks for reading such a long post!
