New Season No New Laws!! No new Laws old law variations in Law now - - PowerPoint PPT Presentation

New Season – No New Laws!!

• No new Laws – old law variations in Law now
• Last years scrum engagement remains in place
• What questions do you have from last year?
• Download new lawbook from IRB website
• http://www.irblaws.com/

IRB Laws Exam

Personal Development

• IRB Rugby Passport
• http://www.irbpassport.com/
• Huge amount of information to support your

understanding, refereeing or coaching.

• Plenty of stuff to interact and learn

IRB Passport

Game Management System

• Rugby First is no longer!!
• New ‘England Rugby’ website
• www.englandrugby.com
• Easier and simpler to use and log-in to.
• Keep your own details up to date

Up to date information

• Will help Society to have an accurate list of

members

• Will help RFU to have accurate data and a real

time view of the game

• Applies across the board to anyone involved in

Rugby.

Concussion – the landscape has changed

Zachary Lysadt Law

RFU Concussion Risk Management Strategy – Summary

Education Prevention Management Research Communication

Evidence based, independently reviewed, and effectiveness evaluated Across communities of practice (Priority = coaches)

Concussion

• Part of the RFU “Don’t be a headcase” concussion awareness and education

programme - Launched Jan 2013

• Superseded previous campaign – “Use your head” launched in 2007.

For more information visit - www.englandrugby.com/headcase. For resources email – health@rfu.com Follow - @EnglandRugbyCoach

Welcome

RFU Survey 2009/10 of 16 – 18 year olds

• Regarding personal concussion history:

–66.2% of this group did not leave the field after a concussion; –37.9% did not report their concussion. –Only 9.8% of concussed players waited the stipulated 3 weeks before returning to play.

• Coaches = key source of information

What is concussion?

• The brain is injured as a result of a blow to the head or body
• It is a traumatic brain injury
• ? Functional disturbance – routine brain scans are normal
• Usually mild with complete recovery
• Loss of consciousness in only 10 - 15% of cases
• Variable threshold
• Recognition can be difficult
• Symptoms may be delayed up to 72 hours
• Repetitive concussions, particularly before full recovery can

have potential for serious and/or long term consequences

What have we started to understand?

• Concussion takes longer to resolve than previously thought
• The brain is more vulnerable to further injury immediately

after and during recovery from a concussion:

– Risk of further concussion – likely to be more severe and prolonged – Other injury - slowed reactions and poor coordination – Further brain injury – very rare but fatal brain injury in young players (second impact syndrome)

• Repetitive concussions:

– Increase the risk of prolonged concussion symptoms – May cause early onset cognitive and memory impairment in latter life – Potential association with degenerative brain disease in latter life.

Where do head injuries occur?

• Road traffic collisions e.g. cars, cyclists
• Falls e.g. playground
• Assaults e.g. Saturday nights out!
• Sport and recreational activities

Concussion Rates

Sport Concussion rate per 1000 player hours

Horse racing (Amateur) 95 Horse racing (Jumps) 25 Horse racing (Flat) 17 Boxing (professional) 13 Australian football (professional) 4 - 20 Rugby union (professional) 7 – 11 Ice Hockey (NHL) 1.5??? Rugby Union (Youth) 1 – 2 Rugby union (amateur adult) 1 – 1.5 Soccer football (FIFA) 0.4 NFL football (NFL) 0.2???

Source – 4th Int Concussion Conference Presentation – Dr M Turner + subsequent publications

Prevention

ALL have a part to play

BUT – Coaches & Referees have a key role because:

• Primary source for concussion information for players
• Set culture within the team/squad/club
• Develop players:

– Techniques – Influence behaviours – Provide information/education

• Select who plays and plan training sessions
• Often first or only adult on scene
• Manage replacements

Prevention

• Reduction in head trauma is key:

– Tackle technique – Player behaviour in contact – Zero tolerance of foul play:

• Collision “tackles”
• High tackle
• Tip/spear tackle
• Taking out player in the air
• Targeting head in contact and punching

– Playing/training ground conditions

Injuries Injuries by Ev by Event ent - Youth

• uth

On field Management

TAKE CONCUSSION SERIOUSLY

RECOGNISE – know the symptoms and signs of concussion. Remember you do not need

to be knocked out to have a concussion.

REMOVE – any player with suspected concussion, right away. Continuing to play increases

their risk of more severe injury, and longer lasting concussion symptoms, as well as increasing their risk of other injury.

RECOVER – take time to fully recover as you would with any other injury. RETURN – all players must follow a step-wise Graduated Return to Play (GRTP) and must

not go back to rugby/sport until they have been cleared to do so by a doctor For more information visit - www.englandrugby.com/headcase.

RECOGNISE

• Obvious:

– Actual or suspected Loss of consciousness – Convulsion or posturing – Loss of coordination/balance – Vomiting – Confusion – Memory loss – Clearly dazed

3.9 THE REFEREE’S POWER TO STOP AN INJURED PLAYER FROM CONTINUING If the referee decides – with or without the advice of a doctor or other medically qualified person – that a player is so injured that the player should stop playing, the referee may order that player to leave the playing

• area. The referee may also order an injured player to

leave the field in order to be medically examined.

RECOGNISE

• Less obvious:

– Nausea – Drowsy – Irritable – Emotional – Fatigue/low energy – Anxious/nervous – Poor memory – Neck pain – Headache/pressure in head – Dizziness – Blurred vision – Sensitive to light/noise – Difficulty concentrating – Feeling in a fog – “Don’t feel right”

RECOGNISE

REMOVE

1. First Aid principles 2. Head injury + reduced conscious level +/- neck pain = treat as NECK INJURY and DO NOT move. 3. Concussion/suspected concussion = REMOVE 4. NO RETURN 5. If in doubt sit them out 6. Player to be assessed by healthcare professional

Danger Signs

• Danger Signs = dial 999

– Deteriorating conscious level – Increasing confusion or irritability – Severe or increasing headache – Repeated vomiting – Unusual behaviour – Seizure/convulsion – Double vision of deafness – Weakness/tingling/burning in limbs

What to do next – CHILDREN?

• Injury event but no suspected concussion or other injury:

– Assess and observe – BUT “if in doubt sit them out”

• Suspected concussion but no LOC, no seizure, no significant memory

loss, no danger signs:

– REMOVE – Notify parents/carer and provide HI instructions – Player to be assessed by a doctor (school nurse if not possible) that day

• Any LOC, seizure, significant memory loss, danger signs, or concerned:

– REMOVE (if safe to do so, if not, do not move and wait for ambulance) – Dial 999 for ambulance service – Notify parents/carer

RECOVER & RETURN - RTP Guidelines

U19 and below

2 weeks rest + symptom free

Earliest RTP = 19 days Earliest RTP = 23 days GRTP 24 hrs per stage GRTP 48 hrs per activity stage Adult

2 weeks rest + symptom free Clearance by HCP Recommended Clearance by Doctor Clearance by Doctor Clearance by Doctor Recommended Return to Academic Studies

RECOVER & RETURN

• RECOVER:

– Rest:

• Initially avoid TV, computers, reading, load noises/flashing lights
• From exercise e.g. PE, sport training sessions (no different from

ankle sprain!)

• May require a few days off school/work - usually only one or two

if symptoms e.g. headache, dizziness, fatigue.

• RETURN:

– To academic activities before return to sport – Graduated Return to Play – Medical clearance to return to play

Graduated Return To Play

Stage Rehabilitation Stage Exercise Allowed Objective

1 Rest Complete physical and cognitive rest without symptoms Recovery 2 Light aerobic exercise Walking, swimming or stationary cycling keeping intensity, <70% maximum predicted heart rate. No resistance training. Increase heart rate and assess recovery 3 Sport-specific exercise Running drills. No head impact activities. Add movement and assess recovery 4 Non-contact training drills Progression to more complex training drills, e.g. passing

• drills. May start progressive resistance training.

Add exercise + coordination, and cognitive load. Assess recovery 5 Full Contact Practice Normal training activities Restore confidence and assess functional skills by coaching

• staff. Assess recovery

6 Return to Play Player rehabilitated Safe return to play once fully recovered.

Note:

• Must be symptom free after each stage before progression
• Students must return to academic work symptom free before return to play

Repeated Concussion Guidance

Second concussion in a 12 month period Must be assessed by GP (referral to concussion specialist) If cleared - Conservative RTP Technique/Behaviour Modification

Headcase Website

"Having reviewed the RFU's HEADCASE resource as an independent expert, I think that it is an excellent source of information for those involved with rugby. It is an accurate, thorough and appropriate source of information, based on the most up to date medical consensus. The RFU should be applauded for making this available in such an accessible format.“ - Dr Richard Greenwood,

Centre for Neurological Diseases, Queens Square Hospital, University College London.

http://www.irbplayerwelfare.com/concussion

Match Officials

Questions?

• Prevent head trauma
• 4 Rs = Recognise – Remove –Recover – Return
• Majority recover without problems BUT follow the

guidelines for management and RTP to protect your players and yourself

EXPERTS AGREE BENEFITS OF RUGBY OUTWEIGH RISKS

Summary