I'm a professor in sports medicine - this is why we need to take concussion seriously in sport in the aftermath of Princess Anne and Barnabas Varga's injuries

Both Princess Anne and Hungarian footballer Barnabas Varga are currently in hospital following a significant head injuries which resulted in concussion.

Varga’s trauma, which also caused multiple facial fractures, was seen by millions across Europe. Princess Anne’s injury, likewise, sporting related, was from a kick from a horse. These two high-profile events are examples of what happens every week throughout the UK during and training for sport.

Everyone is hoping that they will recover completely without long-term consequences but that is not always the case. This article explores what can help to reduce the potential long-term risks of concussion particularly if head trauma is repeated regularly.

As an NHS doctor and a professor of sports medicine, I am continually looking at ways to make sport safer without making it less competitive, thrilling or entertaining. Head trauma leading to concussion is one of the more common injuries in many popular sports from boxing, rugby, hockey and cricket. Footballers not only risk knocking other players’ heads but also having the regular minor trauma from heading the ball.

Although less dramatic, repeated heading has been linked to earlier onset dementia among professional football players.

One notable study from the Karolinska Institute in Sweden, published in the Lancet, compared 6,000 elite footballers and more than 56,000 non-footballers and found that footballers were 50 per cent more likely to develop dementia than the rest of the population. As a consequence of this research and others, the Football Association (FA) has announced recently it will be banning headers in under-11s teams. More awareness of the risks and lighter balls are also helping adults.

When I was young, playing rugby matches in the South Wales valleys, which always seemed to be in horizontal sleet rain on the side of a slag heap, being “knocked out” was seen to be just part of the game. A sponge of water to back of the neck and a slap on backside and you’d be on the field again to face rampaging miners’ sons who always seemed to have beards even at 12 years old. People thought this was character building, but receiving another head trauma without adequately recovering from concussion is one of the most surefire ways to cause permanent loss of brain function and cognitive ability.

Although I went on to play rugby to 50 and encourage my three sons to play, it is only within the very sensible guideline of sporting associations which are now routinely imposed. All references and coaches of all age groups to force players to immediately leave the field of play if a concussion is suspected.

What’s more, sporting associations are stating that suspected concussion victims should not return to playing in games until they have recovered for at least 21 days.

What is Concussion

This is the name given a type of traumatic brain injury caused by a blow to the head, a fall, or any incident that shakes the brain inside the skull. A person may be knocked out completely, as we distressingly saw with Varga, or just be dazed for a little while. Either way the 10 most common immediate post-trauma symptoms to look out for, include:

1. Headache or a feeling of pressure in the head
2. Temporary loss of consciousness
3. Confusion or feeling dazed
4. Amnesia surrounding the traumatic event
5. Dizziness or “seeing stars”
6. Ringing in the ears
7. Nausea or vomiting
8. Fatigue
9. Slurred speech
10. Delayed response to questions

Over the next few days following a head trauma, it’s not uncommon to experience difficulty concentrating, memory problems, feeling mentally “foggy”, irritable, sadness and nervousness. In more serious cases, people can experience, sensitivity to light and noise, balance problems and sleep disturbances. Rarely a head trauma can lead to an intracranial bleed which can cause severe headaches, especially with lying flat. If this happens, particularly if associated with nausea, dizziness and confusion, immediate medical attention must be sought as neurosurgical interventions may be required in order to prevent permanent brain damage

Up to 3 months after the trauma there can be an increased risk of mental health issues such as depression, anxiety or other mood disorders. In the longer term, lack of intellect and cognitive decline can occur, typically leading to memory problems, difficulty with problem solving and reasoning and ultimately dementia or Alzheimer’s disease.

The immediate management of concussion is to remove the player from the pitch to avoid further trauma. Physical and mental rest is crucial immediately after a concussion. If the blow was thought to be significant or symptoms such as nausea and dizziness persist, it is important to seek medical attention to assess the severity of the concussion and receive appropriate guidance.

It’s essential not to return to physically activity which could result in another head injury before 21 days or even longer in initial symptoms lasted more than one week. When returning to exercise it should be controlled, structured and gradual, paying attention to the return of any neurological symptoms.

In the long term, however, exercise should not be avoided as this is one of the most important habits which can maintain brain health as well as reducing the risk of many chronic disease such as high blood pressure, raised cholesterol , heart attacks and even cancer.

Finally, with the rising incidence of dementia, whether you have injuries or not, all of us should consider more lifestyle and dietary manoeuvres which help maintain brain health. As well as regular exercise, these include improving gut health, getting a regular night’s sleep, reducing alcohol intake, quitting smoking, eating more phytochemical rich fruit, herbs, vegetable and spices, avoiding processed sugar, ensuring adequate vitamin D levels, omega 3 fats and essential minerals.