Why delayed onset concussion forced Sam Whitelock out of test
As the All Blacks celebrated their 42-19 victory over Ireland in Auckland last Saturday night, many fans expected test centurion Sam Whitelock to play the second test a week later. We now know he won’t. Lock Whitelock, who had played his 133rd test to become the second most capped All Black behind Richie McCaw, has been scratched from the test in Dunedin because he self-reported delayed onset concussion.
For those who had watched the All Blacks surge to victory against the Irish, the news came as a surprise because Whitelock looked fine during the hectic 80 minutes at Eden Park.
At no stage was he required to leave the field for a head injury assessment (HIA), or require medical treatment for a prolonged period of time.
This, for all intents and purposes, appeared to be just another big shift for the 33-yearold.
Although Whitelock, like the rest of the All Blacks forwards, looked physically spent, there was no mention of concussion immediately after the match.
So what happened?
Yesterday the All Blacks announced Whitelock won’t play against Ireland at Forsyth Barr Stadium in Dunedin on Saturday, and under the new World Rugby 12-day stand down protocols it seems unlikely he will be sighted again in the three-match series.
Given Whitelock didn’t require an HIA during the match, why make the call now to withdraw him from the Dunedin test?
Because player welfare is paramount.
Even if a player didn’t cop a severe head knock during a game, it doesn’t mean he is OK.
According to information published by the Queensland Brain Institute, for a mild concussion that doesn’t involve being knocked out, symptoms may not seem obvious until days later.
So what are the symptoms?
Each individual case is different. Delayed concussion symptoms can vary. This includes headaches, blurry vision, dizziness, ringing in the ears, nausea, drowsiness and fatigue.
University of Queensland neurologist Professor Michael O’Sullivan explained on the university’s website that part of the problem is that initial symptoms of a concussion, such as memory problems, can sometimes be subtle and aren’t noticed until they become more pronounced
Why do symptoms become more severe over time?
Queensland Brain Institute’s Dr Fatima Nasrallah said there can be a few reasons for this. She said every concussion was different.
The location and force of some impacts are more likely to cause immediate loss of consciousness or vision problems, and these are hard to miss.
‘‘But it might be that the concussion or impact happened in an area that took a long time to cause further damage,’’ she said on the University of Queensland’s website.
In this case, the associated symptoms, such as headaches and ability to multitask, may take a little longer to become apparent.
So even mild concussions can cause brain injury?
Yes. Nasrallah said that even if a concussion doesn’t have any initial symptoms, it doesn’t mean the brain hasn’t been damaged. Even a mild concussion needs time to heal.
This is particularly an issue in sport. If a concussion isn’t obvious at first, continuing to play even the next day or the next week can aggravate the original injury and lead to further damage and the onset of symptoms.
As time passes, and new symptoms emerge, it’s quite difficult to tell whether these are due solely to the initial concussion or whether additional injuries have accumulated on top of it.