Written by Gwen Rizzo and published in April 2023 edition of POLO Magazine.
POLO Magazine recently spoke with Thorkild “Thor” Norregaard about head injuries and how to know if someone has a concussion. Norregaard is a neurosurgeon and neuroscientist. He is also a polo player and former chairman of the USPA Safety Committee and continues to be a member of the committee.
What is a concussion?
The mechanism is fundamentally any abrupt movement of the head that comes to an abrupt standstill. The brain is suspended in spinal fluid inside the skull. When there is a strong force going in one direction and then is abruptly stopped, the brain will hit the inner wall of the skull and ricochet back.
Are most concussions caused by fall or can other injuries cause a concussion?
Movements such as whiplash injury in a motor vehicle accident or blast injuries to those in the military can cause a concussion. So, in polo, imagine in a ride off that one player’s helmet hits the other player’s helmet, that can result in a concussion, and certainly, if you are hit with a ball or a mallet, it can cause a concussion.
Does a player have to be unconscious to have a concussion?
That is very important to emphasize. You do not need to lose consciousness in order to suffer a concussion.
In the case of any injury, should it looked at as a concussion risk?
It is fair to say it should be considered as a concussion risk until proven otherwise.
What are the symptoms to look out for?
After a head injury, if a person feels dizzy, nauseated, has a headache or is more easily fatigued, they should be examined by a doctor and preferably a neurologist. They may also have some emotional symptoms, such as having a shorter fuse or being more tearful, or issues with concentration or memory.
Can someone initially think they are fine?
Someone may not know they have a concussion like they would a broken bone. They might think they are fine and then all of a sudden, a couple of days later, they realize they are headachy or whatever the symptoms might be. In polo, it is a natural reaction to fall, then immediately get up and say, “I’m fine.” The person might be embarrassed they fell off the horse, but they may not necessarily be fine.
What can an umpire, another player or bystander do to determine if the player is truly fine or may need to be examined further?
Whomever is around can do a quick exam asking things like, do you know where you are; do you know what day it is; or do you know what game are you playing here? If they are unable to answer these questions or are confused, then they likely have a concussion and should not continue playing.
Is there anything else that should be considered?
You would have to consider if significant mechanical forces were involved. For instance, if the horse trips and the player falls and there is clear evidence of grass or sand on the player’s helmet, there is some level of head injury.
If a person is knocked unconscious, is a concussion a given?
Yes, if someone is knocked out for any length of time, they may have a concussion and should be taken out of play. USPA rules prevent any player that is knocked unconscious from returning to play that day.
What are the dangers of ignoring a concussion?
There is always the concern that there can be a cumulative effect. If you have a concussion, become dizzy and are still mounted on a horse and possibly still playing polo, then the risk of having a second injury is higher than if you don’t have dizziness.
Even without getting a second concussion, if you ignore a concussion, symptoms can linger longer and recovery can be longer. There is also something called second impact syndrome. If someone has a clear-cut concussion, and then within two to three weeks they have a second concussion, that can be significantly more dangerous. There was a female athlete in New Hampshire that actually died of the swelling that occurred in her brain after a second impact.
In all professional sports and certainly interscholastic and collegiate sports, if an athlete has a diagnosed concussion, they are required to be cleared by a neurologist or neurosurgeon before returning to play. The American Academy of Neurology has fairly clear-cut guidelines for concussion diagnosis and clearing people from a concussion. It is something you should take seriously.
Can a person have longterm effects from multiple concussions?
Yes, that is where we start to see the more serious consequences referred to as chronic traumatic encephalopathy. A neuropathologist at Boston University examined over 100 brains from deceased professional football players. By looking at the brain under a microscope, they determined they had this so-called chronic traumatic encephalopathy.
Typically, these athletes have a dementing process that sets in prematurely, often in their late 40s. They often become depressed and some commit suicide because of the depression and demented state they are in.
There is also evidence that consecutive traumatic brain injuries or concussions can impact your longevity. It can impact your body in terms of other diseases. People who have identified several concussions actually show that their overall health is affected by repetitive injuries.
Are there different levels of concussions?
We don’t have a clear-cut scale that you can say you have an A concussion or B concussion, or Type 1 or Type 2 or 3 but, it is a graded scale.
If you have a mild concussion, typically a scan is not going to show it, but if you have a more severe concussion and the brain is bruised and there is bleeding in the brain tissue or surfaces of the brain, then typically people are a lot more symptomatic.
If someone suspects a concussion, what should they do?
They need to go to an emergency room to be evaluated. Anybody who comes into a hospital with a bump on their head will likely get a CT scan because it is fast and you get a lot of information.
If a person is diagnosed with a mild concussion, what are the treatments?
Rest. There is no medication that can mitigate it. If you have a symptom and otherwise feel alright, slow down and take a nap. It is not like anything else where some physical therapy or push-ups can speed up recovery. If you start to exercise or do certain intellectual activities, such as reading or writing, and symptoms get worse, that is an indication you have not fully healed yet.
How long does it take to recover from a concussion?
It is very difficult to say. Some people recover within two or three days, while it lingers around for three or four weeks for others. That is why being cleared by a professional is recommended. There has to be heightened awareness. Don’t tough it out. If somebody has fallen off a horse and is wobbly when they stand up and doesn’t know what day it is, then they have a concussion. Take them out of play and have a professional review how they are doing and clear them for going back into a contact sport. Polo technically is a contact sport, you can have contact with the ground, the mallet, the ball or somebody in a ride-off.
What is the best way to keep yourself safe?
No helmet is concussion proof, but wear the safest helmet available. The USPA Safety Committee continues to have helmets evaluated to determine if there are improved technologies to consider.