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30th April 2000
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Preventing and coping strategies.... 

Head injuries in contact sports

Rugby , Soccer, Boxing, Cricket, Gymnastics, Martial arts etc are notorious to inflict head injuries among sports people. 

The role of the doctor & the first aid team is three fold (3R's) - recognising, resuscitating and referral. 

The well known concussion is a minor head injury - meaning violent shaking up of the brain - what happens is that there is temporary disturbance of the brain functions. 

Repeated concussion leads to permanent brain damage. The famous punch-drunk syndrome of Mohamed Ali is a classic example. 

How serious is concussion?

Too early return to sport following concussion causes several forms of undesirable brain function - poor short term memory, abnormal chemical activity, inability to think rationally, poor judgement and concentration, sub standard muscle control and even EEG changes. 

But the real bad side of concussion is that often it goes unnoticed during a game because it may last only a few seconds. 

Why get concussion anyway?

In humans a long neck carries on top a heavy hard skull inside which is a very soft brain. The net result is that a trivial force on the head gets magnified many times. The brain accelerates for more than 4 milliseconds with a force equivalent to 30 times the force of gravity. (See Picture) 

Why is it dangerous to return to the game too soon?

1. Even a trivial 2nd impact can give a more serious injury. 

2. Once concussed one reacts slowly failing to recognise and to avoid dangerous situations. This leads to injuries elsewhere too. 

3. Full recovery takes longer if one returns to sport too early. Experts believe that headaches and poor concentration, excess tiredness can last many weeks because of changed brain function. 

Caution ! 
Effects of several bouts of concussion can be cumulative. 

The greater our knowldge increases the greater our ignorance unfolds-J.F. Kennedy 

Preventing concussion and other head injuries 

1. At school level - Never leave children unattended while at play - advice to use protective gear. 

2. Change (If necessary) and adhere to rules of the game - while improving coaching principles. 

3. Use mouth guards and helmets etc. Mouth guards preferably custom made helmets - must be well fitting. The bad side of the story is that although the helmet helps prevent fractures, its weight and the volume may in fact increase the chances of a concussion by increasing the acceleration of the brain. 

4. By maintaining strong muscles of the back of the neck - which works as a shock absorber and helps to cut down the effects of force on the head. 

Accessing concussed player on the field. 

Mild cases: - The player gets dazed but remembers what happens after the injury. He recovers in less than a minute. He can return to play only after 20 minutes. But he must stop if continues to feel unwell while at play. With two episodes of mild concussion experts advise one week off play. 

Moderate cases : - If the player takes more than a minute to recover returning to play could be dangerous. He will also forget what happens after the injury (up to one hour). However if he has recovered fully and clinicaly normal he may be allowed to play. Some experts feel however that this player must rest for at least one week before play. 

Severe cases: - Not uncommon. The player is dazed or confused for over a minute. Forgets post injury events for over one hour as well as events before the injury. A severe headache, being irritable, unsteadiness in such a player must not be overlooked. 

Sometimes he may become unconscious. These players must end up in the hospital. Mild training is allowed again only a week after recovery and the normal tests (CT). 

More than two episodes of the above nature makes him unfit for the rest of the season.

A must in all cases of loss of consciousness for more than 5 minutes or if there are fits. In a country with sub optimal facilities (Sri Lanka?) even the conscious player with continuing symptoms must be hospitalised !!!

What are these symptoms?

Persistent headaches, tiredness, being irritable and low memory and concentrtion. 

Word of caution : _ One must always suspect damage to neck and spinal cord if the player is unconscious. On the other hand neck injury must not be excluded even if the player had been conscious. 

Why are the guidelines on return to sport important?

A player recovering from head injury may have sudden swelling of the brain following even mild hit to head following return. He may collapse with fatal consequences. This is called 2nd impact syndrome. On the other hand the player may end up with permanent brain damage and resulting sequelae which may affect study, employment and social life. 

Advice to parents and carers following head injury - 1. Observe 24 hours, 2. .Rest 24 Hours, 3. Only liquid 24 hours, 4. Only Paracetamol, 5. Ice for 15 minutes every hour up to 48 hours, 6. Talk to victim every 2 hours up to 24 hours, 7. Call doctor for any new developments. 

First aid requirements. 

Basic first aid facilities including ambulance and qualified personnel are not availabe in some sport arenas. A cervical collar, which is a must by international standards, is still a more rarity. 

This article is dedicated to sports men and women (competitive and recreational) and to anyone interested in their welfare. What they achieve for their country inspite of limited facilities could be summed up thus - "the heigths by the great men and women reached and kept were not attained by sudden flights but they, while companions slept, were toiling upward in the day and night" - with apologies to H.W. Longfellow. 

- Dr. D. Atukorale

Countdown to the Olympics : 137 days 7

Strategies for events

Sports that are seen as winnable will formulate sound business plans

By Annesley Ferreira 
Strange as it may seem, a large number, and growing, sports mad nations are reviewing strategies that would put them in the forefront to haul medals at the Olympic Games. The need not only to excel at the Olympics has now paled into fierce competition to win a medal and then for the next four years capitalize on the success for lucrative sponsorships and many other perks. 

Take how skillfully the United States Olympic Committee [USOC] have strategised on those Olympic sports that would assure a medal or medals and yet support other sports that lag or are unable to capture supremacy. 

USOC looked at several sports that they believe would never capture medals in sports such as table tennis as an example. USOC believes that there are sports that excel only at regional level, such as table tennis dominated by the Asians, and so is badminton. In track and field, all distance running is dominated by African nations, as was seen at the recent Boston marathon where 1, 2, 3 places were taken by the Kenyans and the 1st place in the women's was also by a Kenyan. 

Sports that are seen as winnable will formulate sound business plans, budget strategies and growth programs. Those sports that are seen with low medal potential would be encouraged and urged to look for alternative funding sources with assistance from USOC. 

With this backdrop let's look at the local scene. The penchant to promote those sports that have no chance whatsoever at the Olympic Games get the best billing in this respect. The best example is rifle shooting. Sri Lanka would not stand a chance - even to be placed within the first fifty or so places at the Asian or Olympic Games. Recently a press report stated that one of our more recognized 'shooter was only 8 points behind the world record or a possible medal winner' displayed the shallowness of the statement and the ignorance of his knowledge of the sport of shooting. At the 1988 Seoul Olympics in the air pistol forty shots event taken from a distance of 10 metres with a time limit of 90 minutes, the top eight qualifiers took part in a 10-shot final with 75 seconds per shot. Came out as follows: first with a world record of 489.5 points and the eighth with 472.6 points, or 6.9 points apart between the gold medallist and the eighth placement. 

At best, a Sri Lankan would come around the 60th position or marginally better while it is laudable for the chairman of the shooting selection committee to have resigned since the chairman of the national sports council for having taken the decision to drop the recommended nominee for the selection committee shows the degree of depravity of the chairman/national sports committee and his total ignorance of the sport. This is exactly what is going on at the Ministry of Sports. 

Many are of the opinion that rifle shooting should not be considered a Olympic sport since it's confined to the forces. 

In the case of the recent AAA elections it was even more bizarre. The president is the coordinating secretary to the Ministry of Sports and is also a coach, where one of his trainees was disqualified for having taken performance enhancing drugs. His wife who is the deputy director at the ministry, was elected president, "Literally at gun point". In the same organization, the secretary, is the former secretary of the NOC who was booted out and whose wife is the additional secretary of the Ministry of Sports. What more brazen contempt for civilized values and conflict of interest, can surpass this situation. The very Ministry of Sports that would adjudicate on such situations is in breach of the laws with compelling impunity. 

With the new elections of NGBs going the rounds, one can see yet another change of musical chairs such as in badminton, cycling, kabbadi and swimming. The case of swimming is particularly interesting. The sport has degenerated to such a level and if not for the fact that schoolchildren are swimming, no quality swimming at club level ever takes place. There is not a single swimming club that has conducted a proper meet that would promote competitive swimming. Exaggerating such swimming meets as the two-mile sea-swim or the other odd meets, have no significant impact on swimming in general. Swimming has been on the steady decline 

The inadequacy for NAASU to attract new blood or a younger lot of officials who are in abundance with considerable knowledge to run the organization has never been exposed as would be seen at the recent elections. 

When the Koreans hosted the 1988 Olympic Games, they set out a far-reaching strategic plan some eight years earlier to amass as many possible medals at these games. The Korean NOC assigned each NGB to work with the private sector corporations to achieve this goal. The result was that Korea placed 19th at the 1976 Montreal Olympics to the 10th position at the 1984 Los Angeles games [Korea did not participate at the boycotted 1980 Moscow Olympics] to an astonishing 4th position with a medal count of 33 at the games hosted by them. After Soviet Union [132 medals] East Germany [102 medals] and United States [94 medals]. 

Sadly all NGBs in our little island nation is under the "boot" of the Ministry of Sports and over the past seven years orbited in this direction with disastrous consequences to sports. The saddest part is that the NOC is completely overwhelmed by the ministry and no independent decision or action can be taken without the minister's clearance. As you turn any sports page of any given newspaper all you read is of administrative mismanagement, financial irregularities and the utter incompetence in handling the affairs of these NGBs.

In association with C. Vijitha Fernando, Duncan White Sports Foundation.

Mobil Eliya - Making the difference

Holidaymakers this season in picturesque Nuwara Eliya had more than just a salubrious clime to go to. They were home in Mobil Eliya where the local agent for the world oil giant Exxon Mobil launched their range of lubricants slap bang in the middle of the bustling holiday crowd. Not only did their Team Mobil give the local big guns Caltex a run for their money but also catered to the general motoring public with a 3-day car clinic manned by a team of experts who provided a free engine inspection and lube change.

City Mayor Bandula Seneviratne was at hand to inaugurate the service clinic followed by a stream of discerning motorists who thronged the venue to take advantage of this unique Mobil service.

Spearheading this operation was the surprising presence of Trevor Reckerman of Nestle fame whom we understand has now moved to head up the Mobil lubricants operation in Sri Lanka. 

He is teaming up with racing ace Rohan De Silva, the man responsible for the joint venture of McLarens and Mobil.

As their advertising slogan portends they have "The Energy to Make a Difference". Not much doubt about that it takes.

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