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September 2016, Volume 66, Issue 9

Letter to the Editor

Sports-related concussion awareness in Pakistan

Mohammad Nadir Haider  ( First Response Initiative of Pakistan. )

Concussions are mild traumatic brain injuries (mTBI) which cause short-lived neurological impairments that can develop immediately or over several hours and can produce functional cognitive, emotional and autonomic symptoms rather than a structural injury. They can cause significant impact on education, social and professional responsibilities. Majority of the cases (80-90%) are self-limited, lasting between 7-10 days, but a not so insignificant minority can persist from weeks to months.1 Ever since the discovery of chronic traumatic encephalopathy, global awareness and research on sports related concussion (SRC) have increased several fold and the Center of Disease control have labelled it a silent epidemic with estimated 1.6 - 3.8 million head injuries in sports a year in USA alone.2Unfortunately there is no public awareness of SRC in Pakistan even though sports are a big part of our society. Why is this? One study states that concussion rates are lower in Pakistan. 3 This is surprising because Pakistan\\\'s most commonly played sports like cricket, field hockey and squash are contact sports with a moderate rate of concussion, whereas the traditional sport of Kabaddi has a surprisingly high concussion rate with 32% of the injuries. 4 There have been several newspaper articles which describe international cricket athletes, including several Pakistanis, being hit in the head who receive proper assessment and management. Unfortunately this does not occur at school or college level sports.
This could be due to the lack of awareness of the consequences of concussion which leads to the lack of importance given to them, financial constraints or unavailability of medical facilities in a low-income country like Pakistan. A study by Lincoln et al. 5 discussed that the increasing incidence of concussion in USA is due to more awareness and better diagnostic criteria. This statement can be backed by the deficiency of concussion research in Pakistan, their lack of integration into the medical school curriculum and subsequently no management knowledge among physicians, and the absence of any mention of future goals regarding it in the Sports Medicine Association of Pakistan\\\'s agenda.
Currently, Pakistan is lacking a proper body to regulate this matter. Our priority should be to improve the knowledge about management among healthcare professionals and spread awareness of the symptoms of concussions so that the injured decide to seek treatment. Only after they seek treatment can we truly know the burden of this disease in our country so important recommendations can be made to our medical and sports regulating authorities and reduce the unknown burden of disease.

Disclaimer: None.

Conflict of Interest:
None.

Funding Disclosure: None.

References
1. McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorák J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013; 47: 250-8.
2. Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006; 21: 375-8.
3. Voss JD, Connolly J, Schwab KA, Scher AI. Update on the epidemiology of concussion/mild traumatic brain injury. Curr Pain Headache Rep 2015; 19: 32.
4. Sen J. Injury profiles of Indian female kabaddi players. Int J Appl Sports Sci 2004; 16: 23-8
5. Lincoln AE, Caswell SV, Almquist JL, Dunn RE, Norris JB, Hinton RY. Trends in concussion incidence in high school sports: a prospective 11-year study. Am J Sports Med 2011; 39: 958-63

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: