Ulster’s Iain Henderson suffered concussion in the Guinness PRO14 game against Munster and had to follow the return to play protocols. Here he shares the process with sports editor, Richard Mulligan, on those protocols and getting the all clear to face Connacht on Friday night.
The awareness around concussion injuries in sport and specifically in rugby have been well documented in recent years. Indeed just recently Sport NI launched Concussion.net in association with a number of sports, highlighting the importance of understanding and reacting properly to concussions.
Last weekend, British Lions, Ireland and Ulster lock, Iain Henderson, suffered a bang to the head during Ulster’s Guinness PRO14 Irish derby against Munster at Limerick’s Thomond Park.
There are Head Injury Assessment (HIA) procedures put in place and when Henderson did not return to play it was assumed he had failed that HIA.
However, a decision had already been made when he was taken off that he would not be returning.
He then goes through a return to play protocol during the week to assess if he is fit to play in the next game.
In a fascinating and frank discussion with the media at this week’s pre-match day briefing ahead of the game with Connacht on Friday night in Belfast, Henderson explained the process around the HIA and the return to play protocols.
Henderson has been given the green light to face Connacht at Kingspan Stadium, having been named in the starting XV yesterday meaning he has passed the protocols this week.
But while there are general guidelines in place, what process did Henderson follow this week.
It was the first time he had suffered concussion and he admitted it was a little scary.
He explained: “There are three HIA tests.
“One (HIA-1) is done immediately after the incident, or if you have certain symptoms it’s not done.
“I wasn’t HIA-1 and that’s the Head Injury Assessment you do when you come off the pitch for 10 minutes, so they decided on the pitch that I would not be continuing.
“Then I did HIA-2 which is post game and is exactly the same thing to see if your symptoms have alleviated or completely disappeared, and then HIA-3 is following one full 24 hour rest period after the game, again to measure where your symptoms are, whether it be.”
What are the symptoms?
“These are all symptoms of concussion – emotion, sadness, balance problems, dizziness, headaches, everything you would associate with a head injury,” said Henderson.
“Following that you go into light exercise, which is sit on a spin bike for 20 minutes, then you report back after that on whether your symptoms are getting any better or worse or indifferent.
“Following that, the next day you go for a 2k run, and after the run you come back and get assessed on whether or not whatever symptom you had before, is it bothering you more or less, all that carry on.
“Then you return to decision making in training without contact, then you return to contact, and that takes up to six days. So the other day I was in decision making.
“Other tests include balance tests, they give you a list of 10 words and then in 10 or 15 minutes you need to remember those 10 words, read numbers backwards and all sorts.
“That was all fine in HIA-2, I had no symptoms in HIA-2, I was able to remember everything fine.
“Fortunately for me I’ve skipped through all the hoops so far, so all being well I’ll be fine for the weekend.
Those attending the match or watching via Premiers Sports will have been aware that Henderson took the knock several minutes before he came off.
Revealing the reason Henderson said: “I went into a lineout and went to call it and I just couldn’t remember any calls. Literally went into the huddle and I paused for 10 seconds, and I think it was Andy Warwick asked ‘what do you want to call’ and I was just looking at the ground.
“I couldn’t even think of the simplest lineout call and I was just standing there, and Big Al O’Connor said ‘I think we’ll do this one’, and I went into the lineout and still couldn’t think of it.
“The next break in play I said to Big Al ‘you are’ going to need to call these lineouts because I can’t remember any of them’ and he said ‘there’s no point in you going on if you’re like this’.
“In my head I was fine to go on, but that’s probably something that’s good from Big Al because he’s had a good few concussions in his time, so to have the support of, at the time, my captain and whoever else around you could be supportive just to say there’s no point in you going on.
“After one concussion the risk of another concussion dramatically increases. The physio came on to me and after the initial knock I didn’t feel too bad, and then the doctor said it can be three or four minutes for the symptoms to manifest.
“The doc and I then talked and I explained to him and when you cannot remember stuff, that rules you out of the rest of the game,” added Henderson.
Henderson added: “It was just bizarre, I was lost for words. I was standing there, and I remember everyone was looking at the ground and a bit of panic set in because I couldn’t think of what to call, so I was like just call something simple and I didn’t even know any simple calls.
“As I said, Big Al said ‘let’s do this’ and I thought perfect, he’s looking out for me!
“I was well looked after, and I felt completely fine after the game and I kind of felt like saying to them do I have to go through all the HIAs protocols?
“Because I felt fine and I’ve been fine through all of them, but you just need to look to Big Al or Luke Marshall who have had some problems with their head before, they’ll tell you that.
“Yes they may have felt fine for the first, but then once you start doing more stuff that’s when it’ll hit you.
“I’ve been grand so far and I had a relatively intense decision making training session today, so grand.”
Henderson believes there has not been an increase in the number of concussions in the game, but it is more a case of they are being picked up more regularly.
“I can’t remember the exact stats but I’ve been told them by the docs, the chance of reinjuring after your first concussion goes up dramatically, and that is either another concussion or another injury, whether it be head, neck, balance, all sorts of stuff.
“The chance of injury just goes way, way up.
“Whether or not there’s a slight doubt, there’s been a change in the laws this year that you have to stay off for the whole time (10 minutes) before you can come back in, and players wanted to come on as quickly as possible, whereas now you’re in there for the whole time, which is good because it is going to prevent more injuries in the game, and nobody wants more injuries.
“Mental health is something you’ll deal with later in life having a sore hip, but you want to be alright upstairs.”