Understanding possible complications – Second Impact Syndrome (SIS)

Second Impact Syndrome (SIS) is rare but extremely serious. It occurs when a person sustains a second concussion before fully recovering from an initial one. This second injury doesn’t need to be severe—it can be minor—but it can lead to rapid and severe brain swelling (cerebral oedema).

After the initial concussion, the brain’s ability to regulate blood flow and pressure is compromised, making it highly vulnerable. Symptoms can escalate quickly, often within minutes: unconsciousness, severe headaches, dilated pupils, respiratory failure, and even death. Young athletes are especially at risk.

Due to its swift progression and severity, SIS is considered a medical emergency requiring immediate treatment.

Preventing SIS relies on strict adherence to concussion protocols, ensuring full recovery before returning to play, and monitoring symptoms carefully.

Addressing Chronic Traumatic Encephalopathy (CTE)

Dr Viljoen explains that CTE is a long-term degenerative brain condition linked to repeated head impacts. "CTE is challenging because currently, it can only be definitively diagnosed after death. However, ongoing research aims to develop methods to detect CTE in living patients, potentially using advanced imaging techniques like Positron Emission Tomography (PET)."

Current research is focused on non-invasive ways to assess the living brain and track changes over time.

Common causes of head injuries in rugby

Head injuries in rugby usually stem from the sport’s high-impact nature. Tackling is a major contributor, especially when performed incorrectly or at a dangerous height. Young players are particularly at risk due to undeveloped tackling techniques. Teaching safe methods from an early age is key to reducing injuries.

The game’s dynamic nature often results in players being brought down forcefully or landing awkwardly. Even with protective gear, the impact of the head hitting the ground can cause concussions or more serious trauma.

Unintentional collisions are also common—clashes of heads, or contact with knees and elbows, can lead to anything from mild concussions to serious brain injuries. Safer playing practices and preventative strategies can help reduce these risks.