Rugby is a game played by two teams using an oval ball. Players try to score points by carrying the ball to their opponent’s end of the field, or by kicking it over a bar fixed between two posts.   As a “rugby Mum” I was compelled to writ

e this thesis to encourage others to research more into rugby concussion management and some of the options available. I shall be covering the allopathic approach to treatment along with some of the homeopathic treatments which are available

Head Concussion Injuries in Rugby

WHAT IS A CONCUSSION?

A head concussion is also known as mild traumatic brain injury (mTBI). A concussion is an injury to the brain resulting in a disturbance of brain function. It is a common injury that occurs when the brain is jolted inside the skull due to a blow to the head.

It can be caused by a direct blow to the head, but can also occur when a blow to another part of the body results in rapid movement of the head, such as whiplash-type injuries. It can be a result of a variety of activities, such as sports-related activities, car accidents, and falls. Loss of consciousness does not always occur – in fact, it occurs in less than 10% of concussions.

It is considered a mild injury because it does not cause structural damage to the brain, but it can still result in significant neurological dysfunction and a wide range of symptoms.

The primary pathophysiological mechanism underlying concussion is believed to be a disruption in neuronal communication caused by shear forces that result from rotational acceleration-deceleration forces acting on the brain within the skull. This disruption can cause a temporary loss of consciousness, confusion, dizziness, headache, nausea, vomiting, fatigue, and other symptoms.

Concussion is a common injury, with an estimated incidence of 1.6 to 3.8 million cases per year in the United States alone. It is frequently seen in contact sports, military combat, Equestrian pursuits and motor vehicle accidents. However, it can also occur in everyday activities such as falls, assaults, and work-related accidents.

The diagnosis of concussion is typically based on a combination of clinical symptoms, physical examination, and cognitive testing. The most commonly used diagnostic criteria are the Zurich Consensus Statement, which was last updated in 2017, and the American Academy of Neurology guideline from 2013.[iii]

In the UK we have guidelines from the 2017 Concussion in Sport Group (CISG).

It is important to note that Sports Related Concussion (SRC) is an evolving injury in the acute phase, with rapidly changing clinical signs and symptoms, which may reflect the underlying physiological injury in the brain. SRC is considered to be among the most complex injuries in sports medicine to diagnose, assess and manage.

The majority of SRCs occur without loss of consciousness or frank neurological signs. At present, there is no perfect diagnostic test or marker that clinicians can rely on for an immediate diagnosis of SRC in the sporting environment. [iv]

Concussions can happen to participants at any age.

However, children and adolescents,(18 and under) –

• are more susceptible to brain injury
• on average take longer than adults to recover – usually four weeks compared to two weeks
• have more significant memory and mental processing issues
• are more susceptible to rare and dangerous neurological complications, including death caused by a single or second impact.

A history of previous concussion increases the risk of further concussions, from which it may also take longer to recover.[v]

Types of Concussions

The brain is made of soft tissue. The skull acts like a protective shield, but when you have a blow or bump to your head, the impact can affect your brain. In some cases, it literally moves around the head. Concussions can cause bruising, injury to the nerves and damage to the blood vessels. As a result, your brain won’t be functioning as it should.

If you have had a concussion, you might experience disturbed vision, loss of equilibrium, or a period of unconsciousness. Some things can increase your risk of a concussion, such as lack of safety gear when playing contact sports, tackling dangerous jobs, falls (especially on children and older adults), motor accidents or pre-existing brain injuries.

These are the essentials of concussions. Which type of concussion you have will be determined by concussion symptoms and severity. Doctors rank the severity of concussions based on things like loss of consciousness, loss of equilibrium and amnesia.

Categories of concussion

Below are the three grades of concussion:

Grade 1, Mild: Symptoms that last less than 15 minutes and entail no loss of consciousness

Grade 2, Moderate: Symptoms that last for longer than 15 minutes and involve no loss of consciousness

Grade 3, Severe: The person loses consciousness

Most people with concussions fully recover after receiving appropriate treatment. However, every brain injury needs to be taken seriously.[vi]

HOW TO RECOGNISE A CONCUSSION

The following signs and symptoms of a concussion are a broad guideline and each person’s presentation may differ to some degree. Some people may present with just one or many of these symptoms but it is wise to remember that signs and symptoms may take hours or sometimes days to appear and should be treated with the same urgency. The symptoms of a concussion can vary from person to person, some of them can be as described below.

Physical changes can be seen as –

• slowed reaction time
• inability to perform or poor performances
• appears dazed
• slurred speech
• loss of consciousness or lack of responsiveness
• poor coordination/balance
• drowsiness
• Amnesia

Physical changes which the injured person may report to you can include –

• headache or pressure
• neck pain
• nausea/vomiting
• finding it difficult to balance
• sensitivity to light or noise
• feeling sluggish or slowed down
• ringing in the ears
• fatigue

Cognitive function is usually the foremost symptom which is presented and can be observed as-

• confusion
• easily distracted
• forgets instructions
• difficulty concentrating
• doesn’t know the activity, class, game, sport etc. they were participating in.

The patient may report these Cognitive issues as –

• issues concentrating
• memory problems
• confusion
• feeling dazed

Behavioural changes.

Behaviour changes are by far the most reported long-term effects following a Concussion and should give rise to the most important symptoms to watch out for, some of these include –

• changes in mood, behaviour or personality
• strange, inappropriate emotions (e.g. easily angered, laughing, crying etc.)

Behavioural changes which the patient may report as experiencing can be –

• irritable or unusually emotional
• nervous, anxious, depressed
• drowsy
• change in sleep patterns

The management of concussion typically involves a period of strict rest, both physical and cognitive, to allow the brain to heal. This may include avoiding physical activity, limiting screen time, reading, and play and reducing mental stress. More severe cases may require hospitalisation or referral to a specialist, such as a neurologist or a neuropsychologist.

Overall, the prognosis for concussion is generally good, with most people recovering within a few weeks to a few months. However, some individuals may experience persistent symptoms that can interfere with daily activities and quality of life. Therefore, it is important to seek medical attention if a concussion is suspected and to follow up with appropriate care as needed.

Long-term emotional effects of head concussion

Concussions, also known as mild traumatic brain injuries (mTBI), can have long-term emotional effects. Emotional symptoms can arise from the injury itself, as well as the stress and anxiety related to recovery. Here are some of the long-term emotional effects of concussion:

Anxiety and Depression: Studies have shown that concussion is associated with an increased risk of anxiety and depression, which can persist for months or years after the injury. Research has also shown that people who experience depression and anxiety prior to concussion may be more likely to experience these symptoms following the injury.^[vii]

Irritability and Aggression: Some people may experience increased irritability or aggression following a concussion. This may be due to the physical effects of the injury on the brain or the emotional stress of coping with the injury and its aftermath.^[viii]

Post-Traumatic Stress Disorder (PTSD): In some cases, concussion can lead to the development of PTSD. This is more likely to occur in people who have experienced multiple concussions or other traumatic events, or who have a history of mental health problems.^[ix]

Sleep Disturbances: Concussion can disrupt normal sleep patterns, leading to insomnia, daytime drowsiness, or other sleep disturbances. These can contribute to emotional problems such as anxiety and depression.^[x]

Reduced Quality of Life: Concussion can have a significant impact on a person’s quality of life, including social relationships, employment, and leisure activities. This can lead to feelings of frustration, sadness, or isolation.

It is important to note that not everyone who experiences a concussion will develop long-term emotional effects. However, those who do may benefit from counselling or other forms of support to address their emotional concerns. In some cases, medication may be recommended to help manage symptoms such as anxiety or depression.

If you or someone you know is experiencing emotional difficulties after a concussion, it is important to seek medical attention and talk to a healthcare professional about available treatment options.^[xi]

As a “rugby mum”, I will focus more on the rugby side of concussions, as these are what I have researched and have had to deal with.

The RFU has one of the most comprehensive set of guidelines out of all UK sports, on how to recognise and deal with concussions, yet there are still a huge majority of coaches, first aiders, helpers and parents who are totally unaware of the concussion guidelines. I cannot help but wonder just how many undiagnosed children have suffered concussions which have resulted in behaviour changes which have been attributed to hormones, naughtiness or a spectrum disorder?

CONCUSSION IN RUGBY

Concussions occur in everyday life and not just in sport. As a contact sport, rugby does involve frequent body impacts and a risk of accidental head impacts, and therefore a risk of concussion.

According to data collected through the RFU’s Community Rugby Injury Surveillance & Prevention (CRISP) programme, in age grade rugby (age 15 – 18) on average there is one concussion per team every 10 games and one concussion per team every 25 games in adult male community rugby. In professional rugby the rate is one every 2-3 team games.

The heights of the yellow bars and percentage figures in the graph above express the percentage of all time-loss injuries that are suspected concussions.

There has been at notable rise in concussion rate over the last 10 years or so, is likely due in large part to the increased awareness of, and a lower threshold for suspecting concussion, which reflects the success of awareness and education programmes, and media coverage.[xii]

England Rugby

The England Rugby Union has implemented a comprehensive concussion protocol to help protect the health and safety of its players. The protocol includes the following key components:

1. Pre-season baseline testing: All players undergo pre-season baseline testing that includes cognitive assessments, balance tests, and symptom evaluations. This information is then used as a reference point in case a player sustains a concussion during the season.
2. Immediate removal from play: If a player shows signs or symptoms of a possible concussion, they are immediately removed from play and evaluated by the team doctor.
3. Side line assessment: The team doctor performs a side line assessment using a standardized tool such as the Concussion Recognition Tool (CRT) or the Sport Concussion Assessment Tool (SCAT).
4. Medical evaluation: If a concussion is suspected, the player is referred for a full medical evaluation, which includes more extensive cognitive, balance, and symptom assessments.
5. Graduated return-to-play protocol: If the player is diagnosed with a concussion, they are not allowed to return to play until they have completed a graduated return-to-play protocol. This protocol involves a step-wise process of gradually increasing physical activity, cognitive activity, and sport-specific activity under medical supervision until the player is symptom-free and has passed all required tests.
6. Education and awareness: The England Rugby Union provides education and awareness training to all players, coaches, and support staff to help them recognize the signs and symptoms of concussion and to promote a culture of safety and respect for player welfare.[xiii]

It is worth noting that the England Rugby Union’s concussion protocol is in line with the guidelines set out by the World Rugby and the International Olympic Committee. The aim is to ensure that players are appropriately managed if they suffer a concussion and to reduce the risk of long-term harm to their health.[xiv], [xv].

United Kingdom Rugby

Although the UK nations of England, Wales, and Scotland share a close rugby union heritage, each has its own distinct concussion protocols.

England, Wales[xvi], and Scotland have implemented their own versions of the Head Injury Assessment (HIA) protocol, which is designed to assess players who may have suffered a concussion during a match.

The HIA protocol involves a series of assessments, including a standardized tool such as the Sport Concussion Assessment Tool (SCAT), to evaluate the player’s symptoms, balance, cognitive function, and other factors.

If a player is suspected of having sustained a concussion, they are removed from play and referred for further medical evaluation.

In addition to the HIA protocol, each nation has its own specific guidelines and regulations for concussion management, which can differ in their details.

For example, in Scotland[xvii], the Scottish Rugby Union has implemented a three-stage Graduated Return to Play (GRTP) protocol for players who have suffered a concussion, which involves a gradual return to full rugby activity over a period of several days or weeks.

Meanwhile, in England,[xviii] the Rugby Football Union (RFU) has established a Concussion Management Review Group, which oversees the management of concussions in professional rugby and advises on the development of protocols and guidelines.

Despite these differences, there are also many similarities between the concussion protocols of England, Wales, and Scotland, and all three nations are committed to ensuring that players are appropriately managed if they suffer a concussion and that player welfare is prioritised.

SECOND IMPACT SYNDROME

The RFU advise that Exposure to further head impacts before full recovery can increase the risk of a more serious brain injury and lead to Second Impact Syndrome.

It is known that children’s or adolescents’ brains are still developing, there is therefore a particular concern that concussion can have more of an impact, and that a second concussion occurring before recovery from the first can result in prolonged symptoms that can have a significant impact on the player.

It can be difficult in the initial stages to differentiate concussion from other serious brain injuries, which at its most extreme, can lead to death. Therefore, the “Recognise and Remove” approach to any suspected concussion is promoted and should be applied across the community game.[xix]

MULTIPLE/REPEATED CONCUSSIONS

Players who experience two or more concussion in 12 months or multiple concussions over the course of their career should be reviewed on an individual basis. The severity of the concussion, nature, timescale and recovery can affect the approach that is taken; some players may require an extended period out of the game.

It may also be important to look at the mechanism of injury/how the concussions are occurring, for example is it due to poor tackle technique and if so, how can this be addressed by the coach/player or should there be a focus on neck muscle strengthening?

If a player has repeated concussions, it is recommended that they are seen by a doctor specialising in concussion management (through a GP referral). Each concussion should be considered on its own merits but a more conservative timescale for recovery or directed rehabilitation may be recommended especially if each time the force required to cause the concussion is lessened and/or the symptoms are prolonged.[xx]

RETURN TO PLAY (RTP)

There are 2 different Graduated Return to Play programmes, one for adults and one those playing at U19s and below. The Return to Play is aligned across other sports in the UK, with NHS guidelines and are endorsed by the Sport and Recreational Alliance.

These guidelines can therefore be used across sports and in managing return to play in rugby when the concussion occurred in another sport or in everyday activities.

RETURN TO PLAY – KEY POINTS

REST: Following a suspected concussion, the best thing to help with recovery is appropriate rest!

Initial Rest means:

• No physical activities e.g., running, cycling, swimming and other forms of exercise.
• No cognitive (brain) activities e.g. reading, television, computer, video games and smart phones.
• Get some sleep, this is good for recovery.

However, balance is needed and too much complete rest is thought to delay recovery; 24-48hrs of complete rest is all that is needed in most cases.

In some cases, it may be appropriate for the player to miss a day or two of work/study after a concussion if they feel unwell or if on returning to work/studies their symptoms return. The player should have returned to work/academic studies before starting physical activity (see GRTP Stage 2b).

In a small number of cases, symptoms may be prolonged, and this may impact on work/studies. In such cases, early referral back to a doctor is advised.

Extended absence from work/study

Where extended absence from work/study is needed the following should be considered:

• Good communication with the workplace/place of study is important
• A gradual return to work or academic studies more time may be required
• Consideration should be given to a managed return to full work or study days i.e., part days initially

For children in school specifically:

• Communicate with the school, which may have a support worker who can help and advice.
• Gradual re-introduction of homework is advised to avoid long days of work.
• Consideration should be given to delaying tests and exams until fully recovered. If this is not possible then the school should advise the Examinations Board.
• All those with suspected or diagnosed concussion should follow the relevant programme (Adult or U19 & below).
• All players should be assessed by a health care professional within 24 hours of the incident to ensure that there are no significant underlying medical issues (see Review by a Healthcare Professional section).
• If signs or symptoms of concussion are clearly identified at the time of injury but have resolved by the time of the subsequent assessment by a healthcare professional, the player should still follow the RTP programme.
• Day 1 of the RTP starts from the day after the concussive injury.
• Each phase of the RTP are “minimums”. Players who do not recover fully within these timeframes should undertake a longer RTP[xxi]
• 

Conventional Medicine Treatment of Head Injuries

The National Health Service (NHS) website provides information on the symptoms and treatment of concussions, including rest and pain relief medication as well as advice on when to seek medical attention. Some of the treatments recommended are-

• Hold an ice pack (or a bag of frozen peas in a tea towel) to the area regularly for short periods in the first few days to bring down any swelling. This is Contrary to the Rugby Football Unions advice that you DO NOT USE ICE If there is a suspected concussion.[xxii]
• Rest and avoid stress – you or your child do not need to stay awake if you’re tired
• Take painkillers such as paracetamol for headaches
• Make sure an adult stays with you or your child for at least the first 24 hours
• Do not go back to work or school until you’re feeling better
• Do not drive until you feel you have fully recovered
• Do not play contact sports for at least 3 weeks – children should avoid rough play for a few days.
• Do not take drugs or drink alcohol until you’re feeling better.
• Do not take sleeping pills while you’re recovering unless a doctor advises you to. [xxiii]

Homeopathy and a Rugby Family

As a “Rugby mum” my weekends have been spent generally standing in a wet and muddy field, cringing at every hard knock and tough tackle, watching my daughter or son play the game that they love.

We are a “rugby family” . Our autumn, winter and spring are busy times for us. The new season starts in September and games are generally all played by May. It is rare to get a warm weather match or a dry one for that matter, and as a family, we all have “rugby clothes”.

These outfits, would be better suited for hiking or expeditions, but with our glorious British weather, we have to be prepared for horizontal rain and lashing winds, along with snow and occasionally but rarely, sun.

We have a “rugby box” which is packed into the boot of the car every Sunday and then removed until the next week. The box contains many things needed for a Sunday of Rugby, waterproof trousers, and shower curtains to wrap around mud-covered kids before strapping them into the back of the car, all whilst trying to avoid the hail stones, rain or snow.

Hand warmers, woolie hats, gloves, along with thermos flasks to get refilled at club houses etc and most importantly an extended first aid kit. I say extended as this kit contains all of the usual items that you would expect to find, bandages, plasters, etc, but this one has something special within it, a Homeopathic first aid kit inside.

The Homeopathic kit contains the usual Arnica, Hypericum, Calendula etc for those initial injuries or symptoms which happen in daily life, aswell as those sustained during a rugby match.

I keep these in a 30c potency which is the most widely used potency for those first aid situations, along with a more urgent or high energy 200c potency. Previous experience has encouraged me to be prepared for the need to increase potency faster than would be usually expected.

Training as a St johns first aider at the age of 18, I have attended to many accidents and injuries and feel confident treating and caring for people whilst in my care over the years.

I have been a “rugby mum” since my daughter started playing when she was 7 years old.  Over these years I have had to deal with her many injuries which have been sustained on and off of the pitch.

My daughter sustained many injuries, which I am pleased to say that most of them were minor injuries, but she did suffer a head concussion, which I now know was not dealt with correctly at the time during the match.

As a mum, I trusted what the team medic told me and nothing more came of it, until hindsight and experience stepped in and a few connections started to be made in the months following the injury.

Fast forward a little and Homeopathy came onto my horizon. I started studying it and incorporated it into daily life and it soon became the first port of call for any symptoms arising for my family, on or off of the pitch.

In October 2019, during a very cold and sideways rain, evening match, my daughter Rebecca, was stretchered off of the pitch with a suspected broken hip. She was in immense pain and the club medics were pretty much useless. As she lay on a stretcher in the cramped changing room corridor waiting for the ambulance to arrive, I grabbed my little blue kit from the car.

I started giving her Arnica Montana, Bellis Perennis, Ruta Graveolens, Hypericum etc, much to the distrust of the team medics, who tried to stop me administering those little magic pills, “She is my daughter and I will give her these, I will not see her suffer due to your ignorance” I shouted frustratedly at them.

Thankfully the ambulance arrived and we were taken to the nearest accident and emergency. By this time the Homeopathic remedies were working their magic and my daughter refused the morphine offered by the nursing staff.

She continued using the homeopathic remedies throughout the night whilst being treated and on her discharge from hospital and eventually made a full recovery and is now the South Bristol Girls Rugby team under 12’s coach. Thankfully a non- playing role.

The reason why I felt compelled to write this story is due to my son Archie, who on the other hand, has suffered 3 major concussions in less than 4 years, whilst playing rugby, the sport he loves. The most recent one in December 2022, which resulted in his early retirement at 16 years old from the sport and a huge transitional trauma from being a “rugby lad” and part of his schools Rugby Squad, to a teenager who cannot play any contact sport at all

Head Injuries in Rugby and the Role Homeopathy Can Play

As a mother, I have always been proud of my Son’s passion for rugby. Watching him on the field, I knew that he was giving it his all, chasing his dreams of becoming a 1^st team rugby player. However, those dreams came crashing down when he suffered his third head concussion during a match, on a cold and wet Sunday morning.

The weeks following the injury were a blur. I remember taking him to the hospital, and sitting anxiously by his side as doctors ran tests and monitored his condition. A brain bleed was suspected and we anxiously waited the scan results.

The diagnosis was a severe concussion, and the doctor advised us that it would take time for him to recover. My son was in pain, and I felt helpless as I watched him struggle with symptoms such as headaches, dizziness, and sensitivity to light.

As he started his recovery, it was apparent that rugby was no longer an option for him anymore. The doctor advised against any contact sports, and it was a difficult decision to accept. My son had always loved rugby, and the thought of giving it up was devastating to him. We had to sit down and have a tough conversation about the potential long-term effects of concussions and how important his health and safety was.

It was tough for my son to come to terms with the fact that he could no longer play rugby. He had to find new hobbies and ways to stay active without putting himself at risk. It was a tough adjustment, one in which we are still coming to terms with.

As a family, we also had to deal with the emotional impact of the injury. It was difficult seeing our son go through such a traumatic experience, and it took time for us all to process the event.

He had to have several weeks off from school, a pretty low-key Christmas, with minimal excitement and screen time. His reading was limited and so was his revision and homework, which all had to stop, and all of this when he should have been revising for his upcoming exams.

Archie loved going to gym for exercise and this too had to stop completely.  At 16 his body was flooding with hormones and all that comes along with them, the gym was somewhere that he felt good and released the normal stresses and strains that a 16-year-old boy suffers from. It was a tough few months for us all as a family.

His personality change was devastating and we all struggled to cope with the new uncaring, angry young man who stood in front of us. He was frustrated and hurting and his normal releases were taken away from him. In the end, my son’s health and safety were more important than his rugby career. Although it was difficult, we learned to adapt to the new reality and support him in finding new passions.

As a mother, I am proud of my son for his strength and resilience in the face of adversity, and I know that he will continue to chase his dreams in new and exciting ways. His head injuries have led me to investigate the condition further along with the different treatment options and recovery prognoses that modern medicine and Homeopathy offers.

The following pages are only a small selection of the information available regarding this type of injury, but you have to look for it, it is not freely given by the medical establishments.

 Homeopathic help for Head Injuries in the Acute Phase

As with all other conditions, homeopathy believes in getting to the root of the issue and not just treating the symptoms which arise. There have been cases reported where the patient had severe concussion symptoms, was then given homeopathic remedies which resulted in the complete cure of symptoms.  There are specific remedies in the acute phase of head injuries and the later chronic phase.

In the initial acute phase, some of the commonly given remedies include Aconite, Arnica, and opium. They are aimed at stimulating recovery and should be given immediately or as soon after the injury has happened. This is where a glove box homeopathic kit can make all of the difference.

The last concussion suffered by my son was not recognised until some 20 to 30 minutes after the incident. In this case he was kicked in the jaw, in an upward motion during a tackle. He asked his coach if he could come off as he did not feel right. Unfortunately, the coach did not remove him from play and he continued to play for a further 20 minutes.

As the team photographer, I was at the try line, some 60 yards or so away from him, and noticed that my son was continually blinking and seemed dazed. This got the alarm bells ringing for me and I rushed to his side. The first aider and coach had both spoken to him but were not concerned, but as a mum, I knew something was wrong.

Helios Family Homeopathic Kit

I sent my husband to fetch my Helios homeopathic kit, affectionately known as the “little blue kit” from the car along with a 200c potency first aid kit which is also stored in the car.

I started administering remedies straight away. First off was Aconite, used when the patient is restless and panicky with the fear of death. Followed by Arnica, Arnica montana is the most frequently used homeopathic medicine for concussions. The medicine can be given for any head trauma with bruising, swelling, or pain.

The patient may seem shocked or dazed, denying that anything is wrong and asking to be left alone, my son was denying help and claimed to feel well, but I knew him better. Because I feared a concussion had happened and the number of nerve endings which can be affected within the brain, I gave him hypericum next. I continued dosing him with the remedies over the next hours.

He seemed to be ok and I was relieved that the remedies had worked well and he was feeling better. He did not want to go to the hospital and at that point, I had no concerns to warrant spending several hours in the accident and emergency department and causing further stress to my son.

How wrong was I

At that time there was a nasty Strep throat infection doing the rounds in the local area, my daughter succumbed to it and then so did Archie. It was a worrying time as Archie has always suffered with delusions during a fever and can become uncontrollable.

It was difficult deciding which symptoms were due to the Strep throat and what may be due to his head injury. I treated the foremost symptoms as they arose. I slept next to him and checked him regularly throughout the night.

The following day his symptoms grew progressively worse. He was suffering from a headache, he had photophobia, a fever, feeling faint headed, and feeling sick. We set off to Bristol Royal Infirmary’s accident and emergency department.

By this time my son was a little unsteady on his feet, and at 6 foot 4 inches and 15 stone, I needed to get him there safely. We managed to find a porter wheelchair inside of the hospital and my daughter wheeled him in whilst I tried to find somewhere to park.

We spent the next 8 hours wheeling him to and from various departments for assessments, scans and tests. A doctor suspected that he had a bleed on the brain and more tests followed. Several hours later and the scan results thankfully showed no brain bleeds and we were sent on our way.

I was given a basic leaflet regarding head injuries with the advice of resting for 48 hours and giving him paracetamol if he had a headache. That was it, no advice about seeing our family doctor, no advice about no screen time, no advice about any possible emerging symptoms which can and do happen.

We returned home and the very long recovery started, I slept next to him for the first week as he would still be disorientated, especially when getting out of bed during the night. The following weeks were very difficult. Trying to stop a 16-year-old X-box addict from not having ANY screen time, which included his X-Box, Mobile phone, TV, games consuls etc.

No going to his mates house for a game of football. Not being able to even go for a walk with him to relieve his boredom or read a book. It was torture for both of us. I felt like a caged animal, so could completely appreciate the frustration that Archie was feeling.

He gradually returned to school several weeks later on a reduced workload and selected timetable, but he still had to have reduced screen time at home and rest was still needed.  He received various homeopathic remedies as needed over the coming months, but he was still nowhere near the normal loving and caring personality of his, which he had prior to this concussion.

Not one paracetamol passed his lips and his physical symptoms were all but gone, but the mental and emotional side still needed a lot of help.

During a conversation with one of my tutors, Robert Duddell about Archie, a few remedies were discussed which prompted a more thorough investigation.  In the chronic phase of a concussion injury, there are many remedies listed in the Materia Medica, some of these remedies can help in managing the long-term implications of the damage sustained. These symptoms can sometimes take days, weeks or even months to start to show after the initial injury.

Key Remedies in the Treatment of Head Injuries

There are many remedies listed in the Materia Medica’s which fit the head injury and concussion symptom picture, some of major ones are:

Arnica montana:  This is the most frequently used homeopathic medicine for concussions. The medicine can be given for any head trauma with bruising, swelling, or pain. The patient may seem shocked or dazed, denying that anything is wrong and asking to be left alone.

They may refuse to be examined or touched. They can be sleepy, going in and out of a stupor. If they are asked a question, they will answer correctly, then go back to sleep. The face may be hot while the rest of the body is cold. This can be used for someone suffering from the chronic after-effects of a head injury – they can be spacey and seem disconnected from the world around them.

Belladonna: Following a Head injury with Brain inflammation. Symptoms of this remedy include fever, severe throbbing headache, flushed face, stiff neck, heat in the head, nausea, drowsiness, convulsions, vomiting and they may bore their head into a pillow. It has been shown to have a marked action for the Preventive treatment of post-traumatic epilepsy following brain injury.[xxiv]

Cicuta Virosa: Childish, at times imbecilic behaviour after a concussion. Convulsions and dizziness. This is a major remedy for a head injury that is followed by seizures. Violent convulsions with distortions of the limbs, bending of the head, neck, and spine backwards are the most prominent feature indicating this remedy.

Other significant symptoms can include frothing at the mouth, rolling of eyes upwards, and dilated pupils. It has been noted that a spasm begins in the head and travels down the body into the limbs. Prolonged unconsciousness can follow an episode of convulsions. There is extreme weakness following the convulsions. The convulsions can be triggered by noise, and visual disturbances as a result of head injuries. This was a key remedy to Archies recover from a previous head injury.

Conium Maculatum: Vertigo is a key note of this as a head injury remedy. In these cases, vertigo gets worse with eye movement or when turning the head sideways. Loud noises, along with lying down and turning in bed may also worsen vertigo.  Vertigo with an inclination to fall sideways is also treated well with this remedy.

Hypericum:  The person will have convulsions immediately after the head injury. Chronic mental changes and headaches can be persistent after the injury. This is a major remedy for the effects of spinal contusions, usually involving the bruising of the spinal cord. The person can complain of pins and needles sensation later on.

Helleborus:  The person seems to shut down since the injury, they are numb with little reaction to pain or pleasure. For chronic mental dullness, slowness and confusion after head injury. The person seems stupefied, answering questions slowly, if at all. Their awareness of their mental limitations may be frightening to them.

Hyoscyamus:  The person becomes talkative, and excited, they laugh inappropriately, and in rare cases, has muscle spasms or even epilepsy. They can feel light and confused. Their brain feels loose, with pulsating within the brain. They have dilated pupils.

Natrum Sulphuricum: For the after-effects of concussions. While several symptoms typical of post-traumatic brain damage may be seen in this remedy such as cognitive thinking, concentration, memory changes, dizziness, vertigo, convulsions, tinnitus.

The personality changes are most characteristic of Natrum Sulphuricum is that the person shows irritability, confusion, and especially depression, even suicidal thoughts.  The symptoms are worsened in wet or damp conditions.

Natrum muriaticum: This person becomes sad or withdrawn, they can have a chronic headache that is worsened when out in the sun and develop a dislike for salt.  Being at the seaside can make these symptoms improve or worsen dramatically.

Opium: For stupor or coma following head injury. The breathing tends to be rattling or snoring. Pupils are constricted. The face is bloated and flushed. Reflexes may be almost absent.

Helleborus to the rescue

A good read through of the symptom pictures of the mentioned remedies and a gradual elimination of some of them led me to read more on Helleborus.

As homeopaths we all have a collection of books in which we draw our knowledge from, some of us collect homeopathic books, like a fine wine, just waiting to be read when the time is right and others may use an electronic reporatory or have a handful of well-read Materia Medica and repertory’s. Myself, I like to think I am more of a collector, some I have read several times and others I pick up at random times when the mood takes me.

Of all of the many books I have, I do like Roger Morrisons, Desktop guide to keynotes and confirmation of symptoms. I find this particularly useful when a few remedies come to mind, and as the book says, you need confirmation to whittle it down to which one fits the best.

Roger Morrison M.D. , writes in his book  Desktop Guide to Keynotes and Confirmatory Symptoms that –

“Helleborus produces stupefaction in all of its complaints, whether a migraine which produces a temporary dullness of mind or in organic brain conditions. The stupefaction as Hahnemann described it is a state “where with sight unimpaired, nothing is seen clearly; with hearing perfectly sound, nothing is heard distinctly” The patient seems cut off from the world and from his own thoughts and perceptions. He answers slowly and with great difficulty. Memory and concentration are almost paralysed. At times he feels almost no emotion; indifferent to the surroundings. At other times this state may be terrifying and the patient feels as if something indescribable and catastrophic is happening to him. Also, there may be great remorse and guilty feelings”.[xxv]

Some other keynotes of this remedy include–

Mentals

• Stupefaction and mental dullness
• Mind Slow, answers slowly and with great effort
• Memory weak, can hardly remember what was said to him.
• Mind is completely blank with almost no thoughts passing.
• Concentration difficult.
• Mental dullness with headache.
• Guilty feelings and remorse. Even suicidal feelings because of his poor performance.
• Apathy and indifference.
• Anguished state; cannot comprehend what is happening; begs for help.
• Wild, whirling sensation in the brain.
• Must concentrate continuously on his activity or “his hands forget what they were doing”

Head

• Head injury with mental dullness and confusion. Concussion.
• Headache with stupefaction.
• Occipital headache ameliorated on closing the eyes.
• Staring, vacant look.[xxvi]

In Robin Murphy ND Natures Materia Medica 4^th edition under Helleborus Niger it states the following symptom picture (page 957)

Clinical

• Brain Disorders
• Concussions
• Head Injury

Homeopathic

• Low states of vitality
• Sensorial depression
• Muscles do not obey the will

Mind

• Sensorial apathy and constant thoughtless staring at one spot, alternating with unintelligible muttering.
• Indifference to loved ones, relations.
• Indifference to pleasures.
• Indifference to everything.
• Fixed ideas. Just sits and says nothing, does nothing.
• Involuntary sighing
• Picks at lips and clothes.

Eyes

• Photophobia without inflammation.
• Pupils are fixed and dilated

Head

• Concussion of the brain from a blow on the head (after ARNICA has failed)[xxvii]

Rubrics used during the Repertorisation.

Some Rubrics taken from Robin Murphy Meta Reporatory 4^th edition

Page 13 Mind-emotions, anger from interruption.

Page 15 Mind- emotions, answers, confusedly, as though thinking of something     else

Page 16 Mind-emotions, answers, reflects, long.

Page 16 Mind-emotions, answers, repeats, questions

Page 16 Mind- emotions, answers, stupor returns quickly after

Page 77 Mind-emotions, delusions, doomed, being

Page 109 Mind-emotions, dullness, says, nothing

Page 110 Mind-emotions, dullness, understands, questions only after repetition

Page 166 Mind-emotions indifference, family, to his

Page 166 Mind-emotions, indifference, loved, ones, to

Page 266 Mind-emotions, thoughts, vanishing, of

Page 537 Brain, concussion, ailments from

Page 537 Brain, Concussion, ailments from mental functioning’s altered.

Page 734 Eyes-vision, photophobia, light sensitivity

Page 740 eyes-vision, pupils, dilated

Page 1083 Head-headaches, concussion, ailments, from

Page 1084 Head-headaches, concussion, ailments after

Page 1084 Head-headaches, concussion, ailments after[xxviii]

Prescription

After a careful case analysis, and investigation, Helleborus was decided upon. Archies symptom picture ticked so many boxes of this remedy, there was no close contender.

At this point, my sons high energy and destructiveness needed help and it needed it fast. I wanted to give him an ascending dose, which under normal circumstances I would have spaced out over several weeks, but this called for a fast-track option. This required urgency, he was in self-destruct mode and we were all at the end of our tethers.

I gave him a split dose, one at night and one the following morning. I started at 30c, then the following day 200c, followed by 1m and then 10m all in the space of 5 days.

The outcome

The personality change was remarkable, within a week or so a noticeable change had started and it was now a joy to be around him, instead of cringing every time I heard his footsteps approaching, as I knew it would end in an argument between us.

My lovely caring son started to appear once again. His mood swings, headaches, anger, and indifference all started to melt away. He could concentrate more and would engage with the family once again in a positive and calm manor.

There is still some way to go to return him to full mental, emotional and physical health, but I know that homeopathy will achieve this in a safe and gentle way. He is doing well in his exams and he is back training at the gym. Unfortunately, we did have to make the decision to officially retire him from rugby which was an extremely emotional and difficult time for us all, but he does now understand why we had to make this decision and has accepted it.

He is hoping to continue with his team in other roles, maybe taking over from me as the team photographer? Who knows what the future holds for him, but at least he has a future now, which at one point looked uncertain, disastrous and full of problems.

Homeopathy has healed and saved many lives in my family, human and animal and to watch Helleborus melt away the concussion injury and the symptoms it threw out is a wonderful thing to see. I now have my loving son back.

If only I had learnt more about homeopathy long ago and studied it fully before having my children, then many childhood diseases and accidents could have been rolled back or erased instead of being covered up with some paracetamol and a plaster as is the modern medicine way.

Behaviour changes from head injury or autism spectrum disorder?

This more recent concussion and the subsequent personality change do however lead to more questions regarding reported behaviour changes in children.

During my research I came across many articles with comparisons of symptoms which could be an autistic spectrum disorder or a brain injury, and it was not until reading the articles in full some times that I discovered just how similar these conditions can present themselves with such frightening similarity.

How many children are suffering from a Brain injury that has gone undiagnosed, due to the parents not being aware of the injury or its symptom picture and its significant behaviour changes?

How many of these children have fallen off their bike, fell out of a tree whilst playing, taken a headshot from a football whilst playing with friends or headed the ball during a football game?

These innocent activities along with many other causes can all factor in when it comes to a brain injury, and yet most will be brushed off with some paracetamol and a little rest and maybe an ice cream to sooth the tears away.

It is only when, following this injury, the child becomes indifferent, closed, off, uncaring, disruptive, unmanageable, aggressive or unable to concentrate at home and in school, and the parents are advised to get them assessed for a spectrum disorder.

Some of these children are confirmed as being on the spectrum and then labelled with this disorder, sometimes they may receive additional help whilst at school and some receive medication to ease their symptoms or calm them down. But how many of these behaviour problems could have been caused by a head injury and misdiagnosed and mistreated?

According to the National Health Service (NHS) in the UK, around 1 in 10 children and young people aged 5 to 16 years old have a diagnosed mental health disorder. Behavioural disorders such as attention deficit hyperactivity disorder  (ADHD) and Conduct Disorder are among the most common mental health disorders diagnosed in children and young people in the UK.[xxix]

Traumatic Brain Injury and Autism: Is There a Link? (Understanding Similarities and Treatment)

Is there a link between Traumatic Brain Injury (TBI) and autism? Can a brain injury cause autism?  While many symptoms of TBI and autism overlap, there is currently no evidence to suggest that a brain injury causes an increased risk of autism.

However, because the two conditions are so similar, some of the interventions used to manage autism may also be helpful for TBI patients.[xxx]

Paediatric traumatic brain injury (TBI) and autism spectrum disorder (ASD) are two serious conditions that affect youth. Recent data, both preclinical and clinical, show that paediatric TBI and ASD share not only similar symptoms but also some of the same biologic mechanisms that cause these symptoms. Prominent symptoms for both disorders include gastrointestinal problems, learning difficulties, seizures, and sensory processing disruption.[xxxi]

TBI and ASD share many of the same characteristics. They both cause deficits in social judgments and communication skills and problems with regulating behaviour. Other similarities between brain injury and autism include:

• Anxiety
• Balance and coordination problems
• Reduced muscle strength
• Impaired executive function
• Seizures
• Language disorders
• Attention problems
• Difficulty interpreting body language
• Sensory processing disorders

There are also several differences between TBI and autism though. For example, a frontal lobe injury often causes problems with empathy and self-centred behaviour.  However, contrary to popular stereotypes, most people with autism do not lack empathy. They just struggle with social norms.

Because autism and brain injury do share so many characteristics though, the interventions used to treat autism can be helpful for brain injury patients, and vice versa.[xxxii]

It is important to note that these statistics are based on diagnosed cases and may not reflect the full extent of behavioural changes among teenagers in the UK, as some individuals may not seek help or receive a diagnosis. Additionally, these statistics may have changed since writing this, as mental health issues are a dynamic and evolving field of study.

It is very concerning that potentially so many children may still be suffering from a head injury which could effectively be eased with homeopathic treatment, but who have now been diagnosed with a spectrum disorder.

So, the next time a child with behaviour issues comes into your clinic, just bear in mind that you are an unprejudiced observer. A disease label is not necessarily needed, nor correct or useful to analyse the full case,  and that this child may not have one of the spectrum disorders in which his guardian seeks your help, but may in fact be suffering the after-effects of a head injury.

If in doubt, Check them out!

My Son Archie.

Following a serious concussion sustained during a rugby match, showing clear signs of a brain injury. Dazed, confused and indifferent.

A poem for my Son, Archie Ridler. Once a boy, strong and swift on his feet His passion was rugby, his sport, his heartbeat But one fateful day, a collision so harsh Left him with a concussion, his dreams left in the marsh. The game that he loved, now a distant memory His anger and frustration, a painful legacy But hope still remained, in the form of homeopathy To help him recover, in a safe and gentle way. Arnica was the first, to soothe his pain and bruising Belladonna, to calm the fever that was rising Hypericum, to ease the nerve damage he sustained Helleborus, for the confusion and dizziness, to be tamed. Natrum sulph, to heal the emotional wounds he bore And slowly but surely, the boy began to restore His anger and aggression, giving way to love and care A loving son once again, with his family to share. Homeopathy, a gentle yet powerful aid Helped him recover, from the injury he’d sustained The boy, now a man, with a heart full of gratitude For the remedies that healed him, his journey of recovery renewed.

References

[i] https://www.pngkit.com/view/u2w7u2r5a9t4r5t4_neck-pain-from-sports-rugby-silhouette/

[ii] https://commons.wikimedia.org/wiki/File:Concussion_Anatomy.png

[iii]  McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847

[iv] https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097699.full.pdf

[v] https://www.britishequestrian.org.uk/assets/EXTRA_Docs/BEF_concussion_guidance.pdf

[vi] https://broadviewhealthcentre.com/3-different-types-of-concussions-you-need-to-know-about/

[vii] Centers for Disease Control and Prevention. (2021). Concussion Signs and Symptoms. Retrieved from https://www.cdc.gov/headsup/basics/concussion_symptoms.html

[viii] Fann, J. R., et al. (2015). Psychiatric outcomes in long-term survivors of traumatic brain injury. Journal of Neurotrauma, 32(5), 311-318.

[ix] Iverson, G. L., & Lange, R. T. (2019). Examination of post-concussion-like symptoms in healthy university students: relationships to mood states and cognitive performance. Journal of the International Neuropsychological Society, 25(2), 191-198.

[x] McInnes, K., Friesen, C. L., & MacKenzie, D. E. (2017). Mild traumatic brain injury (mTBI) and chronic cognitive impairment: A scoping review. PloS one, 12(4), e0174847.

[xi] Centers for Disease Control and Prevention. (2021). Concussion Signs and Symptoms. Retrieved from https://www.cdc.gov/headsup/basics/concussion_symptoms.html

Fann, J. R., et al. (2015). Psychiatric outcomes in long-term survivors of traumatic brain injury. Journal of Neurotrauma, 32(5), 311-318.

Iverson, G. L., & Lange, R. T. (2019). Examination of post-concussion-like symptoms in healthy university students: relationships to mood states and cognitive performance. Journal of the International neuropsychological Society, 25(2), 191-198.

McInnes, K., Friesen, C. L., & MacKenzie, D. E. (2017). Mild traumatic brain injury (mTBI) and chronic cognitive impairment: A scoping review. PloS one, 12(4), e0174847.

References continued

[xii] https://www.englandrugby.com/dxdam/fc/fc36ddd4-fa06-413e-865a-3fb1d7c15926/HEADCASE%20EXTENDED.pdf

[xiii] https://www.englandrugby.com/participation/playing-concussion-headcase

[xiv] International Olympic Committee. (2017). Consensus statement on concussion in sport – the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838-847.

[xv] https://www.world.rugby/handbook/regulations/concussion-management

[xvi] Welsh Rugby Union. (2022). Head Injuries. Retrieved from https://community.wru.wales/player-welfare/concussion

[xvii] Scottish Rugby. (2022). Concussion. Retrieved from https://www.scottishrugby.org/safety/concussion/

[xviii] Rugby Football Union. (2022). Concussion. Retrieved from https://www.englandrugby.com/participation/playing-concussion-headcase

[xix] https://www.englandrugby.com/dxdam/fc/fc36ddd4-fa06-413e-865a3fb1d7c15926/HEADCASE%20EXTENDED.pdf

[xx] https://www.englandrugby.com/dxdam/fc/fc36ddd4-fa06-413e-865a-3fb1d7c15926/HEADCASE%20EXTENDED.pdf

[xxi] https://www.englandrugby.com/dxdam/fc/fc36ddd4-fa06-413e-865a-3fb1d7c15926/HEADCASE%20EXTENDED.pdf

[xxii] https://www.englandrugby.com/dxdam/c5/c5165a8d-66cd-4da4-99f6-407e306d912e/RugbySafe%20Essential%20Guides%20and%20Templates%20(FINAL).pdf

[xxiii] https://www.nhs.uk/conditions/head-injury-and-concussion/

[xxiv] Popek K. Prevence posttraumatické epilepsie po tĕzkých zranĕních mozku. Zavĕrecná zpráva o plnĕní dílcího úkolu státního plánu výzkumu za pétileté období 1965-1969; k publikaci upravil akad. Z. Servít [Preventive treatment of post-traumatic epilepsy following brain injury. Closing report summarizing results of the research done in the framework of the state research plan for the years 1965-1969; edited by Z. Servit]. Cesk Neurol. 1972 Jul;35(4):169-74. Czech. PMID: 5044144.

[xxv] 1. m.d, Roger Morrison. Desktop guide to keynotes and confirmatory symptoms. california : Hahnemann clinic publishing, 1993.

[xxvi] m.d, r. m., 1993. Desktop guide to keynotes and confirmatory symptoms. california: Hahnemann clinic publishing.

[xxvii] Robin Murphy ND, Natures Materia medica, 4^th edition, 2020. Lotus health institute, virginia.

[xxviii] Robin Murphy ND, Natures Materia medica, 4th edition, 2020. Lotus health institute, virginia.

[xxix] https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/symptoms/

[xxx] https://www.flintrehab.com/tbi-and-autism/

[xxxi] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198096/

[xxxii] https://www.flintrehab.com/tbi-and-autism/