6. Central nervous system injuries

In collision sports, severe, and sometimes unfortunately fatal, brain injuries and spinal cord injuries can occur (quite rarely, on the whole).

Concussion is a mild form of nervous system trauma, and may result in a loss of consciousness and memory problems after injury. Later, headaches, nausea and dizziness can follow, symptoms which are natural concomitants of concussion.

However, if the injury involves

• limb paralysis

• double vision or

• speech disorder

after the trauma, the injured person should be immediately given neurological care because these symptoms may indicate more serious brain damage (e.g. brain bleeding).

Likewise, if the athlete complains of a headache, and this headache

• occurs suddenly, and strikingly during strenuous activity,

• is a changed form of a previous ache, or gradually intensifies

• is associated with fever

• or with numbness

• or with a weakness in one side,

• or with double vision,

the person should immediately be referred to a doctor because the symptoms may indicate abnormal changes in the nervous system. Cerebral edema (fluid accumulation) can also be caused by a high-impact shock, and requires hospitalization because the increased fluid pressure can damage sensitive nervous tissue both mechanically and in its metabolic processes.

Great effort and high compression force acting on the vertebrae, can also cause spinal cord herniation (more correctly called spinal disc herniation), in the course of which the outer, stronger part of the intervertebral disc (Figure 10) weakens (or may also tear off), and the inner, softer tissue protrudes. The protruding part of this can exert pressure on the roots of the spinal nerves, so we can be dealing with this injury – which is in fact a cartilage injury – as a neural injury. The protrusion can also squeeze the spinal cord itself, which can produce even more serious symptoms (paralysis, loss of perception, disturbances of urinary- and faecal retention). Severe disc herniation that does not respond to drugs and physiotherapy should be surgically treated. People who are the most exposed to this are those who are overweight, and also those who rarely do sports, but when they do, do them with high intensity and perhaps without even warming up properly.

If lower back pain, developing for any reason, is accompanied by

• weakness in the foot, or

• difficulty in holding back or starting to pass urine,

then the injured person should be taken to the doctor as a matter of urgency because the body may be indicating a more severe injury to the central nervous system.

In high-speed, collision-threatening sports (such as racing, hang gliding, skiing) on rare occasions a transverse lesion to the spinal cord can occur, resulting in paralysis and loss of sensation of the body parts below the site of injury. To cure this extremely serious condition there have, in the past decade, been attempts which are very encouraging but still – at least in terms of general availability – in their infancy (e.g. Capogrosso et al. 2016, Wenger et al. 2016).