I understand, the problem i see with that line of argument is say i could demonstrate that difference age groups had different incidences of WADs, should we take that into account too?
Oh, I agree, and I don't discriminate (though I do enjoy the odd game of devil's advocate); IIRC the increased incidence is statistically significant, but relatively minimal.
I'm not aware of an increased incidencde on race, creed, socioeconomic background etc, only gender. There are increase incidence of insurance claims for younger age groups and for lower socioeconomic groups; but not (as far as I'm aware) for incidence.
Please also note, I was interjecting your conversation with Old Hooker; not TallShort
Perhaps I am seeing something in the video differently from how you are seeing it. There is a single frame in the video which show the referee's head back at a large angle
If the red arrow points to her hairline and the yellow arrow ponits to her chin, then her head has been snapped back close to, perhaps even beyond 90°. That looks a lot like a severe hyper-extension to me, and it happened quickly.
Perhaps I am not making myself clear.
If you were the medic attending this referee, would you be looking for signs of concussion more so that if you were attending her for a leg sprain or a pulled hammie?
Yes, there are signs of hyperextension - which is relevant to whiplash, not concussion; I've gone through the (poor quality) video "frame" by "frame" and she's (appears to be) face-front all the way through, so no rotational element, she's (within reason) in control of her body and brings her arm up to break her fall to the ground; and whilst there are legs in the way for some of it, the way her hair whips around, and what we can see of her landing implies minimal to no head trauma with the ground.
For a straight hyperextension whiplash with no other risk factors (history, rotation, head trauma etc) to cause any concern of concussion at all, you'd be looking at a grade IIB WAD; which is the lowest grade to include ANY psychological/neurological effects; and which are the sort to manifest later, rather than immediately; you're up to grade III WAD before you get anything psychological/neurological that you'd have a chance of picking up pitch-side; and by that time you're calling an ambulance, and not performing an HIA.
If I were treating that ref, based purely on that video; I would not be conducting an HIA unless something from examining her for whiplash showed me physchological or neurological symptoms, and assuming that her past history is clear of previous head trauma. There would be need.
My nephew's Rugby League playing days ended when he was blind-sided by a shoulder charge in the back. There was no head impact, just the hyper-extension of the neck. He played on but then collapsed a few minutes later. He was later diagnosed with a concussion caused by the whiplash. That was about 10 years ago when he was in his early 20's and he still suffers from severe migraines, vertigo-like dizzy spells and and the occasional neck spasm, nione of which he ever had before. It has severely impacted on his life.
I feel sorry for your nephew. given those symptoms I would be amazed if there was no rotary element in his neck during the whiplash; I also wouldn't be too surprised if there was had trauma that he didn't remember, or even LOC that he didn't remember.
Severe migraines, vertigo, and neck spasms are all signs of whiplash by the way; don't fall into the trap that because there's concussion that all his symptoms are because of concussion.
Of your nephew's symptoms:
Collapse can be a sign of concussion or whiplash; given a 10 minute delay it's (much) more likely to be a symptom of whiplash; though I'd need a lot more information on it before labelling it either way (eg; are we talking collapsed in pain; collapsed with LOC; collapsed with fitting - I'm not asking you to answer these for your nephew; just giving examples of questions that would need answering).
Migraines can be caused by concussion, they can also be caused by whiplash; they are frequently mid-diagnosed as people (including Dr.s) get really lazy with headache terms' about 15% of my patient baseis "migraines" that are actually cervicogenic headache.
Vertigo is an unusual symptom for concussion, but it does happen - it's a common symptom of whiplash, especially the; it would need a neurological examination to determine whether it's true vertigo, or vertigo-like dizzyness (which is usually cervicogenic).
Neck Spasms are not a symptom of concussion, but very much a symptom of whiplash.
TBH, from your description (which was nowhere close to a 90 minute consultation with the patient, complete with examination) my working diagnosis for your nephew would be Grade III WAD, possibly only Grade IIA dependant on the answer to some questions and examination. From your description alone, I wouldn't even diagnose concussion at all (though nor would I rule it out).
As your blog posts of Paige Decker show, whiplash and concussion feed in on each other; and treatment* for concussion will make no difference to whiplash, whilst treatment for whiplash should relieve the concussion symptoms caused/aggravated by whiplash.
Regardless of whether concussion forms part of the diagnosis or not, I would certainly be getting him phsyical therapy (physiotherapist, chiropractic or osteopathy; possibly even massage or acupuncture). Treat the whiplash, then whatever symptoms are left can be put down to post-concussion syndrome (or still unresolved whiplash). Paige Decker's blog most definitely agrees with me here.
* As of the last time I researched, there was no treatment for concussion; just a list of things to avoid, and let time happen. There is pharmacological treatment for some of the symptoms however, but that's symptom management, not treatment.
ETA: Please note, information is getting a little personal here, and my first thought was to take it to PM - I've decided not to, as many of us are sports(wo)men; and the information could easily be relevant to someone reading this and in a similar situation