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Doctor Martin Hadler, the All Blacks and Concussion

Oct. 30, 2017


What do Martin, the All Blacks and concussion have in common? Quite a lot, actually.

On 16th September Martin was one of the Match Day Doctors at the North Harbour Stadium for the All Blacks vs South Africa game. Sitting next to the 3rd Referee, with a series of screens in front of him, he was able to pick up the head injury Liam Squires sustained and along with the rest of the medical team he ensured that Liam's safety was paramount, pulling him off for concussion screening.

That was Martin's debut as a Match Day Doctor for an All Black game, and the Medplus team couldn't have been more pleased and proud of him had he been called up to play.

Martin has had a long involvement in sports and sports medicine, and he combines it all with his passion for rugby. Back in the day, as a junior doctor in Palmerston North, he used to accompany his boss to manage medical problems at Manawatu Rugby Union games and his interest in sports medicine was born. He subsequently used his skills in emergency medicine to set up the medical support for New Zealand Iron Man events, having become involved through his marathon running.

More recently Martin has been involved with North Shore Rugby Club, and for the last 3 years he has been their honorary doctor. Martin really enjoys his relationship with the club, and he highly rates the club as being family friendly, offering rippa, touch and opportunities for girls. Over winter, Martin spends most of each Saturday at the club, firstly proudly watching his son, Elliot, play in the juniors, and then being on hand as the doctor for the Premiers and Reserves games later on in the day. Whenever Martin is there on duty he has a Medplus flag up on the side-line, so everyone knows he is there to offer medical assistance for injuries.

In July he was delighted to accompany the North Shore Leavers rugby tour of Samoa, going as a team doctor to over thirty 13-year-old boys and twelve parents.

When asked about the huge amount of time and energy he commits to the rugby club, he is very humble, and says it combines his favourite things: - his family, the local community, rugby and sports medicine. He is certainly a good sort, who freely supports all kinds of community activities. He has also been involved in providing free CPR training not only at the Rugby Club but at North Shore United Soccer Club and at local schools.

Martin has also become the Match Day Doctor at North Harbour Stadium for the Mitre 10 Cup games. The NZRU takes concussion very seriously, and whilst all provincial clubs have their own doctors, the independent Match Day Doctor attends to ensure that players with potential concussion are taken off and to perform or oversee the concussion tests. Initially the head injury assessment is done on an app, and the results are immediately sent off to Wellington to ensure there is no premature return to play. A second head injury assessment is done after 2 hours, normally by the team doctor (Dr Lynn Coleman if it is a Harbour Player), and then a third assessment is done after 48 hours, often by a GP.

At club rugby the process is not so formal, however the referee can give a Blue Card – ensuring a player with a head injury has 3 weeks off the field. Players are told to seek medical attention that day and then to see their GP within 48 hours. This will be covered by ACC. It is hard to know if everyone injured follows through on the advice.

What is a concussion anyway? A concussion is an injury to the brain that results in temporary loss of normal brain function. It usually is caused by a blow to the head, causing the brain to shake within the skull. Often there is no bruising or visible signs of trauma on the outside. It is a common misbelief that concussion cannot happen without a loss of consciousness – it frequently does.

People with concussions often cannot remember what happened immediately before or after the injury and may act confused. A concussion can affect memory, judgment, reflexes, speech, balance and muscle coordination. Match Day Doctors like Martin, look to see how people fall after a head injury, did protective reflexes kick in to protect them or did they just drop to the ground? How long does it take them to get up, are they staggering, what is their gait like? Do they know what to do, do they go back to their correct position?

Even mild concussions should not be taken lightly. Neurosurgeons and other brain-injury experts stress that there is no such thing as a "minor concussion." In most cases, a single concussion should not cause permanent damage. A second concussion, soon after the first one, does not have to be very strong for its effects to be permanently disabling or deadly. This is the rationale for a stand down period of 21 days for adults, and 23 days for players under 19 years.

Hopefully the days of players being allowed or even encouraged to play on after a concussion are long gone. For those interested the NZRU offers some good advice about recognising concussion:

http://nzrugby.co.nz/rugbysmart/concussion

Concussion has become a major issue in sports but is especially an issue for rugby and American Football. There is a high incidence of dementia in former players of these sports and we are only just beginning to realise the long-term consequences of sports induced head injuries. It is good to see that AUT is leading the way on some international research in this field:

http://www.nzherald.co.nz/sport/news/article.cfm?c_id=4&objectid=11813831