Concussions in French Savate Boxing June 19nd 2018 - André MONROCHE State of play : Actions to limit the causes and consequences - Medigames
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Concussions
in French Savate Boxing
June 19nd 2018
State of play : Actions to limit the causes and consequences
André MONROCHE
Médecin Fédéral National Savate Boxe Française & DA
Responsable de la Com Med de la CFAMSC
monroche@sport-medical.org
What is French Savate Boxing ?
Laurent LAZARE and Virginie LESAURE
2
A FEW POINTERS
31.01.2018 : 760 clubs – 54703 licenciés
(15000 in 1990)
- 30% of women,
- 25% of juniors (less than 16 years old)
- 107 high level : - 1/3 of women
- 1/3 combats
NB : Averave career length of a French Savate Boxer
= 7 years
3
Definition of concussion
• [Concuction] Concussion = mouvement, shaking
• Role of meninges
• Axonal lésions difused by shear or compression (invisible on
RMI or classic scanners)
• Functional anomilies but non-strucural
• It is about disfunctionment (transitory) of cerebral functions
(VIDALIN – SFMES – Marseille september 2017)
4
1- Mesure the degree of gravity (1)
• Thourough interrogation, inspired through
Maddock’s score :
- At what stage are we ?
- At what round are we ?
- Who is your opponent ?
5
1- Mesure the degree of gravity (2)
• If coma : take necessary mesures : ensure
freedom of airways, placing a rigid collar,
applying the necessary reanimation
measures…
• Recall : Glasgow scale. Conscience rating
scale > 8 / 15 (opening of the eyes, verbal
response, motor response…)
6
2- Different amnesias
• Retrograde amnesia : memory impairment before the
shock (transitory if the traumatism is light)
• Anterograde amnesia : after the concussion. The lenght
of time depicts the severity of the CC
- < à 15 mn, C light grade I
- > More than 15 mn, C grade II
- Impossibility to retain all new information,
grade III
7
3- Other memory problems
• Short-term memory : only pertinent information is
retained
• Long-term memory : all that necessary for our
existence (moreover temporal lobes)
• Evocative memory « intuitive »
8
4 – Post-concussion signs of accompaniment
Headaches, trouble with balance, fatigue, intolerance
to noise, irritability, anxiet, attention spain of
memory, insomnia, reduction in alcoohol tolerance,
automation sensations (finishing a match without
remembering it)…
9
Concept of severity of new concussions
Second-impact syndrome (T. Beyet) in the days which
follow.
• Greater severity with subjects < 20 years and with
women, on a weakened brain (inflamatory vascular
lesions)
• Risk of major edema and of engagement syndrome.
10Long-term risks
• Pugilistic dementia, Alzheimerisation, cronic
encephalopathie post traumatic
• Notion of secretion of beta amyloïdes and of
tauproteins (neuro-transmission)
Ref. : Cabanis E Alain et coll. – La boxe de combat, de la traumatologie à la prévention. Bull.
Acad. Nale., 2010, 194, n°7, 1219-1236, séance du 05 octobre 2010.
11Mike Borich, amateur, université,
42 years (2009)
overdose
Document présenté par le Pr. Ph. DECK à l’AG de la CFAMSC le 20 novembre 2013 à la FF de
Karaté
12Choice of simple tests both possible
and reproductive
(given the slightest doubt)
After an outofcombat neurological or after the
suspiscion of a cerebral concussion signaled by a
doctor or the team, do the neurologic-connexion
test as a base (TNB) from the Trail Making
Test ®
(combination of numbers and letters)
13Preventing complications
Once the diagnostic has been made :
• Gentle take up of the sporting activity :
- By Paliers
- After sufficient rest-time.
• The duration of stopping the practice of savate,
even during training can only be fixed after a new
examination after 48 hours of complete rest.
14The reality in French Savate Boxing :
• Five respondents on average since combat
competitions since 2005,
(Approximately 500 combats/year : 2,5 /1000)
15Declination : The Averages (1)
In the field
• The importance of the quality of arbitration
and material as well as medic relationships
• Training of the doctor on ring side with help
from a slideshow (downloadable)
• Neuro-psychologic consultation after 48 hours
of complete rest, that is once the concussion
urgence is treated
16PREVENTION
• In savate, as in all boxing in • In particular :
France, it has always been - osteo-joints,
the objectif - ophtalmic,
- dental,
- brain
• Especially in traumatology
17Declination : The Means(2)
• Medical Passeport notably with mentions and
results of TNB : started for SBF in 2013-2014
and revised in 2018.
• Telemedecine : examination of distance for
neurologists qualified with the access-code
throught INSEP start of 2017,
•Interfederal permit of combat currently in
progress with the Minister of Youth and Sports,
June 2018 (program ASKANAN).
NB : 100 autorisation demands per year to go to
other types of Boxing
1819
Preliminary observations
currently under validation (2018)
- Performance amelioration of TNB after
combats (mémorization ?)
- Same for left-handed people and women
- Detection of disruptions justifying immediate
medical advice increase in test time
Increase in test time
Linked featurs between bad numbers
20Thank you for your attention
27APPENDICES
2223
A few points de reference :
• American football : 1000 head injuries per year per
player
• Football : players often have 1500 head clashed per
year
• In rugby : 33% of players having had a CC stayed
on the ground
2425
Risques commotionnels en fonction des sports
aux Etats Unis (J.F. Chermann Congrès SFMES 2017)
2,5 2,34
Base ball
2
Basket male
1,47 Basket female
1,5 1,42
1,27 hockey
1,08 Foot male
1 catch
0,6 Foot female
0,5 Hockey glace
0,5 0,32
0,19 Foot us
0• Dans le football américain un joueur moyen reçoit 1000 coups à la tête par an… • Dans le football des joueurs font parfois 1500 têtes par an selon les positions. • 33% des joueurs ayant subi une C.C. et qui sont restés sur le terrain,
SPORTS LES PLUS TOUCHÉS EN FRANCE
• 10 % des CC surviennent au
• Hockey sur glace, cours de la PS
f o o t , r u g b y, s k i ,
boxes… • Les autres : AT, route, actes
criminels ou guerriers…
28Bibliographie :
Chermann J.F. : le KO le dossier qui dérange. Ed Stocks, 2010, 221 p.
Chermann J.F., Savigny A., Radafy A., Blandin N., Bohu Y. : Commotion cérébrale du
sportif de haut niveau. Etude prospective de 211 cas pris en charge en consultation
spécialisée. JTraumatol du Sport, 2015, http://dx.doi.org/10.1016/j.jts.2015.12.008
Chermann J.F., Vesselle B., Vidalin H., Deriaz H; Creste L., Peres G. Guérin M., Pieyre
C, Louquet J.L., Moktar A., Roman F, Boudenah R, N’Guyen M., Machin P., Le VanP,
Rollet M, Deroche F., Monroche A., Cabanis E.A., Calmat A. : Une affiche pour
sensibiliser les athlètes à la commotion cérébrale. Cinésiologie, 2011
Egoumides M. :Traumatologie des sports de combat. Conduite à tenir sur le terrain.
Sauramps Médical. Diffusion Vigot, 137 p.
Monroche A. : Risques inhérents à la pratique de la Boxe Française, Cinésiologie –
1999 : n°185-186, TP 111-117
Mezaache F., Bouquet S. : «L’essentiel de la boxe française», Ed Chiron – 2000 : 189 p.
Tisal H. : Pathologie des sports de combat pieds et poingts. Médecine du sport, n° 125,
novembre 2016, TP 9-18
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