Iain Henderson on concussion: ‘I couldn’t even think of the simplest lineout call’

Ulster’s Iain Henderson suffered a concussion during the defeat by Munster at Thomond Park last week, suffering memory loss. It was the Ireland international’s first concussion and he immediately came off the field and didn’t return; Henderson was named yesterday in the Ulster team to face Connacht tonight.

He describes how the incident affected him and walked us through the Head Injury Assessment (HIA) protocols, writes Jim Stokes

Iain Henderson of Ulster leaves the field due to a concussion during the Guinness PRO14 Round 5 match between Munster and Ulster

Q:Walk us through the HIA process after your injury at Thomond Park.

A: There’s three HIA tests. One is done immediately after the incident, or if you have certain symptoms it’s not done. I wasn’t HIA1-ed. That’s the Head Injury Assessment you do when you come off the pitch for 10 minutes. They had decided on the pitch that I would not be continuing, so I didn’t do that one.

I did HIA2 which is post-game and is exactly the same thing, to see if your symptoms have alleviated or completely disappeared. Then HIA3 follows one full 24-hour rest period after the game, again to measure where your symptoms are, whether it be — and these are all symptoms of concussion — emotion, sadness, balance problems, dizziness, headaches, everything you would associate with a head injury.

Following that, you go into light exercise, which is sit on a spin bike for 20 minutes, then you report back after that on whether your symptoms are getting any better or worse or indifferent. Following that, the next day you go for a 2k run, and after the run you come back and get assessed on whether or not whatever symptom you had before, is it bothering you more or less, all that carry on.

Then you return to decision-making in training without contact, then you return to contact, and that takes up six days. So the other day, I was in decision-making.

Q:You can pass it in six days?

A: Yep.

Q: To clarify, HIA1 is only done if you’re returning to the game?

A: Yep. So you’ll get ruled out for a number of reasons, whether you’ve been knocked out or you’re showing certain symptoms.

Q: Did you make the call to come off?

A: I went into a lineout and went to call it and I just couldn’t remember any calls. Literally went into the huddle and I paused for 10 seconds. I think it was Andy Warwick asked ‘what do you want to call’ and I was just looking at the ground. I couldn’t even think of the simplest lineout call and I was just standing there, and Big Al O’Connor said ‘I think we’ll do this one’, and I went into the lineout and still couldn’t think of it.

The next break in play I said to Big Al ‘you’re going to need to call these lineouts because I can’t remember any of them’ and he said ‘there’s no point in you going on if you’re like this’.

In my head I was fine to go on, but that’s probably something that’s good from Big Al because he’s had a good few concussions in his time, so to have the support of, at the time, my captain and whoever else around you could be supportive, just to say there’s no point in you… Because after one concussion the risk of another concussion dramatically increases. The physio came on to me and after the initial knock I didn’t feel too bad, and then the doctor said it can be three or four minutes for the symptoms to manifest. So then I took a knee and said to the doc at that lineout I couldn’t remember stuff, that’s one of the ones that would completely rule you out (of the rest of the game). So they said we’re not doing HIA1, let’s leave it there and we went back in.

Those HIA tests are balance tests, they give you a list of 10 words and then in 10 or 15 minutes you need to remember those 10 words, read numbers backwards, and all sorts. That was all fine in HIA 2, I had no symptoms in HIA 2, I was able to remember everything fine. Fortunately for me, I’ve skipped through all the hoops so far, so all being well, I’ll be fine for the weekend.

Q: Was this your first concussion?

A: This is my first concussion, yeah. Ulster’s Medical Director, Michael Webb, was actually quite surprised by that, most of the boys have had something. Definitely the guys who have been around for six or seven years have had one or two before but that’s my first one.

Q: Was it a scary experience to completely forget the lineout calls?

A: It was just bizarre, I was lost for words. I was standing there, and I remember everyone was looking at the ground and a bit of panic set in because I couldn’t think of what to call, so I was like just call something simple and I didn’t even know any simple calls. As I said, Big Al said ‘let’s do this’ and I thought perfect, he’s looking out for me.

I was well looked after, and I felt completely fine after the game and I kind of felt like saying to them, do I have to go through all the HIA protocols. Because I felt fine and I’ve been fine through all of them. But you just need to look to Big Al or Lukey Marshall who have had some problems with their head before, or even Jared (Payne), they’ll tell you that, yes, they may have felt fine for the first… Jared always said two or three days, but then once you start doing more stuff, that’s when it’ll hit you. I’ve been grand so far and I had a relatively intense decision-making training session today, so grand.

Q: Having experienced a concussion, how do you feel about referees and doctors forcing players off for HIAs?

A: Personally, I’m not 100% convinced there are more concussions now. I think there are potentially the same number of concussions, it’s just they’re being picked up a lot more regularly which is a good thing. Like I said, I can’t remember the exact stats but I’ve been told them by the docs, the chance of re-injury after your first concussion goes up dramatically, and that is either another concussion or another injury, whether it be head, neck, balance, all sorts of stuff. The chance of injury just goes way, way up.

Even if there’s a slight doubt, there’s been a change in the laws this year that you have to stay off for the whole time. Players wanted to come on as quickly as possible, whereas now you’re in there for the whole time, which is good because it is going to prevent more injuries in the game, and nobody wants more injuries. You just need to talk to Lukey Marshall or big Al O’Connor, those boys who have had serious concussions — back-to-back concussions. Mental health is something you’ll deal with later in life. Having a sore hip (is one thing), but you want to be alright upstairs.

Q: Does it linger with you, mentally?

A: I’ll tell you next week! I don’t really know, I haven’t really thought about it.

I would say no (it won’t affect me). There are times when I’ve thought about things with other injuries and I’ve wondered if it’ll annoy me during the game, and I get to the game and I completely forget about it. Hopefully, that’s what happens.


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