Concussion in sport: signs, why you must stop playing and returning safely

TUREFF• •0

Concussion is a brain injury. It can happen in any sport, not just rugby or boxing: a fall from a bike, a clash of heads in football, a ball to the head in cricket or a hard landing in gymnastics. It often looks minor, and that is exactly what makes it dangerous. This guide is general information only; anyone with a suspected concussion should get advice from a doctor or NHS 111, or the equivalent service where you live.

What concussion is

A knock to the head, or a blow elsewhere that jolts the head, can disturb how the brain works for a time. Most people do not lose consciousness. Symptoms may appear straight away or develop over hours, and there is no visible sign on the outside.

Signs to look for

In someone else:

Lying still or slow to get up after a knock.
Unsteadiness, poor balance or stumbling.
A blank or vacant look, or seeming confused.
Not knowing the score, the venue or what just happened.
A seizure, or any loss of consciousness.

What the player may report:

Headache or pressure in the head.
Dizziness, nausea or blurred vision.
Feeling dazed, foggy or slowed down.
Sensitivity to light or noise.
Feeling more emotional, irritable or tired than usual.

If in doubt, sit them out

The UK concussion guidelines for grassroots sport, published in 2023 for non-elite sport across England, Scotland, Wales and Northern Ireland, are built around one message: if in doubt, sit them out. Anyone with a suspected concussion should be removed from play immediately and not return that day, however well they say they feel. The reasons are serious:

A concussed player reacts more slowly and is more likely to be injured again.
A second blow before the brain has recovered can cause more severe and longer-lasting harm.
Symptoms can worsen over the following hours.

You do not need to be a doctor to remove someone from play, and nobody on a touchline can rule concussion out.

Red flags: get emergency help

Call your emergency number or go to A&E straight away if, after a head injury, someone has:

Lost consciousness, even briefly, or had a seizure.
A headache that is getting worse.
Repeated vomiting.
Increasing confusion, drowsiness or difficulty staying awake.
Weakness, numbness or tingling in arms or legs.
Double vision, slurred speech or difficulty understanding.
Neck pain or tenderness, in which case do not move them unless trained to.

The first days

The UK grassroots guidelines advise:

Seek advice from NHS 111 or a doctor within 24 hours of a suspected concussion.
Rest for the first 24 to 48 hours, including cutting down on screens, and do not drive until you feel better.
Do not play sport or do strenuous exercise for at least 24 hours.
After that, gentle everyday activity such as walking can resume gradually, as long as symptoms do not get worse.

Someone should stay with the injured person for the first night if possible, watching for red flag symptoms.

Returning to sport

The guidelines set out a gradual, staged return, moving up only when activity at each stage causes no symptoms:

Light activity first, then more demanding exercise, then non-contact training.
Return to school, study or work comes before full return to sport.
For a confirmed concussion, the guidelines recommend no competitive play or contact training until at least 21 days after the injury, and only when completely free of symptoms.
If symptoms last more than four weeks, see a doctor for further assessment.

Your sport's governing body may have its own protocol, sometimes stricter, so check what applies to your club. Children and teenagers may take longer to recover and should be managed cautiously.

What clubs and parents can do

Make sure coaches and volunteers know the signs and have authority to remove players.
Keep a record of head injuries and who was informed.
Support players who feel pressure to play on. Sitting out one match is far better than months of problems.

Has your club changed how it handles head knocks in recent years? Share what works in the comments.