Concussions in sport are far more than just a “knock to the head.” They are brain injuries that demand prompt recognition, careful management, and structured rehabilitation. If left unchecked, concussions can lead to prolonged symptoms, memory and learning difficulties, and an increased risk of future concussions.
In October 2022, the 6th International Conference on Concussion in Sport held in Amsterdam released an updated consensus statement. This global framework offers healthcare providers, coaches, athletes, and families evidence-based guidance for identifying, treating, and preventing concussions in sport.
Let’s explore this framework and break down what to do when a concussion occurs—from recognition to recovery.
What Is a Sport-Related Concussion?
A sport-related concussion (SRC) is a type of mild traumatic brain injury that occurs as a result of a direct or indirect blow to the head, neck, or body during athletic activities. Although there may be no visible signs of trauma, the brain’s function is temporarily affected.
Symptoms may include:
- Headache or pressure in the head
- Dizziness or balance issues
- Confusion or memory disturbances
- Nausea or vomiting
- Blurred vision
- Sensitivity to light or noise
- Difficulty concentrating or feeling “foggy”
- Sleep disturbances
Symptoms may emerge immediately after the injury or take hours to develop. While most resolve within a few days, others may persist for weeks.
1. Recognise: Identifying a Concussion in Sport
Early recognition is the most critical step. Anyone involved in sports—coaches, trainers, teammates, and parents—should be familiar with the signs and symptoms.
Warning signs of concussion include:
- Loss of consciousness (even briefly)
- Stumbling or unsteadiness
- Slow to get up
- Blank or dazed look
- Confusion or disorientation
- Answering questions slowly
- Seizures or convulsions
If any of these are observed, it’s essential to assume a concussion has occurred until proven otherwise
2. Reduce: Prevention Strategies in Sport
While it’s impossible to eliminate all risk, various preventative measures have been shown to reduce the incidence of concussion in sports.
Evidence-Based Prevention Technique:
- Mouthguards: Research shows a significant reduction in concussions among ice hockey players who wear properly fitted mouthguards. These should be made mandatory, especially for youth athletes.
- Modified Contact Rules: Reducing contact in training and gameplay, particularly in youth sports like rugby and hockey, helps prevent head trauma.
- Neuromuscular Training: Balance, strength, agility, and reaction time exercises improve postural control and reduce concussion risk.
3. Remove: Sideline Evaluation and Immediate Response
If a concussion is suspected, immediate removal from play is essential.
The mantra is: “If in doubt, sit them out.”
Once removed, the player should undergo an initial assessment by a trained health professional. Tools like the SCAT6 (Sport Concussion Assessment Tool, 6th edition) are often used to assist in diagnosis.
Important:
Players showing signs of concussion must not return to play the same day unless cleared by a qualified medical professional. Premature return risks further injury and worsened outcomes.
4. Rest & Relative Activity: The First 48 Hours
Contrary to older practices advocating complete rest, recent evidence highlights that strict rest can delay recovery.
Current Recommendations:
- Relative rest (not strict bed rest) is advised for 24–48 hours. This includes:
- Reduced screen time
- Avoiding intense mental effort
- Avoiding physical exertion
- Light activity, such as gentle walking or stretching, is permitted if it does not significantly worsen symptoms.
If symptoms become more than mild and brief, stop the activity and try again the next day.
5. When to Refer to a Specialist
If symptoms last longer than four weeks, it’s time to involve a specialist in concussion management.
Persistent post-concussion symptoms could be caused by:
- Unresolved concussion effects
- Pre-existing conditions like anxiety or migraines
- Neck or vestibular system dysfunction
Early referral ensures targeted treatment, potentially reducing the duration and impact of symptoms.
6. Rehabilitation: Tailored Recovery Plans
Not every concussion heals the same way. A structured, personalised rehabilitation plan is essential.
Common Rehab Focus Areas:
- Vestibular therapy: For dizziness and balance issues
- Neck treatment: For whiplash-like injuries or headaches
- Cognitive rehabilitation: For memory and concentration difficulties
- Graded physical activity: Gradually reintroducing exercise
A multidisciplinary team—including physiotherapists, sports physicians, and neuropsychologists—can deliver comprehensive care.
7. Return to Learn (RTL): Getting Back to School
For student-athletes, school participation is just as important as returning to play.
Most children and adolescents (around 93%) return to school within 10 days of their injury using a Return to Learn (RTL) strategy. This encourages early re-engagement with minimal symptom increase.
RTL Accommodations May Include:
- Modified school hours or reduced workload
- Frequent breaks during the day
- Reduced screen and reading time
- Extended time for assignments and tests
- Adjusted physical activity levels
Collaboration between educators, healthcare providers, and families is vital to ensure a smooth academic transition.
8. Return to Sport (RTS): A Safe Step-By-Step Approach
The 6-Stage Return to Sport (RTS) Protocol offers a clear roadmap to resume play safely.
RTS Protocol Overview:
| Stage | Activity Example | Criteria to Progress |
| 1 | Symptom-limited activity (e.g., walking) | No symptom worsening |
| 2 | Light aerobic exercise | Mild, brief symptoms only |
| 3 | Sport-specific exercise (non-contact) | Full symptom resolution |
| 4 | Non-contact training drills | Medical clearance advised |
| 5 | Full-contact practice | Confidence + no symptoms |
| 6 | Return to game play | Return to baseline performance |
Key Principles:
- Start after 24–48 hours of relative rest.
- Wait at least 24 hours between stages.
- If symptoms return (score >2/10 severity), drop back to the previous stage.
- Children and adolescents may require up to one month to fully recover.
- Average time to full return to sport is around 19.8 days.
Concussion Management is Everyone’s Responsibility
A concussion is an invisible injury, but the consequences can be long-lasting if not managed appropriately. With increased awareness, early removal from play, and structured rehabilitation, most athletes can make a full recovery and return to both learning and sport.
Key Takeaways:
- Recognise the signs early and remove players from play.
- Rest smart – early light activity is better than complete inactivity.
- Use stepwise Return to Learn and Return to Sport strategies.
- Refer to concussion specialists when symptoms persist.
- Prevention through education, training, and safety gear is key.
Logan Physio is here to help.
If you or your child is dealing with a concussion, our experienced team offers comprehensive assessment, rehabilitation, and return-to-play guidance. Don’t wait—reach out today to support a safe recovery.
