If concussion is suspected, remove the person from play immediately and seek medical assessment. Any player with suspected concussion must not have any further participation in that game/training or any future game/training until cleared by a doctor.
If concussion is suspected, there is no 20 minute observation period that permits same-day return to sport.
Any suspected concussion should be assessed by a doctor within 48 hours, ideally as soon as possible. Even mild symptoms need guidance about gradual reintroduction of school, work, exercise and sport. If symptoms worsen, new symptoms develop, or the player is not improving as expected, seek medical advice straight away.
A suitably qualified physiotherapist may assist with concussion assessment and rehabilitation.
The first 24-48 hours following concussion are important. The brain needs stability to begin to heal and recover.
In the first 48 hours, active physical and cognitive rest is encouraged. This does not mean doing nothing, but choosing low-energy tasks to keep symptoms under control. Quiet daily activities, short and slow walks, and listening to music (quietly) are suitable if they do not significantly worsen symptoms.
Reduce screen use, bright lights, loud noise, and exercise if these activities clearly increase symptoms.
Do not return to high intensity exercise, rough play, or contact activities.
If symptoms are stable after 48 hours, gradually increase daily activiy involvement and re-introduce light school/work activities as well as light aerobic exercise as tolerated (without >2/10 increase in symptoms). At this point, consultation with a sports physiotherapist to review neck pain, dizziness, balance issues, vision symptoms, and to create a graded return-to-learn/work and return-to-sport plan.
Normal daily routines with symptom control, followed by return to learn/work take priority before return to sport.
After 48 hours, gradually resume all daily activities monitoring for symptom changes. Then add light to moderate difficulty school/work tasks allowing for adequate breaks. The duration it will take to return to normal school/work commitment will depend on symptoms. Return to normal routine and learn/work takes priority over sport.
After 48 hours, start re-introducing exercise. Begin with light aerobic exercise such as walking or stationary bike, keeping heart rate under control. Slowly progress duration, and then intensity. Ensure symptoms don't increase by >2/10.
Start with simple, predictable skills and sports-specific movements. For example. stationary partner passing, shooting, or stationary ball skills. This stage is non-contact skills, with minimal head movement. Start to re-introduce running at a low intensity, build duration as symptoms allow.
Build running intensity, up to 80% heart rate max as symptoms allow. Add individual training, increasing demand of head movements, change of direction, jumping, and faster-paced individual skills. Also add resistance training at this step, starting with bodyweight and progressing weight as able. No contact or high-risk activity.
Reintroduce of non-contact team drills, passing, and interacting with teammates. Increase intensity up to 90% heart rate max. No contact or high-risk activity.
A review with your trusted General Practitioner is required to progress to contact training and competition. As well as a full 14 day symptom-free period whilst progressing through these steps. Once clearance has been obtained, progress participation into contact drills, then small sided games, and finally larger games at training. Return to competition only after completing the graded program and full training, with written medical clearance, and not before day 21 after concussion.
