Concussion: If in doubt, sit them out!

Published: 01 Apr 2022

Concussion: If in doubt, sit them out!

What is concussion?

Concussion is a type of mild traumatic brain injury caused by a direct impact to the head or anywhere on the body causing the brain to strike against the skull. A hard knock is not always required. 

It commonly causes short-lived disturbances in brain function and the symptoms may evolve over the hours or days following the injury. 

How to Recognise concussion?

Recognising concussion can be difficult as the symptoms and signs are variable, non- specific and may be subtle. It is Important to know that concussions can be instant or delayed and gradual, even up to 72 hours after the impact!

You do not have to be a trained health professional to recognise a person with concussion. Onlookers should suspect a concussion when there is a knock to the head or body that transmits force to the head. This can include falling on the ground, in a tackle or direct hit to the head. 

You simply need to be able to 

  1. Recognise the signs and symptoms
  2. Remove the player from sport (immediately and no return to play on the same day)

The Sport concussion assessment tool [SCAT5] identifies 22 possible symptoms: 

  • Headache
  • ‘Don’t feel right’ 
  • Pressure in the head
  • Difficulty remembering
  • Nausea or vomiting
  • Fatigue or low energy 
  • Dizziness
  • Confusion
  • Blurred vision
  • Drowsiness
  • Confusion 
  • Blurred vision
  • Drowsiness 
  • Balance problems
  • Sensitivity to light
  • More emotional 
  • Sensitivity to noise
  • Irritability 
  • Feeling slow down
  • Sadness
  • Feeling like ‘in a fog’ 
  • Nervous or anxious
  • Trouble falling asleep (if applicable)

If the person with a suspected concussion shows of any of the following signs or symptoms:

  • Loss of consciousness or seizures,
  • Neck pain
  • Weakness, numbness or tingling down their arms or legs
  • Increasing confusion or irritability 
  • Deterioration in symptoms (e.g. severe or increasing headache, drowsiness or repeated vomiting
  • Double vision

You should not move the player and call an ambulance immediately. These features suggest more serious injury that needs urgent medical attention.

How to assess a Concussion?

The diagnosis of concussion should be made by a medical practitioner. The SCAT5 is the internationally recommended concussion assessment tool. There is a SCAT5 for children aged 5-12 years old and a SCAT5 for 13+. 

How to manage a concussion?

Once diagnosed, immediate management is physical and cognitive rest for 24-48 hours. This may include time off school or work and relative rest from cognitive activities (tasks that involve concentration, attention and understanding) e.g. computer and video games, watching television and reading and writing. Physical activity, physiological stress can all worsen symptoms and possibly delay recovery after a concussion. 

Immediate management of concussion in children and adults is physical and cognitive rest – and usually means no screen time.

When can you return to sports?

Having rested for 24-48 hours after sustaining a concussion the patient can return to light intensity physical activity as long as the activity does not cause a significant and sustained deterioration in symptoms. The majority of symptoms should resolve in 10-14 days. 

The activity phase should proceed as outlined below with a minimum of 24 hours at each level

  1. Light aerobic activity (at an intensity that can be easily  maintained while having a conversation until symptom-free)
  2. Basic sport specific drills which are non-contact (may add resistance training) 
  3. Full contact practice following medical review
  4. Normal competitive sporting activity 

The activity should only be upgraded if there has been no recurrence of symptoms during that time. If there is a recurrence of symptoms, there should be a ‘step down’ to the previous level for at least 24 hours (after symptoms have resolved). 

A consistent and growing body of evidence supports a slower rate of recovery in children and adolescents aged 18 and under. 

The child’s return to sport program should be extended so that the child does not return to contact/collision activities less than 14 days from the resolution of all symptoms. 

More concussion resources

See concussion position statement Link below for full return to sport protocols for children and adults (pages 11-16)

See link below for information on an athletes experience

Concussion in sport Australia: Position statement [Internet]. Australian Institute of sport; 2019. Available from:


  • Concussion is a type of brain injury that occurs from a knock to the head or body 
  • Recognise concussion is critical to ensure appropriate management and prevention of further injury 
  • The concussion recognition tool 5 is recommended to help recognise signs and symptoms
  • Any Athlete suspected of having a concussion should be removed from sport and not allowed to return to sport that day. The athlete should be reviewed by a medical practitioner. 
  • The main treatment for concussion is rest. After 24-48hours of rest light intensity activation is allowed as long as symptoms are not sustained. 
  • Children and adolescents take longer to recover from concussion. 
  • Long term consequences of concussion are not fully yet clearly understood 

If in doubt, sit them out