Concussion in Sport

Overview

Concussion is a mild traumatic brain injury caused by a direct or indirect force transmitted to the brain. It is one of the most common and most frequently under-recognised injuries in sport. Concussion can occur in any sport or physical activity but is particularly prevalent in contact and collision sports such as rugby, polo, equestrian sport and cycling.

Unlike many other injuries, concussion does not always involve a direct blow to the head. A significant impact to the body can transmit enough force to cause the brain to move within the skull. Symptoms may appear immediately or develop gradually over several hours, and in some cases may not be apparent until the following day.

Common Causes

• Direct impact to the head, face or neck during a collision or fall
• Indirect force transmitted through the body, such as a heavy tackle in rugby
• Falls from height, including falls from horses in polo or equestrian sport
• Being struck by equipment such as a polo mallet or cycling handlebar
• High-speed collisions in road cycling or motorsport environments
• Head-to-head contact in rugby scrums, lineouts or tackles
• Ground impact following a fall during competition or training

Signs and Symptoms

Symptoms of concussion vary between individuals and may not all be present. Any athlete displaying one or more of the following signs following a head impact should be assessed and removed from play.

• Headache or a feeling of pressure in the head
• Dizziness or balance problems
• Confusion or feeling mentally 'foggy'
• Nausea or vomiting
• Sensitivity to light (photophobia) or noise (phonophobia)
• Blurred or double vision
• Slowed reaction times
• Difficulty concentrating or remembering
• Unusual behaviour, irritability or emotional changes
• Excessive tiredness or fatigue
• A brief loss of consciousness (though this is not always present)

Immediate Actions

• Remove the athlete from play immediately — do not allow them to continue
• Conduct an initial assessment using a recognised tool such as the SCAT5 or Sport Concussion Recognition Tool
• Do not leave the athlete alone — monitor closely for deterioration
• Ensure the athlete is seated safely and rested
• Do not allow the athlete to drive or travel alone
• Advise the athlete to avoid alcohol, screens and strenuous activity
• Inform a responsible adult or carer of the suspected concussion
• No same-day return to play under any circumstances

When to Call Emergency Services

Event Environment Considerations

At organised sporting events, medical personnel should be equipped and prepared to assess suspected concussion at the trackside or pitch side. Effective management in these environments requires:

• A designated quiet area away from the playing field for assessment
• Access to a concussion assessment tool such as the SCAT5
• Clear communication between medical staff, referees and team officials
• A documented record of the assessment and actions taken
• Coordination with the athlete's own medical team where applicable

In equestrian and polo environments, additional considerations include the risk of further falls if the rider is returned to activity prematurely, and the importance of helmet integrity assessment following a significant head impact.

Prevention Advice

• Wear appropriate, well-fitted protective headgear for the sport — replace helmets after significant impacts
• Follow sport-specific concussion protocols and return-to-play guidelines
• Ensure all coaches, officials and team staff receive concussion awareness training
• Encourage athletes to report symptoms rather than playing through them
• Review tackle and collision techniques to minimise head contact
• Implement structured pre-season concussion baseline assessments where possible

Return to Sport Guidance

Return to sport must follow a graduated return to play (GRTP) protocol. Each stage should only be progressed once the athlete has been completely symptom-free for a minimum of 24 hours. Medical clearance from a qualified clinician is required before full contact training or competition.

Sport-Specific External Guidance

The graduated return to play protocol above is generic. Please also refer to your sport's governing body for sport-specific concussion protocols and requirements.

When to Seek Medical Assessment

All athletes with a suspected or confirmed concussion should be reviewed by a medical professional before returning to sport. A GP, sports medicine physician or emergency department assessment is appropriate depending on the severity of symptoms.

• Any athlete who has lost consciousness, even briefly
• Athletes whose symptoms have not resolved within 10–14 days
• Children and adolescents — who should always be assessed by a clinician
• Anyone with a history of previous concussions
• Athletes experiencing persistent memory problems, mood changes or sleep disturbance