Concussion and return-to-activity advice

Concussion is a traumatic brain injury diagnosed clinically from symptoms and signs after direct head or body force. It may cause headache, pressure, nausea, dizziness, visual sensitivity, slowed thinking, memory gap, irritability, anxiety, sleep change or imbalance. Loss of consciousness occurs in only a minority. The first task is not to prove concussion but to exclude immediate threats, cervical injury and CT-indicated structural brain injury using mechanism, GCS, neurological examination and NICE criteria.

At the scene or pitch, recognise and remove. Stop play immediately if concussion is suspected and do not return the person the same day. Check ABC, cervical pain, GCS, pupils and red flags. A sideline tool can structure recognition but cannot clear a player. Arrange appropriate healthcare assessment and emergency transport for deterioration. Record the event and notify parents, carers, school, employer and other clubs so restrictions follow the person across settings.

Early advice balances protection and activity. For the first twenty-four to forty-eight hours, encourage sleep and relative rest: ordinary quiet activity is acceptable if it causes no more than mild, brief symptom increase, while intense exercise, alcohol and safety-critical tasks are avoided. Reduce screen, reading and noisy environments when they clearly aggravate symptoms. Prolonged total rest, isolation or waking a stable patient repeatedly without clinical reason can impair sleep and recovery.

After the initial interval, begin a graded return to daily life. Add light walking or stationary cycling, then more demanding cognitive and physical work while symptoms remain mild and settle promptly. Education and employment adjustments can include shorter days, rest breaks, reduced screen brightness, delayed tests, quiet space, reduced driving and lighter duties. Progress is individual rather than based on pressure from a fixture, examination or staffing need.

Sport follows successful return to ordinary function. The UK grassroots principle is recognise, remove and return gradually. Build from symptom-limited daily activity to light aerobic exercise, sport-specific non-contact work, more complex non-contact training, contact practice only after appropriate clinical clearance, and competition last. Each governing body may impose a longer minimum. Any meaningful recurrence means stop, recover and return to the previous tolerated stage rather than pushing through.

Driving and work require task-specific judgement. Headache alone does not define safety; slowed processing, poor concentration, diplopia, dizziness, fatigue and sleep disturbance impair hazard response. Advise no driving until symptoms no longer compromise control and the person meets DVLA and occupational requirements relevant to their licence or job. Machinery, heights, lone work, armed roles and professional sport may need formal occupational or specialist clearance.

Persistent symptoms need phenotype-based care rather than a generic label. Reassess for missed structural or cervical injury, medication overuse, migraine, vestibular or ocular dysfunction, sleep disorder, mood symptoms and autonomic exercise intolerance. Symptoms lasting more than four weeks warrant healthcare review and often multidisciplinary rehabilitation. Discuss urgent mental-health help for suicidal thinking. Repeated injuries require a specialist risk conversation about longer restriction or retirement from exposure.