What it is
A concussion is a mild traumatic brain injury caused by a sudden blow to the head, neck, or body that causes the brain to move within the skull, temporarily disrupting brain function. It results in a transient disturbance in brain function, impacting cognition, balance, vision, mood, and neck function to varying degrees. Loss of consciousness is not required.
Symptoms can include confusion, headaches, dizziness, memory changes, and concentration issues, and are typically temporary.
Care is guided and stepwise, with a period of rest followed by a gradual return to activities. It balances early relative rest with a prompt, graded return to activity. Neck, vestibular, and vision rehabilitation are integrated as indicated.
Sports Concussion
Concussions are common in sports. There is growing concern in Australia and internationally about the incidence of sport-related concussion and potential health ramifications for athletes.
Management follows immediate removal from play and is crucial. A period of both physical and mental rest. A gradual, symptom-free return to sport is then managed under medical guidance, involving staged steps from light activity to full practice and competition.
If managed appropriately, most symptoms and signs of concussion resolve spontaneously. However, complications can occur, including prolonged symptoms and increased susceptibility to further injury.
How to recognise a concussion
Recognising concussion can be difficult. It is important to know when to suspect a concussion, because appropriate response and management can help prevent further injury or even death. There are several possible symptoms and signs, but they can be subtle, and they are not specific to a concussion.
Onlookers should suspect a concussion when an injury results in a knock to the head or body that transmits a force to the head. A hard knock is not required, as a concussion can occur from relatively minor knocks.
What happens when it occurs
Metabolic and neuromuscular changes follow the impact. Overexertion too early can flare symptoms; prolonged rest slows recovery. A short rest, followed by controlled sub-symptom aerobic work and task-specific progressions, provides the best path back.
“If in doubt, sit them out!”
Suppose there is any doubt about whether an athlete is concussed. In that case, that athlete should not be allowed to return to sport until cleared by a medical practitioner.
Common causes and risk factors
- Contact and collision sports, cycling incidents, and falls
- A previous concussion increases the risk of another
- High match exposure without recovery blocks
Who is most affected
Adolescents and young adults in sports are often present. Cyclists and workers who have fallen also feature in Australian clinics.
Typical signs and symptoms of a concussion
The signs of concussion vary and may be difficult to detect. For example, athletes may:
- appear normal apart from appearing vacant, dazed or stunned
- be disoriented and unable to recall team plays, scores, who the opponent is or be disoriented in terms of place and time
- ask repeatedly about what happened or what the score is; amnesia is common
- have difficulty concentrating and answering specific questions.
Loss of consciousness, seizure or balance difficulties are clear signs that an athlete has sustained a significant injury. Urgent medical support is critical in these circumstances.
Symptoms of concussion can be very subtle and may present as nothing more than the athlete reporting that they do not ‘feel right’. Concussed athletes often report these symptoms:
- visual disturbance
- feeling ‘foggy’, lethargic or slow
- having sensitivity to light or noise
- feeling dizzy or nauseous
- headache
Athletes need to be alert for evidence that a teammate or competitor is behaving unusually or out of character, or is exhibiting signs of disorientation, clumsiness, or loss of balance.
When to seek care
Immediately after a suspected concussion. Urgent emergency review for worsening headache, repeated vomiting, seizures, slurred speech, weakness, or unusual behaviour. First-aid principles apply. Neck injuries should be suspected if there is any loss of consciousness, neck pain or a mechanism that could lead to spinal injury. Athletes in this type of situation shouldn’t be moved without guidance from appropriately trained individuals.
How we diagnose
History of mechanism, symptom checklists, neurological and neck examination, balance and eye movement testing. Standardised tools support assessment. Imaging is used to exclude more serious injury when indicated.
Management
Specifically, concussed athletes should avoid:
- aspirin
- anti-inflammatories (such as ibuprofen, diclofenac or naproxen),
- sleeping tablets
- sedating pain medications.
If diagnosed with a concussion, athletes should have immediate physical and mental rest; this allows the brain to ‘rest’ and helps recovery.
To properly rest, time off from school or work may be needed. Mental rest may include refraining from playing computer games, reading and watching television.
Children and adolescents
Children and adolescents aged 18 years or younger take longer to recover, so a more conservative approach to concussion management should be taken. Concussive symptoms usually resolve in less than four weeks.
The child should be completely free of symptoms for at least 14 days before returning to contact or collision activities.
Return to learn
‘Return to learn’ is about the athlete’s gradual return to their usual program at school or work.
Having rested for 24 – 48 hours after sustaining a concussion, school-age athletes can return to school or study – as long as these activities don’t worsen symptoms. Thinking or concentrating for long periods can bring on or worsen symptoms of concussion. Gradually increasing the load on the brain without provoking symptoms is recommended. School programs may need to be modified to include more regular breaks, rests and increased time to complete tasks. Exams during that period may need to be postponed.
Return to school and learning should take priority before returning to sport. A concussed child should not return to sport until they have successfully returned to normal school activities.
Rehabilitation milestones
Phase 1 days 0–2: relative rest, symptom education, sleep routine.
Phase 2 days 3–7: light aerobic work, neck mobility, short cognitive tasks.
Phase 3 weeks 1–3: targeted vestibular/vision therapy, strength, and longer school or work blocks.
Phase 4 weeks 3+: sport‑specific drills, non‑contact practice, full return after medical clearance.
Readiness to progress
Return to sport
‘Return to sport’ is about the athlete’s gradual return to full sporting activity.
Having rested for 24 – 48 hours after sustaining a concussion, the athlete can begin light physical activity – as long as the activity doesn’t worsen symptoms. Once symptoms have cleared, the athlete can begin a staged return to sport.
These Graded Return to Sport Frameworks can be used to inform Return to Sport programs.
Prevention
- Technique coaching in contact sports
- Protective equipment that fits and is maintained
- Season planning with recovery weeks
Australia snapshot
- Common in community and school sports and cycling
- Return‑to‑play decisions follow staged protocols and medical clearance
- Most recover within days to weeks with structured care
Long-term consequences of concussion
There has been recent concern about the potential long-term consequences of a concussion. Chronic traumatic encephalopathy neuropathological change (CTE-NC) is a type of degenerative neurological disease that is associated with a history of repeated head trauma. There has been a growing number of former athletes diagnosed with CTE-NC post-mortem. There are many unknowns about why some athletes are susceptible.
The best way to safeguard the immediate and long-term health of athletes is to:
- Remove athletes suspected of having a concussion
- Treat each case of concussion carefully
- Adopt a conservative approach to return to sport.
Protective headgear and concussion
Helmets will not stop a concussion from occurring.
Current evidence suggests that helmets, mouth guards, or other protective wear offer little, if any, benefit in the prevention of concussion. Research into protective wear is continuing. Protective wear is important, however, for the prevention of other traumatic head injuries such as lacerations, skull fractures and dental injuries.
Sporting code policies
Sporting organisations need to continually review their policies for best practice concussion diagnosis and management.
High-risk sports, such as professional collision sports, need to ensure that medical personnel are appropriately trained in the detection and management of concussion.
Proposed rule changes require careful consideration of the potential benefits versus possible unintended negative consequences.
Sport organisations in Australia continue to monitor the evolving evidence around repetitive head trauma and concussion. Sport organisations continue to introduce changes to rules and regulations to optimise the detection and management of concussion, aligned with the latest evidence.
The increasing awareness of sport-related concussion and the associated community concern mean many sporting organisations have developed their own guidelines for the management of the condition. These guidelines are constantly evolving through ongoing review. There is a strong alignment across the various sporting codes, supported by the latest scientific evidence on concussion diagnosis and management.
Latest insights
Too little and too much activity both delay recovery. The middle path is best.
The neck, vestibular, and visual systems often require targeted treatment.
