What should I do if a player of any age, from primary school children to adults, might be concussed at grassroots sport in the UK? Spotting concussion, red flags, who assesses the player, and the graduated return to school, training and matches under the November 2024 UK guidelines.
It is the core rule of the UK Concussion Guidelines for Non-Elite (Grassroots) Sport, which apply to all grassroots sports from primary school age upwards, across England, Scotland, Wales and Northern Ireland.
Teammates, coaches, match officials, team managers, administrators and parents who suspect a concussion must all do their best to get the person off safely and quickly. Playing on can make symptoms worse, delay recovery and, if another head injury happens, cause more severe injury or, rarely, death.
Any one or more of these visible clues after a knock can indicate concussion. The player should be removed from play immediately:
Spotting head impacts can be hard in fast-moving sports, so the guidelines make it everyone's responsibility (players, coaches, teachers, referees, spectators and families) to watch out for suspected concussion.
Ask the player how they feel. Any one or more of these, after a head injury, may suggest concussion:
Concerns raised by a parent, official or spectator about a player also count.
Concussion can affect four areas: physical (headaches, dizziness, vision changes), thinking (not thinking clearly, feeling slowed down), mood (short-tempered, sad, emotional) and sleep (sleeping too little or too much). Players should be honest and report symptoms straight away: hiding them is linked to a longer recovery.
No. Most concussions happen without loss of consciousness. Being knocked out occurs in fewer than 10% of concussions and is not needed for a concussion to be suspected or diagnosed. However, anyone who loses consciousness because of a head injury has had a concussion.
Concussion can also happen without a direct blow to the head. A knock to another part of the body that makes the head move rapidly (for example a whiplash-type injury) can cause it.
Symptoms usually appear straight away or within minutes, but can be delayed and appear over the first 24-48 hours. Further symptoms such as mood changes, sleep problems or poor concentration may show up over the next few days.
If any of these are seen or reported, the player needs urgent assessment by a healthcare professional on site or at A&E, using an emergency ambulance (999) if necessary:
If a neck injury is suspected, don't move the player unless you are a trained healthcare professional.
Everyone with a suspected concussion should be assessed within 24 hours of the injury, either:
If there are red flags or concerns about another serious injury, the player needs urgent assessment on site or at A&E, calling 999 for an ambulance if necessary.
Until a healthcare professional has ruled out concussion, or the player has completed the graduated return to activity and sport, they must not go back to sport. In any case, no-one returns to competition, training or PE within 24 hours of a suspected concussion.
The guidelines give coaches, teachers and volunteers these responsibilities:
If a neck injury is suspected, the player should only be moved by healthcare professionals with the right training. If any red flags appear, call 999.
The guidelines ask parents and carers to:
Your child must not return to any sport, training or PE lessons within 24 hours. In that time they also should not ride a bicycle, and older teenagers should not drive.
No, not complete rest. The guidelines recommend relative rest for the first 24-48 hours, then a gradual return to normal life.
During the first 24-48 hours:
After that, light physical activity actually helps recovery. The old requirement for 14 days of complete rest no longer applies.
Return to school comes before return to sport. A part-time return (for example half-days or scheduled breaks) is fine even with some symptoms, as long as they are not severe or significantly worse.
The guidelines set out a six-stage Graduated Return to Activity and Sport (GRAS). Return to school or work comes before return to sport.
| Stage | Daily life | Exercise |
|---|---|---|
| 1. Relative rest (24-48 hours) | Minimise screen time; easy daily activities in 10-15 minute slots | Gentle walking |
| 2. Daily activities | Easy reading, limited TV, games and phone use; some school work at home | Light activity, e.g. short walks |
| 3. Build tolerance | Homework or reading in 20-30 minute blocks with breaks | Walking or exercise bike for 10-15 minutes, building up; body-weight exercises, no heavy weights |
| 4. Back to school/work, non-contact training | Part-time return (e.g. half-days) | Sport training with no risk of head impact, once symptom-free at rest; harder exercise and resistance training |
| 5. Full school/work, full training | Back to normal | Contact training, only when symptom-free at rest for 14 days (not before Day 15) |
| 6. Return to competition | Not before Day 21 |
Moving between stages
The day of the injury is Day 0.
| Step | Earliest | Condition |
|---|---|---|
| Training with risk of head impact (Stage 5) | Day 15 | Symptom-free at rest for at least 14 days, and Stages 1-4 completed |
| Matches and competition (Stage 6) | Day 21 | Stage 5 completed, symptom-free at rest for the previous 14 days and during full training |
Each stage should last at least one day. If concussion symptoms come back after a head impact in training, the player should be removed from the activity.
Example from the guidelines: concussed on Saturday 3 June (Day 0), headache and nausea until Day 4, symptom-free at rest from Day 5. Contact training can start on Day 19, and the earliest match is Day 21 (Saturday 24 June).
About two-thirds of people are back to full sport by 28 days, but children, adolescents and young adults may take longer.
No. Under the 2024 guidelines there is no longer any expectation of a review by a doctor or healthcare professional to move through the return programme, including moving to contact training or back to matches.
What is required:
Players in elite settings with specialist medical teams may follow an individualised plan and can be cleared earlier. That does not apply to grassroots sport.
Most concussion symptoms clear within two to four weeks, but recovery varies and children can take longer than adults.
Headaches can carry on for several months after the injury has healed and may feel like migraine, sometimes with nausea or sensitivity to light or sound. Sometimes they come from a neck injury. If a headache is not made worse by mental or physical activity and is well managed, it need not stop someone returning to school, work and physical activity.
The same core rules apply to everyone: remove from play immediately, no return within 24 hours, and no return to competition before day 21. The guidelines add some points for particular groups.
Children and adolescents
Disabled players
Girls and women
Limited research suggests female athletes may be at higher risk and may take longer to recover. All concussions should still be managed individually.