Concussion in sport: why new guidance has implications for governing bodies across the board
03 May 2023
Concussion in sport is rapidly becoming a top-table debate for sporting associations, national governing bodies and amateur clubs – and the recent guidance for grassroots clubs, released by the Department of Culture, Media and Sport, underlines the reason why.
The DCMS has published a paper entitled: If in doubt, sit them out – UK Concussion guidelines for non-elite (grassroots) sport.
Now it is time for all NGBs to consider the impact of the new guidelines on their individual sports.
The guidance was developed by clinicians, academics and governing bodies – and forms part of the government’s Action Plan on Concussion.
It is designed as a ‘call to action’ for all players, coaches, parents, schools, NGBs and sports administrators.
Key details of the announcement include:
- No player, adult or junior, should return to competition for at least 21 days after a concussion
- Anyone showing concussion symptoms after 28 days should seek further and expert medical advice
The paper also provides advice, aimed at everyone in the amateur game, to help them:
- Recognise the signs of concussion
- Remove from play anyone suspected of being concussed immediately
Return safely to daily activity, education/work, and, ultimately, sport
The guidelines include a recommendation to call NHS 111 within 24 hours of a potential concussion, to rest and sleep as much as needed for the first 24 to 48 hours and avoid using devices which involve screen time.
So, one of the first considerations for clubs and National Governing Bodies is how to ensure the guidelines are seen and understood by everyone involved – including players, coaches and parents.
These guidelines, which apply across England, Wales and Northern Ireland, have been in discussion across the UK for a long time. In fact, Sport Scotland issued similar guidelines as long ago as 2018.
What’s clear, is that there is an increasing desire to understand and prevent concussion in sport and to take action to inspire change, whether that is new protocols or even alterations to the rules of the game, to ensure future generations do not suffer unnecessary medical impacts.
The government’s latest guidance has implications for a wide range of sports, and it comes with insurance implications, too, as the spotlight focuses firmly on governing bodies to put protocols in place which protect those who take part.
It’s not just contact sports which should take notice
Of course, some sports are more prone to concussion incidents than others, especially those where physical contact is built into the rules.
But this is a topic which impacts almost all sporting activities, and not all governing bodies or national associations will be ready.
There’s an argument, for instance, that sports with a higher prevalence of concussions are probably better equipped to deal with new protocols because they have been immersed in the topic for a long time.
Rugby Union, for instance, has been heavily resolved in research around how to reduce concussions and is currently widely consulting clubs at all levels of the professional and amateur game.
Professional rugby extended its minimum stand-down period after concussion to 12 days last year, and the earliest a player can currently return to action under RFU protocols is 19 days for an adult, 23 days for a junior. Updating policies to meet the new deadlines does not seem as complicated as it may do for other sports.
Boxing has always had to deal with concussion and has been answering questions on this issue for many years. Football is already experimenting with new protocols that reduce the number of times a professional player can head a ball in training and removing heading all together in some younger age groups of the amateur game.
For sports which come across concussion less often, understanding the government’s new protocols and having the ability to roll them out across amateur clubs may be tougher.
It is not only those with physical contact which need to be aware. There are plenty of non-contact sports, such as basketball, which suffer a surprising number of concussion incidents.
Cricket, where risk comes from the ball, bat or heavy fall in the field, is another example, as are sports in which a fall at speed is possible – such as cycling or equestrian sports.
It’s important that clubs of all kinds talk to their insurance brokers about how to manage the new environment.
Take learning from other sports
There is certainly a change in risk management required, and it is often possible to learn from other sports.
Rugby has long been in the headlines around the concussion debate, which is inevitable because of the high impact nature of the game, but as a sport it is also one of the most advanced in terms of research into concussion and in developing new protocols to reduce risk.
In the NFL in America, there were 149 concussions suffered across 271 games in 2022 despite all players wearing helmets. So, equipment is not the entire answer and sports may need to consider deeper change.
The new guidelines have been welcomed by players, clubs and governing bodies, including the RFU, whose Medical Services Director Dr Simon Kemp was a member of the expert writing group.
A statement from the RFU said: “Providing uniform, evidence-based, guidance across grassroots sports, the education sector and in NHS settings is a great step forward and we are delighted to have contributed to the work on this, led by the Government.
“Our guidance to the community adult and age-group game will change to reflect the new UK-wide guidance. It will take time for all the RFU resources and education modules to be updated and we will communicate to the game when these are available. It is our aim to have everything updated ahead of the 2023-24 season.”
Lisa Wainwright MBE, Sport and Recreation Alliance CEO, said: “Concussion is a serious issue, and we must always strive to make sport as safe as possible for all those who take part at a grassroots level in clubs, schools and many other settings every week across the UK.
“The Sport and Recreation Alliance is pleased to have supported the development of these guidelines which will ensure there is a consistent, evidence-based approach to concussion in sport across all four home nations."
Concussion in women’s sport
It's important that government bodies and national associations take equal concern around women's and girls’ sport, with an awareness that not all threats may be exactly the same as in the men's or boys' game.
In a three-year project funded by World Rugby, for instance, leading sports scientists are working on a project to reduce concussions for the growing number of girls playing rugby.
World Rugby’s Chief Player Welfare and Rugby Services Officer Mark Harrington said: “When World Rugby launched our six-point plan on player welfare last year, it was clear that there was a significant gap in the amount of research into concussion and injury prevention in the women’s game. We set out to help solve that problem. The findings this group uncovers will be key to informing World Rugby’s approach to the women’s game and ensuring that we never stand still on player welfare.”
Other NGBs will come under increasing pressure to take action around concussion, and with varying levels of funding there will be challenges associated.
The key aspect here is that everyone across the sporting spectrum, from clubs, to NGBs, charities, schools, universities and the insurance industry, come together to find solutions.
As the If in doubt, sit them out report explains, it is vital that everyone involved in grassroots sport is able to recognise concussion and understand how it should be managed – from the time of injury through to a safe return to education, work and playing sport.
It is now up to NGBs, as well as amateur clubs, to ensure that happens.
How Howden can help
At Howden, we can help associations understand the impact of the new guidelines and also providing learning from other NGBs that have taken an early lead on concussion, including, for instance, the RFU.
By extracting the learning from those who have been studying the issue for a long time it is possible to provide guidance on good practice and help you to understand the risks involved.
It is important that clubs at an amateur level liaise with national governing bodies, medical experts and insurance experts to ensure they are doing things the right way. And of course, vital for all sports associations to ensure they are communicating effectively – passing on guidance so that it is clearly understood by everyone in amateur sport.
The government’s latest guidance is expected to be followed by sports across the board to achieve a consistent approach. But each sport will need to interpret them based on their own risks - and explain to clubs how to carry that protocol out and deliver it at grass roots level.
- Help NGBs to understand the insurance implications of concussion risks in their sport
- Work with NGBs to put in place practical systems to help manage concussions and the graduated return to play for participants
Further advice from Howden
The Government is looking for individuals to be protected across all activity, including other sports participants may be involved in and, with young people, in the education sector too.
At youth level, for instance, a player may suffer a concussion with his or her club and go through the correct protocols. But what happens a couple of days later when they play for their school – or play a different sport?
It’s a situation which needs to be managed holistically for that individual and the risk goes beyond the boundaries of the club. What matters most is that individual is protected by the protocol and that systems are in place to ensure everyone in that chain understands the player has a concussion and what that means.
At Howden, we are well placed to help governing bodies in this aspect, especially when it comes to putting guidance in place to help clubs manage concussion risks on a day-to-day basis.
We work with risk management partners to provide materials which can help in this process and technological solutions, too. We are already working with national governing bodies on strategies to achieve this, and our doors are always open for advice.
Other research to look out for
The UK Concussion Prevention Network
This body was officially launched at an event in Bath in March, incorporating experts from across the world of sports science and medicine.
Its aim is to significantly reduce concussions within youth and community sport, setting an ambitious mission to reduce these concussions by 30% by 2030 through new policy, training and equipment interventions.
The group is an example of how the topic is being driven by a wide and diverse range of bodies – providing learning opportunities for all.
It was inspired by charity Love of the Game and supported by academics from the Edinburgh-Bath International Olympic Committee Research Centre, as well as Leeds Beckett ad Calgary (Canada) universities.
One of the key aspects it will explore is whether changes to the rules of the game, across many sports, could help prevent head injuries.
Many sports are also working in this way behind the scenes in a bid to reduce the threat of concussion.
For more details about how Howden Sport can help, contact Andy Goulbourne at [email protected] or call 07854 150059.
Visible signs of concussion
- Loss of consciousness or responsiveness
- Lying motionless on ground/slow to get up
- Unsteady on feet/balance problems or falling over/ incoordination
- Dazed, blank or vacant look
- Slow to respond to questions
- Confused/not aware of plays or events
- Grabbing/clutching of head
- An impact seizure/convulsion
- Tonic posturing – lying rigid/ motionless due to muscle spasm (may appear to be unconscious)
- More emotional/irritable than normal for that person
Symptoms of concussion to look out for
- Disoriented (not aware of their surroundings e.g. opponent, period, score)
- Dizziness/feeling off-balance
- Mental clouding, confusion or feeling slowed down
- Drowsiness/feeling like ‘in a fog’/ difficulty concentrating
- Visual problems
- Pressure in head’
- Sensitivity to light or sound
- More emotional
- Don’t feel right
- Concerns expressed by parent, official, spectators about a player
Coaches, teachers, volunteers: what’s your role?
If a player suffers a suspected concussion, you should:
- Immediately remove the individual from the field of play and ensure that they do not return to play in that game even if they say that their symptoms have resolved.
- Observe the player or assign a responsible adult to monitor the individual once the player is removed.
- If player is under 18 years old, contact parent/guardian to inform them of the possible concussion.
- Arrange for the player to get home safely.
- Arrange for a responsible adult to supervise the player over the next 24-48 hours.
- Ensure any relevant injury report form is completed and stored by the club/school/organisation.
- Follow a graduated return to activity (education/work) and sport programme with an emphasis on initial relative rest and returning to education/work before returning to training for sport.
The guidance in a nutshell
- If an individual is suspected of having a concussion, they must be immediately removed from play.
- If there are concerns about other significant injury or the presence of ‘red flags’ then the player should receive urgent medical assessment onsite or in a hospital Accident and Emergency (A&E) Department using ambulance transfer by calling 999 if necessary.
- All those suspected of sustaining a concussion should be assessed by an appropriate onsite Healthcare Professional or by accessing the NHS by calling 111 within 24 hours of the injury.
- No-one should return to competition, training or Physical Education (PE) lessons within 24 hours of a suspected concussion.
- Anyone with a suspected concussion should NOT drive a motor vehicle (e.g. car or motorcycle), ride a bicycle, operate machinery, or drink alcohol within 24 hours of a suspected concussion.
- Individuals with concussion should only return to playing sport which risks head injury after having followed a graduated return to activity (education/work) and sport programme.
- All concussions should be managed individually, but there should be no return to competition before 21 days from injury.
- Anyone with symptoms after 28 days should seek medical advice from their GP (which may in turn require specialist referral and review).
You can find the full guidance here:
Facts about concussion
What is concussion? Concussion is a traumatic brain injury resulting in a disturbance of brain function. It affects the way a person thinks, feels and remembers things.
Do you have to be knocked out to have concussion? No. Loss of consciousness occurs in only 10% of concussion cases and is not required for a diagnosis of concussion. However, anyone who loses consciousness because of a head injury has had a concussion.
Do all concussions come from an impact to the head? Not necessarily. Concussion can be caused by a direct blow to the head but can also occur when knocks to other parts of the body result in rapid movement of the head (e.g. whiplash type injuries).
What are the possible consequences of concussion? A history of previous concussion(s) increases the risk of sustaining a further concussion, which may then take longer to recover. A history of a recent concussion also increases the risk of other sports related injuries (e.g. musculoskeletal injuries).
Are children more susceptible to concussion? Concussion is possible at any age. However, children may be more susceptible and take longer to recover. Returning to education too soon may exacerbate symptoms and prolong recover. Children are also more susceptible to rare neurological complications, including death caused by a second impact before recovering from a previous concussion.