Concussion is an injury to the brain resulting in a disturbance of brain function. It affects the way a person thinks, feels and remembers things. There are many symptoms of concussion, with common ones including headache, dizziness, memory disturbance and balance problems. Concussion can be caused by a direct blow to the head, but can also occur when a blow to another part of the body results in rapid movement of the head (e.g. whiplash type injuries).

If any of the following signs or symptoms are present following an injury the player should be suspected of having concussion and immediately removed from play or training and must not return to play that day.

·         Headache
·         Dizziness
·         Mental clouding, confusion, or feeling slowed down
·         Visual problems
·         Nausea or vomiting
·         Fatigue
·         Drowsiness / feeling like "in a fog" / difficulty concentrating
·         "Pressure in head"
·         Sensitivity to light or noise

The symptoms of concussion typically appear immediately, but their onset may be delayed and can appear at any time after the initial injury. Loss of consciousness does not always occur in concussion (in fact it occurs in less than 10% of concussions). A concussed player may still be standing up and may not have fallen to the ground after the injury. 

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Anyone with a suspected concussion MUST be IMMEDIATELY REMOVED FROM PLAY.

Once safely removed from play they must not return to activity that day. Team-mates, coaches, match officials, team managers, administrators or parents who suspect someone may have concussion must do their best to ensure that they are removed from play in a safe manner.

If a neck injury is suspected, suitable guidelines regarding the management of this type of injury at pitch side should also be followed (see useful links for pitch side injury management training).

If ANY of the following are reported then the player should be transported for urgent medical assessment at the nearest hospital emergency department:

Severe Neck Pain, Deteriorating consciousness (more drowsy), Increasing confusion or irritability, Severe or increasing headache, Repeated vomiting, Unusual behaviour change, Seizure (fit), Double vision, Weakness or tingling / burning in arms or legs. 

In all cases of suspected concussion it is recommended that the player is referred to a medical or healthcare professional for diagnosis and advice, even if the symptoms resolve.

Concussion should be managed with a short period of relative rest followed by a gradual return to normal activities as symptoms allow. Relative rest involves resting both the body (physical rest) and resting the brain (cognitive rest). After the initial 24-48 hour period of relative rest, a staged and graduated return to full daily activities (education/work) and football training is allowed but at a rate that does not worsen existing symptoms, more than mildly, or produce new symptoms. More information on the graduated return to play programme can be found in The FA’s concussion guidelines.

FA ITMMiF course 

Intermediate pitch-side trauma management for doctors, physiotherapists and allied health care professionals working in football. Get started here

FA ATMMiF course 

Advanced pitch-side trauma management for doctors, physiotherapists and allied health care professionals working in football. Get started here