All concussions must be taken seriously to safeguard the health and welfare of players. Failing to do so can have serious consequences, including death.
What is a concussion?
• Concussion is a brain injury caused by a blow to the head or body which leads to shaking of the brain
• Concussion results in a disturbance in brain function that can affect a child or young person’s thinking, memory, mood, behaviour, level of consciousness, as well as producing physical symptoms such as headache and dizziness
• Concussion usually occurs without loss of consciousness
• Most concussions recover with physical and mental rest
Principles of concussion management:
RECOGNISE – REMOVE – RECOVER – RETURN
1. RECOGNISE – know the symptoms and signs of concussion and the DANGER SIGNS of potentially more serious brain injury.
After a fall or impact, concussion should be suspected in the presence of any one or more of the following:
• Symptoms e.g. headache, dizziness, nausea
• Physical signs e.g. unsteadiness, dazed/dinged
• Impaired brain function e.g. confusion, memory loss, disorientated
• Abnormal behaviour e.g. change in personality
• Confirmed or suspected loss of consciousness
• Deteriorating conscious state (more drowsy)
• Increasing confusion or irritability
• Severe or increasing headache
• Repeated vomiting
• Unusual behaviour change
• Seizure or convulsion
• Double vision
• Weakness, tingling or burning in limbs
If a concussion is suspected immediately remove the individual from play and do not allow to return.
Players with any symptoms following a head injury must be removed from playing or training and must not return to activity until all symptoms have cleared. Specifically, they must not return to play on the day of any suspected concussion.
The player should be monitored over the next 24-48 hours for any of the danger signs (listed above) and if any symptoms or signs that develop, or if there is an overall deterioration, then immediate medical help should be sought.
All cases of concussion and suspected concussion must be given time to recover – rest the body (e.g. avoid sports, running, cycling, swimming and weight training) and rest the brain (e.g. avoid reading, television, computer, video games and social media) until symptom free.
Children and young people (under 18) must rest from training and matches for a minimum of 14 days unless cleared to do so by a doctor specialising in concussion assessment and management.
For Players Over 18 years of age
• Once the player is entirely symptom free then they should follow a Graduated Return To Play (GRTP) protocol. This should be done under the guidance of a Doctor or Physiotherapist familiar with the protocol
• Players that fail to progress through the GRTP because symptoms return should be referred for further medical review
• Players who complete a GRTP must receive medical clearance from a doctor or an approved healthcare professional before returning to play
For Players Under 18
Concussion and participation in sport:
• Following the 14 day rest period, if entirely symptom free, they should then follow a Graduated Return To Play (GRTP) protocol under the guidance of a Doctor or Physiotherapist familiar with the protocol
• It is recommended that every child or young person is assessed by a doctor before returning to play. Ideally, that doctor should be one with expertise in managing concussion
• Children and young people that fail to progress through the GRTP because symptoms return should be referred for further medical review
Concussion and school studies:
• Children and young people should return to academic studies before they return to sport.
• It is reasonable for a child to miss a day or two of school after a concussion if they feel unwell or if on returning to lessons their symptoms return. But extended absence is
• In a small number of cases, symptoms may be prolonged and this may impact on the child‘s studies. In such cases, early referral back to GP and educational support services is advised
RECOGNISE – REMOVE – RECOVER – RETURN
For a more comprehensive guide and GRTP protocol please see the full Hockey Concussion Guidelines