Concussion: returning to exercise and sport safely
Concussion is common in footy, rugby, soccer, netball, combat sports and cycling, and it's often under-recognised at community level. Most people recover fully, but returning too soon carries real risks. This is general information; anyone with a suspected concussion should be assessed by a doctor.
What is a concussion?
A concussion is a mild traumatic brain injury caused by a blow to the head, face, neck or body that transmits force to the brain. You don't need to be knocked out; most concussions don't involve loss of consciousness. It affects how the brain functions for a period, and standard scans are usually normal.
What are the signs and symptoms of concussion?
Headache, dizziness, feeling foggy or slowed down, confusion, memory gaps around the event, nausea, blurred vision, sensitivity to light or noise, balance problems, fatigue, irritability or feeling more emotional, and sleep changes. Signs others may notice include a dazed look, slow answers, unsteadiness and being unable to recall what happened.
When is a head injury an emergency?
Call 000 for loss of consciousness, a seizure, repeated vomiting, a severe or worsening headache, increasing confusion or drowsiness, weakness, numbness or tingling in the arms or legs, double vision, slurred speech, neck pain, or clear fluid or blood from the nose or ears. If in doubt, treat it as an emergency.
What should happen straight after a suspected concussion?
The player should be removed from play immediately and not return that day: 'if in doubt, sit them out'. They shouldn't be left alone for the first few hours, shouldn't drive, and should avoid alcohol. They should see a doctor as soon as practical, even if they feel fine.
Should I rest completely after a concussion?
Only briefly. The international consensus statement recommends relative rest for the first 24 to 48 hours, which means limiting screen time and demanding activity while continuing light daily activities, rather than strict rest in a dark room. After that, light physical activity such as walking, which doesn't more than mildly and briefly worsen symptoms, is encouraged and appears to help recovery (Patricios et al., British Journal of Sports Medicine, 2023).
What is the graded return to sport?
It's a step-by-step progression: symptom-limited daily activity, then light aerobic exercise such as walking or a stationary bike, then sport-specific exercise without head impact risk, then non-contact training drills, then full-contact practice after medical clearance, and finally return to competition. Each step takes at least 24 hours, and if symptoms worsen you drop back a step.
How long until I can play again?
Longer than many people think. The Australian Institute of Sport's guidelines for community and youth sport advise being symptom-free for at least 14 days before returning to contact training, and a minimum of 21 days from the time of the concussion before returning to competitive contact sport. Children and teenagers generally take longer to recover than adults, and return to school and learning comes before return to sport.
Why does returning too early matter?
A brain that's still recovering is more vulnerable. Returning early increases the risk of a second concussion, of longer-lasting symptoms, and of other injuries because reaction time and balance are affected. Repeated head impacts over years are also a concern for long-term brain health.
What if symptoms are lasting weeks?
Most adults recover within a couple of weeks and most children within about four. Symptoms that persist beyond four weeks should be reviewed by a doctor, ideally one experienced in concussion. Treatment may include a guided exercise program and rehabilitation for the neck, balance system and vision.
Can neck pain be part of it?
Yes. The forces that cause concussion often strain the neck, and neck problems can contribute to headaches and dizziness afterwards. Once a doctor has assessed the concussion, treating the neck can be a helpful part of recovery.
How can an osteopath help after a concussion?
We don't diagnose or clear concussion; that's a doctor's role. Once you've been medically assessed, we can assess and treat the neck and upper back, help with neck-related headaches and dizziness, and support your graded return to exercise in line with your doctor's advice.
Do headgear and mouthguards prevent concussion?
Mouthguards protect teeth and are recommended in contact sports. Soft headgear reduces cuts and bruises but hasn't been shown to reliably prevent concussion. Technique, rule enforcement and removing players with suspected concussion matter more.
What about combat sports and sparring?
In boxing, Muay Thai, MMA and judo, the same rules apply: stop that session, see a doctor, and don't spar or compete until you've completed a graded return and been medically cleared. Technique work without head contact comes back before sparring.
See our posts on Muay Thai and boxing injuries and judo, wrestling and MMA injuries.
If you've had a head knock and have ongoing neck pain or headaches after seeing a doctor, see our neck pain guide. Book an assessment at our Berwick clinic. A 60-minute initial consultation is $149, with no referral needed and HICAPS on-site.
Sources
Australian Institute of Sport. Concussion in sport: Australian guidelines and resources.
Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.
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