The Australian Institute of Sport (AIS) released new guidelines for youth and community sports last week – and their recommendation about on-field concussion management could save lives.
It’s a move that will change the way concussion is managed on school ovals and in community clubs across the country.
While the guidelines contain a host of recommendations about on-field concussion management and identifying symptoms, University of South Australia (UniSA) Lecturer in Exercise and Sport Science Dr Hunter Bennett says the biggest changes relate to how a concussion is managed after it happens.
Under the new AIS guidelines, any player who sustains a concussion should be symptom-free for at least 14 days before restarting contact training. This was already the advice for children, but now applies to community sports. Additionally, all players should wait a minimum of 21 days to return to competition, after being concussed.
The recommendations are in contrast to previous recommendations made by many Australian sporting organisations, which typically enforce a ten to 14-day minimum period before a concussed athlete can return to competition. They follow last year’s Senate inquiry into concussions and repeated head trauma in contact sports.
“I think these should be viewed as a positive,” Dr Bennett told EducationDaily. “As the guidelines are fairly clear, it gives them some very clear instruction on how to treat students’ post-concussion even if they are not experts in the area.”
Understanding concussion care is critical for teachers
For sports teachers and classroom teachers guiding students through sporting activities, Dr Bennett says one of the most important things to know about concussion care is how to identify symptoms of concussion so they can then be referred out to a GP for further evaluation and guidance.
“Obviously, knowing how long they need to be symptom free for is important as well, but recognising the symptoms is critical,” he told EducationDaily.
“It is fairly well-established that repeated concussions can have negative health implications, as well as increase the risk of future injury. If these guidelines have the potential to mitigate the likelihood of repeated concussions, then they can only have a positive effect on health.”
And if the guidelines are not taken seriously, he says the long-term impact can be life changing.
“If players come back too soon, they see an increased risk of future concussions and future musculoskeletal injury, both of which can be quite impactful in the short-term,” Dr Bennett told EducationDaily.
In the short term, he says concussion can cause fatigue, light sensitivity and nausea, as well as more severe symptoms including behaviour change, loss of balance and coordination, and severe headaches.
“In the long-term, ignoring these guidelines could lead to an increased risk of poor mental and emotional health and well-being in later life.”
The dangers of concussion
Sport-related concussion has been defined as a traumatic brain injury caused by a direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain that occurs in sports and exercise-related activities.
With the potential effects of a concussion including blood flow changes and inflammation affecting the brain, there’s good reason why concussion in sport has become a hot topic in recent years.
Concussion and kids
Children who have previously had a concussion are almost four times more likely to get concussed in the future than those who have never been concussed before.
Similarly, reearch has shown adolescent athletes who return from concussion are around 50 per cent more likely to suffer any type of future injury than other athletes. Dr Bennett and his colleagues also found most athletes were returning to competition after roughly 12 days, which may suggest insufficient recovery is increasing their injury risk after concussion.
He says that, although they don’t know the exact reason children and adolescents take longer to recover from concussion, it seems they do.
Recent evidence indicates that children, on average, may not be fully recovered and able to return to sport until around 20 days after concussion, while adults may recover after closer to 14 days. It’s important to note that this is not true for everyone, with some taking much longer to recover.
A step in the right direction
Taking these factors into consideration, Dr Bennett believes increasing the recovery period of concussion to 21 days is not only justified, but a positive step.
“While additional recovery time seems especially important for children, this change will also increase the likelihood adults playing community sport are ready to return, particularly if they don’t have access to medical guidance,” he says.
“Most people in sport are happy to accept recovery from a muscle strain can take from four to eight weeks, so why wouldn’t they accept the brain (which is arguably a much more important part of the body) needs a shorter time?”
Australia is not the first country to tighten its guidelines.
In April 2023, the first concussion guidelines for non-elite sport to cover the whole of the United Kingdom set out the same minimum recovery days.
Similar guidelines have also been implemented throughout New Zealand for a range of sports.
“There’s no research examining whether these updated guidelines have had a positive effect yet but given coming back too early may pose a risk, they offer very little downside,” Dr Bennett says.
Implementing the guidelines
While these guidelines are positive for the health and welfare of athletes across the nation, there are also potential issues with their implementation – especially at the grassroots level where there may be few on-site medical staff.
But the good news, he says, is that you don’t have to be an expert to reduce the effects of concussion.
Dr Bennett recommends the first step for those involved in community sport is simply being aware of the concussion management protocols the AIS proposes. This means making sure everyone in charge knows what the symptoms of concussion look like, and when to encourage their players to see a medical professional.
The second step, as recommended by the revised guidelines, is to introduce a ‘concussion officer’ to oversee the management of concussion.
“This person doesn’t need to be a concussion expert and is not expected to diagnose concussion. Like the role of a fire warden, the concussion officer ensures anyone diagnosed with concussion follows the agreed protocol,” he says.
As a final tip, Dr Bennette says that, when it comes to young athletes and concussion care, a conservative approach is always best.
“When in doubt, sit them out.”
