Concussion in community sport: signs, red flags and a safe return

A NSW parliamentary committee is deciding whether collision running, bare-knuckle boxing and competitive slapping should be regulated by the state’s Combat Sport Authority. At the hearing on Friday 6 November, a neurologist urged the committee to ban the sports, especially collision running. AMA NSW said it does not endorse them, but supports regulation plus government-funded public education about concussion and repeated head knocks (ABC News). The committee’s report is due by the end of 2026, and a collision-running event is being planned for Sydney.

Whatever the inquiry decides, concussion is not limited to new or extreme sports. It happens in local football, rugby, netball, basketball, cycling and at the playground. This article covers what every Inner West parent, player and coach should know: the signs, why a doctor comes first, and how a safe return to sport works.

Signs of concussion to look for

The Australian Concussion Guidelines for Youth and Community Sport were released in February 2024 by Sports Medicine Australia, the Australian Institute of Sport, the Australasian College of Sport and Exercise Physicians and the Australian Physiotherapy Association. Their headline rule is simple: if in doubt, sit them out.

Signs you might see after a knock to the head or body:

• Lying still, slow to get up, or knocked out
• A fit or stiffening of the body
• Confusion, or not knowing where they are or what happened
• Poor balance or coordination
• A dazed or blank stare
• Acting differently, or “not themselves”
• Falling to the ground without protecting themselves
• An injury to the face

Symptoms the person may describe:

• Headache or pressure in the head
• Feeling sick or vomiting
• Dizziness, blurred vision, or sensitivity to light or noise
• Feeling foggy, slowed down or tired
• Trouble concentrating or remembering
• Feeling more irritable or emotional than usual
• Sleeping much more or much less than normal

Symptoms do not always show straight away. The guidelines note it can take up to 48 hours after a knock to rule concussion out.

Call 000 or go to emergency if you see these

The guidelines list red flags that need immediate emergency care:

• Neck pain or tenderness
• Weakness, tingling or burning in the arms or legs
• Severe or worsening headache
• Repeated vomiting
• A seizure or convulsion
• Loss of consciousness, or becoming more drowsy
• Worsening confusion, agitation or unusual behaviour
• Double vision or loss of vision
• A visible deformity of the skull

If neck pain is present, do not move the person. Wait for paramedics.

Why you see a GP first

If there are no red flags, the guidelines say the person should be reviewed by a healthcare practitioner at the earliest opportunity, with another review at around day 3 to 4. Our advice is to make that first visit your GP, or a sports doctor if you have one.

A doctor can rule out a more serious head or neck injury, confirm the diagnosis, and guide time off school or work. Remove the person from play straight away and do not let them return to the game or training that day.

The first 24 to 48 hours are relative rest. That means rest for the body and the brain, with screens and reading brought back slowly after 48 hours.

A graded return to sport: at least 21 days

In community and youth sport, no one should return to contact or collision competition before day 21. They must also have been symptom-free at rest for at least 14 days. School or work should be fully back to normal before full contact sport.

The Graded Return to Sport Framework moves step by step. Each stage lasts at least 24 hours, and symptoms must settle back to normal before moving up.

1. Day 0: Remove from play. Relative rest for 24 to 48 hours.
2. Light activity: Daily activities, a gentle walk or stationary bike, and a graded return to school or work.
3. Stationary skills: Sport skills with very little head movement, like passing a ball from the front.
4. Skills with head movement: Passing while turning, walking or jogging.
5. Increased training: Add resistance training, harder cardio (up to 80% of maximum heart rate) and training drills.
6. Full training, no contact: Up to 90% effort, and full school or work.
7. Checkpoint: At least 14 days symptom-free, then review and clearance by a healthcare practitioner before any contact.
8. Return to play: Full contact training, then match simulation, then competition, no earlier than day 21.

If symptoms persist or get worse at any stage, the guidelines recommend going back to a healthcare practitioner for review. Players under 19 should never use the faster pathways some elite sports allow.

How Incline Health fits in

At Incline Health in Leichhardt, our chiropractors and physiotherapists follow the Australian Concussion Guidelines for Youth and Community Sport. If you come to us after a head knock, we check for red flags first. Anyone who has not seen a doctor yet will be referred to their GP or emergency before we go further.

Once a doctor has assessed you, we can help with:

• Assessing and managing neck pain, stiffness and headaches that can come with a knock to the head or a heavy tackle
• Planning your stages of the graded return to exercise and sport, and keeping you to the timeframes
• Strength, balance and conditioning work as you move back towards full training
• Liaising with your GP and coach so everyone works to the same plan

Every recovery is different, and we cannot speed up the minimum timeframes. Our job is to help you move through them safely.

If you or your child plays sport in the Inner West and you have questions about a recent knock, call us on (02) 9569 9552 or book online. In an emergency, call 000.

This article is general information, not personal advice.