For health professionals

Sports related concussion (SRC)

Sports related concussion is an area of study within the mild traumatic brain injury (mTBI) field and relates to the traumatic brain injury induced by biomechanical forces during sports.

SRC can be identified in the community by athletes, coaches, parents, teachers, trainers and officials as well as licenced healthcare professionals. However, a formal diagnosis and assessment should be made by a medical physician. SRC can be challenging to assess and recognise during play and can often be an evolving injury with delayed signs and symptoms. Therefore, repeated assessment may be required. Assessment tools look at recognising the injury, observable signs and symptoms, cognition (ie memory), neurological and balance assessments. If a concussion is suspected, without significant injury to the spine or head, athletes should be removed from play immediately and appropriate sideline assessment performed. For health care professionals, it is recommended to use Sport Concussion Assessment Tool (SCAT5) for athletes 13 years or older and the Child SCAT5 for those under 12. For non-medically trained individuals the Concussion Recognition Tool 5 (CRT5) is recommended. If there is any suspicion of concussion / mTBI further medical evaluation and assessment is required.

 

Those diagnosed with SRC should receive education from a health care professional in regards to the management of ongoing signs and symptoms as well as guidance on return to work, school and sport. Prior to returning to play they be reviewed by a medical professional and receive medical clearance.

For most people, symptoms improve within 1 to 4 weeks. If there have been multiple concussions, it may take longer to recover. If their symptoms do not settle within a reasonable timeframe (10 to 14 days for adults and 4 weeks for children), or you are concerned, you should recommend an assessment with a healthcare professional who is experienced in concussion management. For those with multiple concussions (>3), unable to return to school or work full time, had subsequent concussions from lesser force, or increased duration of symptoms, consideration of retirement from play in consultation with an interdisciplinary healthcare team may be appropriate.

The information provided on this website is a general guide to return to activity not specific to sport related injury. For further information and guidance on acute and sub-acute assessment and management of SRC please refer to the latest Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport held in Amsterdam (PDF), the recent Concussion in Sport Australia Position Statement (PDF) or brief video update by Associate Professor Stacey Jankelowitz (external site) to provide outline of changes in Australia to sports protocols.

Connectivity (external site) is a WA website about traumatic brain injury and has a health guidelines (external site) section that will also provide information on current best practice post-concussion in sports.

Most sporting organisations will also have specific recommendations unique to their sport that run parallel with existing guidelines including:

Sound icon Return to sport protocol

Allow 24 hours as a minimum between each stage, if symptom free. Go back one step if symptoms resume.

Stage Functional exercise Objective
1. No activity Complete physical and cognitive rest. Recovery
2. Light aerobic exercise Walking, swimming or stationary cycling for 10 to 15 minutes, keeping intensity <70% maximum permitted heart rate. Avoid resistance training and other heavy lifting. Increase heart rate
3. Sport specific exercise Running and throwing drills. Avoid body contact, resistance training, heavy lifting and other jarring motions. Add movement
4. Non contact training drills Progression to more complex training, eg passing / press drills. Start progressive resistance exercises but avoid impact activities. Exercise, coordination and cognitive load
5. Full contact practice Following medical clearance, return to normal training activities. Restore confidence and assess functional skills
6. Return to play Normal game play. Full return to pre-concussion activities

Sound icon Return to study protocol

Allow 24 hours as a minimum between stages 1 to 3 and 1 to 2 weeks as a minimum between stages 4 to 6, if symptom free. Go back one step if symptoms resume.

Stage Functional exercise Objective
1. No activity Complete cognitive rest Recovery
2. Minor cognitive activity at home Short periods (5 to 15min) of cognitive activity (homework) Gradual, closely monitored increase in sub symptom threshold activities
3. Moderate cognitive activity at home Longer periods (20 to 30mins) of cognitive activity (homework) Increase cognitive stamina, self paced activity
4. Partial school entry Part day of school attendance, plus 1 to 2 cumulative hours of homework Re-entry into school with accommodation to maintain cognitive load below symptom threshold
5. Gradual reintegration to school Gradual increase to full day of school attendance Increase cognitive stamina, gradual decrease of accommodations
6. Full cognitive workload resumed Catch up on essential missed work, re-introduce testing and assessments Full return to school, recommended to commence RTP protocol

Return to study for school administrators

Return to study fact sheet (PDF) 

Return to study for school administrators

Return to study fact sheet (PDF) 

Sound icon Return to work protocol

Allow 24 hours as a minimum between stages 1 to 3 and 1 to 2 weeks as a minimum between stages 4 to 6, if symptom free.

Stage Functional exercise Objective
1. No activity Complete cognitive rest (Maximum of 1 to 2 days). Recovery
2. Minor cognitive activity and light aerobic exercise in/around home Short periods (5 to 15min) of cognitive activity (texting / computer) and going for walks up to 10 to 15 minutes, simple chores. Gradual, closely monitored increase in sub symptom threshold activities
3. Moderate cognitive / physical activity in / around home Longer periods (20 to 30mins) of cognitive activity (social media / TV) or housekeeping tasks. Increase cognitive / physical stamina, self paced activity
4. Part time work Part day in work environment, consider 3 mornings a week (ie Monday, Wednesday, Friday) for 3 to 4 hours. Ensure one task at a time. Re-entry into work environment with accommodation to maintain cognitive load below symptom threshold, commence GRTWP
5. Gradual reintegration to work Gradual increase to full work days (ie Monday, Wednesday, Friday), then onto a full working week with reduced responsibilities, time pressures and restricted duties. Increase cognitive stamina, gradual decrease of accommodations, progress GRTWP
6. Full time work and duties Catch up on essential missed work, and plan out priorities. Full return to work

Return to work for the employer

Return to work fact sheet (PDF) 

Last Updated: 21/08/2023