Concussion: How Do We Keep Our Players Safe?

In recent times sports media has been full of talk about concussion and mild traumatic brain injuries. This discussion may have left you worried and confused about your children’s safety when playing field sports. As head physiotherapist for the CUS rugby team and Trinity College senior hurlers, I have witnessed teenage and adult concussion first hand.

The word concussion seems to strike fear in parents and coaches alike, most likely because many are unaware of what exactly concussion means and how best to deal with it. As such, the primary aim of this article is to educate players, parents and spectators about concussion and how to handle the situation in 4 simple steps.


A concussion is a mild form of traumatic brain injury. The AASA (American Association of Neurological Surgeons) define a concussion as a clinical syndrome characterised by immediate and transient alteration in brain function .It is common in sports such as rugby, hurling, soccer, and Gaelic and American football. It can be sustained from rapid accelerating and decelerating forces in the brain (diffuse injury), or as a result of direct impact to the skull (focal injury).

It is extremely important for players, coaches and relatives to recognise the symptoms of concussion.

It is equally important to remember that a player does not necessarily need to sustain a blow to the head or lose consciousness to sustain a concussion.

Players with concussion may present with any of the following symptoms:

  1. Dizziness
  2. Fatigue
  3. Confusion
  4. Mood disturbances
  5. Visual impairments/Sensitivity to Light
  6. Balance Impairments
  7. Amnesia
  8. Nausea
  9. Pressure in the head
  10. Just not “feeling right”

Often a person may not present with signs or symptoms of a concussion until 3 hours after the injury has occurred. This is why the mechanism of injury is should be identified in real time by the health care professional on site.

Step 2: Report

If you yourself present with any of these symptoms after an event where you could have sustained a concussion, you should report this to your coach immediately. This is the responsibility of the player themselves;

the onus is also on team mates, referees and health care professionals to notify the coach in the event that you observe a player showing signs of concussion.

After attending the National Concussion Symposium in Croke Park last year, it became evident to me that a significant problem exists in relation to players themselves denying symptoms of concussion in order to continue playing. Rena Buckley (Cork Ladies All Ireland Camogie and Football winner) spoke about the importance of observing your team mates to notice any change in their behaviour if they have had a “hard knock”. 50% of parents were unsure whether their child would tell them if they had sustained a concussion during a match.  I found this extremely worrying as this makes it difficult to discern whether a player has sustained a concussion or not.

It is important that both coaches and medical professionals are familiar with the SCAT3 tool in order to accurately and objectively assess players. Dr Kevin Moran (doctor for the Donegal GAA team) spoke about the importance of correctly identifying the mechanism injury. If a player has received a knock to the head, they should immediately be removed from play and thoroughly assessed by a health care professional. As previously mentioned a person may not present with the signs and symptoms until 3 hours after the incident, therefore if a player has been removed from play I do not feel it is appropriate for them to return to play the remainder of the match.

Step 3: Rehab

Depending on the sport, if a player has received a concussion it is imperative that they go through a gradual rehab process before they return to play. These guidelines vary for different sports and also depend on the age of the player.

Generally this consists of a 5 point process

  1. Rest –(mental and physical)
  2. Light aerobic exercise
  3. Sport Specific exercise
  4. Non-contact training
  5. Full contact training

Your health care professional will advise and guide you on how to adhere to this.

Step 4: Return to play

Once this procedure has been followed, players are safe to return to play if they have been cleared by a medical professional.

“It’s not JUST a concussion”

If a player receives a second knock to the head after an initial concussion, this can leave a player at risk of catastrophic injury, such as Second Impact Syndrome .SIS may even result in death in severe cases. By recognising the symptoms of concussion and removing players from play where necessary, we can reduce the risk of serious injury, ensure our players safety and maybe even save lives.

“If in doubt, sit them out”.