What to do about concussion

Recognizing concussion is the first step.  Having decided that someone is concussed they should be medically assessed and guided on a path to recovery.

sportscotland produced an excellent guide to concussion called ‘If in doubt, Sit them out’ which has been endorsed by many major organisations (Scottish Football Association, Scottish Rugby & the Scottish Government to name a few).  As well as the information on how to recognize concussion, it also contains guidance on what to do after being diagnosed with concussion.  It is an easy to read 7 page document - well worth a quick look.

So let’s assume that someone has been identified as concussed - how should they behave / what should they do over the days & weeks post injury?   Let’s start with a few basic principles:

  • as soon as someone is identified as concussed they do not participate any further in that day’s competition
  • they do not return to physical activity until all concussion symptoms have gone away
  • return to work / education takes priority over return to riding.

The most important principle of recovery after concussion is rest.  Rest the body, rest the brain.  For adults there should be  period of 7 days complete rest from physical activity (running, swimming, riding, mucking out boxes, shifting large bales etc) and from mental activities (this can include video games, watching TV, homework etc).  For under 18s this should probably be 14 days.  Good luck separating your 16 year old from the x-box for 2 weeks!

During this period someone who has been concussed should not drive or take alcohol until they have been cleared by a doctor or until all concussion symptoms have gone completely.

Once the initial 7 (or 14) day rest period is past and the concussion symptoms are all resolved a staged return to riding can be considered.  The sportscotland guide describes a six stage ‘Graduated Return to Play’ (GRtP) program.  For full details of this it is probably best to go to the original document. The principles are that each step introduces a little more physical activity, and providing the concussion symptoms do not return each day (or two days for under 18s) will see progression to the next level.  There are 6 stages in the sportscotland GRtP program, and after a single concussion the minimum time to full return to play is 12 days (23 days for under 18s).

Further reading

“If in doubt: Sit them out”.  Scottish Sports Concussion Guidance: Grassroots sport & general public.  Published by sportscotland 2015