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Never underestimate a head injury

Two points are important in head injuries: firstly, you may have suffered a concussion. Secondly, if you have, the crucial question is when you can safely return to play.

A concussion is a brain injury that is feared because it may affect your memory, concentration problem-solving and more. In real life, it is not at all easy to recognise that you have suffered a concussion. Contrary to common belief, you do not need to have lost consciousness to suffer concussion. You may be confused or unaware of the time, date or place for a while after the injury, or you may have headache, dizziness, nausea and unsteadiness/loss of balance.

When in doubt, keep out

With every impact to the head, it is important that you always think of concussion and watch out for it. If you feel a little out of sorts, but think you can still play, that may not be a good idea. The safest is: “when in doubt, keep out”.

Do not take a head injury lightly. No match is that important.

In important matches or with minor incidents, you might be very reluctant to do so. A short touchline assessment helps in the decision. The “Pocket SCAT” entails symptoms, questions and a balance test. If any of the described signs or symptoms is present, you might have a concussion and need to be removed from play. As a general rule, use this test for all head injuries.

When to return to play

In general, most concussions will heal on their own over several days. During this time, absolute rest is required including activities in which you need to concentrate, such as text messaging, video games or learning. When you are free of symptoms, a step-by-step guide will take you gradually back to play. If you do not experience any symptoms, this will take about a week.


Never return to play if you still have any symptoms!

Step-by-step guide for return to play following a concussion:

1. No activity, complete rest. Once the athlete is asymptomatic, they proceed to level two. The athlete spends, at the minimum, one day at each stage.
2. Light aerobic exercise such as walking or stationary cycling, no resistance training. Performing step two without symptoms allows the athlete to proceed to level three. If symptoms return, the athlete moves back one stage then continues.
3. Sport specific training (e.g. skating in hockey, running in football), progressive addition of resistance training at steps three or four. Performing step three without symptoms allows the athlete to proceed to level four.
4. Non-contact training drills. Performing step four without symptoms allows the athlete to proceed to level five.
5. Full contact training after medical clearance. Performing step five without symptoms allows the athlete to proceed to level six.
6. Game play.


- McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, Cantu R. Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Br J Sports Med 2009;43 Suppl 1:i76-90.
- McCrory P, Johnston K , Meeuwisse W, Aubry M , Cantu R, Dvorak J, Graf-Baumann T, Kelly J, Lovell M, Schamasch P. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Clin J Sport Med 2005;15(2):48-55.
- Aubry M, Cantu R, Dvorak J, Graf-Baumann T, Johnston K, Kelly J, et al. Summary and agreement statement of the First International Conference on Concussion in Sport, Vienna 2001. Recommendations for the improvement of safety and health of athletes who may suffer concussive injuries. Br J Sports Med 2002;36(1):6-10.