Concussion in Grassroots and Junior Sport: If in Doubt, Sit Them Out

In April 2023 the UK Government and the Sport and Recreation Alliance published the first concussion guidance written for grassroots sport, not professionals. Its rule fits on a line: anyone with a suspected concussion comes off, does not return that day and does not play a contact match for at least 21 days.

What does the UK guidance actually say?

The UK concussion guidelines for non-elite (grassroots) sport apply to every age and every sport, from under-9 rugby to veterans' hockey. They are written for coaches, parents and volunteers, which is the point: there is no doctor on the touchline at most club fixtures, so the decision falls to whoever is standing there.

The core of it is three lines. Recognise the signs. Remove the player. Return them gradually, and never within 24 hours.

The 21-day figure is the earliest return to competitive sport with a risk of contact. It is a floor, not a target. A child who still gets headaches after a full day at school is not ready for training, let alone a match, and the guidance says anyone whose symptoms last more than four weeks should go back to a healthcare professional.

How do you spot a suspected concussion from the touchline?

You do not need to diagnose anything. You only need to suspect it.

Look for what you can see: lying still after a fall, slow to get up, clutching the head, unsteady on their feet, a blank or vacant look, a fit, or a face injury that came with a heavy knock. Then ask what you cannot see. Headache, dizziness, feeling sick, blurred vision, "I don't feel right". A player who cannot tell you the score, which half it is or who they are playing against is not fit to carry on. The NHS head injury and concussion page lists the same symptoms and is worth printing for parents.

Call 999 straight away for any loss of consciousness, a seizure, neck pain or tenderness, repeated vomiting, double vision, weakness or tingling in arms or legs, a severe or worsening headache, or a player who becomes more confused or drowsy. If the neck might be hurt, do not move them.

Why should the coach never be the one who decides to keep a player on?

This is the trade-off clubs actually argue about, and we take a firm side: the coach should not have the power to overrule a removal, and nor should the player or the parent on the touchline.

The pressure is real. It is the second half of a cup semi-final, the player is your best and he is telling you he is fine. A coach in that moment is the worst-placed person to judge, because he wants the answer to be yes. Concussion symptoms also tend to arrive late, sometimes hours later, so "he looked fine after five minutes" proves nothing. Write the rule so that any coach, referee or first aider can take a player off and nobody can put them back on. That takes the decision away from the person under pressure, which is kinder to them as well.

Coaches we speak to often put it something like this: "Nobody has ever complained that I took a child off. I only get grief when I leave them on."

What happens between the knock and the first match back?

1. Off and not back that day. Sit the player somewhere they can be watched. Never leave a child alone and never let them drive or go home on their own.
2. Parent told before they leave. Say what happened, what you saw and what the warning signs are. Give them a printed advice sheet.
3. NHS 111 or GP within 24 hours. The family makes the call. The club's job is to make sure they know to.
4. Rest for 24 to 48 hours. Relative rest, with less screen time, then a gradual return to school or work, which comes before sport.
5. Graded return to sport. Light exercise, then non-contact training, then full training. Move up a stage only if symptoms do not come back; drop back if they do.
6. Day 21 at the earliest for a contact match. Only when every earlier stage is done without symptoms.

Most clubs lose track at step five. The player stops coming for a fortnight, turns up to Thursday training and nobody remembers why they were missing.

What does this look like at a real junior club?

Take Greenbank Colts, a fictional but typical under-12 rugby section in Otley with 46 players, four coaches and Sunday fixtures from September to April. Last season it recorded seven suspected concussions, all removed on the day.

Every coach carries a laminated card with the visible signs and the 999 red flags on one side and the six steps on the other. When a player comes off, the coach logs it in the incident record before the end of the session: time, what happened, signs seen, who was told and when. The welfare officer then sets the earliest match date, counted 21 days from the knock, against the player's record, and checks in with the parent at day 7 and day 14. The player does not appear on a team sheet until a parent has confirmed that every stage went by without symptoms.

It costs about five minutes per incident. In return the club can answer the only question that matters if things go wrong: who knew, and what did they do?

How does Bitir help?

In Bitir, the incident is recorded on the coach's phone at the side of the pitch and sits on the player's member record, visible to that team's managers and nobody else. The parent hears through the team channel the same evening, with the advice sheet attached, rather than through a coach's personal WhatsApp. A dated task for the welfare officer on day 21 means the return date does not live in one volunteer's head, and attendance shows whether the player has been at non-contact training before anyone puts them on a team sheet. Our guide to accident and incident reporting covers the record itself, and the risk assessment guide covers where head injuries belong in your session plan.

Related reading: how a Leicester BMX club stopped losing its accident records, and how a Stoke junior football club cut referee reports about its touchline.