Most concussions in amateur sport settle within about two weeks, but the first priority is spotting the small number that are medical emergencies. If a player has been knocked out, cannot stay awake, has a seizure, or has clear fluid or bleeding from the ears or nose, call 999. Everyone else follows the same rule: if in doubt, sit them out.
The short version
- Concussion is a brain injury from a knock to the head or body.
- Most symptoms clear within about two weeks.
- Some signs are 999 emergencies: not waking, seizures, fluid from the ears.
- No return to sport within 24 hours. If in doubt, sit them out.
- Stay off contact sport for at least three weeks, then return in stages.
What a concussion actually is
A concussion is a mild traumatic brain injury. It is caused by a blow to the head, or a hit to the body that jolts the head hard enough to shake the brain inside the skull. You do not have to be knocked out to have one. Most concussions in amateur sport involve no loss of consciousness at all.
The usual symptoms are headache, dizziness, feeling dazed or foggy, nausea, sensitivity to light or noise, and trouble concentrating. They can come on straight away or over the following hours. For most people these settle within about two weeks.
Red flags: when it is a 999 or A&E situation
The reason concussion is taken seriously is not the concussion itself. It is the small number of head injuries that are something more dangerous underneath. After any knock to the head, call 999 if the person:
- has been knocked out and has not woken up
- cannot stay awake or keep their eyes open
- has a fit or seizure
- has clear fluid coming from the ears or nose
- is bleeding from the ears, or has bruising behind the ears
- has new numbness or weakness anywhere in the body
- has problems with their vision or hearing
Also treat a fall from height, a high-speed impact, or any symptom that is getting worse rather than better as a reason to get seen urgently. The priority in that first assessment is ruling out a serious brain or neck injury, which is exactly what the NICE head injury guidance is built around. When you are not sure, go to A&E or call 111. Nobody has ever regretted getting a head injury checked.
The first 24 hours
Remove the player from the game or session immediately. There should be no return to sport within 24 hours of a suspected concussion, full stop. This is where the strapline earns its place: if in doubt, sit them out. A coach or parent is not letting anyone down by pulling a player off. They are doing the one thing that matters most.
For the rest of that day, someone should keep an eye on them, because the dangerous signs above can appear late. Avoid alcohol, do not drive until fully recovered, and ease right back on screens, work, and school. Rest, but you do not need to sit in a dark room for days. Gentle daily activity that does not bring symptoms on is fine once the first day has passed.
Return timelines: the staged approach
This is the part people get wrong, usually by coming back too soon. The NHS advice is clear: do not play contact sport for at least three weeks. The UK grassroots guidance then sets out a graduated return: light activity first, then sport-specific training, then contact, then competition, moving up a stage only if symptoms stay away at the level below.
The reason for the caution is real. A second knock while the brain is still recovering carries a far higher risk than the first. The same graded-return principle applies across sports injuries, and it is the same logic we use when someone is returning to running after a hamstring strain: load goes up in steps, guided by symptoms, not by the calendar. If symptoms are still there beyond four weeks, that is the point to get properly assessed by a healthcare professional.
Where osteopathy fits, and where it does not
Acute concussion is a medical matter, and it always has been. It is not something an osteopath treats. That is A&E, your GP, and the return-to-play protocol above. When I was practising, it was never the head injury itself that reached an osteopath. It was the neck and the headaches left behind once the concussion had settled.
That aftermath is common, because the same impact that concussed someone often strained the neck at the same time. Tension-type and neck-driven headaches, and a stiff, sore neck that lingers for weeks, are musculoskeletal problems. Once a doctor is happy the head injury itself has resolved, that is where the clinic team can help, with assessment and hands-on treatment of the neck and the muscles around it.
If the concussion has settled but you are left with a painful, stiff neck or ongoing headaches, an assessment is a sensible next step. Book at hardimanperformance.com/book-online.