Women's Football Hub

Concussion in Grassroots Sport: A Decade of Progress and the Road Ahead

Editor: Carolyn Kent Women’s Football Hub

Concussion is one of the most complex and misunderstood injuries in sport. It’s invisible, unpredictable, and often underestimated especially in grassroots environments where medical support is limited. In this episode of Women’s Football Hub, I had the privilege of speaking with Dr Stephanie Adams, a neuropsychologist and founder of concussED, whose work has helped shape concussion education and policy across the UK.

Together, we explored the evolution of concussion guidance over the past decade, the science behind recovery, and the cultural shift needed to protect athletes especially young ones from long-term harm.

From Research to Real-World Change

Dr Adams’ journey into concussion research began with a master’s in neuropsychology and a personal experience with concussion. Her academic path led her to a PhD focused on sport-related concussion, initially intended for rugby but ultimately pivoting to motorsport. This unexpected shift, facilitated by her supervisors’ connections with the Young Driver Development Programme, opened up new avenues for understanding concussion in high-G-force environments.

Her work with rally drivers and PE teachers revealed a critical gap in concussion education not just in awareness, but in sustained behaviour change. This insight became the foundation for concussED, a company dedicated to improving concussion literacy and response across sport and education.

The Tragedy That Sparked a Movement

The 2011 death of Benjamin Robinson, a young rugby player who suffered multiple concussions in a single match, was a watershed moment. His story catalysed the creation of the Scottish Sports Concussion Guidance, launched in 2015. Dr Adams, who had just moved to Scotland, joined a passionate coalition of researchers, medics, and advocates determined to prevent similar tragedies.

This guidance was the first of its kind in the UK, offering a unified approach to concussion management across all grassroots sports. It emphasised caution, education, and the mantra that has since become central to concussion response: “If in doubt, sit them out.”

What’s New in the 2024 Guidance?

The updated guidance introduces several key changes:

  • Unified Protocol Across Ages and Sports: Previous versions differentiated between youth and adult athletes. The 2024 update applies the same principles to everyone, with flexibility for individual recovery times.
  • Minimum 21-Day Return to Competition: Athletes must not return to competitive sport before 21 days post-concussion, regardless of symptom resolution.
  • Active Recovery Over Isolation: The outdated “dark room” approach has been replaced with a more evidence-based strategy. After 24–48 hours of relative rest, light physical and cognitive activity is encouraged to support recovery.

These changes reflect a growing understanding of concussion as a dynamic injury requiring nuanced care. The GRAS (Graduated Return to Activity and Sport Program) framework helps athletes, coaches, and parents navigate recovery in six stages, balancing rest with progressive re-engagement.

Recognising Concussion: Beyond the Obvious

One of the most important takeaways from our conversation was the need to recognize concussion symptoms beyond the classic headache or dizziness. Dr Adams outlined four key categories:

  1. Physical: Headache, nausea, dizziness, vomiting.
  2. Cognitive: Feeling foggy, slowed down, memory issues, difficulty concentrating.
  3. Sleep-related: Trouble falling asleep or staying awake.
  4. Emotional: Irritability, anger, sadness, or emotional outbursts.

The emotional symptoms, in particular, are often overlooked. In some cases, they may be the only visible sign especially in children or adolescents. Dr Adams shared examples from motorsport where emotional changes were the primary indicator of concussion.

The Challenge of Behavior Change

Education alone isn’t enough. As Dr Adams pointed out, behavior change is the hardest part. Even with free resources available online, athletes, coaches, and parents may ignore symptoms or rush recovery.

That’s why cultural change is essential. The “If in doubt, sit them out” campaign has helped simplify decision-making, especially for non-medical personnel. It empowers volunteers, teachers, and parents to act cautiously without needing a formal diagnosis.

Red Flags and When to Seek Help

While many concussion symptoms can be managed with rest and monitoring, some require urgent medical attention. Red flag symptoms include:

  • Loss of consciousness
  • Repeated vomiting
  • Increasing confusion or headache
  • Neck pain
  • Pressure in the head
  • Coming in and out of consciousness
  • Weakness or tingling in more than one limb

If any of these symptoms are present, the athlete should be taken to hospital immediately. For less severe cases, NHS 111 can provide guidance within 24 hours.

Supporting Recovery in Schools and Clubs

One of the most practical challenges is managing concussion in environments without medical staff. Dr Adams emphasised the importance of adapting activities to keep young athletes engaged without risking further injury.

For example, PE teachers can modify lesson plans to allow students to participate in non-contact roles such as assisting with instruction or observing. This helps maintain inclusion while respecting the recovery process.

The GRAS protocol also includes guidance for returning to education, recognizing that screen time, noise, and cognitive load can exacerbate symptoms. Recovery isn’t just about sport it’s about the whole person.

Professional vs. Grassroots: A Critical Distinction

Many young athletes idolise professional footballers who return to play within a much shorter period of concussion. But as Dr Adams explained, elite players have access to multidisciplinary teams, baseline testing, and constant monitoring. Grassroots athletes do not.

That’s why the 21-day minimum is so important. Without the infrastructure to assess recovery accurately, caution must prevail. Returning too early can prolong recovery or lead to more serious injuries including second impact syndrome, which can be fatal.

Special Populations: Children, Women, and Athletes with Disabilities

Concussion symptoms and recovery can vary significantly across different populations. Children and adolescents may take longer to recover. Female athletes may experience different symptom profiles. Athletes with disabilities may require tailored support.

Dr Adams highlighted the work of Dr Katie Mitchell in Canada, whose research into concussion in para sport and female athletes is helping to refine best practices. The key message: every concussion is unique, and care must be individualised.

Managing Multiple Concussions

For athletes who experience recurrent concussions, the guidance is clear: seek support from a healthcare professional trained in concussion management. This may involve longer recovery periods, sport modifications, or even switching to lower-risk activities.

The goal is not to exclude athletes from sport, but to protect their long-term brain health. As Dr Adams said, “We only get one brain.”

Looking Ahead: The Next 10 Years

The past decade has seen significant progress in concussion awareness and policy. But there’s still work to do. Dr Adams believes the next frontier is education in schools embedding concussion literacy early to foster a culture of safety and respect.

She also advocates for continued training of medical professionals, coaches, and volunteers. Her work with SportScotland and concussED is helping to build these foundations, one workshop at a time.

Final Thoughts

Concussion is not just a medical issue it’s a cultural one. It requires education, empathy, and a willingness to prioritize long-term health over short-term performance. The updated guidance, combined with tools like GRAS and campaigns like “If in doubt, sit them out,” offer a roadmap for safer sport.

As we look to the future, let’s commit to protecting athletes at every level. Because every child, every player, and every brain deserves that care.

Resources:

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