Concussion management info

Occupational Therapist Kathy Wong, who works at the GF Strong Rehabilitation Centre but also has two kids playing soccer, passed on this great information that’s been put together to help coaches recognize and deal with concussion symptoms. I’ll cut and paste it here verbatim…


The concussion rate among youth soccer players is similar for both elite and recreational athletes to that of American football and ice hockey players (‘Injuries in Youth Soccer’, Journal of Pediatrics, Jan. 2010). In girls’ sports, the rate of concussion is highest in girls’ soccer and basketball (‘Sport-Related Concussion in Children and Adolescents, Journal of Pediatrics, August, 2010).  There is less data for the grade school athlete.

All coaches should carry a Concussion Management card that lists some of the signs and symptoms of concussion (eg. dizziness, nausea, blurred vision, confusion, disorientation etc.) as well as the return-to-play protocol.  Each equipment bag has been given a card.

Concussion information for coaches, parents and athletes and return to play guidelines can be found on the ThinkFirst website ( – these guidelines are supported by Soccer Canada.


•”When in doubt, sit them out”

If it is suspected that a player has sustained a concussion, he/she should stop playing soccer immediately.

•He/she should not be left alone and should be seen by a physician as soon as possible on that same day.

•If a player loses consciousness; call 9-1-1 for an ambulance to take him/her to the hospital.

Important note:  You do not need to lose consciousness to sustain a concussion.

•Adolescent athletes often do not report that they have a concussion and will continue to play in the game.

•Symptoms of a concussion may not develop immediately after injury.  They may appear hours or even days later (e.g. when the athlete returns to school on Monday after receiving the injury on Saturday.  As the “thinking demands” of schoolwork increase, the student could begin to experience symptoms).


•The focus is to reduce the potential of further injury or stress to the brain.

•Since the brain is responsible for all moving (physical) and thinking (cognitive) functions of the body, athletes with concussion need to rest physically and cognitively (this may mean no computer games, texting, TV, reading) until the symptoms have resolved at rest and with exertion.

•Reducing just the physical demands (and not the cognitive demands) may delay or hamper recovery.

During the recovery period, contact sports and any other activity where there’s a risk for another concussion (eg. cycling, basketball, skiing etc.) should be avoided.  After one concussion, the athlete is 3 times at risk for another concussion.

• The majority of athletes recover (become asymptomatic) after a week, although studies indicate that pediatric and adolescent athletes take longer for a full cognitive recovery.


•After a concussion, it is recommended that the athlete follow a graded return to play protocol outlined by the 2008 Zurich Consensus Statement on Concussion in Sport.  If symptoms return, the athlete should always return to the previous step.  Each step has a minimum of 1 day.

Step 1 No activity, complete physical rest, quiet time with maximum rest.  Go to step 2 when 100% symptom free for 24 hrs.
Step 2 Light aerobic activity such as walking or stationary cycling 10 – 15 mins
Step 3 Sport-specific training (eg. skating in hockey, running in soccer) 20 – 30 mins.  Low risk activities
Step 4 Non-contact training drills
Step 5 Full-contact training after clearance by a physician
Step 6 Return to game play.  If symptoms return, athlete should return to previous step.

Medical clearance by a physician is always advised before any return to play.


Training Module for coaches: – this is an excellent website devoted to brain and spinal cord injury prevention in children and youth

The above information was taken from the Early Response Concussion Service for Adolescents pilot project, Adolescent/Young Adult Services, GF Strong Rehab Centre (August 2011).

By request, you can download a PDF here:


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7 Responses to Concussion management info

  1. MJ says:

    Gregor– does Kathy have an electronic copy of the Management Card? I’ve been in a couple of situations where decision making would have been enhanced by a written protocol.

  2. Julie says:

    Awesome info. Thanks so much.

  3. Julie says:

    Gregor, I’ve always wondered … does heading the ball cause concussion or contribute to it?

    • Gregor says:

      I would never pretend to be able to give any sort of medically-based answers to anything. All I can say is that one of the pieces of evidence supporting that the theory that heading the ball causes concussions was an autopsy performed on a former English soccer player who was known to head the ball. His brain showed trauma consistent with repeated concussions.

      Linking the two is a bit of guesswork as he could just as easily got into a lot of fights and just not done very well in those fights and taken a lot of shots to the head. More likely though is that he did get the damage from heading soccer balls but he played in the 50’s in England so the balls were leather and with the playing season seeing a lot of rain, those balls were often heavy from absorbing water.

      Today, balls are much lighter and do not absorb water.

      Anecdotally, I’d find it hard to believe that there’s many people in this country who have headed a soccer ball more than I have. While I did get minor whiplash once when I got hit hard by a ball I didn’t see coming (not really heading the ball), the only injuries I got related to heading were not from the ball but from elbows and head to head contact jumping for balls.

  4. Burnsie says:

    Your biggest head injury was in ‘CAPS’…….

    Good article, Gregor. I am always very conscious of my players and of any players on the field when I’m reffing. It is obviously a very serious issue and it’s good that more precaution is being taken. Only if I had known of this information when I was playing. 🙂

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