The basics
What is a concussion?
A concussion is a brain injury. It happens when a blow to the head, face, neck or body makes the brain move quickly inside the skull. This temporarily affects how the brain works.
You do not need to be knocked out.
Most concussions happen without any loss of consciousness.
Scans are usually normal.
A CT or MRI scan cannot rule out concussion. Scans are only done to check for more serious injuries such as bleeding.
Every concussion is different.
Symptoms and recovery time vary between people and between injuries.
If in doubt, sit them out: anyone with a suspected concussion must stop playing straight away and must not return to play on the same day.
Signs to watch for
Common symptoms
Symptoms can appear straight away or develop over the next few hours, and sometimes the next day. Watch for any of these:
- Physical
Headache, pressure in the head, dizziness, nausea, balance problems, blurred vision, sensitivity to light or noise, tiredness
- Thinking
Feeling slowed down or "in a fog", poor concentration, trouble remembering, confusion
- Emotional
Irritability, feeling more emotional, sadness, nervousness or anxiety
- Sleep
Drowsiness, sleeping more or less than usual, trouble falling asleep
Symptoms often get worse with physical or mental effort, such as exercise, screens, reading or a busy, noisy room.
Emergency
Red flags: go to the emergency unit now
Call an ambulance (10177, or 112 from a cellphone, or 084 124 for ER24) or go to your nearest emergency unit straight away if any of these happen, at any time after the injury:
- Neck pain or tenderness, or weakness, tingling or burning in the arms or legs
- Severe headache, or a headache that keeps getting worse
- Repeated vomiting
- A seizure (fit or convulsion)
- Losing consciousness, even briefly, or being very drowsy or hard to wake
- Increasing confusion, restlessness, agitation or aggression
- Double vision, slurred speech, or not recognising people or places
- Clear fluid or blood from the nose or ears
Do not move someone with neck pain or tingling in their limbs unless they are in danger. Wait for trained help.
Straight after the injury
The first 24–48 hours
Take it easy for the first 1–2 days, but complete bed rest is not needed and does not speed up recovery. A responsible adult should stay with the injured person for the first 24 hours.
Do
- Rest, and do light everyday activities at home that do not make symptoms more than mildly worse
- Go for short, easy walks once you feel able
- Sleep as normal — you do not need to be woken during the night unless a doctor has told you to
- Take paracetamol (e.g. Panado) for headache if needed
Avoid
- Sport, training, the gym and any activity with a risk of another knock to the head
- Alcohol and recreational drugs
- Driving, cycling or operating machinery until a doctor confirms it is safe
- Anti-inflammatories (e.g. ibuprofen, diclofenac) and aspirin in the first 48 hours, unless a doctor advises otherwise
- Long periods on screens — short breaks are fine
Return to learn and work
Returning to daily life, school and work
After the first 1–2 days, slowly build up everyday activity, using your symptoms as a guide. Mild, brief symptoms are acceptable; stop and rest if symptoms get clearly worse.
School and work come before sport
A full return to learning or work must happen before a full return to sport.
Short days to start with
Begin with half days or shorter tasks, with regular breaks.
Ask for temporary adjustments
Where needed, such as extra time for tests, reduced screen work, a quiet place to rest, or postponing exams.
Dr. Ganda can provide a letter for your school or employer.
Graduated return
Returning to sport
Return to sport happens in stages, with at least 24 hours at each stage. Move up only if you have no new or worsening symptoms. If symptoms return, drop back to the previous stage for at least 24 hours.
- 1
Symptom-limited activity
Daily activities that do not make symptoms worse
e.g. Walking, light household tasks
- 2
Light to moderate aerobic exercise
Gradually increasing effort, no resistance training
e.g. Stationary bike, brisk walking, easy jogging
- 3
Sport-specific exercise
Individual training away from team drills, no head impact
e.g. Running drills, ball skills on your own
- 4
Non-contact training drills
Harder training with teammates, no contact
e.g. Passing drills, resistance training
- 5
Full-contact practice
Normal training, only after medical clearance
e.g. Full team training including contact
Medical clearance required - 6
Return to sport
Normal match play
e.g. Competition
Medical clearance and stand-down periods
Medical clearance is required before full-contact training. Many sports also set minimum stand-down periods, often longer for players under 19. This includes World Rugby and school and community rugby in South Africa. Dr. Ganda will explain which rules apply to you or your child.
Children and teenagers usually recover more slowly than adults and are managed more cautiously.
Further reading
More information on concussion
For more information on concussion, visit the BokSmart Medical Protocol: Concussion (SA Rugby).