If In Doubt, Sit Them Out: A Grassroots Coach's Guide to Concussion
Pre-season training is back underway across grassroots football and rugby clubs this month, which means it's exactly the right time for coaches, volunteers, and parents to refresh what they actually know about concussion — not what they half-remember from a training session a few years ago.
The UK now has a single, official set of Concussion Guidelines for Grassroots Sport, developed by an expert panel of clinicians and academics and backed by the Government, Sport England, the FA, and the RFU among others. The message at the centre of it is deliberately simple: if in doubt, sit them out.
Why grassroots needed its own guidance
Professional sport has doctors and dedicated head injury assessments pitchside. Grassroots sport, by definition, mostly doesn't. Hundreds of thousands of people play sport at grassroots level every week in the UK, usually with a coach, a parent, or a volunteer first aider as the only person available to make a call in the moment. The guidance exists specifically for that situation — where there's no medical professional on hand, and the decision has to be made by someone without a clinical background.
Recognising a suspected concussion
Any player who takes a blow to the head, face, neck, or body with force transmitted to the head should be assessed for symptoms. Signs to watch for include:
Being dazed, confused, or "not quite right"
Loss of consciousness, even briefly
Balance problems or unsteadiness
Vomiting
Headache
Sensitivity to light or noise
Memory problems, such as not remembering the incident or events just before it
Behaving out of character
You don't need all of these to suspect concussion. Even one visible sign or reported symptom is enough to act on.
What to actually do
Remove the player from play immediately. Not "next stoppage," not "if they say they're fine" — immediately, and regardless of how important the moment in the game feels.
Do not let them return to play that day, under any circumstances, even if symptoms seem to clear quickly. Symptoms can resolve temporarily and then return, or be masked by adrenaline.
Assign a responsible adult to stay with them and monitor how they're doing.
If the player is under 18, contact their parent or guardian to let them know what's happened.
Get medical assessment. Current UK guidance recommends contacting NHS 111 or seeing an appropriate healthcare professional within 24 hours of the injury.
Arrange for the player to get home safely and have a responsible adult supervise them for the next 24 to 48 hours.
Follow a graduated return. No return to sport within 24 hours of a suspected concussion, and return to activity should be gradual — education or work first, sport only once that's comfortably managed.
Why "if in doubt" really does mean "if in doubt"
The hardest part of this, honestly, isn't the medical knowledge — it's the social pressure in the moment. It's the last ten minutes of a cup match, or a player insisting they're fine, or a parent on the sideline who just wants their kid to finish the game. None of that changes the guidance. The entire point of "if in doubt, sit them out" is that hesitation and uncertainty aren't a reason to wait and see — they're the trigger to act.
Coaches and first aiders aren't being asked to diagnose concussion. Diagnosis is a job for a healthcare professional. What's being asked is much simpler: recognise the possibility, remove the player, and pass it up the chain. Getting that decision "wrong" by being overly cautious costs a player a game. Getting it wrong the other way carries a genuinely different level of risk.
Building this into your club, not just your head
If you coach, volunteer, or run first aid for a grassroots team:
Make sure every coach and volunteer, not just the designated first aider, knows the "if in doubt, sit them out" principle
Keep a simple, visible process for what happens after a suspected concussion — who calls the parent, who monitors the player, who follows up
Build concussion awareness into pre-season briefings alongside the usual kit and fixtures admin, so it's established before the season gets competitive
Treat it the same for training as for matches — a knock in a Tuesday night session carries exactly the same risk as one on a Saturday
FAQ
What does "if in doubt, sit them out" actually mean? If there's any suspicion a player has concussion, even without certainty, they must be removed from play immediately and not allowed to return that day, regardless of how they say they feel.
Can a player go back on if their symptoms clear up quickly? No. Current UK guidance is clear that a player suspected of concussion should not return to play on the same day under any circumstances, since symptoms can be temporarily masked by adrenaline or return later.
Who should assess a suspected concussion? A grassroots coach or first aider's role is to recognise the possibility and remove the player from play, not to diagnose. UK guidance recommends the player be assessed by a healthcare professional or NHS 111 within 24 hours.
How long should someone rest after a suspected concussion? There should be no return to sport within 24 hours, followed by a gradual, graduated return — resuming normal daily activity and education or work first, with sport being the last stage once that's comfortably managed.
Does this guidance apply to training sessions or only matches? It applies equally to both. A suspected head injury carries the same risk whether it happens in a competitive match or a routine training session.
Cracking Training's first aid courses include practical guidance on recognising and responding to head injuries, built for people without a clinical background. See our upcoming courses or get in touch to get your coaching team properly prepared this season.
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