head injury

There has been ongoing debate as to whether repeated impact to the head, such as when heading the ball in football, can contribute to serious brain injury and dementia in later life. There have been continuous calls for professionals to investigate the cause and effect properly and appreciate the extent of brain damage that can occur following repeated head injuries. Former England captain Alan Shearer, 50, has expressed his concern that repeatedly heading balls in training may have resulted in damage to his brain. Many players, particularly from England’s 1966 World Cup squad have been diagnosed with dementia. For instance, Nobby Stiles, whose family believe continually heading the ball attributed to the disease.


Current heading guidelines

A study in 2019 at the University of Glasgow found that former professional footballers were 3.5 times more likely to die from dementia and other serious neurological diseases. Following this study the Football Association announced changes to heading coaching. The up-to-date guidelines state that:

  • There should be “no heading in training for primary school children
  • Graduated approach to heading for children in the development phase U12-U16
  • U18 heading drills should be reduced, to take into consideration the heading exposure in matches
  • Don’t over inflate the footballs: use the lowest pressure authorised by the Laws of the Game”

Footballs used nowadays are heavier than those used in the past. Some people fear that todays footballers are at greater risk of head injury and of developing dementia. Although the footballs are engineered for precision and appear more stream lined they are actually 40g heavier than the leather balls used before the 1990s. Issues arise when considering the old footballs on a rainy day. When wet, these balls become significantly heavier and thus more dangerous when headed. Research suggests that this is the time when severe head injuries will have been inflicted:

The Latest Head Injury Advice for Football and Rugby

The Latest Head Injury Advice for Football and Rugby

For a copy of this poster, please email [email protected]

What is a concussion?

Concussion is the disturbance to the normal working of the brain usually resulting from a blow to the head. Repeated concussions are linked to serious long-term brain conditions.

Initial symptoms of concussion – in football and rugby the most common symptoms are: Headache, confusion, blurred vision, nausea, difficulty concentrating, fatigue, drowsiness, dizziness, memory impairment

The FA have a campaign – If in doubt sit them out! http://www.thefa.com/get-involved/coach/concussion

What to do in the case of a concussion

This document gives clear guidance that coaches should remove someone with a suspected concussion from the pitch immediately and they should not resume play that day.

The Latest Head Injury Advice for Football and Rugby

Currently in Rugby, they operate extremely similar guidelines…

  • Club doctors have 13 minutes to decide if a player is fit to return to the field if there is a suspected concussion
  • All Premiership grounds and Twickenham have medical teams with access to replays to help with this crucial decision.
  • Any player with confirmed or suspected concussion will be permanently removed and will not be permitted to return to training until deemed fit by medics. 

Concussion can also affect someone’s mood, balance, sleep, thinking, concentration and senses. Most symptoms resolve in 7-10 days and many much sooner.

Concussions are an injury to the brain and they need to rest to fully recover, in a similar way to that of a sprain or strain. The brain in shaken within the skull in the collision, which results in an injury. If someone rests appropriately following a concussion they will nearly always make a full recovery.

Most important advice following a head injury –

  • Don’t make things worse – important to take seriously and rest
  • Do not risk injury again
  • Rest your brain = lots of sleep, avoid reading, screens and sports for at least 24 hours / 48 hours 

Children and adolescents may need one or 2 days off school and a gradual return to academic study. They can start light reading and small amounts of screen time, but this should be monitored and stopped if there are signs of any recurrence of symptoms.

At least 2 weeks with no training to give the brain a chance to fully recover.

If there are no symptoms players can then start the gradual return to play GRTP –

  • 24 hours per stage (48 hours for children and adolescents) – go back a stage if symptoms occur
  • Light aerobic exercise
  • Sport specific exercise
  • Non-contact training
  • Full contact practice

19 days is the earliest that an adult can return to play

23 days is the earliest that a child or adolescent can return to play

Repeated concussions, particularly in children are associated with long term consequences and serious conditions including second impact syndrome and post-concussion syndrome.

Coaches and first aiders should be confident to:

Remove – any player who has experienced a head injury and shows any of the above symptoms should be removed from play immediately.

Recognise – learn the signs of concussion. Only about 10% of people experiencing concussion will actually be unconscious, therefore the other 90% of people who have experienced concussion will remain conscious. Look out for the more obvious signs such as a dazed or blank expression or tonic arm extension following the blow to the head; along with the symptoms listed above.

Applying a wrapped ice pack will reduce superficial bruising and swelling – but has no effect on any brain recovery.

Someone appropriately trained to do so should remove a casualty from the field if a severe head injury has been sustained and you are concerned about the casualty’s spine. If worried and no one appropriate to help; reassure the casualty, support their head in a neutral position, stop the game – or move to another pitch and await removal of the casualty by paramedics.

Rest – for at least 24 hours for an adult and 48 for a child or adolescent (see above)

Recover – Ensure the player remains completely symptom free before contemplating any form of return to play.

Return – return to play using the gradual return to play GRTP method as outlined above

It may take 4-6 weeks before a player is fully fit and back to competitive play. This may seem a long time away from the game. However, it is incomparable to the recovery time following a soft tissue injury and your brain is so important to every aspect of life, that it is vital we take head injuries seriously.

The RFU have a superb online training course specific to parents, players, teachers and coaches. http://www.englandrugby.com/my-rugby/players/player-health/concussion-headcase/

The Football Association have the following:



New pitch side saliva test to immediately diagnose concussion

The University of Birmingham, in association with the Rugby Football Union (RFU), Premiership Rugby and the Rugby Players’ Association have developed a new pitch-side test to quickly diagnose concussion and brain injuries. During matches in 2017-19, players with suspected or confirmed concussion were asked to provide samples of saliva immediately following the injury. The samples were then compared to samples taken from other players who did not sustain injuries. The test uses microscopic DNA markers in saliva to diagnose a concussion and it has a 94% accuracy.

This test may start being used for elite players in a few months and a pitch side test that gives immediate results could be several years away. However, due to a lack of data this test cannot be used for women yet.

For more information click here


Train with us

We offer tailored first aid courses covering the above topics to empower you with the skills to keep you and your family safe and well. We have a superb online 8 hour course for mental health first aid. It consists of videos, step by step directions, infographics and test yourself sections. You can stop and start as you wish. It covers all aspects of Mental Health First Aid, with an emphasis on promoting good mental health. There are tips for mental well-being, help for organisations, advice for mental first aiders and key pointers to help recognise early warning signs someone may be struggling with their mental health.


About us


First Aid for Life provide award-winning first aid training tailored to your needs – Please visit our site and learn more about our practical and online courses. It is vital to keep your skills current and refreshed. We are currently providing essential training for individuals and groups across the UK. In addition, we have a great range of online courses. These are ideal as refreshers for regulated qualifications or as Appointed Person qualifications.


You can attend a fully regulated Practical or Online First Aid course to understand what to do in a medical emergency. Please visit https://firstaidforlife.org.uk or call 0208 675 4036 for more information about our courses.


First Aid for Life is a multi-award-winning, fully regulated first aid training provider. Our trainers are highly experienced medical, health and emergency services professionals who will tailor the training to your needs. Courses for groups or individuals at our venue or yours.


First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken on this information.

Emma Hammett
Author: Emma Hammett