An evaluation of the implementation of the UK Concussion Guidelines for Non-Elite (Grassroots) Sport

Sport-related injuries are the leading cause of concussion among children and young people and there is growing awareness of the possible long-term impacts of concussion on brain health, including dementia.. This has led to increased focus on sports-related concussion as an important public health concern.   

In the UK, the cross-party Digital, Culture, Media and Sport Committee’s Report on Concussion in Sport (2021) highlighted that while the evidence of a causal link between particular sporting activities and dementia remains uncertain, what is known should provide grounds for sporting national governing bodies and the Government to take a precautionary approach when advising on concussion in sport.   

In response the Committee’s recommendations, the Government and the Sports and Recreation Alliance published the ‘UK Concussion Guidelines for Non-Elite (Grassroots) Sports’ in April 2023. The guidelines were developed by an expert panel of sports medicine specialists and build on pre-existing guidelines in Scotland.  

The guidelines are intended to provide a consistent approach across all sports in England, Scotland, Wales and Northern Ireland. They aim to help players, coaches, parents, schools, national governing bodies and sports administrators to identify, manage and prevent concussion affecting participants in grassroots sports. The strapline “if in doubt, sit them out”, makes clear anyone with a suspected concussion should be removed from play immediately and not return to sport within 24 hours. They apply to all participants of grassroots sport, at all ages.  

The overarching aims of this study were to examine (i) how the UK Guidelines have been or are being implemented, and (ii) attitudes to and awareness of the UK Guidelines within grassroots sport. We focused on six sports: football, rugby union, gymnastics, field hockey, swimming and taekwondo.

Specifically, we sought to:

• review the concussion policies published by sporting national governing bodies and other national organisations involved in the development and/or distribution of the guidelines, including how easy they are to find;

• explore how sporting national governing bodies and other national organisations have circulated the UK concussion guidelines to the grassroots-level and what they have done to support the grassroots-level to implement them; and

• explore the attitudes to, awareness and use of the UK Guidelines UK Guidelines among coaches, welfare officers, participants and parents within British Gymnastics.

This study used a combination of document review, interviews with individuals representing organisations involved in the development and/or distribution of the UK concussion guidelines, and an online survey.  

We wanted to understand how the UK Guidelines have been implemented and conducted interviews with 34 national-level stakeholders. We also looked at the six sports’ concussion policies as presented on their websites. In addition, we explored whether people at the grassroots are aware of the guidelines and what they knew about them. To do this, we fielded a set of online surveys with 289 members of British Gymnastics, which had adopted the UK Guidelines in full.  

We reviewed the websites and other publicly available documents of national organisations identified as having been involved in the development and/or distribution of the guidelines. We also looked at the six sports’ (football, rugby union, gymnastics, field hockey, swimming and taekwondo) concussion policies as presented on their websites. The review examined whether the UK concussion guidelines are prominently displayed and easy to find, and whether additional material has been developed to support grassroots-level organisations and individuals in implementing the guidelines.  

Interviews were held with 34 national-level stakeholders to gain a better understanding of how the guidelines are anticipated to result in change at the grassroots level, including how they have been shared and what support is being provided to implement the guidelines.  

British Gymnastics had adopted the UK guidelines in full. We fielded a survey to 289 of their members of to examine whether they are aware of the guidelines, their understanding of the guidelines and if they have used the guidelines. The survey was designed with the input of four young people who themselves are involved in one of the six sports we focussed on. 

Interviews found broad support for the guidelines’ intentions, but there was variation in how they had been adopted and communicated. Concussion materials were difficult to locate on the six sports national websites, with limited signposting and inconsistent presentation. People we interviewed welcomed the pan-sport consistency of the UK Guidelines and that they were based on the best available evidence. But they also raised concerns about the technical language, length, and lack of clarity in key areas—particularly the return-to-activity section and guidance on when to seek medical advice.

Survey results showed that while general awareness of concussion was high, knowledge of the UK Guidelines themselves was limited: more than two-thirds of survey respondents could not recognise any of the concussion guidelines presented. Coaches and welfare officers generally had better knowledge than parents or gymnasts, but understanding of the timeline of return to education/work and sport and what ‘If in doubt, sit them out’ meant was low across the board, especially among younger gymnasts.

What does this mean?

To improve the accessibility and impact of the guidelines, clearer communication and simplified, audience-specific formats are needed, including child-friendly versions and visual materials like posters and videos. A national body could be appointed and tasked with supporting ongoing communication and dissemination, providing resources to smaller sports organisations, and maintaining consistent updates. There is a need to more clearly define roles across sectors, particularly in education and health, and embedding the guidelines into broader behavioural and safeguarding strategies in sport would support safer, more consistent practices. Further research is needed to explore how cultural, structural, and financial factors shape concussion-related behaviours in different sports, and to identify how knowledge can be better translated into action.