Sport after head injury


These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.


To guide staff to appropriately advise patients regarding sport activity after head injury.


  • Current evidence supports a gradual return to sport following a head injury, with a step wise return to play
  • Children who return to sport too early are at risk of sustaining complications from their head injury
  • The child should have a period of physical and mental rest ('brain rest'). This includes avoiding sporting activities but also activities that require mental concentration including computer use, tablets,television, texting and play stations
  • Once the child has been symptom free for 48 hours and feels back to normal, they can commence a gradual return to sporting activities as below.
Stage Activity Aim of stage
Stage 1: No activity (for first 48 hours after injury)
Complete physical and mental rest
Stage 2: Light aerobic exercise
Walking, swimming, stationary cycling
Gentle increase in heart rate 
Stage 3: Sport-specific exercise
Running drills at football codes, cricket, basketball, netball, hockey
Adds movement
Stages 4: Non-contact training drills 
Passing drills at football codes, cricket, basketball, netball, hockey
Adds co-ordination and exercise 
Stage 5: Full contact practice
Participate in normal training activities
Restores confidence and allows coaching staff to assess progress
Stage 6: Return to play
Normal game play

  • Each stage should last 24-48 hours
  • If the child remains symptom free, they can move on to the next stage
  • If the child develops any symptoms (headache, dizziness, nausea, or tiredness), they should move back a stage and try to progress again after a further 24-48 hour rest period
  • If the child has persistent headaches, dizziness, nausea or vomiting, they should be reassessed by their general practitioner or at the Emergency Department.

Endorsed by:  Director, Emergency Department  Date:  Jun 2017

 Review date:   Jan 2020

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