Community footballers who suffer concussion face a three-week stand-down from competition under new national guidelines to be introduced for the 2024 winter season.
Guidelines have been developed by the Accident Compensation Corporation in partnership with seven national sports, including football.
They are designed to improve the health outcomes and wellbeing for people who play community sport by introducing a standardised approach to managing concussion.
The key changes are:
- When a player suffers a concussion, they must have a minimum period of 21 days away from full competition.
- Medical clearance must be obtained before they return to play.
Main photo: Guidelines bring a common approach for sports. Photo: Shane Wenzlick / Phototek.
NZ Football’s medical director Dr Mark Fulcher, who helped develop the guidelines, says while football has fewer risks than other sports, the code still needs to change its approach to concussion.
He told NewstalkZB sports host Jason Pine:
“I think there is still a perception that maybe football is not somewhere where you get concussed regularly, and I think that there’s work to be done amongst our people to say ‘look actually, just because you’re playing a sport that is lower risk, does not mean it is no risk.’
“We should still be looking and considering the possibility of a concussion.”
Of sports-related concussions, Fulcher said: “It is probably way more common than we appreciate.
“If we look at recorded concussions, it’s not as common as other types of injury but we know a lot of concussion doesn’t get reported or doesn’t get recorded when it is reported.
“People might go to a doctor but the code that’s used in the ACC database is wrong.
“It’s very hard to know exactly what the risk is but I guess what we’re all concerned about, and one of the reasons we have got these guidelines, is to try and mitigate the risk of future harm.
Fulcher said “unquestionably” a large number of concussions had gone unreported and he was pleased multiple sports had worked together to deal with the issue.
He said the guidelines dealt with community sportspeople but professional athletes might have shorter stand-down periods because they had medical support to monitor their progress.
Listen to Mark Fulcher’s interview
Listen here to Mark Fulcher’s 12-minute interview with Jason Pine here:
How the new guidelines were developed
ACC began work on the new guidelines in mid-2023, convening an expert panel with medical directors from the larger and higher-risk sports codes.
The panel included:
- Dr Mark Fulcher (NZ Football medical director)
- Dr John Mayhew (NZ Rugby League medical director)
- Dr Ian Murphy (ACC Principal Clinical Advisor)
- Sharon Kearney (Netball NZ Injury Prevention consultant)
- Dr Melinda Parnell (Netball NZ medical director)
- Karen Rasmussen (NZ Rugby Medical manager)
- Dr Stephen Kara (expertise and specialist interest in concussion),
- Dr Graeme McCrory (Equestrian Sports NZ medical director and community GP)
ACC collated the latest research around concussion, including international consensus statements, and applied this in the New Zealand context, with concussion being managed in primary care.
The panel agreed on the return-to-play changes for a player who has suffered a concussion. This approach is consistent with community sport in Australia and the United Kingdom.
This was based on guidance in the International Consensus Statement on Concussion in Sport, the UK Concussion Guidelines for Grassroots Sports and other relevant research.
The AIS, the Australian Sports Commission’s (ASC) high-performance arm, in a world first has aligned the Youth and Community Sport Guidelines with advice in both New Zealand and the United Kingdom.
Keeping our young sportspeople safe
Sport NZ Group Manager of Play, Active Recreation and Sport, Jim Ellis, says keeping young people safe when they participate in sport is paramount and it’s great to see sports organisations engaging with this initiative.
“A collective approach to concussion guidelines will have big benefits,” he says.
“Ultimately, it will help players, coaches, parents, volunteers and everyone involved in community sport to ensure there’s consistency in terms of diagnosis, treatment and the return to sport.
“It’s also important to see our new national concussion guidelines aligning with what’s happening in community sport across Australia and the UK.”
It’s believed the guidelines will lead to greater awareness of concussion and a decrease in risk of longer-term negative effects of concussion.
These guidelines are for community and grassroots sport only, on the assumption these players do not have medical support.
In elite and high-performance sport environments, athletes have immediate access to medical support and will continue to have that wrap-around support and time to develop tailored rehabilitation programmes that can be monitored daily.
‘This is a game changer for community sport’
Dr Stephen Kara, the independent member of the expert panel, says the national concussion guidelines are an important step to putting players’ welfare first.
“This is a game changer for community sport in this country,” he says.
“We know it can be confusing for coaches, players, family and health practitioners if concussion management advice from each sport is different. This will change that with clear guidelines and process for all sports.”
Kara says managing and preventing concussion is everyone’s responsibility.
“Concussion can happen at home, work or on the sports field and everyone can learn to recognise when a concussion may have occurred,” he says.
“We all have a role to play in creating a culture where concussion is called out and reported to a medical professional. Collectively, we can make a big difference.
“These national concussion guidelines make it very clear for everyone on the steps to follow to ensure the player is in a fit state to return to play.”
The true cost of concussion
In 2023, ACC accepted 10,648 claims for sports-related concussion.
These injuries came at a cost of $64 million to help people recover. This was the highest number of claims and the highest cost over the past five years. From 2019 to 2023, ACC spent $266 million helping people recover from sports-related concussion.
Research from ACC suggests that around 1,100 concussions currently go untreated.
The highest number of sport-related concussions occur in team-based sports such as rugby, football, basketball and from cycling and equestrian activities.
Tane Cassidy says it’s important concussion symptoms are managed well.
“Good early management of concussion can improve long-term outcomes,” he says.
“We’re committed to increasing awareness and education around concussion, and these guidelines give community sport the direction it needs.”
The importance of full recovery
Cassidy says good recovery from concussion before return to play ensures players get back to their best. This is better for the player and their team’s performance.
“Taking 21 days to get right gives the player the best chance to fully regain their strength, coordination, speed and skills,” he says.
“So, when they’re back, they’re able to hit the ground running and play to their ability.”
The highest volume of sport-related concussions are in the 10 to 19 age category and research shows people play multiple sports in this age group.
Currently, depending on what sport the person plays, when they suffer a concussion they will get different advice around a safe return to sport, varying from six days to 23 days.
But that is all set to change in a landmark new direction for community sport.
The four Rs of concussion management
Recognise (the signs and symptoms of concussion)
Remove (the person from play)
Refer (to a medical doctor to confirm diagnosis and provide treatment)
Recover (before returning to school/work and sport)