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Concussion in Community Sport
Concussion physio Brisbane athletes can trust starts with understanding what happens after a knock. Learn why the 21-day rule matters, why dark-room rest is outdated, and how the right rehabilitation can help you return to play safely.
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For concussion physio Brisbane athletes can trust, understanding what happens after a knock is the first step.
It is the middle of winter sport season, which means it is also the middle of concussion season. Every weekend across Brisbane, someone cops a knock in a footy tackle, a netball collision, or a fall on the bike, shakes it off, and hears the same well-meaning advice from the sideline: you’ll be right, have a rest, see how you pull up. Sometimes they are back on the field the following Saturday. Australian sport has now drawn a firm line under that approach.
Under the Australian Concussion Guidelines for Youth and Community Sport, the minimum time between a concussion and a return to competitive contact sport is 21 days, and more than 30 sports including the AFL have adopted it. If that number surprises you, this post is for you.
(At PEAK, we call all our patients Athletes, not because of fitness level but because of mindset: our job is to help you reach your goal, whatever that is. After a concussion, that goal might be returning to the footy field, but it might just as easily be getting through a work day without a headache or walking down the supermarket aisle without the shelves seeming to move.
A concussion is a mild traumatic brain injury. The knock, whether it comes from direct head contact or from a whiplash-style jolt that whips the head around, stretches brain cells and triggers a temporary energy crisis inside them. The brain suddenly needs more fuel to restore order at exactly the moment its fuel delivery is disrupted. That mismatch is why the symptoms of concussion are so varied: headache, fogginess, dizziness, nausea, sensitivity to light and noise, irritability, poor sleep, and trouble concentrating can all show up, sometimes immediately, sometimes over the following 24 to 48 hours.
Two things about concussion catch people off guard. First, you do not need to be knocked out. Loss of consciousness happens in only a small minority of concussions, and a player who stays on their feet can still be concussed. Second, a concussion is a functional injury rather than a structural one, which is why standard scans usually come back clear. A normal CT does not mean a normal brain; it means the injury lives in how the brain is working, not in what it looks like.
Physiotherapist Callum MacDiarmid has developed a special interest in vestibular and concussion conditions, and he spends a good part of his week with patients whose dizziness, visual strain, or lingering fog traces back to a knock that everyone assumed would sort itself out.
“The advice people remember from years ago is to lie in a dark room until every symptom disappears, and we now know that is close to the worst thing you can do,” Callum explains. “After the first day or two, the brain recovers better with gentle movement than with total shutdown. When I assess someone after a concussion, I am looking well beyond the headache: how the eyes track a moving target, how the balance system is coping, what the neck is contributing, and how symptoms respond when we gradually raise the heart rate. Those findings tell us exactly what to rehabilitate.
And the 21-day minimum is not a punishment, it is a floor. Some people are ready at day 21, plenty need longer, and proper testing is what tells us who is who. The worst outcomes I see are almost never from the first knock. They are from the second one that happened before the first had healed.”
Pain: the first 24 to 48 hours call for relative rest, which means winding back physical and mental effort, limiting screens, and letting the initial storm settle. It does not mean lying motionless in the dark. From there we treat what we find: hands-on treatment for the neck, which is involved in a large share of concussions, vestibular rehabilitation for dizziness and balance problems, and clear education, because understanding what is happening reliably lowers the anxiety that can amplify symptoms.
Prevention: this is where guided, graded activity does its work. The strongest recent evidence, reflected in the 2023 international consensus on concussion in sport, shows that light aerobic exercise introduced within days of injury, kept just below the level that stirs up symptoms, speeds recovery and reduces the risk of symptoms persisting. We build that progression with you checkpoint by checkpoint, alongside a graded return to school or work, so you are not left guessing what is safe this week.
Under the Australian community sport guidelines, that includes being at least 14 days symptom free at rest before returning to contact training.
Performance: before you return to competition we retest the systems the concussion disrupted: balance, eye-head coordination, reaction under fatigue, and confidence in contact. The 21-day minimum is the floor set by the guidelines; our job is to make sure that when you do go back, you go back with a brain and body that have earned it, performing at or above where you were before the knock. A structured Strength and Conditioning program can then help rebuild the physical capacity needed for your sport.
A concussion handled well is a few weeks of structured patience. A concussion handled badly can shape your whole season, or longer. Make an appointment with our team today, and let’s get you back to experiences you never felt possible.
You can book directly with our team, no GP referral required, although with concussion we work hand in hand with your doctor, and any red flags belong in an emergency department first. Callum and our team will assess your neck, balance and vestibular system, eye movement control, and exercise tolerance, then map your path through pain, prevention, and performance: settling the early symptoms, progressing your activity checkpoint by checkpoint, and clearing you for contact with objective testing rather than guesswork. If your symptoms have already dragged on for weeks, that is exactly the post-concussion picture we treat, and it responds to the right rehabilitation far better than to more waiting.
Sources referenced: Australian Concussion Guidelines for Youth and Community Sport (Australian Institute of Sport, 2024); Consensus Statement on Concussion in Sport, 6th International Conference (Amsterdam), British Journal of Sports Medicine 2023; PEAK Sports and Spine Centre post-concussion syndrome condition page.
Get Back to Sport With Confidence.