Return to Play Documentation: What Protects You After a Concussion

Under the UK grassroots concussion guidelines, return to competition should not be reached before day 21, and only after 14 days symptom-free at rest. Only athletes managed under enhanced care pathways may be formally cleared for an earlier return, and a therapist at a grassroots club is not that pathway.

Which means when a coach asks whether the player can be available on Saturday, the answer is fixed by guidance rather than by your judgement, and your record needs to show you did not try to shortcut it.

Search for a return to play form and what you will find is American: state high school athletic association templates, written for a different system. There is no widely available UK equivalent, which is why this article exists.

What do the UK guidelines say?

The UK Concussion Guidelines for Non-Elite (Grassroots) Sport, published by the Sport and Recreation Alliance with DCMS in April 2023 and updated in November 2024.

The timeline that matters:

The headline for anyone working in grassroots sport is the 21-day minimum. Not a guideline to be weighed against the player's eagerness. A floor.

Who can authorise an earlier return?

Almost nobody you will encounter.

The guidance provides that athletes managed within enhanced care pathways, meaning elite and professional settings with healthcare professionals experienced in concussion management, may be formally cleared for an earlier return.

A sports therapist covering a Sunday league side, a school team or an amateur club is not operating an enhanced care pathway. So the earlier-return route is not available, and the 21-day minimum applies.

This is genuinely useful to you, because it removes the pressure. You are not making a judgement call that a coach can argue with. You are applying a national guideline that does not give you discretion to vary it.

What should the record show?

Six things, and they map to the decisions somebody might later question.

1. The incident. Date, time, mechanism, what you observed, and what the player reported. Written the same day.

2. The immediate action. That the player was removed, that they did not return that day, and the advice given.

3. The NHS 111 advice. That it was recommended within 24 hours, and to whom you gave that advice.

4. Who was informed. For an adult, them. For a child, the person with parental responsibility, and our guide to consent for under-18 athletes covers who that actually is, because it is narrower than clubs assume.

5. The graduated progression. Each stage, the date it began, and confirmation of symptom-free status before progressing.

6. The return decision. The date, that day 21 had passed, that the 14-day symptom-free period was met, and who confirmed it.

That sixth entry is the one that matters if anything goes wrong afterwards. A record showing the guideline was applied is a complete answer. A record showing the player returned on day 12 because the club needed them is not.

The pressure you should expect

Be realistic about this, because it is the actual difficulty.

Coaches want players available. Players want to play. Parents are sometimes the most insistent of all. And nothing visible is wrong with the player by week two, which makes the restriction feel arbitrary to everyone except the person applying it.

Two things help.

Give the club the timeline in writing at the start of the season, not at the moment you are enforcing it. A policy agreed in August is much easier to apply in November than one produced on the day.

Put the date in writing when the injury happens. "Earliest return date: 21 November" removes the negotiation. It is a date rather than an opinion, and it stops the conversation being about your judgement.

Do not sign off what you cannot assess

One boundary worth naming.

A graduated return to play protocol involves assessing whether the player is symptom-free at rest and through exertion. If you are not present for the stages, you are relying on what you are told, and your record should say so.

There is a difference between "player reports symptom-free through stages 1 to 4" and "assessed symptom-free at each stage". Both can be appropriate. Recording the second when the first is true is what creates a problem later.

What about your insurance?

Worth checking specifically for pitchside work, because it is not always covered on the same terms as clinic work, and acting as a first aider is a different activity from acting as a clinician. Our guide to pitchside qualifications covers the cover question alongside the awards.

The short version

Twenty-one days, with fourteen symptom-free before it, and no discretion to shorten it at grassroots level.

Write the earliest return date down on the day of the injury, give it to the club, and record each stage as it happens. The guideline is doing the difficult part for you. Your job is to apply it and to be able to show that you did.

This is general information about published guidance, not clinical advice. The UK Concussion Guidelines are updated; check the current version before applying any timeline. Individual sports may impose additional or stricter requirements through their governing bodies.

Sources: UK Concussion Guidelines for Non-Elite (Grassroots) Sport, Sport and Recreation Alliance · NHS 111

Related: What qualifications do you need for pitchside work? · Consent to treat under-18 athletes · Sports therapist versus physiotherapist