Nutrition for concussion – practices and perspectives from sports dietitians employed within elite-level Australian collision sports

Introduction: Concussion is common in collision sports such as Rugby League and Australian Rules Football, and can negatively affects athletes’ physical, mental, and emotional health. Nutrition strategies may convey preventative benefits and/or support recovery following concussion. Sports dietitians are uniquely positioned to provide tailored nutrition care, yet limited guidance exists within consensus guidelines. This study explored the practices and perspectives of sports dietitians working in elite-level Australian collision sports regarding nutrition for concussion.
Methods: Individual semi-structured interviews (~30 minutes) were conducted via an online platform. Fourteen sports dietitians employed as Head of Nutrition in Australian Rules Football (n=7), Rugby League (n=5), and Rugby Union (n=3) codes participated; one worked across two codes. Both men’s and women’s squads were represented. Data were analysed using reflexive thematic analysis.
Results: Five themes were identified. Theme 1 (Dietitian Role in Concussion Management): Dietitians supported recovery and prevention of concussion but were not involved diagnosis or coordination of care, unlike other health professionals (e.g., physiotherapists). Theme 2 (Nutrition Strategies for Concussion): Nutrition strategies were implemented to mitigate the symptoms (e.g., nausea, low appetite) and sequalae of concussion, and achieve metabolic requirements. Common practices included altered quantity/timing of dietary provision, and implementation of supplemental protocols (e.g., creatine monohydrate, omega-3’s and/or vitamin B2). Theme 3 (Barriers and Enablers to Recommendations): barriers included poor food provision at-home (particularly in younger players), limited dietitian workload, and extensive symptoms. Enablers included readily available supplements, support from other staff (e.g., High Performance Manager), and dietitians’ reinforcement of nutrition’s importance. Theme 4 (Difference in Care Between Squads and Codes): Male squads received greater resourcing, while female and developing squads had limited access to dietitian time, food provision, and supplements. Theme 5 (Confidence in Management of Concussion): Dietitians felt confident applying non-specific strategies for concussion management (e.g., strategies to reduce nausea), but less confident providing individualised evidence-based recommendations for concussion.
Conclusion: Sports dietitians are important members of the multidisciplinary team that supports athletes with concussion. They are proactively managing athletes’ concussion through nutrition strategies and navigating the complexities of implementation. Guidance from consensus concussion guidelines regarding the best practice for dietitians is needed.