All players who are diagnosed with concussion or have a suspected concussion during a game or training at which there is no appropriately qualified person (as applicable in the relevant jurisdiction) present to diagnose concussion must follow a graduated return to sport (GRTSport) programme. This GRTSport starts after the minimum rest period AND if symptom free at rest.
The principle of the GRTSport is to ensure that increasing levels of activity do not provoke a recurrence of the symptoms of concussion in the player. The player may progress to a new stage every 24-48 hours provided that the current stage does not provoke symptoms. All involved in the process of concussion management must be vigilant for the return of symptoms.
The GRTSport programme contains six distinct stages:
- The first stage is the recommended rest period;
- The next four stages are training-based restricted activity;
- Stage 6 is a return to play.
Under the GRTSport programme, the player can proceed to the next stage only if there are no symptoms of concussion during rest and at the level of exercise achieved in the previous GRTSport stage
If any symptoms occur while going through the GRTSport programme, the player must return to the previous stage and attempt to progress again after a minimum 24-hour period of rest without symptoms.
World Rugby recommends that a medical practitioner or approved healthcare professional supervises the GRTSport and confirms that the player can take part in full contacts training before entering Stage 5.
|Exercise step||Functional exercise at each step||Goal of each step|
|1. Symptom-limited activity||Daily activities that do not provoke symptoms.||Gradual re-introduction of work/school activities.|
|2. Light aerobic exercise||Walking or stationary cycling at slow to medium pace. No resistance training.||Increase heart rate.|
|3. Sport specific exercise||Running drills. No head impact activites.||Add movement.|
|4. Non-contact training drills||Harder training drills, eg, passing drills. May start progressive resistance training.||Exercise, coordination, and increased thinking.|
|5. Full contact practice||Folliowing medical clearance, participate in normal training activities.||Restore confidence and assess functional skills by coaching staff.|
|6. Return to play/sport||Normal game play|