1. Concussion must be taken extremely seriously to safeguard the long-term welfare of players
Concussion producing forces are common in Rugby; fortunately most of these do not result in concussion. There is widespread variation in the initial effects of concussion. Recovery is spontaneous, often with rapid resolution of signs, symptoms and changes in cognition (minutes to days). This could increase the potential for players to:
- ignore concussion symptoms at the time of injury; or
- return to play prior to the full recovery from a diagnosed concussion.
2. On-field management of a suspected concussion at training or during a match
Any athlete with a suspected concussion should be IMMEDIATELY REMOVED FROM PLAY, using appropriate emergency management procedures.
Once safely removed from play, the injured player must not be returned to activity that day and until they are assessed medically.
If a neck injury is suspected, the player should only be removed by emergency healthcare professionals with appropriate spinal care training.
Team mates, coaches, match officials, team managers, administrators or parents who suspect a player may have concussion MUST do their best to ensure that the player is removed from the field of play in a safe manner.
3. Sideline management of a suspected concussion
It is recommended that, in all cases of suspected concussion, the player is referred to a medical professional or approved healthcare professional for diagnosis and guidance as well as return to play decisions, even if the symptoms resolve.
Athletes with a suspected concussion:
- should not be left alone in the first 24 hours
- should not consume alcohol in the first 24 hours and thereafter should avoid alcohol until provided with medical or healthcare professional clearance or, if no medical or healthcare professional advice is available, the injured player should avoid alcohol until symptom-free
- should not drive a motor vehicle and should not return to driving until provided with medical or healthcare professional clearance or, if no medical or healthcare professional advice is available, should not drive until symptom-free
If ANY of the following are reported, then the player should be transported for urgent medical assessment at the nearest hospital:
- Athlete complains of severe neck pain
- Deteriorating consciousness (more drowsy)
- Increasing confusion or irritability
- Severe or increasing headache
- Repeated vomiting
- Unusual behaviour change
- Seizure (fit)
- Double vision
- Weakness or tingling/burning in arms or legs
4. Managing a concussion or suspected concussion
REST THE BODY, REST THE BRAIN
Rest is the cornerstone of concussion treatment. This involves resting the body - ‘physical rest’ - and resting the brain - ‘cognitive rest’. This means avoidance of:
- Physical activities such as running, cycling, swimming, etc
- Cognitive activities, such as school work, homework, reading, television, video games, etc
This complete rest should be for a minimum of 24 hours. It is important that concussion is managed so that there is physical and cognitive rest until there are no remaining symptoms.
Before restarting activity, the player must be symptom-free at rest. Medical or approved healthcare provider clearance is recommended before restarting activity.
Children and adolescents should be managed more conservatively. World Rugby recommends children and adolescents should not play or undertake contact training for a minimum of two weeks following cessation of symptoms. Students must have returned to school or full studies before recommencing exercise.
After the minimum rest period AND if symptom-free at rest, a graduated return to play (GRTP) programme should be followed.
5. Returning to play after a concussion
- If any symptoms are present or reappear, contact training and playing must be avoided.
- A minimum complete rest period of 24 hours is recommended for adults but a longer "complete rest period" is recommended in children and adolescents.
- Rest from playing or contact training is recommended for a minimum of two weeks following cessation of symptoms in children and adolescents.
- A graduated return to play (GRTP) must be completed:
- for ALL players diagnosed with a concussion
- for ALL players even suspected of having concussion during a game or training at which there is no appropriately qualified person present
- A GRTP should only be commenced after the completion of the rest period recommended and only if the player is symptom-free and off medication that modifies symptoms of concussion.
- Any player with a second concussion within 12 months, a history of multiple concussions, players with unusual presentations or prolonged recovery must be assessed and managed by health care providers (multi-disciplinary) with experience in sports-related concussions and no further participation in Rugby should take place until the player is cleared by a doctor with experience in concussion management.