What is a concussion?
A concussion is a brain injury caused by a blow to the head, or by a blow to the body that snaps the head around. The brain moves inside the skull and nerve cells get stretched. You do not have to be knocked out to have one, and plenty of concussions happen without anyone losing consciousness at all.
Recognising a concussion
If you or a teammate shows any of these signs after a head impact, they must leave the field immediately. No exceptions.
- Confusion or disorientation ("Where are we? What half is it?")
- Headache or pressure in the head
- Dizziness or balance problems
- Nausea or vomiting
- Blurred or double vision
- Sensitivity to light or noise
- Feeling "foggy" or "not right"
- Difficulty remembering what happened (before or after the impact)
- Slow responses or a blank expression
- Loss of consciousness (even briefly)
Red flags that mean hospital now
- Loss of consciousness for more than 30 seconds
- Seizure or convulsion
- Repeated vomiting
- Worsening headache that does not respond to paracetamol
- Increasing confusion or drowsiness
- Weakness or tingling in arms or legs
- Slurred speech
- Unequal pupil size
- Clear fluid leaking from the nose or ears
- Any symptom that gets worse rather than better over time
The World Rugby graduated return-to-play protocol
You cannot rush this. Each stage takes a minimum of 24 hours. If symptoms return at any stage, go back to the previous stage and rest for 24 hours before trying again.
Complete rest
Minimum 24–48 hours
Physical and cognitive rest. No screens, no reading, no school or work while you are symptomatic. Sleep is when the brain recovers, so do not set alarms. Your doctor will advise on pain relief, and paracetamol is usually preferred over NSAIDs after a concussion.
Light activity
Minimum 24 hours
Walking, swimming, or stationary cycling at <70% max heart rate. No resistance training. Purpose: increase heart rate without head impact risk.
Sport-specific exercise
Minimum 24 hours
Running drills, passing, non-contact skill work. No activities with head impact risk. Progressively increase intensity.
Non-contact training
Minimum 24 hours
Full training intensity but no contact. Add resistance training, complex tactical drills, coordination exercises.
Medical clearance
1 day
A doctor (not a physio, not a coach, not a parent) must clear you. They will assess symptoms, balance, and cognitive function.
Return to match play
Match day
Full contact training then match play. Minimum 12 days from concussion for adults, 21 days for under-19s.
After recovery: long-term considerations
- Your risk of a second concussion is raised for weeks after the first, which is the whole reason the stand-down exists
- Each subsequent concussion may take longer to recover from
- If you have had 3+ concussions, discuss with a specialist whether continued contact sport is appropriate
- Headaches triggered by exercise in the months after concussion are common but should be monitored by a doctor
- Sleep disruption is normal for 2 to 4 weeks, so keep your sleep habits tight