Concussion in Rugby Union: What Every Player and Coach Needs to Know Right Now
Rugby union has changed the way it manages concussion more than any other sport in the last decade. New protocols, better screening tools, independent doctors, and minimum stand-down periods are now standard at elite level.
At community level, the gap is still significant.
What a Concussion Actually Is
Concussion is a traumatic brain injury caused by a biomechanical force to the brain, either direct or indirect. The brain moves inside the skull, causing a cascade of neurochemical changes: glutamate release, ionic flux, glucose metabolism disruption, and reduced cerebral blood flow.
Critically, this is a functional disruption, not a structural one. A standard CT scan or MRI will appear normal in the vast majority of concussions. The injury is real, the neurological changes are measurable, and the brain is temporarily vulnerable to further injury during recovery.
The concept of the metabolic vulnerability window is important: in the days following a concussion, a second impact can cause disproportionately greater damage, including in rare cases second impact syndrome.
Rugby Union’s HIA Protocol
The Head Injury Assessment (HIA) process used at elite level is a three-stage process: immediate sideline screening (HIA1), review at 3 hours post-match (HIA2), and a standardised assessment at 36-48 hours (HIA3). A player who fails any stage is stood down and cannot return until cleared.
At community level, World Rugby’s Concussion Recognition Tool (CRT6) is the standard. Any player who shows signs is removed and does not return to play that day. This is not a guideline. It is the rule.
Recognising Concussion on the Field
Signs visible from the sideline: any loss of consciousness (even brief), motor incoordination or ‘drunk’ gait, blank stare, slow to get up after a tackle, any seizure-like movement, confused or vacant response to questions.
Symptoms reported by the player: headache, pressure in the head, visual disturbance, nausea, feeling slowed or foggy, difficulty concentrating.
When in doubt, sit them out. No match is worth the risk.
Return to Play: The Six-Stage Graduated Process
World Rugby’s graduated return to play protocol requires at least 24 hours symptom-free at each stage before progressing:
1. Symptom-limited activity (walking, light stretching)
2. Light aerobic exercise (stationary bike)
3. Sport-specific exercise (running drills, no contact)
4. Non-contact training drills
5. Full contact practice (medical clearance required)
6. Return to competition
Minimum stand-down is 7 days for adults (14 days for under-19s) from the time of injury. Medical clearance is required before Stage 5.
The Longer Picture
The evidence on long-term consequences of repeated head impacts, including chronic traumatic encephalopathy (CTE), is evolving and contested. What is clear is that symptom-free does not mean fully recovered, and early return to contact carries measurable risk.
For players with multiple concussions, particularly those with prolonged symptoms, specialist neurology assessment is appropriate before return to any contact sport.
What Clubs Can Do
Every club should have a designated concussion lead, a clear sideline protocol, baseline SCAT6 scores for all players at the start of season, and a return-to-play form that requires medical sign-off before full contact training resumes.
This is not overcautious. It is the current minimum standard.
Want to understand this injury at a deeper anatomical level? The Club Physio’s online anatomy course breaks down the structures, biomechanics, and load patterns behind the most common sports injuries. Built for athletes and therapists alike. [Explore the course at theclubphysio.com.au]