CONCUSSION
Concussion is serious and we outline the steps to be taken by those involved in the game.
IF IN DOUBT, SIT THEM OUT.
A concussion is serious, and this document outlines the steps to be taken by those involved in the game.
REMEMBER 'THE 4 RS'
- Recognise the signs and symptoms
- Remove the player from play
- Recover fully before returning to sport
- Return - only after following a Graduated Return to Activity and Sport.
WHAT IS A CONCUSSION?
A concussion is an injury to the brain causing a disturbance of its normal function without any structural damage, such as bleeding or bruising visible on routine scans.
It affects how a person may think, feel, and remember things, causing a variety of symptoms. Concussion can be recognised by observing changes in behaviour or reported feelings.
Only 1 in 10 concussions result in a player being ‘knocked out’ (loss of consciousness).
Most individuals who sustain a concussion recover quickly without treatment, but some may experience symptoms lasting days, weeks, or, in rare cases, even longer.
WHAT CAUSES A CONCUSSION?
Any blow to the head, face, or neck, or a blow to the body that causes a sudden jarring of the head, can result in a concussion.
RECOGNISE THE SYMPTOMS AND SIGNS OF CONCUSSION
A concussion should be suspected if someone sustains a direct hit to the head or an impact on the body that could cause the brain to move rapidly inside the skull (whiplash).
The severity of the hit is not necessarily an indicator of the severity of the concussion.
A player does not need to lose consciousness to have sustained a concussion. Signs and symptoms may appear immediately or emerge hours or days after the event.
If someone feels "off" in the days following a game, suspect a concussion. You do not need both signs and symptoms to make a diagnosis - only one feature is required.
If symptoms resolve quickly, this is a good sign but doesn’t mean the player is not concussed.
THINGS A PLAYER MAY REPORT OR MAY BE SEEN:
Thinking problems:
- Difficulty recalling time, date, place, or game details.
- General confusion.
- Cannot remember things that happened before and/or after the injury.
- Slow to answer questions or follow directions.
- Easily distracted.
- Not playing as well as expected.
- A blank stare or glassy-eyed appearance—'The lights are on but nobody home
Additional Symptoms or Observations:
- Knocked out
- Headache
- Dizziness
- Feeling dazed or stunned
- Loss of vision, double or blurred vision, seeing stars or flashing lights
- Ringing in the ears
- Sleepiness
- Stomach ache, nausea, vomiting
- Poor coordination or balance, staggering or unsteady on feet
- Slurred speech
- Poor concentration
- Strange or inappropriate emotions (eg, laughing, crying, getting angry easily)
- Feeling generally unwell.
Is concussion different in young players?
Yes, young players may be:
- More susceptible to concussions.
- Slower to recover, especially if returning to education too early.
- At higher risk for rare but severe neurological complications.
What about repeated concussions?
Repeated concussions, particularly if recovery from a previous concussion is incomplete, could:
- Shorten a player's career.
- Significantly interfere with academic performance.
- Result in permanent neurological impairment or death in rare cases
IF IN DOUBT, SIT THEM OUT
Concussion is serious
- All head injuries are serious.
- Head injury can be fatal.
- Concussion is a brain injury which causes a disturbance of the normal working of the brain but without there being any structural damage.
- Most concussions (90%) occur without loss of consciousness (being ‘knocked out’).
- Anyone with one or more visible clues, or symptoms of a head injury must be immediately removed from playing or training and must not take part in any further physical sport or work activity, even if symptoms resolve, until assessment by an appropriate Healthcare Professional or by accessing the NHS by calling 111, which should be sought within 24 hours.
- Return to education and/or work takes priority over return to sport.
- Individuals with concussion should only return to playing sport which risks head injury after having followed a graduated return to activity (education and/or work) and sport programme.
- All concussions should be managed individually, but there should be no return to competition before 21 days from injury.
- Anyone with symptoms after 28 days should seek medical advice from their GP (which may in turn require specialist referral and review).
- Most people who sustain a concussion do not require any treatment as they normally get better by themselves and recover quickly, but for some the symptoms may last for days, weeks or in rare cases even longer.
Is concussion different in young players?
In young players we do need to be more cautious. Because the child or adolescent brain is still developing, there is particular concern that they may be:
- More susceptible to concussion.
- Take longer to recover and returning to education too early exacerbate symptoms and prolong recovery.
- Are more susceptible to rare and dangerous neurological complications including death caused by a second impact before recovering from a previous concussion.
IF IN DOUBT, SIT THEM OUT.
The Sport and Recreation Alliance has released an updated version of the UK Concussion Guidelines for Non-Elite (Grassroots) Sport. These guidelines emphasise the simple message ‘If in doubt, sit them out’ to help identify concussion signs, ensure immediate removal from play, and support a safe return to daily activities and sports. They were developed by an expert panel of domestic and international clinicians and academics in neurology and sports medicine, setting out steps to improve understanding, awareness of the prevention and treatment of concussion in grassroots sport where trained medical professionals are less likely to be routinely present. It is targeted at people of all ages.
A copy of the latest version can be found HERE.
The recent updates include:
Clarification that the guidelines apply to all grassroots sports participants, including those with disabilities, along with an accessible version for wider reach.
Addition of frequently asked questions (FAQs) to aid understanding of the graduated return to activity process.
COACHES AND TEACHERS
Coaches, Teachers and First Aiders can play a vital role in diagnosing concussion.
Coaches, teachers and first aiders can play a vital role in picking up signs and symptoms of concussion and probably have the most important role in the prevention and management of concussion.
Research has shown that young players rely on their coach to provide concussion information and are influenced most in their behaviour towards concussion by their coach.
All coaches, teachers and first aiders should be able to recognise suspected concussion and are in the best position to remove the player from play.
If a coach, teacher or first aider recognises a sign or symptom of concussion, they should:
Safely remove the individual from the field of play and ensure that they do not return to play in that game even if they say that their symptoms have resolved. IF IN DOUBT, SIT THEM OUT!
- Observe the player or assign a responsible adult to monitor the individual once the player is removed.
- If a player is under 18 years old, contact the parent/guardian to inform them of the possible concussion.
- Advise assessment by an appropriate Healthcare Professional in the NHS or by accessing the 111 service. This should be done immediately.
- Arrange for the player to get home safely.
- Arrange for a responsible adult to supervise the player over the next 24-48 hours.
- Ensure any relevant injury report form is completed and stored by the club/school/organisation.
- Follow a graduated return to activity (education and/or work) and sport programme with an emphasis on initial relative rest and returning to education/work before returning to training for sport.
Coaches and Teachers should:
- Be able to recognise signs and symptoms of concussion.
- Recognise Red Flag symptoms which require immediate medical attention.
- Coach a safe and effective tackle technique to reduce the risk of concussions occurring.
- Reduce any unnecessary contact training or in matches (in Primary RL).
- Encourage a supportive environment concerning concussion and its management and use their influence to have a positive impact on players' and parents’ attitudes to concussion.
- Encourage disclosure of symptoms following head impacts or during Graduated Return.
- Put no pressure on players to return sooner than they should, following a concussion.
- Encourage all players to play by the rules and respect the referees.
First Aiders should:
- Be able to recognise signs and symptoms of concussion.
- Recognise Red Flag symptoms which require immediate medical attention.
- Encourage a supportive environment in respect of concussion and its management, and signpost any concerns to appropriate Healthcare Professionals (such as 111, GP, A & E)
- Encourage disclosure of symptoms following head impacts or during Graduated Return
- Place no pressure on players to return sooner than they should, following a concussion.
- Suspected concussion reports must be logged on LeagueNet, which automatically generates an advice email to the player.
- Encourage all players to play by the rules and respect the referees.
WHAT IS A CONCUSSION?
A concussion is an injury to the brain that cannot be seen on routine x-rays or scans. It affects the way a person may think and remember things for a short time, and can cause a variety of symptoms.
WHAT CAUSES A CONCUSSION?
Any blow to the head, face or neck, or a blow to the body which causes a sudden jarring of the head may cause a concussion.
RECOGNISE THE SYMPTOMS AND SIGNS OF CONCUSSION
A player does not need to be knocked out (lose consciousness) to have had a concussion.
Thinking problems the player may experience:
- Does not know time, date, place, period of game, opposing team, or the score in the game.
- General confusion
- Cannot remember things that happened before and/or after the injury
- Seems slow to answer questions or follow directions
- Seems easily distracted
- Not playing as well as expected
- A blank stare/glassy eyed, 'the lights are on but nobody's home'
A concussion may have taken place if the player is unable to answer these questions:
- “What venue are we at today?”
- “Which half is it now?”
- “Who scored last in this game?”
- “What team did you play last week / game?”
- “Did your team win the last game?”
THINGS THE PLAYER MAY COMPLAIN OF OR WHAT YOU MAY SEE
- Knocked out
- Headache
- Dizziness
- Feel dazed, 'dinged' or stunned
- Loss of vision, seeing double or blurred, seeing stars or flashing lights
- Ringing in the ears
- Sleepiness
- Stomach ache, stomach pain, nausea, vomiting
- Poor coordination or balance, staggering around or unsteady on feet
- Slurred speech
- Poor concentration
- Strange or inappropriate emotions (i.e. laughing, crying, getting angry easily)
- Feeling generally unwell
WHEN CAN A CONCUSSED PLAYER RETURN TO PLAY OR TRAIN?
It is very important that the player does not go back to Rugby League or any other sport if they have any concussion symptoms or signs.
Return to sport and activity must follow a step-wise Graduated Return to Play (GRTP).
They should not go back to Rugby League/sport until they have been cleared to do so by a doctor.
HOW LONG WILL IT TAKE TO GET BETTER?
The signs and symptoms of a concussion often last for 7-10 days in adults but may last much longer, especially in younger players and children.
In some cases, players may take many weeks or months to recover. Suffering previous concussions may increase the chance that the person may take longer to recover.
REMEMBER 'THE 4 RS'
- Recognise the signs and symptoms
- Remove the player from play
- Recover fully before returning to sport
- Return - only after following a Graduated Return to Play
WHAT TO DO IF YOU SUSPECT CONCUSSION IN A PLAYER
You must remove them from play right away. Continuing to play increases their risk of more severe, longer lasting concussion symptoms, as well as increases their risk of other injury:
- You should not let them return to play that day
- You should not allow them to be left alone
- You should make sure they are seen by a health care practitioner as soon as possible that day
- You should not let them drive
HOW IS A CONCUSSION TREATED?
Concussion symptoms are made worse by exertion, both physical and mental. The most important treatment for a concussion is:
- The player should not exercise or do any activities that may make them worse, like driving a car, reading, working on the computer or playing video games
- If mental activities (e.g. reading, concentrating, using the computer) worsen their symptoms, they may have to stay home from work, college or school
- If they return to activities before they are completely better, they are more likely to get worse, and to have their symptoms last longer
Once they are recovered, and cleared to do so by a healthcare practitioner they can start a step-wise increase in activities – see When can a concussed player return to rugby? . If possible, they should be seen by a doctor with experience in treating concussions.
CAN IT BE ANYTHING MORE SERIOUS?
Anyone with a suspected concussion should be seen by a healthcare professional as soon as possible.
They will usually give instructions to the injured person to return to them or go to hospital immediately if they have a worsening of symptoms such as:
- Drowsiness when normally awake or cannot be awoken
- A headache that is getting worse
- Weakness, numbness or decreases in coordination and balance
- Repeated vomiting or prolonged nausea
- Slurred speech, difficulty speaking or understanding
- Increasing confusion, restlessness or agitation
- Loss of consciousness
- Convulsions
- Clear fluid coming out of ears or nose
- Deafness in one or both ears
PLAY WELL
Although it may not be possible to stop all concussions happening, there are some measures players can take that have the potential to reduce the number of concussions we see:
- Ensure the playing or training area is safe, and the risk of serious head injury occurring is reduced.
- Check ground conditions - do not play or train if the ground is frozen solid or rock hard due to drought.
- Ensure all posts and barriers on or close to the pitch are protected with appropriate padding. Ensure correct tackle technique is performed consistently. If the head of the tackler hits the ball carrier there is a significant risk of concussion and/or neck injury. You should therefore ensure that you are able to perform correct tackle technique consistently.
- Do not engage in dangerous play such as high, tip and spear tackles. Similarly do not tackle players in the air i.e. when jumping to catch the ball from kicks - falling from height increases the risk of concussion and neck injuries.
The information contained in this site is intended for educational purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion we strongly recommend that you contact a qualified health care professional for appropriate diagnosis and treatment. The authors have made responsible efforts to include accurate and timely information. However they make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.
MATCH OFFICIALS
Match Officials have an important role in the prevention and management of concussion.
Through the correct and consistent application of the laws of the game and concussion protocols, match officials can influence players' and coaches' behaviour toward concussion.
In the community game, if a match official suspects a concussion, they must request that the player be immediately removed from play. The player must not return to the field, even if the player, coach, first aider, or parent advises that the player is now "OK." The match official has the authority to stop the game if a player does not leave the field or attempts to return. Match officials may also ask coaches or first aiders for the reason the player is being removed, for reporting purposes and to ensure the appropriate steps are taken following the player's removal. IF IN DOUBT – SIT THEM OUT.
Continuing to play increases the player's risk of more severe, longer-lasting concussion symptoms and can be fatal, as well as heightening the risk of other injuries.
Remember, RESPECT!
REMEMBER 'THE 4 RS'
- Recognise the signs and symptoms
- Remove the player from play
- Recover fully before returning to sport
- Return only after following a Graduated Return to Play
The information contained in this site is intended for educational purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion we strongly recommend that you contact a qualified health care professional for appropriate diagnosis and treatment. The authors have made responsible efforts to include accurate and timely information. However they make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.
PLAYERS AND PARENTS
Parents
It’s important for parents to understand the risks of concussion and managing it appropriately.
Failing to manage a concussion sensibly can have significant and sometimes serious consequences:
- Performance, playing careers, and enjoyment of the game may be affected.
- Long-term health, particularly brain health, may be impacted.
- Work and academic studies may be disrupted.
Parents need to understand the risks of concussion and manage it appropriately. Ensuring that children know what symptoms may feel like and encouraging them to report any symptoms is vital. Parents should also be aware of the signs and symptoms to help in the recovery process.
Parents should:
- Be aware of the signs and symptoms of concussion.
- Ensure they have all the information about the incident.
- Not leave the child alone for the first 24 hours following the incident.
- Have the child assessed by an appropriate healthcare professional within 24 hours by accessing the NHS through 111.
- Monitor the child for worsening symptoms of concussion for at least 24-48 hours.
- Encourage initial rest and sleep as needed.
- Limit smartphone use and screen time for the first 24-48 hours.
- Inform all other sports clubs, schools, colleges, or workplaces about the suspected concussion and the need for a graduated return, to ensure the child receives support.
- Support the child through the stages of the graduated return, focusing on returning to normal life activities first, then sport.
- Encourage the reporting of symptoms and take action if symptoms worsen.
- Not pressure the child to return to sport too soon or stay on the field.
- Respect the referee's decisions regarding the enforcement of the law and concussion management.
Respect coaches and first aiders when players are removed from the field with suspected concussion.
Players
Failing to manage concussion sensibly can have significant and sometimes serious consequences:
- Your performance, playing career and enjoyment of the game may be affected
- Your long term health and in particular brain health may be affected
- Your work and/or academic studies may be affected
Players should:
- Report symptoms of concussion to parents, first aiders, and coaches as soon as they are apparent.
- Play by the rules.
- Be vigilant for teammates and opponents who may show signs of concussion.
- Follow the graduated return to normal life activities and then sport.
- Not rush back to sport and never ignore symptoms of concussion. Recovery time is individual.
- Be part of a team that takes concussion seriously, where teammates are supported in reporting symptoms and gradually returning to activity. Players should not feel they are letting the team down by leaving the field.
PREVENTION
Due to Rugby League being a collision sport concussion can't be eradicated completely, but we can all take steps to reduce the risks of them occurring.
Concussions can occur whilst playing all sports, in school playgrounds and in every day life – accidents – trips, falls and car accidents are some examples.
Ideally, we all want to prevent concussions occurring in the first place and there are some measures that can be taken during rugby training and games that have the potential to reduce the number of concussions that we see.
Recommendations include:
- Ensure the playing or training area is safe and all posts and barriers on or close to the pitch are protected with appropriate padding.
- Ensure correct techniques are coached and performed consistently by all players. If the head of the tackler hits the ball carrier there is a significant risk of concussion and/or neck injury. You should therefore ensure that you are able to perform correct tackle technique consistently.
- Playing by the Laws of the game – no strikes to the head, no high tackles, tackles in the air or dangerous throws.
- In Primary Rugby League adhering to the recommendation of no tackle to age.
WHAT ABOUT CONCUSSIONS SUSTAINED ELSEWHERE?
To prevent recurrent concussions, and the rare but potential risk of prolonged or severe injury, first aiders, coaches, teachers and parents must encourage players to report concussions that occur during games and training sessions, and to report concussions that occur out of Rugby League.
It is also essential that school and club coaches communicate between themselves if a player is concussed, and involve parents in these discussions and encourage that information to share to other sports Clubs or other organisations which the individual participates in (Reserves, Scholarships included).
PERSONAL PROTECTIVE EQUIPMENT
Current research shows that the use of headguards does not protect against concussions, as the brain can still shake within the skull because of impact. However, headguards do help protect against superficial injuries such as cuts and grazes to the head, as demonstrated in several studies.
Mouthguards/gum shields do not protect against concussion, but they are strongly recommended for all players as they protect against dental and facial injuries.
RECOGNITION
What is concussion?
- Concussion is a traumatic brain injury resulting in a disturbance of brain function. It affects the way a person thinks, feels and remembers things.
- Loss of consciousness (being ‘knocked out’) occurs in less than 10% of concussions and is not required to diagnose concussion. However, anyone who loses consciousness because of a head injury has had a concussion.
- Anyone with suspected concussion should be immediately removed from the field of play and assessed by an appropriate Healthcare Professional or access the NHS by calling 111 within 24 hours of the injury.
WHAT TO DO IF YOU SUSPECT CONCUSSION IN A PLAYER
Anyone showing one or more visible clues or any symptoms suggestive of a possible concussion must be immediately removed from playing or training. Continuing to play increases the risk of more severe, longer-lasting concussion symptoms, as well as the risk of another injury.
It is not necessary to be certain that someone is concussed to remove them from play.
IF IN DOUBT, SIT THEM OUT! There is no head injury assessment process in the community game, so all players with suspected concussion must be assessed by a medical professional through calling 111, or A&E. Help must be sought, even if symptoms completely resolve.
- The individual should be safely removed from the field of play, and it must be ensured that they do not return to play in that game, even if they claim their symptoms have resolved.
- The player should not be left alone FOR 24 HOURS. The player should be observed, or a responsible adult should be assigned to monitor the individual once the player is removed.
- If the player is under 18 years old, a parent or guardian must be contacted to inform them of the possible concussion. The player must be arranged to return home safely.
- They should not drive or ride a bike. Alcohol should be avoided, and commercial drivers (e.g., HGV drivers) should seek a review by an appropriate healthcare professional before driving.
- Both the player and a responsible adult should be provided with an information sheet. Concussion Care Information Link
- The player should not return to play that day, or until they have been assessed by a medical professional.
- The player should be reviewed by a healthcare practitioner as soon as possible that day via calling 111 or A&E.
CAN IT BE ANYTHING MORE SERIOUS?
All head injuries are serious and can be potentially life-threatening. Not all head injuries are concussions; some may involve structural damage to the brain and skull, which can be fatal.
These injuries can sometimes present symptoms similar to a concussion, which is why players must stop all physical activity when signs and symptoms of a concussion are present.
If the player exhibits any of the following symptoms after a head injury, or if they are currently on blood-thinning treatment or intoxicated (by alcohol or drugs), they should be referred to a hospital immediately, either via 999:
- Loss of consciousness due to the injury.
- Deteriorating consciousness (e.g., becoming drowsier).
- Amnesia (memory loss) for events before or after the injury.
- Increasing confusion or irritability.
- Unusual behaviour changes.
- Any new neurological deficit (e.g., difficulty understanding, speaking, reading, writing).
- Decreased sensation.
- Loss of balance.
- Weakness.
- Double vision.
- Seizures, convulsions, limb twitching, or being motionless due to muscle spasms.
- Severe or increasing headache.
- Repeated vomiting.
- Severe neck pain.
- Any suspicion of a skull fracture (e.g., cut, bruise, swelling, severe pain at the site of injury).
- Previous history of brain surgery or bleeding disorder.
- Current blood-thinning therapy.
- Current drug or alcohol intoxication.
Post-Concussion Management
HOW LONG WILL IT TAKE TO GET BETTER?
The signs and symptoms of a concussion often last for 2-4 weeks in adults, but may last much longer, particularly in younger players and children.
Most individuals who sustain a concussion recover without the need for treatment, but in rare cases, symptoms may last for days, weeks, or even longer.
All concussions should be managed individually, but there should be no return to competition before 21 days from the injury.
Anyone with symptoms persisting after 28 days should seek medical advice from their GP, which may require specialist referral and review.
WHEN CAN A CONCUSSED PLAYER RETURN TO PLAY OR TRAIN?
Return to education and/or work should take priority over return to sport.
Players with a concussion should only return to sports that risk head injury after following a graduated return-to-activity program (for education and/or work, as well as for sport).
The player must not return to rugby or any other sport if any concussion symptoms or signs are still present.
What About Concussions Sustained Elsewhere?
To prevent recurrent concussions and the rare but potential risk of prolonged or severe injury, first aiders, coaches, teachers, and parents must encourage players to report concussions that occur during games and training sessions, as well as concussions that happen outside of Rugby League.
It is also crucial that school and club coaches communicate with each other if a player sustains a concussion. Parents should be involved in these discussions, and information should be shared with other sports clubs or organizations in which the individual participates (including reserves and scholarships).
HOW IS A CONCUSSION TREATED?
Concussion symptoms are exacerbated by physical and mental exertion in the early stages. Generally, a short period of relative rest (24-48 hours), followed by a gradual stepwise return to normal life and subsequently Rugby League or any sport, forms the foundation of concussion management.
Returning to activities before full recovery increases the likelihood of worsening symptoms and a longer duration of recovery.
Exercise, when feeling better and as described in the Return to Sport program, can help treat concussion.
In the First 24-48 Hours:
All individuals suspected of sustaining a concussion should be assessed by a healthcare professional (doctor) or by accessing the NHS by calling 111 within 24 hours of the injury.Anyone with a suspected concussion should NOT:
- Drive a motor vehicle (e.g., car or motorcycle).
- Ride a bicycle.
- Operate machinery.
- Drink alcohol within 24 hours of a suspected concussion.
- Commercial drivers (e.g., HGV drivers) should seek review by an appropriate healthcare professional before driving.
- Take medication that may mask or minimize the symptoms of concussion, unless directed by a healthcare professional.
- Be left alone or unsupervised for 24 hours.
Within the first 24-48 hours, individuals can perform mental activities like reading and activities of daily living, as well as walking, if they feel able. If mental activities (e.g., reading, concentrating, using the computer) worsen symptoms, staying home from work, college, or school may be necessary. Returning to activities before full recovery may increase the duration of symptoms.
If symptoms worsen or any red flag symptoms, as mentioned above in the "Can It Be Anything More Serious?" section, develop, immediate medical care should be sought by calling 999.
After the First Few Days:
After the initial 48-hour rest period, the primary goal is a staged return to normal life (education/work) at a pace that does not worsen existing symptoms (more than mildly) or produce new symptoms. This should occur before considering a return to sport.
The graduated return to activity (education/work) and sport program can be self-managed; however, the following should always be kept in mind:
- Recovery varies from person to person and is not a "one-size-fits-all" process. Most symptoms of concussion resolve within two to four weeks, but some may take longer.
- Recovery duration is unique for everyone, which is why following a graduated return to activity (education/work) and sport program is essential to reduce the risks of prolonged recovery, further brain injury, and longer-term issues.
- Children and adolescents may take longer to recover than adults.
It is acceptable for players following the Graduated Return to Activity to initially return to school or work with adjusted hours (e.g., half-days or scheduled breaks). Even if symptoms are still present, provided they are not severe or significantly worsened, a return is permitted. If symptoms worsen beyond mild levels, the level, intensity, or duration of the activity should be reduced before stopping completely, unless this is the only action that alleviates symptoms.
Participating in Light Physical Activity:
The focus should be on returning to normal daily activities (education and work) before participating in matches or full-contact training sessions. Engaging in light physical activity can be beneficial and has been shown to positively affect recovery after the initial rest period.
Finally, Return to Sport:
The final stage of returning to school or work activity is when the individual has resumed full mental activities and tasks, as they were before the injury occurred. This should happen before considering a return to unrestricted sport.
Like the return to education/work progression, the return to sport should occur at a rate that does not exacerbate existing symptoms (more than mildly) or produce new symptoms. It is acceptable to begin light aerobic activities (e.g., walking, light jogging, stationary cycling) even if symptoms are still present, provided they are stable and not worsening, and the activity is stopped if symptoms increase beyond mild levels.
Progression through each stage depends on the activity not exacerbating symptoms more than mildly (for less than a few hours). If this happens, a pause or step back may be necessary for a few days, and the activity can resume once symptoms have subsided.
Medical advice from the NHS via 111 should be sought if symptoms worsen or do not improve by 14 days after the injury.
Severe or prolonged symptoms (lasting over 28 days) should lead to a review by an appropriate healthcare professional (typically their GP), and management of the injury and return to sport will be individualized. If symptoms persist for more than 28 days, individuals need to be assessed by an appropriate healthcare professional, typically their GP. Medical advice from the NHS via 111 should be sought if symptoms deteriorate or do not improve by 14 days after the injury.
The information contained in this site is intended for educational purposes only and is not meant to be a substitute for appropriate medical advice or care. If you believe that you or someone under your care has sustained a concussion we strongly recommend that you contact a qualified health care professional for appropriate diagnosis and treatment. The authors have made responsible efforts to include accurate and timely information. However they make no representations or warranties regarding the accuracy of the information contained and specifically disclaim any liability in connection with the content on this site.
Positional Statement
The RFL takes concussion and player welfare very seriously and follows the guidelines set by the International Consensus on Concussion in Sport and advice from the RFL’s Clinical Advisory Group when formulating its Concussion Regulations. Medication regulation within Community Rugby League is detailed in the RFL First Aid Standards [link] which form part of the Operational Rules Tiers 4-6. All community games must have a first aider present which is monitored by match officials who have been instructed not to allow a game to take place unless a first aider is present. All clubs must register their first aiders on GameDay before playing fixtures.
The RFL is dedicated to promoting education on concussion within the community game. The RFL Emergency First Aid course features a section specifically focused on concussion. For individuals who have received First Aider training from other providers, the RFL offers a concussion module on its Learning Platform. To access the 2025 courses, please visit RL Education, where you will find detailed instructions.
Additionally, education sessions are conducted annually for all First Aiders and Safeguarding Managers. The RFL Coach Education program also includes a section on concussion, while match officials have access to a basic awareness tool online.