Sport and concussion guidelines

What is concussion?

Concussion is the most common head injury in sport and is caused by a temporary disturbance in brain function due to trauma. It can occur following sudden violent movement of the head, usually in a tackle or collision. Most damage is caused by rotation and acceleration (e.g.spinning of the head caused by a blow to the side of the head). Concussion may occur with or without loss of consciousness.

A free resource - ‘Sideline Concussion Check’ - contains information about managing a suspected concussion.

Concussion signs

Does the player show any of these signs?
  • A vacant stare
  • Slow responses (e.g. slow to answer questions or follow instructions)
  • Slurred or incoherent speech
  • Forgets events prior to impact
  • Forgets events after impact
  • Unable to focus attention (e.g. easily distracted)
  • Disorientated (e.g. walking in wrong direction, unaware of time, date, place)
  • Uncoordinated (e.g. stumbling, unable to walk in a straight line). If player reports any of these
  • symptoms, they should not return to play
  • Emotionally confused (e.g. aggressive, appearing distraught, crying for no apparent reason)
  • Dazed or stunned

If a player shows any of these signs, ask the player the questions contained in the ‘Sideline Concussion Check’ card.

Concussion symptoms

Does the player show any of these signs?
  • Feelings of nausea (sickness)
  • Double vision or fuzzy vision
  • Ringing in the ears
  • Any period of loss of consciousness
  • Headache
  • Pupils appear different in size
  • Sensitivity to light or noise
  • Feeling sluggish, groggy or dizzy
  • Concentration or memory problems

What should you do if concussion occurs?

  • ALWAYS assume a cervical spine injury if the player is unconscious
  • If there is any risk of a neck injury, stabilise the player's head and neck, then get help 
  • When appropriate support (doctor or ambulance crew) has stabilised the neck with a collar, the player may be taken from the field on a scoop stretcher or spinal board
  • A doctor or sports medic should make a thorough medical assessment, record the symptoms and events leading to the injury, and make further hospital referral if required
  • No concussed player should return to their sport until they have been cleared by a medical professional

Immediate management for a suspected concussion

What rehabilitation should follow a concussion?

It may take days or weeks to fully recover from concussion. There is no pre-determined way of knowing how long recovery will take. No concussed player should return to training or play for a period of three weeks after they were concussed. After this period the player may only resume participation when they are symptom free and have received a medical clearance. Coaches should sight the medical clearance before permitting the player to take part in training or play. Many symptoms are made worse by exercise so rest is the most advisable.

Once acute symptoms pass, a gradual return to low level aerobic training followed by non-contact drills and finally contact play is recommended. This should only occur after receiving a medical clearance.

If symptoms persist for a few weeks to six months or more this is called 'post-concussion syndrome'.
This may be associated with headaches, a reduced concentration span, slow decision-making, dizziness, fatigue, irritability, impaired memory and personality changes.

If post-concussion syndrome occurs, the player should not be allowed to return to competition until completely symptom-free

What are the effects of repeated concussion?

There is no definitive number of times a person can be concussed before retiring from play. Thus it will be dependent on the player involved, the medical treatment and advice they receive.

Definitive arguments around this issue are difficult to make given the equivocal nature of the literature and insufficient research having been conducted in relation to this issue in sport. Some research would argue that the likelihood of serious sequelae increases when a mild traumatic brain injury is repeated, with longer term effects more evident with repeat concussions. 

Cumulative effects of repeated brain trauma is also believed to play a significant role in the development and persistence of post-concussion syndrome. In athletes with symptoms from a previous concussion, a second blow to the head may cause brain swelling, coma or even death. 
This is called 'second impact syndrome' and may cause death in up to 50% of cases

When can the player return to sport?

No concussed player should return to training or play for a period of thee weeks after they
were concussed. After this period the player may only resume participation when they are symptom free and have received a medical clearance. Coaches should sight the medical clearance before permitting the player to take part in training or play. The only exception to the three-week stand down is some senior player in international competition. These players can return to competition before three-weeks have elapsed if they are symptom-free and received a clearance from a recognised neurological specialist.

What is computer based testing for concussion and how is it used?

Neurologists and other brain injury specialists have developed a number of standardised tests that assist in examining the impact concussion has on brain functions. Computer software containing versions of these tests have recently become available. For more information visit or

Players must be tested prior to the season to establish a baseline and are tested again if they receive any head injury. Players are not permitted to resume play until their score on the tests returns to their baseline levels.

Concussion – guidelines for return to sport

NOTE: This is a guide only. Timeframes for rehabilitation and return to play vary depending on the nature and severity of the injury. Always seek the advice of a medical professional for a rehabilitation
programme specific to you and your injury.

Persistent concussion symptoms include:

Nausea (feeling sick or vomiting)
Blurred or double vision
Ringing in the ears

Aerobic Exercise:

Aerobic exercise works your heart and lungs and includes exercises such as:
Jogging should not be started until symptom-free

How can you reduce the risk of another concussion?

  1. Rugby head gear is NOT designed to reduce concussion. 
  2. Correct/safe tackling techniques should be practised at all times in high contact sports
  3. Wearing a custom-made mouth guard may reduce the risk of concussion
  4. A player must be free of ALL symptoms before a return to sport or training is possible
  5. If unsure, always follow the minimum stand-down guidelines established by your national sporting organisation (e.g. three weeks and no symptoms with physical activity)
  6. If concussion continues to occur, consult a medical professional for advice on other possible contributing factors