Healthcare Professionals

Concussion is a functional disturbance of the brain without any associated structural pathology (as visible using current scanning technology) that results from forces transmitted to the brain (either directly or indirectly). It is generally considered part of the spectrum of traumatic brain injury (TBI).

The Glasgow Coma Scale (GCS) is commonly used to both assess the severity of brain injury and to serially monitor patients following TBI. THE GCS is used to classify TBI as follows:

                Mild; GCS = 13-15          Moderate; GCS = 9-12          Severe; GCS = <8

Typically, in rugby, players who sustain a concussion have a GCS score of 13-15 at the time of medical assessment and therefore fall into the mild end of the injury severity spectrum. The clinical features usually appear rapidly after injury and resolve spontaneously over a variable timescale.

Although the pathophysiology of concussion remains poorly understood, the current consensus is that it reflects a disturbance of brain function rather than a structural injury. Research in animal models of concussion suggests that linear acceleration or rotational shearing forces may result in short‐lived neurochemical, metabolic or gene‐expression changes.

Pressure from Players, Parents and Coaches

Experience shows that there may be pressure from the player themselves, their parent, and or their coach to return to play as soon as possible “for that crucial game”. This pressure must be resisted and the time taken to explain why it is important to follow the guidelines. This will usually result in the pressure being withdrawn. If, however, the advice is ultimately rejected then you are advised to record the advice and if possible obtain a signature to verify that this advice has been given and has been rejected by the individual.


For those interested in research around this subject, please register with and follow the World-Rugby-supported Rugby Science Network.


  • The welfare of the player both short and long term must always come first
  • Concussion is a functional disturbance of the brain
  • All health care professionals involved in rugby must be able to recognise concussion
  • Players with suspected concussion must be removed from play
  • The treatment for concussion is physical and cognitive rest
  • All players must be allowed to recover before returning to play. Complications can occur if a player is returned to play before complete recovery
  • All players with diagnosed or suspected concussion must undergo a Graduated Return to Play

A player who has suffered from a concussive injury must not be allowed to return to play before having a medical clearance. In accordance with current consensus guidelines, there is no mandatory period of time that a player must be withheld from play following a concussion.

Remember the 4 Rs:

Recognise the signs and symptoms (PDF 859KB)

Remove the player from play (PDF 859KB)

Recover fully before returning to sport (PDF 859KB)

Return only after following a Graduated Return to Play (PDF 1.6MB)

Read more... (PDF 612KB)

Resources and downloads

Download the concussion assessment tools:

Presentations from the Fourth International Consensus Conference on Sports Concussion (Zurich, Nov 2012)

2012 Consensus Statement on Concussion in Sport (PDF 197KB)

NHS Guidelines on referral to hospital following a head injury

RFU Emergency First Aid course

RFU Immediate Care in Sport course

British Journal of Sports Medicine Concussion Blog

Clinical Journal of Sports Medicine concussion in sport blog

Headway – resources for general practitioners

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.