While all eyes will be on the Guinness Six Nations over the coming weeks, the tournament also serves as an important reminder that the sport continues to prioritise work to prevent, diagnose and treat injuries, including concussions.

How World Rugby’s Concussion Return to Play Protocol works

World Rugby Chief Medical Officer Dr Éanna Falvey explains the Graduated Return to Play Protocol after a suspected concussion.

From the training field to the international stage, player health and safety is always World Rugby's top priority. All our medical protocols are centred on research and reviewed annually to ensure players are receiving the care that reflects the latest medical consensus, including the sport’s Head Injury Assessment and Graduated Return to Play protocols.

Our concussion return to play protocols are aligned with expert opinion and are managed on an individual basis. There is no set timeframe for completion of our six-stage Graduated Return to Play protocol with the player having to progress through each stage without the presence of any symptoms or signs of a concussion. The average time to complete this process for a player in the English Premiership in 2018-19 was 22 days.

World Rugby’s six-stage Graduated Return to Play protocol must be followed before a player is cleared to participate in full contact training or playing.

Key features of the protocol include:

  • After a player has been diagnosed with a concussion, they are monitored and may only commence the return to play protocol when symptom free
  • Progressing to each new stage also requires that the player remain free of symptoms. Should any of the activities defined in each stage trigger recurrence of symptoms or signs of a concussion, the activities should be discontinued and the player must return to the prior phase in the protocol
  • Every player is treated as an individual and objective decisions about treatment are made based on the current injury, past medical history, risk profile of the player and the player’s response to each stage of the return to play protocol
  • This return to play protocol features a medically supervised six-stage process, starting with complete rest followed by light exercise with gradually increasing intensity culminating with contact training. Each stage is a minimum of 24 hours but often longer
  • The player must remain at the pre-concussion baseline level clear of signs and symptoms during activities outlined in each phase and remain so after before being cleared to move to the next stage
  • Having completed the six stages, a player may only return to play when they have completed a comprehensive neurocognitive test.

This return to play protocol, combined with the Head Injury Assessment (HIA) process used to assess head injuries during and after a game, has transformed the identification, removal and supervision of players with concussion in elite rugby, an approach followed by other sports.

While the elite level of the sport is the most visible level of the sport supported by world-class accredited medical personnel, processes and technology, a much more cautious approach is recommended for all other levels of the sport.

For all forms of the sport outside of the elite level, the process may only commence once the player has completed the requisite physical rest period (this means beginning the return to play process after seven days for community level adult players and after 14 days for children and adolescent players) and only if the player is symptom free. All players should be cleared by a medical practitioner or approved healthcare provider prior to starting the process.

Download the Graduated Return To Play (GRTP) Programme for the Community Game >>

As we look forward to a compelling Guinness Six Nations, all the necessary injury-prevention and COVID-19 standards will be in place to ensure that players and their welfare at the centre of every decision.

Dr Éanna Falvey, Chief Medical Officer