REGULATION 10.  MEDICAL

Concussion is a brain injury, which is serious and can be suffered by a Player of any age. 

Concussion and suspected concussion must be taken extremely seriously by all those involved in the Game in order to protect the safety, health and welfare of Players. 

Extra caution must also be taken with children and adolescents who have a greater risk of concussion and associated complications.

This rugby-specific guidance acknowledges the existence in certain countries of national concussion management guidelines which should be observed as a minimum standard of care.

10.1         Concussion 

ADULTS (19 years and older)

10.1.1    Any ADULT Player with concussion or suspected concussion:

(a)    must be immediately and permanently removed from training or the field of play; and

(b)    should be assessed by a medical practitioner or an approved healthcare professional (as approved in the relevant jurisdiction); and

(c)    must not return to training or to play in a Match on the same day and until symptom free; and 

(d)    should have relative physical and cognitive rest limited to routine daily activities (no exercises or taxing ‘thinking activities’) for 24 hours; and

(e)    should be encouraged to participate in light exercise (activity that does not significantly aggravate symptoms) from 24-48 hours before commencing an individualised rehabilitation programme referred to at 10.1.1(f)-(h) below. The Player must be symptom free before commencing the high intensity components of the individualised rehabilitation programme (Stage 4); and 

(f)    must successfully follow and complete an individualised rehabilitation programme to safely return to activity. Examples of this are contained in the World Rugby Concussion Guidance which is available here; and 

(g)    should receive clearance from a medical practitioner or approved healthcare professional prior to commencing the full contact training stage of the individualised rehabilitation programme.

(h)    The minimum return to play time for adult players (who have completed an appropriate individualised rehabilitation programme) returning from a concussion is 21 days.

10.1.2     The following exceptions may apply:

(a)    The process described in 10.1.1 is obligatory regardless of whether the Player has become symptom free. In any event, there is no exception to the initial 24-hour period of relative physical and cognitive rest;

(b)    the completion of an individualised rehabilitation programme stipulated in 10.1.1(f) is obligatory except in cases of suspected concussion where the Player has accessed an ‘advanced level of concussion care’ (as defined in the World Rugby Concussion Guidance) OR has been cleared by a medical doctor to return to training or to play on the grounds that the Player had not in fact been concussed.

10.1.3    The temporary replacement procedure for head injury assessment set out in Law 3.27 is only applicable in elite adult Matches, Series of Matches or Tournaments, which have been approved in advance by World Rugby. 

10.1.4    If a Union, Association or Tournament Organiser wishes to obtain access to temporary replacement for head injury assessment in approved elite adult rugby Matches, an application for approval must be made to World Rugby. Application procedures are set out in the World Rugby Head Injury Assessment Protocol (“HIA Protocol”) available for elite level match day medical staff here.

10.1.5    Approval will only be given by World Rugby for access to the temporary replacement procedure in the elite adult game if the relevant approval criteria identified in the HIA Protocol are met, which include confirmation by the applicant that: 

(a)    The Tournament or Matches are elite adult Tournaments or Matches; 

(b)    The Core (mandatory) Concussion Player Welfare Standards set out in the HIA Protocol will be adopted and complied with;

(c)    There will be an HIA Review Process in place; and

(d)    They have facilitated access to video to assist with the management of head impact events occurring during Matches. 

CHILDREN AND ADOLESCENTS

10.1.6    Any CHILD or ADOLESCENT Player (aged 18 years or less) with concussion or suspected concussion:

(a)    must be immediately and permanently removed from training or the field of play (this is known as ‘Recognise and Remove’); and 

(b)    should be medically assessed by a medical practitioner or an approved healthcare professional (as approved in the relevant jurisdiction); and

(c)    must not return to training or to play in a Match on the same day and until symptom free; and  

(d)    should have relative physical and cognitive rest limited to routine daily activities (no exercises or taxing ‘thinking activities’) for 24 hours; and

(e)    should be encouraged to participate in light exercise (activity that does not significantly aggravate symptoms) from 24-48 hours before commencing an individualised rehabilitation programme referred to at 10.1.6(f)-(h) below. The Player must be symptom free before commencing the high intensity components of the individualised rehabilitation programme (Stage 4); and 

(f)    must successfully follow and complete an individualised rehabilitation programme to safely return to activity. Examples of this are contained in the World Rugby Concussion Guidance which is available here; and 

(g)    should receive clearance from a medical practitioner or approved healthcare professional prior to commencing the full contact training stage of the individualised rehabilitation programme.

(h)    The minimum return to play time for adolescent and child players (who have completed an appropriate individualised rehabilitation programme) returning from a concussion is 21 days.

10.1.7     The following exceptions may apply:

(a)    The process described in 10.1.6 is obligatory regardless of whether the Player has become symptom free. In any event, there is no exception to the initial 24-48 hour period of relative physical and cognitive rest;

(b)    the completion of an individualised rehabilitation programme stipulated in 10.1.6(f) is obligatory except in cases of suspected concussion where the Player has accessed an ‘advanced level of concussion care’ (as defined in the World Rugby Concussion Guidance) OR has been cleared by a medical doctor to return to training or to play on the grounds that the Player had not in fact been concussed.