Head injury advice - when to play on

There is currently an outcry that Professional Rugby seems to be failing to appreciate the extent of brain damage that can occur following repeated head injuries and putting money before the players’ lives.

George North, the 24 year old Rugby player had six-months out of the game in 2015 when he received four blows to the head in five months, last week he received his 6th serious head injury within 2 years. He was taken off the pitch to be assessed for concussion and then allowed to play on. Had this been an amateur match this would not have been permitted and it could have major repercussions for his future health.

The Rugby Players’ Association (RPA) said  George North’s return to the field was a “significant failing”, and felt that sanctions would have sent a “clear message” about the “gravity of concussion management”.

  • With suspected concussion, club doctors have 13 minutes to decide if a player is fit to return to the field.
  • All Premiership grounds and Twickenham have medical teams with access to replays to help that decision.
  • Any player with confirmed or suspected concussion will be permanently removed and will not be permitted to return to training until deemed fit by medics.

We have all witnessed the inevitable clash of heads during a match and the dilemma of the coach and match officials to do the right thing. This uncertainty is compounded by the player, pumped full of match adrenaline, desperately trying to hide the extent of the head injury to be able to play on. The RFU guidance makes it easier for everyone to do the right thing and ensure the player has every opportunity to make a full recovery. It is a real shame the Professional element of the sport does not appear to take this as seriously.

Head injury advice - when to play on

Concussion is a disturbance to the normal working of the brain usually resulting from a blow to the head. Repeated concussions are linked to serious long term brain conditions.

Initial symptoms of concussion – in Rugby the most common symptoms that you may see on the pitch are the following: Headache, confusion, blurred vision, nausea, difficulty concentrating, fatigue, drowsiness, dizziness, feeling in a fog, memory impairment.

Head injury advice - when to play on

If you would like a copy of the above poster – please email me at emma@firstaidforlife.org.uk

Concussion can also affect someone’s mood, balance, sleep, thinking, concentration and senses. Most symptoms resolve in 7-10 days and many much sooner.

It is important to realise that concussion is an injury to the brain and this injury needs to be rested to fully recover, in a similar way to that of a sprain or strain. The injury to the brain occurs during the collision, when the brain is shaken within the skull. If someone rests appropriately following concussion they will nearly always make a full recovery.

 Most important advice following a head injury –

  • Don’t make things worse – important to take seriously and rest
  • Do not risk injuring again
  • Rest your brain = lots of sleep, avoid reading, screens and sports for at least 24 hours / 48 hours for child

Children and adolescents may need one or 2 days off school and a gradual return to academic study. They can start light reading and small amounts of screen time, but should monitor and stop if there are signs of any recurrence of symptoms.

At least 2 weeks’ with no training to give the brain a chance to fully recover.

If there are no symptoms players can then start the gradual return to play GRTP –

  • 24 hours per stage (48 hours for children and adolescents) – go back a stage if symptoms occur
  • Light aerobic exercise
  • Sport specific exercise
  • Non-contact training
  • Full contact practice

19 days is the earliest that an adult can return to play

23 days is the earliest that a child or adolescent can return to play

Repeated concussions, particularly in children are associated with long term consequences and serious conditions including second impact syndrome and post-concussion syndrome.

Coaches and first aiders should be confident to:

Remove – any player who has experienced a head injury and shows any of the above symptoms should be removed from play immediately.

Recognise – learn the signs of concussion. Only about 10% of people experiencing concussion are knocked out – so 90% of people who have experienced concussion will remain conscious. Look out for the more obvious signs such as a dazed or blank expression or tonic arm extension following the blow to the head; along with the symptoms listed above. Use the pocket concussion assessment tool available from the RFU.

Applying a wrapped ice pack will reduce superficial bruising and swelling – but has no effect on any brain recovery.

If a severe head injury has been sustained and you are concerned about the casualty’s spine; they should only be removed from the field by someone appropriately trained to do so. If worried and no one appropriate to help; reassure the casualty, support their head in a neutral position, stop the game – or move to another pitch and await removal of the casualty by paramedics.

Rest – for at least 24 hours for an adult and 48 for a child or adolescent (see above)

Recover – Ensure the player remains completely symptom free before contemplating any form of return to play.

Return – return to play using the gradual return to play GRTP method as outlined above

It may take 4-6 weeks before a player is fully fit and back to competitive play. This may seem a long time away from the game. However, it is comparable to the recovery time following a soft tissue injury and your brain is so important to every aspect of life, that it is vital we take head injuries seriously.

The RFU have a superb online training course specific to parents, players, teachers and coaches. http://www.englandrugby.com/my-rugby/players/player-health/concussion-headcase/


Want to know more about Sport Related Injuries in Children? have a look at this article.


Written by Emma Hammett for First Aid for Life

It is strongly advised that you attend a fully regulated Practical or Online First Aid course to understand what to do in a medical emergency. Please visit https://firstaidforlife.org.uk or call 0208 675 4036 for more information about our courses. First Aid for Life courses cover all the RFU recommended elements for coaches and clubs.

First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.

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