Concussion in rugby – treatment & advice.

Controversy over the head injuries to Jonny Sexton and Mike Brown provide an opportunity to review some of the protocols involved the assessment and treatment of concussion ahead of Sunday’s big rugby match between Ireland and England in Dublin.

Both the IRFU and the RFU publish their concussion guidelines on their websites. In December 2013 the IRFU issued their document entitled STOP-INFORM-REST-RETURN while English Rugby came up with “Don’t be a headcase”

Both Unions take a zero tolerance approach to suspected concussion in an attempt to move away from the dangerous myths and terminologies of the past such as “a knock to the head” or a “minor concussion”

The IRFU’s protocols require players with suspected concussion to Stop, be removed and not return to the pitch, Inform, report to a coach, physio, colleague or friend, Rest for a minimum mandatory time period as outlined by the Guide to Concussion in Rugby Union and Return to play can only happen after following the IRFU Graduated Return to play protocol contained in the Guide.

An interesting look at some of the assessment techniques with regard to concussion is provided in the short video below by Dr Eanna Falvey of the IRFU.



While concussion at the elite level is very topical for the Ireland England game, the Unions are very conscious of the importance of awareness at all levels of sport.

We are delighted to have a guest post from Dr Katy Pedlow of Rebound Physio who has a PhD in Neurological Rehabilitation and has recently been endorsed by Irish International Chris Henry for her work with the charity Brain Injury Matters


Concussion guidance needed for all

Concussion awareness and management is at the forefront of agendas across sporting fields within the UK and further abroad. More locally in Northern Ireland, the tragic death of Ben Robinson, a rugby playing schoolboy has lead to the ‘Recognise and Remove’ campaign.

This campaign aims to provide education to both the medical and non-medical field on concussion identification and management in the hope to prevent future unfortunate fatalities in the world of sport. More recently controversy arose over Welsh rugby union winger George North who was taken off the field after a head injury before returning to play and suffering another blow to the head, which was missed by all involved.

Officials are now calling for live video analysis for professional rugby games in order to prevent this being missed in future. Although seen as a positive step, much more needs to be done as concussion can happen at all levels of sport or even just on the playground.

Rugby Concussion Vivomed

Thankfully return to play guidelines developed in recent years have provided clinicians with strict guidance for return to sport, enhancing overall management of players and reducing long term risk. Gone are the days of throwing water over the head and giving a pat on the back before stepping back onto the pitch. But is this filtering down to sport at all levels?

With concussion levels on the rise, increasing by 12% this year according to figures released by the Rugby Union, it is hoped this rise is due to increased awareness and therefore reporting rather than increase in the incidence. Locally strategies are beginning to take shape within schools rugby as the Rugby Injury Surveillance in Ulster Schools (RISUS) research project has been set up by MITRE and the Ulster University in order to capture injury data on players in order to inform the development of a regional strategy for schools rugby. Again, this is very positive for those involved in the world of rugby but what about other contact sports?

The main issue with concussion is the inconclusive ‘signs and symptoms’ which may be difficult to identify especially when some do not appear for 48 hours after the head injury has occurred. A concussion should however be given the respect it requires as a traumatic brain injury and the correct management protocols set in place for return to play. More focus however also needs to be on the longer term management of people with concussion to prevent conditions such as second impact syndrome (a potentially deadly swelling of the brain when a second concussive impact is received to the brain before it is fully healed from the first impact) and chronic traumatic encephalitis (repeated blows to the brain causing slow, but irreversible, degeneration of the brain tissue, with the build-up of a protein called tau, which is associated with dementia).

Saracens v Harlequins

Everyone involved with the sportsperson has a role to play in this including coaches, family and school teachers but more needs to be done to inform people of this management. Some of the more specific ways physiotherapists and other medical professionals can help includes:

• Overseeing baseline / post concussion neurocognitive test.
• Assessment of the cervical spine
• Education of sportspeople, parents and coaches on the importance of recognizing and reporting signs and symptoms of concussion.
• Evaluation on the pitch of those who are suspected of having sustained a concussion and observe and refer as appropriate.
• Evaluate athletes and be able to determine if signs and symptoms warrant emergency referral to a medical facility.
• Provide spouses, parents or guardians with verbal and written instructions on observing the sportsperson for complications that warrant emergency care.
• Assisting any physician request for accommodations.
• Monitor athlete’s return to school or work, and physical activities
• Oversee the athlete’s return-to-play program
• Complete any specialist rehabilitation including vestibular and oculomotor training.

Rebound Physiotherapy is a new physiotherapy clinic in Belfast on the Castlereagh Road that specializes in the conduction of neurocognitive testing (both baseline and post concussion) and long term player management post-concussion. More uniquely all of our clinic profits go directly to support the local charity Brain Injury Matters which helps to rebuild the lives of those who have been affected by acquired Brain Injury. If you want more information call our team at Rebound Physio on 02890992444 or go to

 For further advice on Concussion (Mild Traumatic Brain Injury) symptoms and treatment, please click here.

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