Welcome to the Concussion Hub, your club, school or societies one-stop-shop for everything you need to know about concussion.
In a fast moving game of rugby, it can be difficult for one individual to have eyes on all players looking for possible concussive episodes.
It important that everyone involved in the game has good knowledge of what concussion is, how to recognise a possible concussion and react appropriately.
Knowledge, understanding and guidance around concussion is an ever evolving space, and Scottish Rugby recommends that players, coaches, match officials, parents and volunteers of our game regularly view this page for the latest information on the matter.
Scottish Rugby is committed to injury prevention and the welfare of all those participating in our sport.
Below you’ll find a series of resources and information to help you better understand concussion.
Remember, IF IN DOUBT SIT THEM OUT.
What is a concussion?
Concussion is a brain injury that upsets how the brain functions.
Your brain is the body’s control centre so upset brain function will result in changes in behaviour, mood and thinking as well as how you feel.
Changes in brain function will vary from brief (minutes only) to longer lasting but the vast majority of symptoms will resolve with time and rest.
Symptoms will get better before the brain has fully recovered so it is important to follow a graduated return to normal daily life (work and education) as well as sport to avoid developing prolonged symptoms or returning before your brain has healed.
What do common signs of concussion look like?
The change in brain function after a concussive impact may result in changes in consciousness, balance, and other behaviours that will give the observer visible clues that a concussion has occurred.
What are the symptoms of concussion?
A concussive injury is a traumatic brain injury and results in temporary changes to how the brain functions and as a result the symptoms (or what the player feels) can be quite wide ranging.
Symptoms are most usually felt immediately after impact but some may present up to 48 hours later, for example difficulty in concentrating, may only be recognised when the player attempts to return to work or school.
Symptoms can be grouped into symptom type as shown below. There is felt to be age and sex differences in symptom types, however, it’s important to realise that symptoms will vary greatly from player to player as well as between different episodes in the same player and are managed individually.
Physical symptoms of concussion include: headache, pressure in head, sensitivity to light, sensitivity to noise, dizziness, feeling sick and blurred vision.
Symptoms which relate to how you think or process information include: feeling slowed down, difficulty concentrating, difficulty remembering, feeling in a fog or out of body, difficulty completing tasks, poorer problem solving skills, and difficulty sustaining attention.
Emotional symptoms affect how you are feeling and these include irritability, feeling nervous or anxious, feeling sadness or down, depression, more emotional, quickly changing moods.
Concussion can often have an impact on our sleep pattern while the brain is recovering. This can include difficulty getting to sleep, feeling drowsy or sleeping more, difficulty staying asleep and vivid dreams or nightmares.
Red Flag Symptoms/Signs
The following signs and symptoms can indicate a more serious brain injury and if present the player requires transport to the nearest hospital for urgent medical assistance.
- Severe neck pain
- Double vision
- Weakness or tingling or burning in arms or legs
- Severe or increasing headache
- Seizure (fit)
- Loss of consciousness or becoming increasingly drowsy
- Repeated vomiting
- Increasing confusion or irritability
- Unusual behaviour change
If a neck injury is suspected the player should only be moved by health care professionals with appropriate spinal care training.
What causes concussion?
The tackle area is where most concussive episodes occur (approximately 74%).
High tackles are particularly dangerous as both tackler and ball carrier have their heads in the same space. However, concussion can occur in other phases of the game.
Remember any mechanism that causes rapid slowing of a person’s body can shoogle the brain and potentially result in concussion.
Who is at risk of concussion?
Concussions can happen at any age. However, children and adolescent athletes:
- are more susceptible to concussion
- take longer to recover
- are reported to have more significant memory and mental processing issues
- are more susceptible to rare and dangerous neurological complications, including death caused by a single or second impact
What happens if I'm concussed?
Anyone with a suspected concussion must be immediately removed from play.
Team mates, coaches and team staff, match officials, managers, administrators, partners and parents/carers who suspect someone may have a concussion MUST do their best to ensure they are removed from play in a safe manner and do not return that day. We all have a part to play.
It’s vital that if you think you have sustained a concussion that you let your coaches, team management and family members know.
It is also advised that the player seeks advice from an onsite health care professional (HCP) or NHS24 (111) for diagnosis and advice, again even if symptoms have quickly gone. This should occur within 24 hours.
All Concussive episodes should be entered onto SCRUMS using the injury reporting tool so that Scottish Rugby has access to as accurate concussion rates as possible.
You will then follow the Graduated Return to Play Protocols. More on this can be found below.
When can I start playing and training after a concussion?
Players returning to training and playing must follow the Graduated Return to Play Protocols. These are earliest permissible return to play dates after a suspected concussion.
These protocols are mandatory.
Under Scottish Rugby’s current Concussion Policy, earliest permissible return to play dates after a suspected concussion are as follows:
- Players under the age of 19: Day 23 post injury
- Other players: Day 12 post injury
In all cases these protocols must be followed prior to the players return to play.
Physical activity is generally beneficial and evidence shows it can aid recovery from concussion. However, this activity should occur in small amounts initially and increased gradually.
Returning to rugby activity requires a staged approach.
The speed at which physical activity and then rugby/sporting activity will vary greatly between individuals.
It is possible to start returning to some sporting activity while still experiencing symptoms, however, these should be mild and the activity should not cause new or worsening symptoms.
Pushing too quickly through a staged return if symptoms are worsened by activity will prolong recovery.
Every concussion is unique and should be managed accordingly.
Concussion Guidelines for Grassroots Sport (Sport and Recreation Alliance & sportscotland)
What are the UK-wide Concussion Guidelines for Grassroots Sport?
In April 2023, the Government and the Sport and Recreation Alliance published the first UK-wide Concussion Guidelines for Grassroots Sport which will help players, coaches, parents, schools, National Governing Bodies and sports administrators to identify, manage and prevent the issue.
The guidelines, developed by an expert panel of domestic and international clinicians and academics in neurology and sports medicine, sets out steps to improve understanding and awareness of the prevention and treatment of concussion in grassroots sport where trained medical professionals are less likely to be routinely present. It is targeted at people of all ages.
What are the key things I should know about the UK-wide concussion guidance?
Scottish Rugby is taking time to reflect the latest guidance from the Government and the Sport and Recreation Alliance to understand how and when this guidance will be applied to our concussion policy for clubs, schools and societies.
What does sportscotland's guidance say?
sportscotland’s current concussion guidance can be found HERE.
Support from Scottish Rugby on concussion
Brain Health Clinic
Scottish Rugby has the welfare of all our players both current and former central to all we do.
In May 2022, Scottish Rugby introduce the Brain Health Clinic by partnering with organisations such as HITIQ to improve our understanding of concussion and contact in rugby through head impact sensor technology in mouthguards, alongside partnering in a number of other research projects
Providing a service initially to former Scotland players the pilot Brain Health Clinic, thought to be the first of its kind, has been developed by Scottish Rugby’s Chief Medical Officer, Dr James Robson and Prof Craig Ritchie (University of Edinburgh and NHS Lothian).
You can read more about the Brain Health Clinic, HERE.
Tackle Height law trials
On Wednesday 12 April, Scottish Rugby announced that a lower maximum tackle height law trial of below the sternum will be implemented across the community game, beginning in the 2023/24 season, with the aim of reducing the number of concussions in the game.
Click HERE to read the news story published.
To learn more about the Tackle Height law trials, visit Scottish Rugby’s Tackle Height Hub, HERE.
In World Rugby endorsed trials conducted in France and South Africa, lowering the tackle height has been shown to reduce the number of head-on-head contacts and concussions. Lowering the tackle height has also shown positive outcomes regarding increased ball-in-play time and offloading.
- Trials in France resulted in a 64% reduction in head-on-head contacts and a 23% reduction on concussions.
- Research shows that by lowering the tackle height there will be a significant reduction in concussions.
Training and education
Scottish Rugby’s ‘RugbyRight’ course provides information and content around a wide range of player welfare subjects including as concussion management and tackle safety.
The RugbyRight course must be completed by all coaches and match officials, and they are required to complete this course on an annual basis.
Click HERE to find out more about RugbyRight.
Scottish Rugby also offers year-round training and education courses on First Aid in Rugby, and this course covers information on concussion awareness. To find out if there is a First Aid in Rugby course happening near you, please visit SCRUMS.
Scottish Rugby Concussion Policy
Compliance with Scottish Rugby’s concussion policy is mandatory for all those participating in the game in Scotland.
You can find it, HERE.
World Rugby has provided an extensive range of training and education tools in respect of Concussion. Scottish Rugby recommends that players, team management members and club officials make themselves familiar with the contents of these resources.
The World Rugby resources can be accessed here:
Training and Education: World Rugby Concussion Management.
World Rugby Regulation : World Rugby Regulation 10 (Medical)
Sport and Exercise for Brain Health course from Brain Health Scotland
Expand your knowledge of the benefits of lifelong physical activity for maintaining brain health and reducing disease risk by completing the Sport and Exercise for Brain Health course.
The content of the course has been certified by the CPD Certification Service as conforming to continuing professional development principles. Click HERE for more.
You can also find a video from Scottish Rugby and sportscotland on concussion, and a video from ConcussEd featuring Dr James Robson, below.