Significant changes to concussion management for professional rugby in England

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This season will see major changes to the way the risk of concussion is managed across the professional game in England.

The Rugby Football Union, Premiership Rugby and the Rugby Players Association have worked together to focus specifically on concussion awareness and education, game day management and the graduated return to play for those players who have suffered a concussion.

Players, coaches and officials will have to complete a new mandatory online concussion awareness module within a two month period. Failure to do so will result in a fine and they will be unable to play, coach or officiate until the course is completed.

The objective of the module is to improve the understanding of concussion, what it is, what it feels like and how to recognise it, and what is needed from all groups to manage it effectively. It also highlights the potential consequences of the injury.

All Premiership Rugby and Championship medical staff will also undertake additional mandatory concussion management training as part of the annual Immediate Care in Sport (ICIS) programme. The Head injury and concussion section has been updated to reflect recent changes in concussion management.

The Head Injury Assessment (HIA) process, will again be used in Premiership Rugby and England matches in the 14-15 season to help doctors manage head injury events where they are unsure of the diagnosis. Cases of confirmed or suspected concussion will continue to be permanently removed from the field of play.

The memory test has been strengthened and the balance test altered, enhancing the information team and independent doctors have available to them when making a return-to-play decision. The period for this assessment has also been extended from five to 10 minutes.

At all Premiership Rugby grounds and at Twickenham stadium, doctors will have access to live TV feeds and replays when they conduct a Head Injury Assessment to aid their decisions on whether to permanently withdraw a player from the field of play.

There also will be an independent review of the on-field management of confirmed and suspected concussion cases and all HIAs that occur during Premiership Rugby and England matches. They will be conducted by two experienced independent medical practitioners who will review the match footage and seek further information if needed from team medical staff. The review process is linked to the RFU disciplinary process.

For the past two seasons, Bath University have evaluated the return to play processes followed by Premiership Rugby and England players after concussion. For the 14-15 season this review process has been formalised and Bath University will monitor and report on the Graduated return to play (GRTP) pathways for Premiership Rugby and England players.

Richard Bryan, Rugby Director, RPA said: “Player welfare is the top priority of the RPA and so these enhancements to concussion management and the education of players, coaches and referees are very welcome.”

“While these changes represent significant steps in the right direction, it is crucial that concussion management and education continue to be monitored and evaluated to ensure effectiveness and that advances in the understanding of concussion are incorporated into the ongoing safety of players.”

“Ultimately we believe it is the collective responsibility of all stakeholders in the professional game to deliver a culture change in attitudes towards concussion.”