Management of Concussion

Introduction

These Guidelines are based on the Consensus Statement produced following the 5th International Conference on Concussion in Sport held in Berlin in October 2016. The Guidelines should be followed at all times and any decision regarding return to play after concussive injuries should only be made by a doctor with experience in dealing with such injuries.

The NRL also supports the Concussion in Sport Australia Position Statement and recommends it as a valuable resource for First Responders, Medical Practitioners, coaches, parents and others involved in community rugby league (https://www.concussioninsport.gov.au).

Summary

The most important element in the management of concussion must always be the welfare of the player - in both the short and long term. All players with concussion, or suspected of having a concussion, should seek urgent medical assessment.

Concussion is a disturbance in brain function resulting from trauma that is transmitted to the brain either directly or indirectly. There is no absolute need for direct head impact for a concussion to occur. There are no structural changes (e.g. brain bleeds) and the changes that do occur are temporary and recover spontaneously.

Complications can occur if a player continues playing before they have fully recovered from a concussion. Therefore, a player who is suspected of having a concussion must be taken out of the game or training
session immediately. A player who has suffered a concussion or potential concussion or exhibits the symptoms of concussion should not return to play in the same game (or on the same day), even if they appear to have recovered. Concussion is an evolving condition which may develop over minutes to hours (and sometimes days). Some symptoms or signs may resolve only to be replaced by others later. The management of head injuries may be difficult for non-medical personnel. It is often unclear whether you are dealing with concussion, or there is a more severe structural head injury, especially in the early phases of an injury. Concussion is considered a medical condition and therefore needs to be assessed and managed by an appropriately qualified doctor.

In the period following a concussion, a player should not be allowed to return to play or train until they have had a formal medical clearance using the NRL Head Injury Recognition and Referral form by a doctor.

A Graduated Return to Play Program (as outlined below) should be followed to manage the return to training and/or play following a concussion. Children and adolescents generally take longer to recover from a concussion and additional time (around double that of an adult) should be allowed in developing a return to play/training program for a child or adolescent.

Players suspected of having a concussion must not be allowed to drive, operate machinery, drink alcohol, take anti-inflammatory medication (including aspirin and Ibuprofen), or use strong painkillers or sleeping tablets until they have been medically cleared to do so by a doctor.

Background

When considering the management of concussion, the welfare of the player - both in the short and long term - must always remain paramount.

Since 2001, there have been five international conferences addressing the key issues in the understanding and management of concussion. After each meeting, a summary has been published to improve the safety and health of athletes who suffer concussive injuries during participation in sport. The most recently
published conference was held in Berlin in October 2016. The summary from the Berlin meeting provides consensus guidelines for current best practice management of concussion(1). The NRL’s current guidelines for the management of concussion are based on the Berlin conference, as well as research conducted on concussion in the NRL, World Rugby, AFL and other international sports over a number of years.

The NRL also supports the Concussion in Sport Australia Position Statement and recommends it as a valuable resource for trainers, first aid providers, coaches, parents, medical practitioners and others involved in community rugby league (https://www.concussioninsport.gov.au).

To view the full guidelines, download the policy document.