Head Injury Assessment: What You Need to Know

Whether you’re playing in the Rugby World Cup final or against friends in a Saturday afternoon match, player welfare should always be your number one priority. USA Rugby agrees with and follows all of the laws and procedures passed down by World Rugby when it comes to injury prevention.

One specific area that we always need to be aware of in sport is head injury.

While World Rugby, along with all world experts, acknowledges there is no perfect tool or system to diagnose concussion, the increased awareness of the issue has caused a massive decrease in concussion rates at the elite level. Prior to 2012, 56-percent of players with a confirmed concussion returned to play following their head impact. Today, that figure has been reduced to 4.5-percent.

According to the latest data, overall injury rates are not increasing. Not surprisingly, the overall awareness on preventative measures and treatment have also increased. That is why it is imperative that all members of the rugby community continue to study and learn the proper Recognize and Remove process so that we can keep our teammates safe.

“We must continue to improve safety in our sport and place player welfare as our number one priority.” said USA Rugby Director of Medial Services Michael Keating. “The strength of rugby is in our community and we all have a responsibility to protect players – coaches, referees, medical staff, parents and teammates.”


The Head Injury Assessment (HIA) ONLY applies to the professional and international level of the game. This assessment includes mandatory education of medics, video review to assist medics and an Untoward Incident Review.



The HIA only covers a small amount of rugby being played. Nationally and internationally, the majority of our game is not being played at the elite level. It is at this stage that all teams must understand and follow the Recognize and Remove process



The first step in correctly following the Recognize and Remove process is understanding what a concussion is and how it can be diagnosed. A concussion is a brain injury, making each and every concussion is a serious issue. Any or more of the following clearly indicate a concussion:

  • Seizure
  • Loss of consciousness – confirmed or suspected
  • Unsteady on feet, balance problems, falling over or poor coordination
  • Confused
  • Disoriented – not aware of where they, who they are or the time of day
  • Dazed, blank or vacant look
  • Behavioral changes, i.e. More emotional or more irritable

There are more signs of concussion, you can view those here.


Any player with a concussion or suspected concussion should be immediately and permanently removed from training or play. No exception. The appropriate medical checks and procedures must then be followed. After the player has been safely removed, he/she should NOT return the field of play at any time and should be given medical assessment/treatment.

Return to Play

Rest is a key component of concussion treatment. Adult players must rest for a minimum of one week and youth and HS players must rest for two weeks. After the mandatory rest period, and being symptom free, player can continue to the five day Graduated Return to Play (GRTP) program.

You can view the entire GRTP program and more on usarugby.org/concussions.