We’ve all winced when watching a professional rugby game, when you can hear the tackle and you wonder how they manage to get up again and carry on. When you’re working pitchside, you watch the game very differently, watching and waiting for players to get back up off the ground and observing how they move after a tackle.

Rugby injuries are common, and 1 in 4 players will be injured during a season, but probably the most high-profile injury in recent years is concussion. Contact sports have tried hard to minimise the risk of concussion over the last decade, with good reason. In professional rugby, technological advancements have introduced mouthguards with G-force sensors that measure the movement and speed of players’ heads, indicating when a player may have sustained a concussion. This technology isn’t yet available at the grassroots level, but we have to be vigilant, as concussion is the most common match injury across all levels of rugby, accounting for 16–26% of all injuries.

What is a Concussion?

Concussion is a mild traumatic brain injury (mTBI) caused by a bump, blow, or jolt to the head — or even a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce or twist in the skull, creating chemical changes and sometimes stretching or damaging brain cells.

Unlike a broken bone or a bruise you can see on an MRI, a concussion is primarily a functional injury rather than a structural one. It disrupts how the brain normally works, leading to a temporary “energy crisis” where the brain requires more energy to heal but has a reduced blood flow to provide it.

Common Symptoms to Watch For

Symptoms can appear immediately or may take 24 to 48 hours to manifest. They generally fall into four categories:

Physical: Headaches, nausea, dizziness, light/noise sensitivity, and balance issues.
Cognitive: Feeling “foggy,” slowed down, or having difficulty concentrating and remembering.
Emotional: Irritability, sadness, or increased nervousness.
Sleep: Drowsiness, sleeping more than usual, or trouble falling asleep.

Why Manual Therapy Matters

In our clinic, for post-concussion patients, we focus on the cervicogenic component of recovery. Because the force required to cause a concussion is often greater than the force required to cause a whiplash injury, the neck is almost always involved.

By addressing spinal movement, muscle tension, and autonomic nervous system balance, we help create the optimal environment for your body to recover and clear that “brain fog.”

The Golden Rule

If a concussion is suspected, “when in doubt, sit out” and seek a professional medical opinion for a diagnosis. Immediate physical and cognitive rest is the first step toward a full recovery.

Not all concussion occurs in sport, but regardless of how you’ve been concussed, you should take it seriously and rest. If symptoms persist or are severe, you should be checked over by a doctor.

Returning to activity should be gradual and follow the graduated return-to-activity schedule below. If you’ve suffered a concussion by any means and you want to return to activity, it’s a good guide for you too.

As pitchside first aiders, all of us at Remedy Health Clinic have completed the RFU’s Headcase concussion training, which is considered the gold standard of training in grassroots sport. It’s free and has some great additional resources.