Recovery, Return to Play & Australian Rugby Protocols
In Part 1, we looked at how concussions happen in rugby and used Joseph Suaalii’s recent head injury as a real-world example. In this second part, we explore what happens after a concussion—how players are managed, monitored, and medically cleared to return to the game under Rugby Australia’s strict return-to-play guidelines.
Immediate On-Field & Sideline Management
Once Suaalii was assessed and diagnosed with a concussion, the Head Injury Assessment (HIA) protocol was activated. Rugby union uses the World Rugby HIA process, which Rugby Australia follows closely and only occurs at the elite level. It includes:
- Immediate removal from play if a concussion is suspected.
- HIA 1: A 10-minute off-field test conducted by a team doctor or independent match-day doctor.
- HIA 2: This assessment is completed at the end of the game to monitor symptoms and helps to determine if the player is cleared to return to play or further evaluation is required.
- HIA 3: Completed 36-48 hours post head clash to determine progress and return to play
- If a concussion is confirmed or suspected, the player is ruled out for the rest of the match and enters the graduated return-to-play (GRTP) protocol.
Step-by-Step: Rugby Australia’s Return-to-Play Protocol (GRTP)
Rugby Australia adheres to World Rugby’s graduated return-to-play pathway, updated in 2022 to reflect growing concerns over long-term brain health. The process is conservative and medically supervised. Here’s how it works:
1. Initial Rest Period
- Minimum 24–48 hours of complete cognitive and physical rest.
- Symptoms must fully resolve before progression.
2. Graduated Physical Stages
Each stage lasts a minimum of 24 hours (longer if symptoms persist).
| Stage | Activity | Purpose |
| Stage 1 | Light aerobic exercise (e.g. walking, stationary bike) | Increases heart rate, no resistance training |
| Stage 2 | Sport-specific drills (e.g. running drills) | Adds movement, no head impact |
| Stage 3 | Non-contact training (e.g. passing, footwork) | Adds coordination and more complex movement |
| Stage 4 | Full contact training | Normal training activities, under supervision |
| Stage 5 | Return to match play | Cleared by team doctor or independent neurologist |
Minimum Stand-Down Period
Under Rugby Australia’s Concussion Guidelines, the minimum return time depends on the level of the player:
- Elite/Professional players: Can return in 12 days at the earliest, if all criteria are met.
- Community players (including juniors): Must observe a mandatory 21-day stand-down, even if symptom-free sooner.
In Suaalii’s case as an elite player, he would need at least 12 days and must be symptom-free and cleared by medical professionals before playing again.
Cognitive and Neuropsychological Testing
Elite players often undergo baseline cognitive tests pre-season (e.g., SCAT6 or ImPACT tests). These tests are repeated after injury to help determine when the brain has returned to its baseline state. Suaalii would not have been cleared to return until he passed both physical and cognitive criteria.
The Role of Medical Oversight
The final decision lies with the team doctor in conjunction with independent specialists if necessary. In some cases, players may be referred to a neurologist or concussion specialist for prolonged symptoms.
Rugby Australia also mandates concussion education for players, coaches, and medical staff to foster a culture of “If in doubt, sit them out.”
Long-Term Considerations
Repeated concussions can have lasting impacts on brain health. That’s why Rugby Australia tracks player concussions, and in some cases (like repeat head injuries), players are advised to take extended breaks—or even retire early.
Final Thoughts
Joseph Suaalii’s case serves as a reminder of the risks of contact sport—but also of the robust protocols now in place to protect players. While the return to play must be carefully managed, the focus remains on long-term brain health over short-term performance. Whether you’re a fan, player, or coach, understanding the seriousness of concussion can help make rugby safer for everyone. If you feel you would benefit from a comprehensive return to sport assessment, feel free to book online or call us on 039885457.