Concussion Return-to-Contact Toolkit
Guide to concussion and return-to-contact in adolescent girls rugby athletes
This resource helps players safely return to contact after a concussion. It also helps players, coaches, and parents understand how to spot, prevent, and manage concussions.
It includes step-by-step stages to guide players as they return to contact activities:
Return-to-School should be completed before you seek medical clearance for full return to unrestricted sport activities.
The guidance below has been taken from World Rugby and the 6th International Consensus Conference on Concussion in Sport, Amsterdam 2022 and provides a structure to help athletes return-to-sport following concussion.
Return to sport must follow a step-wise approach:
- Each stage is at least 24 hours.
- Under World Rugby and Rugby Canada’s concussion guidance, this takes a minimum of 21 days to complete. However, some players may require longer, and progression should always be guided by symptoms and medical advice.
- The protocol should not replace advice given to a player by their physician.
- Medical clearance from a nurse practitioner or medical doctor is required before step 4.
Why 21 days?
Some athletes may recover more quickly from their symptoms and complete the staged rehabilitation process before 21 days. While these recommendations differ from the International Consensus Statement on Concussion in Sport, the 21 days reflect World Rugby's approach to managing concussion risk. It is intended to provide additional time for brain recovery and to reduce the risk of returning to contact sport before recovery is complete.
Instructions:
- Moving through each stage should be guided by your coach, suited to you, and approved by a qualified healthcare professional.
- The contact exercises included are simple examples that can be done with little to no equipment and can be easily adapted to suit your age, playing position, coach’s preferences and your team’s needs.
- Boosts physical recovery
- Detects symptoms early to direct appropriate medical treatment
- Help restore confidence after injury.
What are the benefits of graduated Return-to-Sport?
- Boosts physical recovery
- Detects symptoms early to direct appropriate medical treatment
- Help restore confidence after injury.
- Reduces the chance of getting injured again.
A brain injury that happens after a direct hit to your head, face, or neck, or a hit to your body that makes your head move suddenly. It can cause visible signs and symptoms that may show up right away or may not appear until 24–48 hours later. ‘knock to the head’ or ‘getting your bell rung’ are all terms used for suspected concussion and should be managed as such.
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Start simple, structured and controlled
Start with basic, structured drills where movements are predictable and there are not many decisions to make.
Progress only when:
Players can consistently show safe technique and good body position. -
Increase difficulty step by step, by:
Follow this order when bringing contact back in:
- standing still
- moving
- moving with decisions
- controlled contact (low speeds)
- live full tackles & rucks
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Ways to make it harder:
- Increase speed: move faster into contact or use bigger spaces
- Increase intensity: do more repetitions or add more resistance
- Increase unpredictability: react to what the ball-carrier does or follow coach instructions
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Return-to-contact
The step-by-step way a player safely gets back into rugby contact after being injured.
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Confidence
How sure a player feels about doing contact skills safely and well.
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Key performance indicator
Small things that show if a player is tackling properly, like correct body position, footwork, or head placement.
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Challenge
How hard an activity is for a player (physically, mentally, or skill-wise).
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Tackle
When one or more players try to stop the player with the ball, whether they bring them to the ground or not.
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Tackler
The player trying to stop the person with the ball.
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Ball-carrier
The player who has the ball during the contact.
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Multi-defender
A tackle where more than one player is involved in stopping the ball-carrier.
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Ruck
When players from both teams stay on their feet and push against each other over the ball on the ground.
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Rucker
A player in the ruck trying to win or protect the ball.
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Counter ruck
When the defending team pushes into the ruck to try to win the ball back.
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Duration
How long the activity or rest lasts from start to finish.
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Repetition
Doing one full action (like one tackle or one drill).
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Non-contact
No physical contact with other players.
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Controlled contact
Contact happens, but it’s slower and more controlled (often using pads or bags).
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Full-contact
Real, game-like contact with no restrictions.
We pay tribute to the traditional territories of the peoples of Treaty 7, which include the Blackfoot Confederacy (comprised of the Siksika, the Piikani, and the Kainai First Nations), the Tsuut’ina First Nation, and the Stoney Nakoda (including Chiniki, Bearspaw, and Goodstoney First Nations). The City of Calgary is also home to the Métis Nation of Alberta, Districts 5 and 6.
We wish to thank the players (Brynn Lamb, Jai LaBelle, Julia Omokhuale), community coaches (Malcolm Lamb, Terri-Lynn Hamilton, John Long, Jayne Isherwood), healthcare professionals (Preston Wiley, Karen Ballinger, Nicole Ainsworth, Maitland Martin), Rugby Canada (Keegan Brantner, Steph Veal, Heather Josephides) and Rugby Americas North (Scott Harland) for their contribution to the development of the Return-to-Contact toolkit.
Big thank you to Parachute Canada (Stephanie Cowle), Richie Gray, Hugh Hogan, and the wider research steering team from University of Calgary (Brooke Dennett, Lisa Loos, Michaela Chadder, Mark Agius, Maitland Martin, Keith Yeates, Carolyn Emery, Stephen West, Carly McKay, Stacy Sick, Preston Wiley, Kathryn Schneider), University of Bath (Keith Stokes), University of Cape Town (Sharief Hendricks), Leeds Beckett (Anna Stodter, Ben Jones), Université de Montreal (Jeff Caron, Quinn Johnson, Les Podlog), La Trobe University (Marcella Ferraz Pazzinatto, Brooke Patterson, Andrea Bruder, Melissa Haberfield, Kay Crossley), Trinity College Dublin (Fiona Wilson, Will Connors), University of Victoria (Isla Shill), Brock University (Carley Jewell, Jeff Brooks), and Wake Forest University (Jillian Urban, Stewart Pritchard) for their contribution to the Return-to-Contact toolkit.
If you have any questions about the Return-to-Contact Toolkit, contact the research team
Project Manager: Dr Kathryn Dane
Principle Investigator: Prof Carolyn Emery
Email: Kathryn.dane@ucalgary.ca
Phone: 403-220-3113