Determining the appropriate starting point and duration of the Return to Play (RTP) process after
injury is fundamental to the practice of clinical sports medicine. The most commonly cited RTP
framework after concussion is outlined as part of all international concussion consensus statements.
This framework is a key element of concussion management across all levels of sport and provides a
‘cornerstone’ of current education initiatives. In Rugby Union, RTP guidelines last underwent a major
update by World Rugby, the International Federation, in 2011 and are consistent with international
There is a limited evidence base informing the content and duration of the Graduated Return to
Play. Specifically, the evidence evaluating the effect, optimal amount and type of rest is sparse.
Moreover, current return to play guidelines for children and adolescents are based on those of
Whilst research concerning a range of clinical outcomes following concussive injury in sport
continues to develop, until recently, little has been known about the consequences of return to play.