Time to revisit the content and duration of the Graduated Return to Play after concussion

Abstract

Determining the appropriate starting time and duration of the Return to Play (RTP) process after any injury is fundamental to the practice of clinical sports medicine. A framework on RTP after concussion is outlined in the Graduated Return to Play protocol (GRTP) of international consensus protocols that is a key element of concussion management across all levels of sport and a cornerstone of current concussion 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 concussion consensus. The limited evidence base informing the content and duration of the GRTP is acknowledged. Specifically the evidence evaluating the effect, optimal amount and type of rest is sparse. Moreover, current RTP guidelines for children and adolescents are based on those of adults [1] making postconcussion exercise prescription largely generic. Whilst research concerning a range of clinical outcomes following concussive injury in sport continues to develop, relatively little has been known until recently about the consequences of return to play.