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Concussions in Rugby: Prevention and Treatment Part 3 By Mark Waller BSc (Physio) Wits

Photo kindly supplied by Derrin van Ginkel

With concussions being so serious it’s important to find ways that can help prevent them from occurring and, in turn, help prevent an individual from suffering from a second concussion. Current protocol has been put into play by World Rugby to help reduce the rate of concussions and this is evident in statistics which show that during the 2019 Rugby World cup there was a 12% decrease in the amounts of concussions compared to the 2015 Ruby World Cup (World Rugby, 2019).

Boksmart has intervened in South Africa and there are certain measures that are in place to help locally. This includes a concussion register that is required for all teams from school level all the way to professional level and the blue card system. Both helps manage and monitor players who have suffered concussions or previous concussions. Education on the condition and how to prevent it is vital.

Physiotherapy can help significantly with concussion management and treatment of possible side effects including co-ordination, balance, proprioception issues as well as aiding in pain management and management of any whiplash complications. Vestibular Ocular Motor screening is also done by the physiotherapist to assess and manage the condition of the players vestibular and ocular systems which is important in returning to previous function.

Physiotherapists can also aid in prevention of the injury; the physio can help with preseason risk screening of the team. Research has shown that strengthening of the neck muscles is very effective in reducing the chances of concussions (Hrysomallis, 2016). Another way that physios have proven to hep is through the administration of a pre-activity movement control programme, which would work on balance training, whole-body resistance training, plyometric/explosive training, and controlled rehearsal of landing and other rugby specific manoeuvres. This type of exercise programme has shown to decrease the risk of injuries including concussions in schoolboy rugby players (Hislop, et al., 2017).

All of this shows us that concussions are really a serious problem in the game that is so loved in our country from grass root levels all the way to professional level. However, we can see that with involvement and input from World Rugby and initiatives like Boksmart, there is a way to reduce the risks of such severe incidents from occurring. On top of this we can see how physiotherapists have a role to play in the picture, whether it’s to do with preseason work, actual injury management and identification or prevention strategies like neck strengthening for example.

To book an appointment with a physiotherapist at Debbie Cameron Physiotherapy contact Michelle or Chantal on 031 765 8898.


Boksmart , 2019. Referees/Coach's On the Field Concussion Guideline. [Online] Available at: [Accessed April 2022].

Childrens Hospital of Philadelphia , 2022. Return to Learn After a Concussion. [Online] Available at: [Accessed April 2022].

Dekosky, S., Ikonomovic, M. & Gandy, S., 2010. Traumatic Brain Injury — Football, Warfare, and Long-Term Effects. Minnesota Medicine, 93(12), pp. 46-47.

Hislop, M. et al., 2017. Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial. Brittish Journal of Sprts Medicine, 51(15).

Hrysomallis, C., 2016. Neck Muscular Strength, Training, Performance and Sport Injury Risk: A Review. Sports Medicine, 46(8).

Ledreux, A. et al., 2020. Assessment of Long-Term Effects of Sports-Related Concussions: Biological Mechanisms and Exosomal Biomarkers. Frontiers in Neuroscience, Volume 14.

McCroy , P. et al., 2017. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Brittish Journal of Sport medicine, 51(11).

Romeu-Mejia, R., Giza, C. C., Giza, C. C. & Goldman, J., 2019. Concussion Pathophysiology and Injury Biomechanics. Current Reviews in Musculoskeletal Medicine, , 12(2), pp. 105-116.

van Tonder, R. et al., 2021. Presenting features of female collegiate sports-related concussion in South Africa: a descriptive analysis. South African Journal of Sports Medicine, 33(1).

World Rugby, 2019. INNOVATIVE RUGBY WORLD CUP 2019 DRIVES BEST-EVER PLAYER WELFARE OUTCOMES. [Online] Available at: [Accessed April 2022].

World Rugby, 2021. Concussion Guidelines. [Online] Available at: [Accessed April 2022].

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