Contents
Graduated return to play after concussion. World Rugby (GRTP), the Paak return-to-play protocol: 6 steps, at least 24 h each; minimum stand-down 21 days (adult) / 23 days (under-19).
Graduated return-to-play (GRTP)
Concussion in rugby follows a common framework, World Rugby’s graduated return-to-play (GRTP), which Paak follows as is in its return-to-play protocol. The starting rule has no exception: a player with a suspected concussion is removed and does not return the same day. Recovery then follows a staged, symptom-limited progression, with a minimum time per stage and medical clearance required before contact and before return to play.
| Step | Content | Rule |
|---|---|---|
| 1 · Rest | Relative rest. | At least 24 h per step. You advance only if symptoms do not return; at the slightest return, you drop back a step. |
| 2 · Light aerobic | Light aerobic exercise. | |
| 3 · Sport-specific | Sport-specific exercise: running, no impact. | |
| 4 · Non-contact | Non-contact training. | |
| 5 · Contact | Full-contact training, after medical clearance. | |
| 6 · Return to play | Return to match play, after medical clearance. |
The number of steps and the 24 h minimum set a floor, not a calendar: six steps, each at least 24 h, with two medical locks. On top of that floor, World Rugby sets a minimum stand-down of 21 days for adults and 23 days for under-19s; youth and community-game timeframes are more conservative than the elite. Those are the figures carried by the ladder above and by Paak's return-to-play protocol.
The carton bleu and the FFR timelines
In France, the FFR layers onto the GRTP an age-differentiated medical protocol built around the carton bleu (blue card): a match official removes a player with a suspected concussion. The blue card triggers a mandatory medical pathway before any return, and Paak treats it as a first-class event. The timelines below are minimums, not targets.
| Age group | 1st concussion: earliest return | 2nd concussion | 3rd concussion |
|---|---|---|---|
| Under 19 | day 23 | day 42 + specialist opinion | day 180 |
| 19 and over | day 21 | + specialist opinion | day 90 |
Notice the consistency with the GRTP: World Rugby’s minimum stand-down (21 days adult, 23 days under-19) matches the FFR minimums for a first concussion exactly. France tightens from the second onward, requiring a specialist opinion, up to 90 days (adult) and 180 days (under-19) at the third. The carton bleu also imposes an initial rest period before any return; the exact number of hours should be read off the current-season FFR form, as the public documentation is not perfectly unambiguous on that point, but it does not change the return minimums above.
Prevention: Activate
Rugby’s reference prevention programme is called Activate: a structured, exercise-based warm-up (balance, whole-body strength, agility, and a neck-activation block), with age-banded versions: U13-U15, U16-U18, and adult / community. In the corpus, the associated form is rug-activate-prep.
What the evidence says. Movement-control warm-ups of this family have exposure- and injury-behaviour evidence in rugby, and strong evidence in other sports. But their effect depends on consistent, dosed use, not one-off application: an Activate done occasionally does not protect. That is the guide’s first piece of honesty: the programme is recommended, provided it is kept up over time.
The neck and the trunk
Neck strength is a rugby-specific focus, because the neck is in the front line of the tackle and the scrum. The corpus trains light isometric neck conditioning with the form rug-gainage-cou, presented as collision preparation, kept light and age-appropriate, and marked rung 3 (the exercise exists in coach education, but no federation fiche dates it by youth band).
Being honest about the evidence: tackle height
The tackle is rugby’s single most injurious phase, which is why the tackle-height law has been actively changed, and studied. From 1 July 2026, in the World Rugby community game, the legal tackle height is set by the match organiser, who chooses the waist or the base of the sternum; the elite game keeps the shoulder line.
How to read it. Lowering the tackle line is plausible but unproven as a concussion-reduction measure; it also shifts risk toward the tackler (a lower body position brings the head closer to the hips and knees). The law is a risk-management choice under uncertainty, not a settled fix. Two instructions follow: never present tackle-height lowering as proven to cut concussion; and do not cite the superseded 2019 “armpit” trial. The low-tackle technique itself is covered in Tackling & the breakdown.
What hurts players, and how often
Epidemiology figures are counted in injuries per 1000 player-match-hours. At the 2019 World Cup (analysis in SAJSM 32(1)), the overall rate was about 79.4 / 1000 match-hours, the tackle accounted for about 47.8% of injuries, and concussion sat at about 12.2 / 1000 (reported not significantly different from previous events).
- The tackle causes roughly half of all injuries, hence the weight the whole corpus puts on tackle technique and head placement.
- Concussion is the most-reported single diagnosis at elite level (English PRISP surveillance; Rugby Europe development data, tackle-dominant).
- Rates rise with age and level: youth rugby is far lower-incidence than the professional game, which is exactly why contact is layered on gradually.
Collision load
In rugby it is not only running load that counts: it is collision load. Total contacts (tackles, rucks, scrums) are the driver of fatigue and risk. So monitor contact volume alongside distance and intensity, not distance alone.
Physical development follows maturity. Strength work is bodyweight-based for the youngest bands, then progresses to loaded work with maturity. The corpus sorts this thread onto three forms of rising demand: rug-motricite-ballon (movement), then rug-activate-prep (Activate), then rug-gainage-cou (neck and trunk).
| Band | “Physique” theme content |
|---|---|
| u9 | Movement preparation, varied locomotion (movement games). |
| u13 | Activate-style movement preparation. |
| u17 | Activate + light isometric neck and trunk work. |
| sen | S&C-integrated preparation + neck conditioning. |
Frequently asked questions
After a concussion, what is the minimum before playing again?
Does lowering the tackle line cut concussion?
Is Activate published by the FFR?
Does neck strength prevent concussion?
Sources
Paak rugby corpus: Sport Science & Injury Prevention (World Rugby graduated return-to-play; the FFR carton bleu, differentiated by age and by number of concussions; the tackle-height law and the trial’s null; injury surveillance; training load; prevention programmes and their evidence) and Paak's return-to-play protocol. Underlying sources cited by the corpus: World Rugby concussion / GRTP guidance; FFR concussion protocol / carton bleu documentation; Stokes et al., RFU lowered-tackle-height trial (BJSM, 2021): the null and the tackler over-risk ≈ RR 1.90; the 2019 World Cup injury analysis (SAJSM 32(1)): ≈ 79.4 / 1000, tackle ≈ 47.8%, concussion ≈ 12.2 / 1000 (ns). Activate programme: RFU / World Rugby curriculum (foreign content, not published by the FFR or the FSR). Reference forms: rug-activate-prep, rug-gainage-cou, rug-motricite-ballon. The injury figures cited are elite data, used for direction, not as a youth benchmark. Content verified August 2026.