Graduated return to play after concussion — World Rugby (GRTP), Paak protocol CONC-001: 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 encodes as protocol CONC-001. 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 protocol CONC-001.
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 protocol CONC-001. 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.
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