What is the concussion protocol, and who can clear a player to return?

Q: What is the concussion protocol, and who can clear a player to return?

SA Rugby's Concussion Regulations (updated December 2025): Recognise and Remove: a player with a suspected or confirmed concussion leaves training or the match immediately and may not return that day. Watch for red flags that need urgent referral to a medical facility: worsening headache, increasing drowsiness or confusion, not recognising people or places, repeated vomiting, seizures or slurred speech, enlargement of one or both pupils, severe neck pain, or weakness or numbness in the limbs. 24 to 48 hours of physical and cognitive rest, then light activity. At least 2 weeks with no contact rugby, then a graduated return to play (GRTP). Earliest return to a match: 21 days after the injury. With an SA Rugby or World Rugby recognised Advanced Care Concussion Doctor, it may be earlier, but never before 14 days. Who may do what in South Africa Step Who Diagnose the concussion A registered medical doctor versed in concussion management Clear the player to start the GRTP A registered medical doctor Monitor the GRTP A doctor; if none is available, someone who knows the player, preferably an HPCSA-registered physiotherapist, biokineticist or nursing sister Clear return to full contact and matches A registered medical doctor A coach or referee cannot clear a player.

Question

Accepted Answer

SA Rugby's Concussion Regulations (updated December 2025):

Recognise and Remove: a player with a suspected or confirmed concussion leaves training or the match immediately and may not return that day.
Watch for red flags that need urgent referral to a medical facility: worsening headache, increasing drowsiness or confusion, not recognising people or places, repeated vomiting, seizures or slurred speech, enlargement of one or both pupils, severe neck pain, or weakness or numbness in the limbs.
24 to 48 hours of physical and cognitive rest, then light activity.
At least 2 weeks with no contact rugby, then a graduated return to play (GRTP).
Earliest return to a match: 21 days after the injury. With an SA Rugby or World Rugby recognised Advanced Care Concussion Doctor, it may be earlier, but never before 14 days.

Who may do what in South Africa

Step	Who
Diagnose the concussion	A registered medical doctor versed in concussion management
Clear the player to start the GRTP	A registered medical doctor
Monitor the GRTP	A doctor; if none is available, someone who knows the player, preferably an HPCSA-registered physiotherapist, biokineticist or nursing sister
Clear return to full contact and matches	A registered medical doctor

A coach or referee cannot clear a player.