Concussion return to play: the graduated steps explained
Covers: Gaelic football, hurling, camogie and ladies football (GAA, LGFA, Camogie Association), Irish rugby (IRFU), English community rugby (RFU) and UK grassroots sport.
Graduated return to play (GRTP) is a six-stage route back to sport after concussion. Minimums vary: 15 days for adult Gaelic games players, 21 for under-18s, and 21 to 23 in community rugby. A clinician or club medic decides.
What graduated return to play is
After a concussion, players don’t go straight from the sideline back into a match. Every major governing body in Ireland and the UK uses a graduated return to play (GRTP): a set of stages that starts with everyday activity and light exercise, builds through non-contact training, and only then moves to full contact and match play. You only move up a stage if your symptoms allow it. England Rugby and the UK grassroots guidelines call their version the Graduated Return to Activity and Sport (GRAS), and the international consensus calls it a return-to-sport strategy, but the idea is the same.
The stages look broadly alike across the GAA, the IRFU, the RFU and the 2022 international consensus, but the minimum number of days differs, and so do the rules for younger players and for medical sign-off. This page sets out what each body says. These rules are updated every few years, so always check your own governing body’s current document, and treat every timeframe here as a minimum or a typical range, not a promise.
One thing doesn’t vary: a clinician or club medic decides when a player returns, following the governing body’s protocol. An app, a tracker or a symptom diary can’t make that call. For the injury itself, symptoms and recovery, see our concussion guide.
First: recognise and remove
All the guidance agrees on the first step. Anyone with a suspected concussion comes off straight away and does not play or train again that day.
- The GAA, LGFA and Camogie Association guidelines and the IRFU both use the message “Recognise and Remove”. The GAA says the impact itself may sometimes be enough reason to remove a player, even with no immediate symptoms.
- The UK Concussion Guidelines for Non-Elite (Grassroots) Sport use the slogan “If in doubt, sit them out”, and say no one should return to competition, training or PE lessons within 24 hours of a suspected concussion.
- The IRFU says playing on, even for five minutes, can delay a full return to sport by three days, and that young players who keep playing with signs or symptoms are nine times more likely to have a recovery longer than 21 days.
- For the first 24 hours, the GAA, IRFU and UK guidance all say the player shouldn’t be left alone, shouldn’t drive and shouldn’t drink alcohol.
- The player should be assessed. The GAA says by an appropriately qualified medical person; the UK guidance says by an onsite healthcare professional or by calling NHS 111 within 24 hours.
The six stages
The stage names vary a little between bodies, but this is the shape of the model in the 2022 international consensus and the GAA guidelines. Rugby versions add rugby-specific work (the IRFU builds in tackle technique and controlled contact drills before full contact).
| Stage | What it involves | Goal |
|---|---|---|
| 1. Symptom-limited activity | Everyday activities that don’t make symptoms worse, such as walking. Less screen time early on. Not strict bed rest. | Gradually get back to normal daily life, work or school |
| 2. Aerobic exercise (light, then moderate) | Stationary cycling or walking at a slow to medium pace. The GAA and the consensus split this into 2A (light, up to about 55% of maximum heart rate) and 2B (moderate, up to about 70%). Light resistance work can start if it only mildly and briefly raises symptoms. | Raise the heart rate |
| 3. Individual sport-specific exercise | Running, changes of direction and individual drills away from the team. No activity with a risk of a knock to the head. | Add movement and direction changes |
| 4. Non-contact training drills | Higher-intensity, more challenging drills, such as passing drills and multiplayer training, still with no contact. | Usual intensity of exercise, coordination and thinking |
| 5. Full contact practice | Normal training, including contact. | Restore confidence and let coaches assess skills |
| 6. Return to play | Normal match play. | Back to competitive action |
The consensus statement says each step typically takes at least 24 hours. World Rugby describes each stage as a minimum of 24 hours but often longer, and the UK grassroots guidance says, as a guide, no stage should last less than one day.
Minimum timeframes by governing body
The table shows the earliest day each stage can start, as each body sets it out. Day 0 is the day of the injury. These are minimums: many players take longer, and that’s normal.
| Stage | GAA adults | GAA under-18s | IRFU adults | IRFU under-20s | RFU and UK grassroots, all ages |
|---|---|---|---|---|---|
| 1. Symptom-limited activity | Days 0–2 | Days 0–2 | Days 0–1 (24–48 hours) | Days 0–1 (24–48 hours) | First 24–48 hours of relative rest |
| 2. Aerobic exercise | Days 3–6 (2A and 2B, at least 2 days each) | Days 3–10 (2A and 2B, at least 4 days each) | Days 2–6 | Days 2–6 | After the initial rest: daily activities and light activity such as short walks |
| 3. Sport-specific exercise | Days 7–8 | Days 11–14 | Days 7–9 | Days 7–9 | When symptoms allow (aerobic exercise and bodyweight work) |
| 4. Non-contact training | Days 9–11 | Days 15–17 | Days 10–13 | Days 10–15 | RFU: no earlier than day 8, and only once symptom-free at rest |
| 5. Full contact training | Days 12–14 | Days 18–20 | From day 14 | From day 16 | No earlier than day 15, and only after 14 days symptom-free at rest |
| 6. Return to play | Day 15 | Day 21 | Day 21 | Day 23 | No earlier than day 21 |
| Medical sign-off | Before full contact training (stage 5) | Before full contact training (stage 5) | Healthcare professional assessment before stage 4 | Healthcare professional assessment before stage 4 | Assessment within 24 hours (onsite healthcare professional or NHS 111); no routine review at later stages |
Notes on the table
- GAA (Gaelic football, hurling, camogie, ladies football): the joint GAA, LGFA and Camogie Association guidelines say adults can expect a minimum of 15 days and under-18s a minimum of 21 days to complete the full strategy, and that a typical return to sport can take up to one month. There is one narrow exception for adult male players (over 18): if assessed by a doctor experienced in concussion care, they may return between day 7 and day 15, but never within 7 days. The GAA advises camogie and ladies football players to follow its female-player protocol, which has the same minimum days and no early-return exception.
- IRFU (Irish amateur rugby): a minimum of 21 days for adults and 23 days for under-20s. The IRFU says the protocol may take longer than the minimum, the timings are a guide only, and it doesn’t replace the advice of a player’s own doctor. The IRFU also says a player in the protocol shouldn’t return to any sport, not just rugby, until it’s complete.
- RFU (English community rugby) and the UK grassroots guidelines: a minimum of 21 days for all community players, whatever their age. Contact training can only start once a player has had no symptoms at rest for 14 days, so in practice, the RFU says, a player misses at least two weeks and could play on the third weekend at the earliest. The UK guidance notes that athletes managed in specialist “Enhanced Care” pathways, as in elite sport, may return to competition earlier; that is outside the standard grassroots programme.
- International consensus (Amsterdam 2022, published 2023): written for healthcare professionals, it says clinicians and athletes can expect a minimum of one week to complete the full strategy, that a typical unrestricted return can take up to one month, and that the pooled average time to return to sport across studies was about 20 days (19.8). Governing bodies set longer, fixed minimums for community sport, and their rules are the ones your club follows.
- NHS and HSE general advice: both say adults shouldn’t play contact sport for at least 3 weeks after a concussion. For organised sport, follow your governing body’s protocol as well.
- World Rugby: its public explainer (last updated February 2022) describes an older community model with a rest period before the stages begin (7 days for adults, 14 for children and adolescents). The IRFU and RFU have since published their own updated community protocols, so follow your union’s current document.
What happens if symptoms come back
Symptoms going up a little during the early stages is expected. The rules for how much is too much are similar across bodies:
- Stages 1 to 3: a mild and brief increase is acceptable. The consensus statement and the GAA define that as no more than 2 points on a 0 to 10 scale compared with before the activity, settling within an hour. If symptoms rise more than that, stop and try again the next day. The IRFU adds that symptoms at rest should be below 7 out of 10 before activity in these stages.
- Stages 4 to 6: players should be symptom-free at rest and after activity. If symptoms appear, the consensus statement and the IRFU say stop and drop back to stage 3 until symptom-free again. The GAA’s under-18 table says to return to the previous stage if an activity worsens symptoms or brings on new ones. World Rugby also says to go back to the previous stage.
- During contact training (RFU): symptoms coming back after a head impact in training should trigger removal from the activity, and any symptoms mean moving back to a stage where activity doesn’t more than mildly worsen them.
When to get more help: the GAA says players with symptoms lasting longer than 10 to 14 days should be referred to a specialist or multidisciplinary clinic. The IRFU recommends seeing a specialist experienced in sports concussion if symptoms continue beyond day 10 to 14 of the protocol, if a specific activity keeps bringing symptoms on, if you’re not progressing as expected, or after 2 or more concussions in 12 months. The UK guidance says call NHS 111 if symptoms get worse or haven’t improved by 14 days, and see a GP if symptoms last beyond 28 days.
Who decides: medical sign-off
The return decision is made with a clinician or club medic, following your governing body’s protocol. A symptom diary or an app can show the pattern, but it can’t decide when you’re ready. What each body asks for:
- GAA: the return-to-sport strategy runs under the supervision of a suitably qualified healthcare professional. Medical sign-off is required before full contact training, and medical approval before return to full contact play. The GAA says a medical decision on readiness may be needed before any of stages 3 to 6 if there’s a risk of contact, collision or a fall.
- IRFU: players must be symptom-free and should have an assessment by a healthcare professional before stage 4. Players shouldn’t return to play until they have returned to learning or work, are symptom-free, have had a healthcare professional’s assessment, and have completed the protocol.
- RFU and UK grassroots: the key medical step is the initial assessment within 24 hours. The UK guidance says there is no longer an expectation of review by a doctor or healthcare professional at each later stage, but it sets clear points to seek help (NHS 111 at 14 days if not improving, GP after 28 days).
- International consensus: a healthcare professional should provide written confirmation of readiness before an unrestricted return, where local laws or sporting regulations require it, and should monitor the later stages (4 to 6).
Children and teenagers
Younger players get longer minimums and more caution, for good reason.
- Longer minimums. In Gaelic games, under-18s have a minimum of 21 days, with at least 4 days each at stages 2A, 2B and 3, and the adult early-return exception doesn’t apply. In Irish rugby, under-20s have a minimum of 23 days, with a longer non-contact stage. The RFU and UK guidance use 21 days for every age, and the UK guidance covers players from primary school age upwards.
- They often take longer to recover. The IRFU says normal symptom recovery is 10 to 14 days in adults, but may take up to 4 weeks in children. The UK guidance says children, adolescents and young adults may take longer than the roughly two-thirds of people who return to full sport by 28 days.
- School comes before sport. The consensus statement, the GAA and the IRFU all say a student should be fully back to learning before an unrestricted return to sport. A typical return-to-school plan starts with everyday activities in short blocks, then homework, then part-time school, then full days. The consensus statement found 93% of athletes were fully back to learning, with no extra support, by 10 days.
- A second knock is the big risk. The GAA warns that children and adolescents face a risk of catastrophic injury from second impact syndrome if they’re returned to play before they’ve recovered.
- Tell everyone involved. The IRFU advises parents to tell the school and the player’s other sports, because the protocol covers all sport. The GAA asks parents and players to tell coaches about a concussion picked up in another sport.
Red flags: call 112 or 999
In Ireland, call 112 or 999. In the UK, call 999. Do this straight away, at any point after a head injury, if the person:
- Is knocked out and hasn’t woken up, or can’t stay awake or keep their eyes open. Call 112 or 999.
- Has a fit or seizure. Call 112 or 999.
- Has severe neck pain, or numbness, tingling or weakness in an arm or leg. Don’t move them unless they’re in danger. Call 112 or 999.
- Has clear fluid coming from the ears or nose, bleeding from the ears, bruising behind the ears, or problems with their vision, including double vision. Call 112 or 999.
- Has problems walking, balancing, speaking, understanding or writing. Call 112 or 999.
- Keeps vomiting, has a severe or worsening headache, or becomes more confused, drowsy, agitated or unlike themselves. Get urgent medical help: go to A&E (the emergency department) or call 112 or 999.
What to track
Return to play is measured by symptoms, and the protocols all depend on knowing how you felt before and after each step. A short daily record makes it much easier for your clinician or club medic to see the pattern.
- A daily symptom score, 0 to 10, at rest: same time each day, so you can see the trend over the week, not just how you feel this hour.
- Before-and-after scores for each session: your score before the activity, your score after, and how long any increase took to settle. This is exactly what the 2-point, under-an-hour rule is based on.
- Sleep: when you went to bed and woke up, and how rested you feel. The IRFU recommends keeping a regular sleep pattern, and the GAA says napping is generally not recommended during recovery.
- Screen and study tolerance: how many minutes on a phone, laptop or schoolwork before symptoms build, and how school or work days are going.
- A stage diary: the date you started each stage, what you did, how it felt, any time you dropped back, and (for rugby and UK grassroots) the date of your first fully symptom-free day, since the 14-day count starts there.
Keep the record in InjuryLog.
Log a daily symptom score and notes in seconds, watch the trend build, and bring the whole pattern to your clinician or club medic. It is educational support, not medical advice, and it never decides when you return. Free on iOS, Android soon.
Questions people ask
How long is the GAA return to play after a concussion?
Under the joint GAA, LGFA and Camogie Association guidelines, adults complete the graduated return to play in a minimum of 15 days, with match play from day 15 at the earliest, and under-18s in a minimum of 21 days. Each stage has its own minimum number of days, and the player needs medical sign-off before full contact training. The GAA notes that a typical return can take up to a month. There is one narrow exception: a doctor experienced in concussion care may return an adult male player between day 7 and day 15, but never within 7 days. These are minimums, not targets.
How long is return to play in rugby after a concussion?
In Irish amateur rugby, the IRFU protocol takes a minimum of 21 days for adults and 23 days for under-20s, with a healthcare professional’s assessment before stage 4 (non-contact drills). In England, the RFU’s HEADCASE programme sets a minimum of 21 days for all community players, whatever their age, counting the day of injury as day 0. Contact training can only begin after 14 days with no symptoms at rest. Professional rugby runs under separate elite rules with specialist oversight, so the return times you read about for international players don’t apply at club level.
What happens if concussion symptoms come back during return to play?
It depends on the stage. In stages 1 to 3, a small, short-lived rise is expected: no more than 2 points on a 0 to 10 scale, settling within an hour. If symptoms rise more than that, stop and try again the next day. In stages 4 to 6, you should be symptom-free, so any symptoms mean stopping and dropping back to stage 3 until they’ve settled. If you keep getting stuck, or symptoms last beyond about 10 to 14 days, the GAA and IRFU both recommend seeing a clinician experienced in sports concussion rather than pushing on.
Can you go back to playing before 21 days?
For most community players, no. The IRFU minimum is 21 days for adults (23 for under-20s), the RFU’s is 21 days for every community player, and the UK grassroots guidelines say no return to competition before day 21. Gaelic games are different: the adult minimum is 15 days, with 21 for under-18s. The only earlier routes are specialist-led. The GAA lets a doctor experienced in concussion care return an adult male player from day 7, and the UK guidance mentions earlier return only for athletes in specialist enhanced care pathways. Feeling fine early isn’t a reason to skip stages.
Do you need a doctor to sign you off after a concussion?
It depends on your sport. The GAA requires medical sign-off before full contact training. The IRFU says players should have a healthcare professional’s assessment before moving to stage 4. The UK grassroots guidance, which the RFU follows, asks for an assessment within 24 hours (onsite or via NHS 111) but no routine review after that, with NHS 111 if you’re not improving by 14 days and a GP if symptoms last beyond 28 days. Whatever the rules, the decision to return is made with a clinician or club medic, not by an app or a symptom tracker.
Should you rest completely in a dark room after a concussion?
No. Strict rest until every symptom has gone is no longer recommended. The international consensus says relative rest, which includes everyday activities and reduced screen time, for up to the first two days, and that light activity like walking is fine if it only mildly increases symptoms. The IRFU says strict rest in the first 24 to 48 hours can delay recovery, and that cutting screen time beyond the first 48 hours brings little extra benefit. What you should avoid early on is intense or vigorous exercise, and anything with a risk of another knock to the head.
Sources
- Concussion Management Guidelines for Gaelic Games (2024 update), GAA, LGFA and Camogie Association
- Concussion Guidelines, IRFU
- Graduated Return to Play (GRTP) Protocol in Amateur Rugby Union, IRFU
- Recognise and Remove: A Guide to Concussion in Amateur Rugby Union, IRFU
- HEADCASE (including the Graduated Return to Activity and Sport programme), RFU (England Rugby)
- UK Concussion Guidelines for Non-Elite (Grassroots) Sport, November 2024 update, UK Government and the Sport and Recreation Alliance
- How World Rugby’s Concussion Return to Play Protocol works, World Rugby
- Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022, British Journal of Sports Medicine
- Head injury and concussion, NHS
- Head injury and concussion, HSE