NRL Concussion Protocols and the HIA Explained

The NRL concussion protocol turns on a single distinction made in the first seconds after a head knock. If a player shows what the game calls category 1 signs — loss of consciousness, a seizure, lying motionless, obvious unsteadiness, or failing to protect themselves in a fall — they are removed immediately, there is no test, and their match is over. If the incident raises suspicion without producing those signs, the player is taken off for a head injury assessment, and may return only if a doctor passes them. Once a concussion is actually diagnosed, a mandatory minimum stand-down of 11 days applies, which in a normal weekly turnaround means the player misses at least the next match.

Two other features define the modern system. Since 2023 the NRL has appointed independent match day doctors, working outside the clubs and with access to replays, who can order a player off. And the community game runs its own published policy with a different and longer clock: adults aged 19 and over sit out a minimum of 11 days, while players aged 18 and younger sit out a minimum of 19 days, with a doctor's clearance on a specific NRL form required either way.

This page explains how those pieces fit together: what the game defines as a concussion, how category 1 and category 2 differ, what the head injury assessment actually tests, why 11 days and not seven, how the exemption pathway works and who is excluded from it, and what a parent or club official at a suburban or country ground is required to do. It also sets out the six-stage return to sport progression that every player, professional or not, has to complete. It is a description of the sport's rules, not medical advice, and nothing here should be used in place of a doctor.

The protocol in one paragraph

A player takes a head knock. A doctor, a trainer, a match official or the independent doctor identifies it. If a category 1 sign is present, the player is removed permanently and no assessment is offered. Otherwise the player leaves the field for a head injury assessment conducted off the field by a doctor, and may return only on a pass. If a concussion is diagnosed at any point, the player enters a mandatory minimum stand-down and a graded return to sport program supervised by a doctor, and cannot return to contact until a specific clearance form has been completed. Nothing about how well the player says they feel shortens the minimum.

What rugby league means by concussion

The game's own policy follows the international consensus on concussion in sport, most recently the statement produced from the Amsterdam conference held in October 2022 and published in 2023, and the Australian Institute of Sport's position statement.

The features that matter for the rules are these. Symptoms and signs may present immediately or evolve over minutes, hours or even days. They commonly resolve within days but can be prolonged. No abnormality shows on standard structural imaging, so a scan cannot rule a concussion in or out. Loss of consciousness, confusion and memory disturbance are classic features but are not present in every case — most concussions involve no loss of consciousness at all.

That last point drives the entire design of the protocol. Because the injury is defined by symptoms rather than by a scan, and because those symptoms evolve, the rules cannot rely on how a player looks at the moment of impact or on what the player says thirty seconds later.

Category 1 and category 2

The NRL's elite system sorts incidents into two categories, and the category determines whether a test is even offered.

Category 1 covers the signs treated as diagnostic on their own. Reported examples include loss of consciousness, a seizure or convulsion, a player lying motionless or slow to get up, clear unsteadiness or balance disturbance, and a player failing to protect themselves as they fall. A category 1 player is off, permanently, and the stand-down follows automatically.

Category 2 covers incidents that raise suspicion without a category 1 sign — a heavy but ordinary collision, a player who looks momentarily vague, a knock the independent doctor wants examined. That player is removed for a head injury assessment. If they fail, they are out and treated as concussed. If they pass, and the doctor is satisfied, they may return to the field.

The distinction is not a judgement about severity. It is a judgement about certainty. Category 1 means there is nothing left to test.

What the head injury assessment actually involves

The assessment is conducted away from the field, not on the sideline, and by a doctor. It covers symptoms, orientation, immediate and delayed memory, concentration, balance and coordination, using standardised tools rather than a conversation. At elite level, clubs also hold pre-season baseline testing so an individual player's result can be compared against their own normal rather than a population average.

The reason it happens in the dressing room is practical. A sideline is loud, adrenalised and full of people who want the player back on. Balance testing in particular is meaningless next to a running touchline.

Assessment does not stop at the whistle. Elite protocols involve further review after the match and again the following day or two, because a player who passes an in-game test can still be symptomatic the next morning. In the community game the equivalent is the requirement to see a doctor within 72 hours regardless of how the player looked at the ground.

The independent doctors

The most significant governance change of recent years was the introduction of independent match day doctors in 2023. They are appointed by the NRL rather than by the clubs, they watch the match with access to camera angles and replays, and they can direct that a player be removed for assessment.

The problem they solve is a conflict of interest that no amount of goodwill removes. A club doctor is employed by an organisation with competition points at stake, working on a player who wants to keep playing, in front of a coach who wants the same. Moving the decision to someone with no stake in the result takes the pressure off everyone, including the club doctor.

Their categorisation of an incident is what triggers the rest of the process: whether the player is automatically ruled out as a category 1 case, or may attempt an assessment as a category 2.

• 11Minimum stand-down days for adults
• 19Community minimum for under-19s
• 72Hours to see a doctor in the community game
• 6Stages in the return to sport strategy
• 10Red flags requiring an ambulance

Policy minimums for the elite and community game as published by the NRL. These are rule thresholds, not measured recovery times, and an individual player's recovery may take much longer.

Why 11 days

The mandatory stand-down was announced in March 2023 by the ARL Commission and applied immediately. Before it, a concussed player who recovered quickly could conceivably return the following weekend if cleared. Afterwards, the earliest a player could be made available for selection — including for any other game day role — became the 11th day after the concussion.

The number is a deliberate piece of calendar arithmetic in a competition played mostly on a seven-day turnaround. Eleven days guarantees at least one missed match and, on a short turnaround, can cost two. It removes the possibility of a Sunday concussion being cleared by Friday, and it removes the argument entirely, because it does not depend on how quickly symptoms resolve.

It is worth being precise about what it is not. It is not a claim that eleven days is how long a brain takes to recover. Recovery varies enormously between individuals and is managed by the treating doctor through the graded program. Eleven days is a floor beneath which the sport will not go, not a prediction.

The exemption pathway

A limited exemption process exists at elite level, and its conditions show how narrow it is meant to be. As reported when the rule was introduced, a club seeking an early return had to satisfy every one of a set of criteria: no category 1 signs observed, the player asymptomatic the day after the concussion, cognitive testing returned to normal, fewer than a defined number of previous career concussions, no prior concussion within the preceding three months, and no history of prolonged recovery. Approval rests with an independent specialist rather than the club.

Crucially, no exemption is available at all where a category 1 sign was present. A player who was knocked out, had a seizure, or was visibly unsteady serves the full period whatever their test results say afterwards.

Because the criteria are cumulative and the approval sits outside the club, the exemption is rare rather than routine, and it is a common misreading of the rule to treat it as a loophole clubs use freely.

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• Adults aged 19 and over11
• Children and adolescents 18 and under19

The two mandatory minimums in the NRL's published community concussion policy. Adults are players 19 and over, children and adolescents are 18 and under. Both are floors, and an individual's actual return depends on symptom resolution and medical clearance.

Show the numbers

Minimum days out after a diagnosed concussion in the community game

Item	Value
Adults aged 19 and over	11
Children and adolescents 18 and under	19

Recognise, remove, refer

The community policy compresses the whole system into three steps, and they are the three most useful things for a club official, a coach or a parent to know.

Recognise. The visible clues listed in the policy are loss of consciousness or non-responsiveness, lying on the ground and not moving or being slow to stand, unsteadiness on the feet or poor coordination, grabbing or clutching at the head, a dazed blank or vacant look, and confusion about the play or events. Non-specific symptoms that should raise suspicion include headache, blurred vision, balance problems, nausea, dizziness, feeling dazed or lightheaded, saying they do not feel right, drowsiness, fatigue and difficulty concentrating.

Remove. A player with a suspected concussion does not return to that game or training, or any game or training, until medically cleared by a doctor, even if they appear to have recovered. The policy is explicit that the assessor should not be swayed by the opinion of the player, coaching staff, parents or anyone else.

Refer. Every player removed with a suspected concussion must be assessed by a doctor within 72 hours, even if the signs and symptoms have gone. If that does not happen, the player is held to the full return to play timeframes regardless.

Red flags and when to call an ambulance

Where any of the ten red flags in the Concussion Recognition Tool are present, the response is not observation but an urgent hospital referral by ambulance on triple zero. Those flags are loss of consciousness, seizures or convulsions, severe or increasing headache, double vision, vomiting, deterioration of conscious state such as increasing drowsiness, neck pain or tenderness, burning or numbness or tingling or weakness in the arms or legs, visible deformity of the skull, and becoming increasingly restless, agitated or combative.

An unconscious player is treated as though they also have a neck injury. First aid principles apply first, and the player should only be moved onto a stretcher by qualified personnel trained in spinal immobilisation. Where no such person is present, the instruction is not to move the player at all and to wait for paramedics, unless the player is in immediate danger.

Clubs are advised to prepare a pre-game list of the local doctors and medical centres, the nearest hospital emergency department, and the ambulance number, which matters far more in a country town two hours from a base hospital than it does in a Sydney suburb.

The paperwork: HIRRF and the clearance form

Two documents run the community system, and neither is optional.

The Head Injury Recognition and Referral Form records the signs and symptoms of a suspected concussion at the ground. The online version housed in the NRL's MySideline platform must be used. On game day, a ground manager's listed duties include making sure any player removed with a suspected head injury is marked on the sign-on sheet.

The NRL Head Injury and Concussion Medical Clearance form is completed by the treating doctor and is, in the policy's words, the only form rugby league will accept as clearance to return to play. A note from a doctor on a letterhead is not a substitute. The form must be completed before a player progresses to full contact practice, not merely before their first match back.

The six-stage return to sport strategy

Every player who sustains a concussion must complete a six-stage graded program before playing. It begins only after an initial relative rest period, described as the first 24 to 48 hours with reduced screen time, and children and adolescents are recommended a minimum initial 48 hours of rest.

Stage	What the player does	Purpose
1	Daily activities that do not exacerbate symptoms, such as walking	Gradual reintroduction of work or school
2	Light then moderate aerobic exercise, stationary cycling or walking, possibly light resistance work	Increase heart rate
3	Individual sport-specific exercise away from the team, running and change of direction, no head impact risk	Add movement and change of direction
4	Non-contact training drills at high intensity, integrated into the team environment	Restore usual training intensity and coordination
5	Full contact practice in normal training activities	Restore confidence and let coaching staff assess function
6	Return to sport, normal game play	Return to competition

Each stage takes a minimum of 24 hours for adults and 48 hours for children and adolescents. Stages 4 to 6 may only begin after all symptoms, cognitive abnormalities and other clinical findings from the concussion have resolved, including on exertion. Contact training may only be attempted after stage 4 and only after a final doctor's assessment and the clearance form. Where sport-specific training at stage 3 carries any risk of inadvertent head impact, medical clearance should occur before that stage.

Do the arithmetic on the adolescent version and the 19-day minimum stops looking arbitrary: 48 hours of initial rest, then six stages at a minimum of 48 hours each, is close to two weeks before a single contact session, in the best possible case with no symptom setbacks.

1. 1RecogniseA trainer, official, parent or teammate identifies visible clues or symptoms suggesting a possible concussion, whether or not the player lost consciousness.
2. 2RemoveThe player is taken from the game or training and does not return that day, and an unconscious player is treated as a potential spinal injury until proven otherwise.
3. 3RecordThe incident is logged on the online Head Injury Recognition and Referral Form in the NRL's MySideline platform.
4. 4ReferThe player is assessed by a doctor within 72 hours, or urgently by ambulance if any of the ten red flags are present.
5. 5Rest then progressAfter an initial rest period the player works through the six-stage return to sport strategy under medical supervision, at least 24 hours per stage for adults and 48 for under-19s.
6. 6Clear and returnThe treating doctor completes the NRL medical clearance form before full contact practice, and the player becomes available no earlier than the 11th day for adults or the 19th day for under-19s.

The sequence set out in the NRL's community concussion policy. The elite pathway adds independent doctors, baseline testing and formal head injury assessments, but the underlying sequence is the same.

Return to learn before return to play

One of the policy's plainest instructions is the one most often missed on a sideline: return to work, learning and school should take precedence over return to sport. A player should not attempt to return to play before they have successfully returned to work or school.

For a school-aged player, the policy includes a return to learn progression alongside the return to sport program, starting with daily activities that do not worsen symptoms, then school work at home, then a partial school day with rest breaks, then a full day. A student who cannot get through a school day without symptoms is not a candidate for training, and a coach pressing the point is asking the wrong question.

The policy also notes the practical supports with growing evidence behind them: hydration, sleep, and managing stress and anxiety, alongside appropriate physical activity rather than complete inactivity.

Multiple and concerning concussions

The policy sets thresholds at which the ordinary process is no longer sufficient and a specialist must be involved. They are two diagnosed concussions within the previous three months, three within a twelve-month period, symptoms persisting beyond 28 days, or an unusual presentation.

A second set of triggers is about pattern rather than count: a player developing concussion symptoms with less force than before, symptoms lasting progressively longer, an increasing number of symptoms, a decreasing gap between concussive events, or significant mental health issues potentially related to head injuries.

In any of those cases the NRL requires formal assessment by a concussion specialist — a neurologist, neurosurgeon or sport and exercise physician with a recognised interest in sport-related concussion — as part of a multidisciplinary approach, with formal neuropsychological testing if the specialist recommends it. The specialist may recommend a prolonged period away from contact, and their opinion must be made available to the governing body on request.

Retirement, and how the game frames it

The policy devotes a section to retirement decisions and is careful about them. It describes them as complex and multifaceted, to be made with clinicians experienced in traumatic brain injury and sport, preferably a multidisciplinary team, and through a shared decision-making process that presents the athlete with both the evidence and the uncertainties, incorporates their own risk tolerance, and is properly documented. For a child or adolescent, the parent or guardian must be part of the discussion.

It also makes a point that is easy to lose in a discussion dominated by risk: athletes who do retire from contact sport should be encouraged into non-contact or low-contact activity, because the health benefits of exercise still apply. Restricting all physical activity is not a neutral choice.

Separately, where a player has been diagnosed with a significant head injury or traumatic brain injury, they remain unavailable for selection in MySideline and must not play or train in any form until a properly qualified medical opinion obtained by the governing body supports the conclusion that they have fully recovered.

Advanced care settings, and why the numbers differ by level

The policy explains the different timeframes through the idea of an advanced care setting, defined by the level of health professional support available. An advanced care setting should include baseline testing before any injury, sideline medical care at training and matches, video recording of matches for review, access to a clinical management team supervising the return, and a documented concussion education program for coaches and players.

That is why the earliest a player 18 or younger may be selected after a diagnosed concussion is 19 days in a pathways competition but 11 days in an elite competition. The NRL and NRLW environment is full time and medically supervised in a way that a Saturday morning club is not. The community rule is more conservative precisely because there is nobody in the sheds to catch a mistake.

The same logic explains why the community policy insists on a single national clearance form and an online incident record. Where there is no team doctor, the system has to run on paperwork.

What the NRL can do that a club's doctor cannot

One clause in the community policy deserves highlighting because it is the sharpest tool in the document. Where the NRL, in its absolute discretion and under the guidance of the NRL and state league chief medical officers, is satisfied there is strong evidence of a player having suffered a concussion — video or other evidence of loss of consciousness, seizure, balance disturbance, or clear signs and symptoms — it reserves the right to impose the relevant minimum stand-down regardless of any medical clearance provided.

In other words, a clearance certificate is necessary but not sufficient. The sport can look at the footage and stand a player down anyway. That authority exists because the incentive to obtain a favourable opinion is real and well understood, and because the rest of the protocol would be hollow without it.

The rules that try to reduce head contact in the first place

Assessment and stand-downs manage an injury that has already happened. The other half of the welfare picture is the on-field laws that try to prevent it, and they are stricter at junior level than in first grade. The national Safeplay Code, enforced in every match from 6 to 15 years, prohibits tackles above the armpits, shoulder charges, lifting a ball carrier, crotch holds, slinging and swinging, and dangerous flops, and requires defenders to stop when a ball carrier surrenders. That is set out in more detail on the junior rugby league page.

At senior level the equivalent levers are the outlawing of the shoulder charge, the referees' treatment of high contact through penalties and the sin bin, and the judiciary and grading system that suspends players for careless or reckless contact with the head. Those interpretations are reviewed most summers and adjusted, sometimes sharply, which is why the number of sin bins in a season can move a long way from one year to the next.

For readers comparing the codes, the treatment of head contact is one of the clearest points of difference and is discussed on the rugby league versus rugby union page.

What a spectator actually sees

On a broadcast, the protocol shows up as a player leaving the field with a trainer, a graphic noting an HIA, and a bench player coming on. The commentary will often describe the player as having "gone for an HIA", which by definition means the incident was treated as category 2 — a category 1 player does not go for a test, because there is nothing to test.

At a suburban or country ground, it looks different and slower: a trainer on the field, a form being filled out, a parent called over, and a player sitting on a bench in a jumper for the rest of the afternoon. There is no bunker, no replay and no team doctor. That is the setting the community policy is written for, and it is where the great majority of Australian rugby league is played, including across the country competitions of regional New South Wales and Queensland.

Where the protocol is argued about

The rules are not universally admired, and the criticisms are worth stating fairly. Some argue that a fixed 11-day minimum is blunt, penalising a player with a mild, quickly resolved injury the same as one with a severe one, and that it creates an incentive not to report symptoms at all. Others argue the opposite, that eleven days is short by the standards of the community game's own nineteen, and that the difference is justified only by the medical support around elite players.

There is also a live argument about categorisation at the margins, since a great deal follows from whether an incident is judged category 1 or category 2, and that judgement is made quickly under pressure. Players' representatives have consistently pushed for more independence in that call, which is part of why the independent doctor role exists.

None of this is settled, and the research base itself is still moving. The policy carries an explicit note that the NRL updates its policies to align with evolving practice, and that participants are responsible for staying across the current version.

This page is not medical advice

Everything above describes the rules of a sport as published by its governing body. It is not clinical guidance and it cannot be used to decide whether a particular person is concussed or when they should play again. Those are decisions for a doctor. If someone has taken a head knock and shows any red flag, call triple zero. If they have been removed from a game with a suspected concussion, they need to see a doctor within 72 hours regardless of how they feel.

For the wider context of the game these rules govern, see the rugby section, the Australia hub, and the venue guides for Accor Stadium and Suncorp Stadium where the biggest matches are played. For how the professional end of the sport is structured and paid, see the NRL salary cap, and for the broader Australian sport index, the sports hub.

The short version

Category 1 signs mean immediate, permanent removal with no test. Category 2 means an off-field head injury assessment, with a return possible only on a pass. A diagnosed concussion means a minimum 11 days out for adults, 19 days in the community game for anyone 18 or younger, a doctor's assessment within 72 hours, a six-stage graded return at 24 or 48 hours per stage, and a specific NRL clearance form before contact. Independent doctors, introduced in 2023, took the decision out of club hands, and the NRL can impose a stand-down on video evidence even where a clearance has been provided.

The protocol has moved a long way in a decade, and by the game's own account it is not finished moving.