Concussion in Contact Sports: Why Pre-Season SCAT Baselines and the 21-Day Rule Matter

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As rugby and American football seasons begin in the UAE, all clubs and players will prepare for the physical demands of contact sports. Alongside fitness and tactics, concussion management must remain a priority. Concussion is one of the most common injuries in these sports, with rates in elite rugby estimated at 4–5 per 1,000 player-hours across levels, and up to 23 per 1,000 player-hours during Rugby World Cup competition (Fuller et al., 2021; Tucker et al., 2021). In American collegiate football, game concussion rates average 3.74 per 1,000 athlete-exposures, with many cases also occurring in practice (Kerr et al., 2019).





The Sport Concussion Assessment Tool (SCAT) is widely used to support clinical evaluation of suspected concussion. SCAT includes a symptom checklist, cognitive screening, balance assessment and coordination tests. First introduced in 2005, the SCAT has undergone several upgrades, with the SCAT6 published in 2023 as part of the 6th Concussion in Sport Group consensus statement (Echemendia et al., 2023). While many governing bodies still reference the SCAT5, the SCAT6 is widely used across world sport in 2025.





It is important that clinicians understand that the SCAT is not a standalone diagnostic and must be interpreted alongside clinical judgment and detailed assessment. Pre-season baseline SCAT testing can provide objective data for comparison after an injury. Research suggests test–retest reliability varies across SCAT components, with moderate reliability for balance measures and greater variability in cognitive scores (Manley et al., 2017; Gaetz et al., 2022). What this means, is that there can be small changes in results if one person completes the testing multiple different times, and as clinicians we need to allow a certain grace for this.


For athletes with a history of concussion, neurological conditions or other risk factors, baseline testing can improve the interpretation of post-injury scores (Schneiders et al., 2010). However, comparison against normative data (the average) may be sufficient in some cases, particularly where resources are limited (Nelson et al., 2016).


In rugby, concussion protocols differ between elite and community levels. Since 2022, elite players with confirmed concussion follow a minimum 12-day graduated return-to-play process, often under the supervision of an independent concussion consultant (World Rugby, 2022a). For the community game and for the main bulk of players in the UAE, World Rugby mandates a 21-day stand-down from all match play, starting from the day of injury, followed by a staged reintroduction to non-contact and then contact training (World Rugby, 2022b). This protocol recognises the slower average recovery times in non-professional settings, where medical and rehabilitation resources may be more limited.





American football has similar return-to-play frameworks, with stepwise progression from symptom-free rest to full contact, guided by medical clearance (McCrory et al., 2017). Across both sports, the principle remains clear: if a head injury is suspected, the athlete does not return to play the same day.


For clubs within the UAE, the start of the season is the ideal moment to embed concussion management into the routine. A structured approach might include a short educational session for players and coaches, baseline SCAT testing where feasible, and clear documentation of each player’s medical and concussion history. Pre-season is also an opportunity to modify training to reduce unnecessary head impacts, particularly in contact drills.


Ultimately, concussion management is not just a medical responsibility—it is a culture that should be set with a club. When players, coaches and support staff understand the risks and adhere to evidence-based protocols, the chances of safe recovery improve, and the integrity of the sport is protected.


If you or your club are interested in learning more about testing and concussion protocol, give me an email on dkennedy@physiocentre.ae and we can arrange a call!



References

Echemendia, R. J., et al. (2023). The Sport Concussion Assessment Tool 6 (SCAT6): Standardised tool for evaluating athletes for concussion. British Journal of Sports Medicine, 57(11), 695–707. Fuller, C. W., Tucker, R., & Starling, L. (2021). Rugby World Cup 2019: Injury surveillance and concussion incidence. British Journal of Sports Medicine, 55(12), 678–684. Gaetz, M., et al. (2022). Test–retest reliability of the SCAT5 in elite athletes. Journal of Science and Medicine in Sport, 25(9), 765–771. Kerr, Z. Y., et al. (2019). Concussion incidence and trends in collegiate football. American Journal of Sports Medicine, 47(11), 2629–2637. Manley, G., et al. (2017). A systematic review of test–retest reliability of SCAT components. British Journal of Sports Medicine, 51(12), 944–951. McCrory, P., et al. (2017). Consensus statement on concussion in sport—5th International Conference. British Journal of Sports Medicine, 51(11), 838–847. Nelson, L. D., et al. (2016). Normative data for SCAT3 in high school and collegiate athletes. Clinical Journal of Sport Medicine, 26(5), 453–459. Schneiders, A. G., et al. (2010). Utility of baseline testing in concussion diagnosis. Journal of Athletic Training, 45(5), 512–519. World Rugby. (2022a). Elite Rugby concussion return to play protocols. https://www.world.rugby/the-game/player-welfare/medical/concussion World Rugby. (2022b). Community Rugby concussion guidance. https://www.world.rugby/the-game/player-welfare/medical/concussion

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