Warning signs: when to get help
These follow our rugby, Pilates for rugby players, stinger, hamstring, shoulder and knee guides word for word. This is general information, not a diagnosis. A&E means accident and emergency; in the US, call 911 for 999.
A head injury with red flags: call 999
The UK guidelines call these red flags, needing urgent assessment by a healthcare professional or at A&E (accident and emergency), by ambulance if necessary. World Rugby adds numbness, tingling, burning or weakness in the arms or legs, and slurred speech. If a neck injury is suspected, only trained healthcare professionals should move the player.
- Any loss of consciousness, or getting drowsier
- No memory of events before or after the injury
- Increasing confusion or irritability, or unusual behaviour
- New problems understanding, speaking, reading or writing, less feeling, loss of balance, weakness or double vision
- A seizure, twitching limbs, or lying rigid or motionless
- A severe or worsening headache, repeated vomiting or severe neck pain
- A suspected skull fracture: a cut, bruise, swelling or severe pain where they were hit
- Previous brain surgery, a bleeding disorder, blood-thinning medicine, or being drunk or on drugs at the time
Sources 13, 14
Signs that mean a player comes off
World Rugby lists signs any one of which may suggest a concussion. The player comes off, and doesn't return that day.
- A seizure, or a known or suspected loss of consciousness
- Unsteady on their feet, or poor coordination
- Confusion, a dazed, blank or vacant look, or a change in behaviour
- Lying motionless, slow to get up, or clutching their head
Source 14
If in doubt, sit them out
With a suspected concussion, if in doubt, sit them out. The UK's grassroots guidelines say no sport for at least 24 hours, get checked by a healthcare professional or NHS 111 within 24 hours, follow a staged return, and no competition before day 21; if symptoms last beyond 28 days, stay out of sport and see a doctor. Yoga waits too: gentle breathing fits the early, light-activity stages, and no head-down poses or inversions until you're cleared (our reading). Our concussion guide has the stages.
The NHS says to get help from NHS 111 if, after a head injury, you're being sick, feel dizzy, take medicine that thins your blood, were drinking alcohol or taking drugs at the time, or have any other symptoms you're worried about. See a GP if symptoms last more than 2 weeks, and don't play contact sports for at least 3 weeks.
The Rugby Football Union's (RFU) graduated return to activity and sport runs in 6 stages: relative rest for 24 to 48 hours; daily activities and light activity such as short walks; easy aerobic exercise and light bodyweight training, using Activate exercises; non-contact rugby drills and weight training, no earlier than day 8 and only once free of symptoms at rest; full-contact training, no earlier than day 15 and only after 14 days free of symptoms at rest, building from walk-throughs to tackle bags; and a return to play no earlier than day 21. The 21-day minimum is the same for adults and children.
Sources 13, 5, 60, 61
Neck and spinal cord
Call 999 or go to A&E: new problems walking, loss of bladder or bowel control, or a sudden loss of coordination, such as difficulty doing up buttons. These can be signs of pressure on the spinal cord.
- At the pitch: neck pain or tenderness after a collision, or severe neck pain. Keep the player still and call 999. Only trained healthcare professionals should move a player with a suspected neck injury.
- Numbness, tingling, burning or weakness in both arms, in more than one limb, or in the legs: keep the player still and call 999. It can be an injury to the spinal cord, even if it passes in minutes.
- Weakness in the arm that doesn't settle within minutes: the player doesn't go back on, and needs urgent medical assessment, by ambulance if necessary.
- Same day: arm weakness, numbness or burning that is still there after the game, or that keeps coming back. Go to an urgent treatment centre or A&E, or get help from NHS 111.
- A second stinger, or stingers that keep coming back: see a sports medicine or spine specialist, usually with an MRI scan, before going back to contact sport.
Sources 14, 43, 15
A pop at the back of the thigh
Same day: a pop near the sitting bone, a large bruise high on the back of the thigh, or you cannot put weight on the leg. The tendon may have pulled away from the bone, which needs assessing before you start these exercises.
Get help from NHS 111 if you think you've injured your hamstring and it's very painful, or the pain is getting worse; there's a large amount of swelling or bruising, or the swelling or bruising is getting worse; it hurts to walk or stand using the injured leg; your leg feels very stiff or is difficult to move; it's not feeling any better after treating it yourself; or you have a very high temperature or you feel very hot, but also cold and shivery, which could be signs of an infection.
Source 58
A pop high on the inner thigh
A pop high on the inner thigh, then a large bruise, a dent or a gap you can feel, and weakness squeezing the legs together, can be a complete tear of the adductor longus tendon: get it checked within days, as our inner thigh pain guide says.
A shoulder that looks out of place
Call 999 or go to A&E: after a fall or injury, your shoulder looks out of place or has changed shape, you cannot move your arm, or your shoulder is painful, bruised or swollen. Do not drive yourself, and do not try to put it back in yourself.
Your shoulder has partly or fully come out of joint, or you worry it might.
Source 57
A knee or ankle injury
Go to A&E (accident and emergency) if you've injured your knee and it has changed shape, it becomes very swollen very quickly, you felt a pop or snap, you can see bone sticking out, or it's bleeding heavily. Don't drive yourself: ask someone to take you, or call 999 if the pain means you can't move your leg to get there.
Get advice from NHS 111 now: you cannot move the knee or put any weight on it, or it is very painful, badly swollen or has changed shape, or it locks, gives way or clicks painfully. A pop, quick swelling and a knee that gives way point to an ACL injury: our ACL injury guide says what to do.
Call 999 or go to A&E if you heard a crack, the joint has changed shape or points at an odd angle, it's numb or tingling, or the skin has turned blue or grey or is cold. Get help from NHS 111 or an urgent treatment centre if you can't put any weight on it or walk more than a few steps.
Sources 62, 63
Back pain that's worse arching back
Back pain that is worse arching back and has lasted more than a couple of weeks can be a stress fracture of the spine (spondylolysis): get it checked.
Chest pain or fainting: call 999
Call 999 if:
- You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
- The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
- You have chest pain and feel sweaty, sick, light-headed or short of breath.
- Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.
Sources 64, 65
During practice
Stop a stretch at the first sharp pull high at the back of the thigh or in the groin, and "Ease off a deep fold, lunge or twist that brings a sharp pinch deep in the groin" (our hip openers guide).
Any burning, tingling, numbness or weakness down the arm, or neck pain, during or after an exercise means stop and get it checked.