Abigail ClarkeEngland winger Immanuel Feyi-Waboso was knocked to the ground in a collision with Ulster's Jacob Stockdale during Exeter Chiefs' European Rugby Challenge Cup semi-final at Ulster on 2 May 2026. Referee Pierre Brousset halted play immediately as Feyi-Waboso remained motionless. He was withdrawn from the match for a Head Injury Assessment — and what happened next sparked a significant debate about how head injuries in sport are managed. Feyi-Waboso passed his HIA, but the independent matchday doctor still judged that the nature of the collision required him to be permanently removed, meaning he could not return even after clearing the formal test.
Exeter director of rugby Rob Baxter called the decision "really odd" and "a perplexing one." Ulster won the semi-final 29-12 and progressed to the final in Bilbao. The controversy reignited questions that apply far beyond elite rugby: what actually happens after a head injury, and when should you — or someone you care about — see a doctor?
What Is a Head Injury Assessment?
A Head Injury Assessment (HIA) is the structured process used in professional rugby to determine whether a player has suffered a concussion. Under World Rugby's protocol, a player who has shown any of the immediate signs of concussion — such as loss of consciousness, seizure, disorientation, or unsteady balance — must leave the field of play immediately. A player who shows possible but not definitive signs may be withdrawn for a temporary assessment.
The HIA involves a trained doctor conducting a battery of cognitive, balance, and symptom tests using standardised tools. Passing the HIA means no immediate indicators of concussion were recorded at that moment. However — and this is the critical distinction that explains Baxter's confusion — a player can be symptom-free on the sideline thirty minutes after a collision while still having sustained a genuine concussion. Concussion symptoms are notoriously delayed and variable.
In Feyi-Waboso's case, the independent doctor applied a separate principle: that the mechanism of the collision itself — the visual appearance of the impact and the player's initial unconsciousness — justified permanent removal regardless of the subsequent assessment result. This is consistent with World Rugby's graduated-risk approach, where serious-looking collisions can trigger mandatory removal even when formal testing does not reveal cognitive deficits.
Why Passing a Test Does Not Mean You Are Fine
The HIA controversy around Feyi-Waboso illustrates a broader truth about concussion and head injuries: the absence of symptoms in the immediate aftermath does not mean the brain has escaped injury. The NHS defines concussion as "a short-lived disruption to normal brain function caused by a head injury," and concussion symptoms can include headache, nausea, dizziness, blurred vision, and memory problems — but these may not appear for several hours.
A 2024 consensus statement from the Concussion in Sport Group, adopted in updated World Rugby guidelines, established that same-day return to play after a confirmed loss of consciousness is not appropriate under any circumstances. The rationale: even a brief loss of consciousness suggests a more significant neurological event than a simple "bell-ringer," and the brain's vulnerability to a second impact in the hours following an injury is markedly increased — a phenomenon known as second-impact syndrome.
For sports players at any level, the practical implication is clear: if you — or a player you are coaching or watching — loses consciousness, appears confused, or shows any of the recognised signs of concussion, they should not return to play the same day. Full stop. This applies whether the formal assessment was passed or not.
Warning Signs That Require Immediate Medical Attention
There is an important distinction between a concussion that can be monitored at home and a head injury that requires emergency care. Seek emergency help — call 999 or go to A&E — if any of the following occur in the hours after a head injury:
- Seizure or convulsion
- Repeated vomiting (more than twice)
- One pupil larger than the other
- Weakness or numbness in the arms or legs
- Slurred speech or difficulty speaking
- Worsening headache that is not relieved by paracetamol
- Difficulty staying awake or loss of consciousness (even briefly)
- Confusion that does not clear up within 30 minutes
These symptoms can indicate a more serious intracranial injury — a bleed inside the skull — which is a medical emergency. The NHS recommends that even a straightforward concussion with no red-flag symptoms be assessed by a GP or at an urgent treatment centre to establish a baseline and receive guidance on graduated return to activity.
The Return-to-Play Protocol — and Why It Matters Off the Pitch Too
In professional sport, the return-to-play (RTP) protocol following concussion is well established: a minimum of six stages, progressing from complete rest through light exercise, sport-specific training, full contact practice, and finally return to competition. No stage can be compressed or skipped, and any return of symptoms at any stage means the player must go back to the previous stage.
This protocol was developed for elite athletes but is recommended for everyone who plays sport, from weekend rugby players to children in school fixtures. The Brain Charity and NHS both advise that amateur athletes follow the same graduated process rather than rushing back to training because symptoms have subsided.
The reason: the brain needs time to recover its metabolic stability after a concussion, and during that recovery window it is disproportionately vulnerable to further injury. A second concussion while recovering from the first — even a seemingly minor one — can cause significantly more damage and a much longer recovery.
When to See a Doctor
For many people, the challenge after a head injury is not identifying the most serious symptoms but knowing whether a moderate presentation warrants medical review. The answer, according to UK clinical guidance, is yes: any documented or suspected concussion should be reviewed by a doctor, even if red-flag symptoms are absent.
A GP or sports medicine doctor can assess neurological function, document the injury for insurance or return-to-work purposes, and create a structured recovery plan. For rugby players, this may include a referral to a specialist and formal clearance before returning to training.
As highlighted in an analysis of recent rugby injuries in the Premiership, head injuries in contact sport are among the most frequently under-reported because players — at all levels — tend to self-assess and minimise. A doctor's assessment provides objective evidence that both protects the patient and ensures any future complications are properly documented.
Feyi-Waboso's case, however confusing the process appeared from the outside, ultimately showed the protocol working as intended: when in doubt, keep the player out. For anyone who has suffered a head injury in sport, that principle should be the starting point — and a doctor's guidance, the next step.
Disclaimer: This article provides general health information about concussion and head injuries. It is not a substitute for professional medical advice, diagnosis, or treatment. If you or someone you know has sustained a head injury, seek appropriate medical attention.
