Very little is known about the Head Injury Assessment Process, a process commonly referred to as the HIA Process or simply the “Concussion Test“.

As players get bigger, fitter, stronger, so the collision area becomes more intense. The force being transferred from one, two or three players to another is larger than it ever has been in the history of the game. In addition, we are now far more aware of the long-term detrimental effects that repeated blows to the head can cause.

But what happens in the HIA process? Have you ever pondered this question? Have you ever wondered why a player can be knocked almost into the next realm and in the next moment is cleared to return to the field? And a player who is seemingly fit enough to juggle and skip at the same time is left off the field?

Here at The 1014 we have pondered these questions and thought it was about time someone asked them. And when we mean ask, we don’t mean ask someone close to the game or who used to play 25 years ago. That isn’t how it works. If you want to know what is happening you need to go to the source and ask the experts.

Thankfully for us the Head Doctor of the Blues Super Rugby team, Dr Stephen Kara, kindly agreed to give up his time to answer a few questions for us.

Common misconception

The first thing I learnt when speaking to Dr Kara about the HIA process was that I had been looking at it all wrong. I had been looking at it from the perspective of a fan; the same perspective that commentators across the globe look at it and commentate on it. “The test is not a test to get people back on the field.“, I was told. Take a moment to consider that statement.

The test is not a test to get people back on the field.

The test, conducted by medical professionals, is a “tool to determine if a person has signs or symptoms of concussion“, a test they want the patient to fail. Fail you say? If we take a moment to consider this it makes sense. From a medical point of view, it is imperative that the player only passes the test if they are showing no signs at all of concussion at that point in time. This is why the test is so thorough, so detailed, and to be honest, it is a little hard, as I found out.

Pre-test tests

Even before commencing the HIA tests the doctor can make a call as to whether or not a player is concussed. And therefore whether or not they are allowed back on the field. These pre-test tests are as follows:

  • 11 criteria that doctors look for. These include ataxia (in simple terms the player is walking like a drunk person), a player walking to the wrong end of the field, convulsions or seizures. Or simply the player has been knocked out, or is suspected of being knocked out, and so on
  • 5 MADICS questions. Who scored last? What half are we in? Who did we play last week? Who are you marking? Did we win last week?
  • Reviewing the video box, the so-called “head box“, a screen the doctors can view on entering the tunnel with the player. This gives them the ability to review the incident that caused the player to be considered for an HIA.

If the player fails any of these initial checks there is no need for the HIA tests to take place. The player is immediately ruled out of the contest and the correct procedures are followed.

It should be mentioned that this is all presided over by a match day doctor. This sort of four-eye analysis is used to ensure there is no hoodwinking going on. As we know in sport, questions would always be raised if this were not the case.

All of this before the HIA even takes place. Who would have thought?

From The Shed

The 1014 Rugby

Author: The 1014 Rugby

The 1014 is servicing the needs of a passionate and respectful global rugby community by producing world-class content based on three important values – Passion, Integrity and Respect.
All content is through the pure eyes of two children starting out on their journey in life. The 10 and 14 represent the two characters on this journey and everything produced is through their outlook on life.


  1. Great to see world rugby looking after its players and even better to hear it straight from the horses mouth. I would love to see these test filter down to all age levels. I think the next step is to start on post game and long term head injury assessments and management.

    As a player I have had several sever concussions and had to stop playing as a result. I won’t wish that on anyone so anything we can do is always welcome.

    Keep up the good work lads

    • Thanks a lot for this comment Damien. In the next instalment of the HIA interview, Dr Kara runs through a little bit of what happens post match and also how it is filtering down the grades. Or at least he identifies the responsibilities at lower grades. I hope that the next instalment will answer some of your questions.
      Thanks for the shout out as well. We are loving putting this content together.
      Cheers, Steven

  2. How timely. Was just wondering what exactly an HIA consists of, and a search led me to your video (which was excellent}, and then to this site. Will be back often.

    • Thanks for the comment Mike. Really pleased you enjoyed the video. Part 2 is going to be out tomorrow morning (New Zealand time). Dr. Stephen Kara runs through a lot of what happens after the player has been diagnosed in terms of recovery and also how it is being looked at in the ranks below full professional. Cheers


Please enter your comment!
Please enter your name here