Rugby Union and Concussion: The game on a knife-edge
Rugby Union is on a knife-edge as the game continues to battle its checkered past with head injuries and concussion stories.
According to data from the Professional Rugby Injury Surveillance Project (PRISP), in the 2022-23 season, concussion continued, for the 12th consecutive season, to be the most common match injury sustained in the English Premiership, accounting for 24% of all match injuries with 128 cases reported.
Rugby is currently under significant threat from a negligence lawsuit by over 300 former players against the game’s governing bodies. The players, who all now suffer from brain damage, are alleging that the governing bodies failed to mitigate and protect players against the dangers of concussion.
Amongst the players is England World Cup winner Steve Thompson, who has been diagnosed with early-onset dementia.
Developments in order to combat concussion have included various law changes in the game, such as the reduction in tackle height, as well as other techniques, like the introduction of the Head Injury Assessment (HIA) as well as smart mouthguards.
Rugby, at its core, is a contact sport, and there are some debates by traditionalists in the game who feel the sport is going too far and ruining the contact nature.
However, the official standpoint of World Rugby is the priority of player welfare and prevention and research into the risks of brain injuries.
“I think clubs and the RFU have done an incredible job to increase awareness and understanding of the dangers, symptoms and signs of concussion.” One healthcare professional who works within professional rugby but asked to remain anonymous told the Sports Gazette.
“At professional clubs, players have to sit down and pass a concussion educational programme at the start of each season, so no one is able to slip through the gaps.
“There is an incredible awareness around it, and it has come a long way from the traditional stigma around playing through a head injury. I think there’s complete 100% honesty within the professional game from players disclosing their symptoms.”
Whilst in the English Premiership, the rate of concussions occurring hasn’t been increasing, the worrying issue is the significantly more severe associated injury rates than any other injury.
“With the information currently backed by science, they [the governing bodies] are doing as much as they can.” The healthcare professional added.
“I hope for everyone’s sake that there are so many more scientific evolutions in our understanding of recognising concussions and the long-term impacts because those long-term impacts aren’t as clearly understood as people might think.
“It’s the unforeseen and unknown effects that concussion has further on in your life post-rugby that are the scariest thing about it, and unfortunately, you don’t know if you’ll have any of those injuries until you get there.”
Whilst concussions have remained the injury with the highest incidence rate, the 2nd most reported match injuries have varied.
Since 2015-16, the average incidence rate of the second most reported injury is 5.1; however, for concussion, it is 19.2, meaning an average of 14.1 more concussions occur per/1000 hours than any other injury.
With the significant incidence rate, it is clear to see why the discussion around concussion is possibly rugby’s most pressing issue, not only in the men’s game but with the growing popularity of women’s rugby, concussion is just as prevalent.
Concussion in the Women’s game:
“The women’s game right now, in terms of its development, is probably where the men’s game was in the mid 2000s. There are a lot of girls who are becoming professionals and girls at grassroots levels who now have aspirations of that because it’s a real possibility, but there needs to be more of a duty of care around these girls’ bodies and heads.” This was the opinion of one former Premiership Women’s and England age-grade rugby player.
“At the grassroots level, there is such a gap in the fundamental knowledge. There’s definitely more we can do in terms of education.”
The player explained how they also feel more research and education needs to be done into concussion specifically affecting female athletes, detailing how out of 27 of the recognised concussion symptoms, 18 of them can be related to the menstrual cycle.
“I had a pretty bad knock just before the pandemic in 2020, where I was left with a speech issue for about seven months, but I still love it just as much as I did because I love the game for other aspects of it.
“You play contact sport. There’s always going to be a risk like that. It’s like a swimmer is afraid to get wet, and there’s always going to be that injury risk associated with a contact game.
“We’re never going to have the amount of money that we need in order to implement the perfect solution at every level and nothing to do with concussions and overnight fix.
“The game is only growing, which is great, but we need more education and understanding from all players on the risk of long-term injury.”
According to the PRISP data, the tackler is significantly more likely to suffer a concussion than the ball carrier. Since the 2015-16 season, on average, 42% of all concussions are suffered by tacklers compared with an average of 21% by the ball carrier.
The PRISP data is vital to understanding and protecting players in the professional game; however, the nature of contact remains the same at any level. It is one that can have a significant impact on anyone.
Concussion in the Community game:
Charlie Lyddon played age-grade rugby at Camp Hill RFC until, at the age of 16, one concussion changed his future forever.
He was running down the wing when he was tap-tackled from behind, flying forwards in the process and landed on the back of his neck.
“I was unconscious the entire time I was in under the ruck,” Lyddon told the Sports Gazette.
“I attempted to get back up to carry on, but my legs wouldn’t do it. All I remember is my coach shouting at me to stay on the floor. Afterwards, I got carried off the pitch and got taken straight to the hospital.
“It happened right before I was to sit my GCSEs. I was on target to pass all of my exams, but because I lost my memory, I had to work hard just to pass Maths and English.
“It was really difficult for me as originally I wanted to go to university. Instead, I went the apprenticeship route and got a trade.”
Lyddon is just one of many examples of how concussion remains a problem throughout the game, but despite his experiences, he remains an ardent supporter of the game.
“If I were to have children in the future, I would never stop them from playing rugby.
“I think it’s one of the best sports out there and not only gives you the best of mates but also the team skills that are needed in life.”
Despite his positive outlook, he did share that he felt some further changes may need to occur to make sure everyone is safe.
“I personally feel that players are educated enough about the dangers of concussion. However, there is still some old-school mentality by some in the game.
“As a mini’s and juniors coach myself, I’ve noticed a lot that when a child gets a concussion and I explain they will be out for a minimum of four weeks, some parents will disagree.
“I think in certain age groups, there really does seem to be a lack of understanding on the importance of concussion and, more importantly, the road to recovery.”
In 2023, the RFU approved a decision to lower the tackle height in all community rugby to ‘below the base of the sternum’ in order to reduce the risk of head-on-head contact and concussion.
In the past few weeks, the RFU released the first set of data following an early analysis of the introduction of tackle height law change.
The data, whilst not yet complete, shows early positive signs with concussion rates in men’s levels 3-9 stabilising in the 2023/2024 season, having increased each year since 2009/2010.
Furthermore, there has been a decrease in the number of red cards issued for dangerous play under Law 9.13.
Speaking about the Domestic Law Variation, Paula Carter, RFU Board and Council Member and Chair of the RFU’s Head Impact Prevention and Management Steering Group, said: “The RFU takes player welfare incredibly seriously, and we are determined to promote the many benefits of our game alongside analysing data and science to make our sport as safe as it can be.
“These early results of the initial impact of the reduction in the tackle height are positive indicators that the community game, where most of the rugby is played in England, are benefitting from the decisions we are taking relating to welfare and injury prevention. We are grateful for all the work the community game is doing to make this a success.”
