Objectives: To undertake a detailed epidemiological study of head injuries sustained by professional rugby union players in order to define their incidence, nature, severity, and causes.
Design: A 3-season prospective cohort design.
Setting: 13 English Premiership rugby union clubs.
Participants: 757 male rugby union players.
Main outcome measures: Anatomical location, diagnosis, severity (number of days unavailable for training and match play), injury incident, and incidence of match and training injuries (injuries/1000 player-hours).
Risk factors: Playing position, use of headgear, and activity.
Results: The overall incidence of match head injury was 6.6 injuries/1000 player-hours, and each injury resulted, on average, in 14 days lost-time. The overall incidence of match concussions was 4.1 injuries/1000 player-hours resulting, on average, in 13 days lost-time. Concussion was the third most common match injury for all players. A large proportion of the players (48%) were able to return to play safely within 7 days. Match concussions were most commonly associated with tackling head-on (28%), collisions (20%), and being tackled head-on (19%). The midfield backs were the playing position at the greatest risk of sustaining a concussion. Only 42% of players were removed from the field of play immediately after a concussion. Foul play was reported by the player to be associated with match head injury in 17% of cases. Mouthguard and headgear usage was associated with a reduced incidence of concussive injury. The overall incidence of training head injury was 0.05 injuries/1000 player-hours, and the overall incidence of training concussions was 0.02 injuries/1000 player-hours.
Conclusions: The results showed that rugby union players were exposed to a high risk of noncatastrophic head injury and concussion, particularly whilst tackling and being tackled head-on. In all, 48% of players sustaining a concussion were able to return to play in less than 7 days. The clinical challenge when assessing the potentially concussed player during a game is compounded by the current regulations regarding the permanent replacement of injured players. Injury prevention strategies should be focussed on minimizing the risk and force of direct contact to the head in the tackle.