Rugby (both codes) is one of the most popular sports in the UK and as such, is played throughout the UK, at all levels and ages. Sports concussion is a common injury (20% of the estimated 1.7 million concussions that occur each year are sports-related) and as a contact sport, this type of injury is a greater risk than others, such as soft tissue injuries. However, we still don’t really know how common this type of injury is. Why would this be?
This is a difficult question to answer for a number of reasons. Players themselves, despite the inherent risks involved of playing with a concussion, still find it difficult to admit to concussion. This could be due to the peer related pressure of admitting this type of injury or the lack of expertise in collating this information (especially at amateur level). This is improving, especially across both codes and there are some very good studies ongoing in respect to injuries and their prevalence.
Research from the RFU has shown that head injuries are common in rugby and account for about 25% of injuries during play (this includes concussions, laceration, bruises etc). How much of these injuries leads to a concussion is unclear but there is certainly a relationship to head injuries and an increase in the signs and symptoms of a concussive incident’ It also varies with the standard of play with studies in professional rugby showing that a concussion occurs at a rate of about 3.9 per 1000 player hours (i.e. 1 concussion in every 6 games amongst all the players involved) whereas studies at amateur adult level suggest that concussion occurs at a rate of about 1.2 per 1000 player hours (i.e. 1 in every 21 games).
How does this compare to other sports?
Comparative concussion rates presented at the 2012 Sports Concussion Consensus Conference are as shown in the following table:
However, new evidence is emerging that the incidences of concussion have increased by 59% in the 12/13 Aviva premiership season.
Source – The Telegraph and England Professional Rugby Injury Surveillance Project
On average, there are 10.5 concussions per 1,000 playing hours. By way of comparison there are 17 concussions per 1,000 hours in boxing and 25 per 1,000 hours in jump horse racing. Why the big increase? It could be due to the greater awareness of the issue and as such, the reporting of concussion is now greater and more prevalent especially as all professional players now have to complete mandatory concussion modules during the season.
So what is Rugby doing about it?
According to the RFU document “Don’t be a headcase” they are determined to tackle the issue “head on”
“The RFU recognises the importance of concussion. There is however, a historical cultural legacy particularly within some circles in sport, where concussion has been seen as a “badge of honour” and players have “toughed it out”. Emerging brain injury research is however leading to a re-evaluation of how concussion is managed”
It is clear that they need to manage the stigma and attitude of players towards a concussion and address the damaging delay in evaluation and treatment. The RFU document also states:
Over the years there have been a number of specific initiatives within rugby and an ongoing programme of player, coach and official training and education which all contribute to the prevention and improving management of concussion. Some of these include:
Laws: The Laws of the game prohibit deliberate head contact, and this must be enforced by all involved in the game.
Regulations: RFU Regulations require all matches and training sessions to have an appropriate level of first aid cover present to manage injuries that occur and that
concussion guidelines are followed. Youth Regulations and their associated guidance identify specific areas for prevention and highlight concussion issues in young players.
Guidelines. As well as these guidelines, the RFU has been involved in and contributed to the development of current international guidelines on concussion management in sport and specifically in rugby, with the IRB. These guidelines have been developed utilising international research evidence and expert opinion and underpin what we develop in this area.
Coach education. We continue to review and develop the content of our coaching courses and education modules to include concussion guidance.
First Aider education.
Health Care Professional education.
Professional Player Testing. The RFU and PRL conduct routine pre-season and post-concussion testing on all professional players as part of a comprehensive concussion management programme.
The RFU program is similarly replicated by Rugby League (RFL) and this mirrors the ability of professional bodies to reduce the evaluation of a concussion but also to mitigate the incidences during training and match play.
With increased incidences of litigation in NFL resulting in pay-outs of over 1$ billion, then the onus would therefore be on most governing bodies to seek a resolution to the any increased risk of concussion but without diluting the nature of a contact derived sport.
*Note: Reported incidence is known to be significantly under-reported by up to 50%, (McCrea, 2004) and do not reflect those that are treated by family doctors or other para-medical professionals.