Subscribe to RSS
Padded Headgear does not Reduce the Incidence of Match Concussions in Professional Men’s Rugby Union: A Case-control Study of 417 CasesFunding This work was funded by the Rugby Football Union and Premiership Rugby.
Concussion is the most common match injury in rugby union. Some players wear padded headgear, but whether this protects against concussion is unclear. In professional male rugby union players, we examined: (i) the association between the use of headgear and match concussion injury incidence, and (ii) whether wearing headgear influenced time to return to play following concussion. Using a nested case-control within a cohort study, four seasons (2013–2017) of injury data from 1117 players at the highest level of rugby union in England were included. Cases were physician-diagnosed concussion injuries. Controls were other contact injuries (excluding all head injuries). We determined headgear use by viewing video footage. Sixteen percent of cases and controls wore headgear. Headgear use had no significant effect on concussion injury incidence (adjusted odds ratio=1.05, 95% CI: 0.71–1.56). Median number of days absent for concussion whilst wearing headgear was 8 days, compared with 7 days without headgear. Having sustained a concussion in the current or previous season increased the odds of concussion more than four-fold (odds ratio=4.55, 95% CI: 3.77–5.49). Wearing headgear was not associated with lower odds of concussions or a reduced number of days' absence following a concussion.
Key wordstraumatic brain injury - mTBI - sports injury - injury prevention - equipment - concussion severity
Received: 26 August 2020
Accepted: 15 December 2020
Article published online:
19 February 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 West SW, Starling L, Kemp S. et al. Trends in match injury risk in professional male rugby union: A 16-season review of 10 851 match injuries in the English Premiership (2002–2019): The Professional Rugby Injury Surveillance Project. Br J Sports Med 2020; DOI: 10.1136/ bjsports-2020-102529.
- 2 Stokes KA, Locke D, Roberts S. et al. Does reducing the height of the tackle through law change in elite men’s rugby union (The Championship, England) reduce the incidence of concussion? A controlled study in 126 games. Br J Sports Med 2021; 55: 220–225 DOI: 10.1136/bjsports-2019-101557.
- 3 Emery C, Palacios-Derflingher L, Black AM. et al. Does disallowing body checking in non-elite 13- to 14-year-old ice hockey leagues reduce rates of injury and concussion? A cohort study in two Canadian provinces. Br J Sports Med 2020; 54: 414-420 DOI: 10.1136/bjsports-2019-101092.
- 4 Hislop MD, Stokes KA, Williams S. et al. Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial. Br J Sports Med 2017; 51: 1140-1146. DOI: 10.1136/bjsports-2016-097434.
- 5 Attwood MJ, Roberts SP, Trewartha G. et al. Efficacy of a movement control injury prevention programme in adult men’s community rugby union: a cluster randomised controlled trial. Br J Sports Med 2018; 52: 368-374 DOI: 10.1136/bjsports-2017-098005.
- 6 Chisholm DA, Black AM, Palacios-Derflingher L. et al. Mouthguard use in youth ice hockey and the risk of concussion: Nested case-control study of 315 cases. Br J Sports Med 2020; 54: 866-870
- 7 World Rugby. Regulation 12: Provisions relating to players’ dress. 2019 available at https://www.world.rugby/handbook/regulations/reg-12
- 8 World Rugby. Headgear Performance Specification. 2019
- 9 Emery CA, Black AM, Kolstad A. et al. What strategies can be used to effectively reduce the risk of concussion in sport? A systematic review. Br J Sports Med 2017; 51: 978–984. DOI: 10.1136/bjsports-2016-097452.
- 10 Kemp SPT, Hudson Z, Brooks JHM. et al. The epidemiology of head injuries in English professional rugby union. Clin J Sport Med 2008; 18: 227-234. DOI: 10.1097/JSM.0b013e31816a1c9a.
- 11 Hollis SJ, Stevenson MR, McIntosh AS. et al. Incidence, risk, and protective factors of mild traumatic brain injury in a cohort of Australian nonprofessional male rugby players. Am J Sports Med 2009; 37: 2328-2333. DOI: 10.1177/0363546509341032.
- 12 Marshall SW, Loomis DP, Waller AE. et al. Evaluation of protective equipment for prevention of injuries in rugby union. Int J Epidemiol 2005; 34: 113-118
- 13 McIntosh AS, McCrory P. Effectiveness of headgear in a pilot study of under 15 rugby union football. Br J Sports Med 2001; 35: 167-169. doi:10.1136/bjsm.35.3.167
- 14 McIntosh AS, McCrory P, Finch CF. et al. Does padded headgear prevent head injury in rugby union football?. Med Sci Sports Exerc 2009; 41: 306-313. DOI: 10.1249/MSS.0b013e3181864bee.
- 15 Fraas MR, Coughlan GE, Hart EC. et al. Concussion history and reporting rates in elite Irish rugby union players. Phys Ther Sport 2014; 15: 136-142. DOI: 10.1016/j.ptsp.2013.08.002.
- 16 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817. doi:10.1055/a-1015-3123
- 17 Bahr R, Holme I. Risk factors for sports injuries - a methodological approach. Br J Sports Med 2003; 37: 384-392. doi:10.1136/bjsm.37.5.384
- 18 Fuller CW, Molloy MG, Bagate C. et al. Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. Br J Sports Med 2007; 41: 328-331. DOI: 10.1136/bjsm.2006.033282.
- 19 Fuller GW, Kemp SPT, Decq P. The International Rugby Board (IRB) Pitch Side Concussion Assessment trial: a pilot test accuracy study. Br J Sports Med 2015; 49: 529-535. doi:10.1136/bjsports-2014-093498
- 20 McHugh ML. Interrater reliability: the kappa statistic. Biochem Med 2012; 22: 276-282
- 21 Bates D, Sarkar D, Bates MD. et al. The lme4 package. R package version 2007; 2: 74
- 22 Cross M, Kemp S, Smith A. et al. Professional Rugby Union players have a 60% greater risk of time loss injury after concussion: A 2-season prospective study of clinical outcomes. Br J Sports Med 2016; 50: 926-931. DOI: 10.1136/bjsports-2015-094982.
- 23 Therneau T A package for survival analysis in S. R package version 236-12 2012
- 24 Zuckerman SL, Lee YM, Odom MJ. et al. Sports-related concussion in helmeted vs. unhelmeted athletes: Who fares worse?. Int J Sports Med 2015; 36: 419-425. DOI: 10.1055/s-0034-1395587.
- 25 McIntosh AS, McCrory P. Impact energy attenuation performance of football headgear. Br J Sports Med 2000; 34: 337-341. doi:10.1136/bjsm.34.5.337
- 26 Van Pelt K, Allred D, Cameron K. et al. A cohort study to identify and evaluate concussion risk factors across multiple injury settings: Findings from the CARE Consortium. Inj Epidemiol 2019; 6: 1 DOI: 10.1186/s40621-018-0178-3.
- 27 Abrahams S, Mc Fie S, Patricios J. et al. Risk factors for sports concussion: An evidence-based systematic review. Br J Sports Med 2014; 48: 91-97. DOI: 10.1136/bjsports-2013-092734.
- 28 Brett BL, Kuhn AW, Yengo-Kahn AM. et al. Risk factors associated with sustaining a sport-related concussion: an initial synthesis study of 12,320 student-athletes. Arch Clin Neuropsych 2018; 33: 984-992 DOI: 10.1093/arclin/acy006.
- 29 Nordstrom A, Nordstrom P, Ekstrand J. Sports-related concussion increases the risk of subsequent injury by about 50% in elite male football players. Br J Sports Med 2014; 48: 1447-1450. doi:10.1136/bjsports-2013-093406
- 30 Lynall RC, Mauntel TC, Padua DA. et al. Acute lower extremity injury rates increase after concussion in college athletes. Med Sci Sports Exerc 2015; 47: 2487-2492. DOI: 10.1249/mss.0000000000000716.
- 31 Howell DR, Lynall RC, Buckley TA. et al. Neuromuscular control deficits and the risk of subsequent injury after a concussion: a scoping review. Sports Med 2018; 48: 1097-1115. DOI: 10.1007/s40279-018-0871-y.