Rugby and Injury Prevention

As I write, it’s early afternoon in the Midwest of the United States.  I hope wherever you are as you read this you are enjoying yourself.  If you’re reading this over the weekend, you may be taking advantage of the many sporting offerings around the globe that involve one of the football ‘codes.’

It took me a long time, as an American, to learn that the ‘football’ I grew up with was  only one of many games sharing a similar genealogy;  and, what’s more,  in most of the world, the word ‘football’ would be understood to refer to a completely different sort of game than what I saw on an NFL Sunday.


The Paul Bunyan trophy,
awarded to the winner of
Michigan v. Michigan State
Football (American!) game

I’m probably ‘preaching to the choir’ if you’re reading this, but today there are many different types of football games being played around the globe.  There are several NCAA American Football games (I have an eye on the Michigan v. Michigan St. (MSU) game, having grown up in Grand Rapids, Michigan); there are of course many ‘Association football’ (soccer) games going on (Arsenal v. Liverpool is one of the highlight matches in the Premiership).  England upset Australia in Rugby Union earlier today; and the Edmonton Eskimos face off against the Saskatchewan Roughriders in the Canadian Football League this evening.

And more out of ignorance than intent, I am probably forgetting to mention any number of fixtures happening in Australian Rules football, Rugby League, or Gaelic football this weekend.

Lots of ‘football.’  Many ‘codes.’

Though most of my current practice in the Northern Hemisphere fall is devoted to caring for injured American football players, I wanted today to look at a different code.  I thought it the proper time to write about a recent news item on rules changes in Rugby Union.


The New Zealand All Blacks
performing their famous
Haka before a match with France

What prompted me to tack in this direction was a BBC article I read on line yesterday, “Rugby and Concussion:  Are Big Hits Bringing Big Headaches?”  There is controversy in the world of Rugby Union, according to the BBC, over how to manage game day concussions.

Barry O’Driscoll, a well-regarded member of the International Rugby Board’s (IRB) Medical Committee, has resigned in protest over proposed new rules for Pitchside Concussion Assessment (PSCA) in Rugby Union matches.  The new approach will replace what previously was a mandatory end to a player’s game and week rest period if a suspected concussion had occurred.  PSCA incorporates a functional assessment by a medical provider, which the BBC states includes the following:

  • A Pitch-Side Concussion Assessment can be asked for by a team doctor or referee if they suspect a player is concussed
  • The referee signals a PSCA has been requested via radio link and with three taps to his head
  • A substitute comes on while the PSCA takes place in pre-agreed place, usually a medical room
  • The injured player is assessed for symptoms, asked a series of questions – Where are we? What’s the score? etc – and given a balance test similar to the ones in drink-driving cases
  • One failed question, four balance errors and the presence of one or more symptoms means the player is removed from game*

*PSCA summary taken from BBC article

Significantly, and this may be news for some readers who are only familiar with the American football code, the notion of a substitute who may not be a permanent fixture in the game is a relatively novel concept for rugby.  In today’s Michigan/MSU game, for instance, the opposing coaches may liberally bring players off the field for a rest, and bring them back into the game as they see fit.  Such substitution practices are common in hockey and basketball as well.  For the Yanks out there, rugby’s substitution practice (as well as that seen in Association Football, a.k.a. ‘soccer’) more resembles that of baseball:  once a pitcher is out, or a player is pinch hit for, their game is over.  Full Stop.

Mr. O’Driscoll, a former elite rugby player himself, is concerned that the PSCA may result in too liberal a return to play decision being made.  He argues that the game has changed from his era; that players are bigger and the hits harder; that with an incidence rate of 5.1 per 1000 hours played, concussion has become the most common injury in the sport.

“If they incorporate the ‘five-minute rule’ I think you’re putting people with brain damage back on the field, and the arena they’re going back into is brutal,” O’Driscoll is quoted as saying.

The IRB, on the other hand, is responding with data it claims supports the PSCA approach.  The article states the IRB data show that 56% of players with a post-match confirmed concussion returned to the field under the previous provision.  And in the first year of the PSCA trial that figure had dropped to 13%.

What do you think?  Take the poll at the end of this post and let us know.

We have written about rugby and concussions (and other injuries in the sport) frequently in CJSM.  I encourage you to check out some of our offerings: Risk of Mild Traumatic Brain Injury in Rugby Players,  When do Mild Traumatic Brain Injuries Occur in Community Rugby, and The Epidemiology of Head Injuries in English Professional Rugby Union are just a few of the many studies we have published about rugby and sports medicine in the past few years. There will be more offerings coming soon, rest assured, given the growing and global reach of the sport.

And so now, the poll:

About sportingjim
I work at Nationwide Children's Hospital in Columbus, Ohio USA, where I am a specialist in pediatric sports medicine. My academic appointment as an Associate Professor of Pediatrics is through Ohio State University. I am a public health advocate for kids' health and safety. I am also the Deputy Editor for the Clinical Journal of Sport Medicine.

2 Responses to Rugby and Injury Prevention

  1. Chris Hughes says:

    There’s a big talking point in the UK this weekend on the subject of Concussion in Sport following a head injury to Tottenham Hotspur goalkeeper Hugo Lloris re: return to play issues following an on-field head injury. Check out the links on the following websites for more information on the incident, together with some video footage :

    Don’t forget to also take a look at the Zurich Consensus group Concussion in Sport guidelines and the AMSSM position statement on Concussion in Sport, both published in CJSM earlier this year and available for free on the CJSM website links below.

  2. Pingback: A Shout From Across the Pond: the “Lloris Affair” | Clinical Journal of Sport Medicine Blog

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