The changing nature of concussion in rugby union: Looking back to look forward

Abstract

Introduction: Concussion is regularly observed in rugby union and has generated a growing public health concern, yet remains one of the least understood injuries facing the sports medicine community. Evidence suggests that multiple concussions may increase susceptibility to long-term neurological complications that present decades after the initial injury for reasons that remain unclear. We aimed to determine the incidence rate and risk factors for concussion amongst community-level rugby union-15s players active during the 1980s given that it may help to better understand the risks and mechanisms of injury. Methods: Injury data were collected from clubs by the coach at the time of injury in players using a 15-item questionnaire (1982-1984). Results: Seventy games were recorded throughout 1982-1983 and 1983-1984 rugby union seasons. Forty-two documented concussions accounted for $6% of injuries corresponding to an incidence rate of 0.64 per 1000 playing hours, more than a third lower than the 'modern-day' equivalent. Tackling (relative risk 1.60, p < 0.05), collisions (relative risk 0.95, p < 0.05) and gum shield use (relative risk 1.69, p < 0.05) were independently associated with concussion whereas no associations were observed for ground condition, quarter of play or players playing out of position (p > 0.05). Conclusion: Despite limitations due to the retrospective focus and reliance on questionnaire data notwithstanding raised awareness of concussion, the incidence rate of concussion during the 1980s appears to be appreciably lower compared to the present-day game. This is the likely outcome of improvements in the clinical understanding of concussion, data collection tools, reporting methods and clinical management of concussive injuries, including changes to both player and game. However, the findings of this study help better understand the risks and mechanisms of injury once encountered by rugby union players active during the 1980s, of which some of those risks are still apparent.

Lower systemic nitric oxide bioactivity, cerebral hypoperfusion and accelerated cognitive decline in formerly concussed retired rugby union players

“…While concussion incidence between the ‘amateur’ and professional eras of rugby are largely different (Gardner, Iverson, Williams et al., 2014 ; Owens et al., 2019 ), tackles remain the primary cause of concussion, particularly when involving head‐to‐head collisions (Cross et al., 2017 ; Owens et al., 2019 ). Moreover, these match events increase the risk of damage to both the frontal and temporal lobes given that contact is most frequent in the anterolateral regions of the head during play (Pearce et al., 2018 ; Tarazi et al., 2018 ).…”

“…Larger scale follow‐up studies using biomarkers of NVU integrity are further encouraged to confirm our findings given the interpretive limitations associated with the small sample sizes employed, including the caveats associated with a Type M error (Gelman and Carlin, 2014). Furthermore, an attempt to record the number of contact events across the playing career of players would have been equally insightful, but was not possible given the varied injury reporting methods documented in the amateur era of the game when participants of this research study would have been competing (Owens et al., 2019 ). Similarly, it was not possible to collect additional information pertaining to concussion severity.…”