Concussion and head injuries in English community rugby union match play: Community rugby union head injuries

Background: Previous research has described general injury patterns in community level rugby union but specific information on time-loss head injuries has not been reported.
Objectives To establish the incidence and nature of significant time-loss head injuries in English community rugby match play, and to identify the injury risk for specific contact events.
Study design: Descriptive epidemiology study.
Methods Over six seasons, injury information was collected from 46 (2009/10), 67 (2010/11), 76 (2011/12), 50 (2012/13), 67 (2013/14) and 58 (2014/15) English community rugby clubs (RFU levels 3-9), over a total of 175,940 hours of player match exposure. Club injury management staff reported information for all head injuries sustained during match play whereby the player was absent for 8 days or greater. Clubs were subdivided into semi-professional (mean player age: 24.6 ± 4.7 years), amateur (24.9 ± 5.1 years) and recreational (25.6 ± 6.1 years) playing levels. Contact events from a sample of 30 matches filmed over seasons 2009/10, 2010/11 and 2011/12, provided mean values for frequency of contact events.
Results: The overall incidence for time-loss head injuries was 2.43 injuries per 1000 player match hours with a higher incidence for amateur (2.78; 95% CI 2.37-3.20) compared with recreational (2.20; 95% CI 1.86-2.53; P = 0.032) but not different to semi-professional (2.31; 95% CI 1.83-2.79) playing levels. Concussion was the most common time-loss head injury with 1.46 per 1000 player match hours. The tackle event was associated with 64% of all head injuries and 73% of all concussions. There was also a higher risk of injury per tackle (0.33 per 1000 events; 95% CI 0.30-0.37) compared with all other contact events.
Conclusions: Concussion was the most common head injury diagnosis, although it is likely that this injury was under-reported. Continuing education programmes for medical staff and players are essential for the improved identification and management of these injuries. With the majority of head injuries occurring in the tackle, improved technique in this contact event through coach and player education may be effective in reducing these injuries.