Concussion in rugby union: improved reporting, a more conservative approach or an increased risk?

Matthew Cross, Grant Trewartha, Simon Kemp, Colin W Fuller, Aileen Taylor, Stephen West, Keith Stokes

Research output: Contribution to journalConference articlepeer-review


Background Epidemiology studies from 2002 to 2011 reported a stable concussion incidence in professional Rugby Union. From 2011, multiple player welfare initiatives have been introduced to increase the awareness, identification and management of concussion.

Objective To investigate the incidence of reported concussion and players' time to return to play following match concussions in professional Rugby Union.

Design In a five-season (2011–2016) prospective cohort study, match concussions and the time taken for players to return to play were recorded. The seasonal incidences of concussion were calculated alongside all injury incidence and contact injury incidence (both excluding concussion) and mean player body mass and height.

Setting English Premiership Professional Rugby Union.

Participants 788 players.

Independent Variables Player match exposure (hours).

Main Outcome Measurement Match injury incidence (concussion and all injuries) was calculated as injuries/1000 player-hours with 95% confidence intervals (CI).

Results Mean incidence of time-loss match concussions over the period was 10.4 (95% CI: 9.4–11.5). The incidence increased year-on-year: 2011–12, 5.1 (95% CI: 3.8–6.9); 2012–13, 6.7 (95% CI: 5.1–8.7); 2013–14, 10.5 (95% CI: 8.5–13.0); 2014–15, 13.4 (95% CI: 11.1–16.2); 2015–16, 15.9 (95% CI 13.2–19.1). This rise occurred in the absence of any significant change in the incidence of all time-loss injuries, contact time-loss injuries and player size.

Conclusions Since 2011, the reported incidence of concussion in professional Rugby Union has risen season-by-season, highlighting the need for a focused injury prevention strategy. It is not possible to separate the effect of an improvement in reporting practice from an inherent increased risk of concussion, but the stable incidence of other time-loss injuries and player size over the same period suggests that changes in reporting behaviour, a lowering of the diagnostic threshold and increased awareness have all had a major influence on the reporting of concussion in recent years.
Original languageEnglish
Pages (from-to)284-413
JournalBritish Journal of Sports Medicine
Issue number309
Publication statusPublished - 1 Feb 2017


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