More than just wearing a mouthguard: a multi-modal approach to concussion prevention in youth rugby

Stephen West, Isla J. Shill, Carolyn Emery

Research output: Contribution to journalMeeting abstractpeer-review



Background: There is a growing need for strategies targeted at preventing concussions at all levels and ages of rugby. There is growing evidence surrounding the short- and long-term consequences and burden of concussion in youth rugby participants as well as the health care system. With the growing base of evidence for multiple concussion prevention strategies in many sports, consideration of a multimodal approach to prevention should be considered.

Objectives: We will demonstrate the importance of an evidence-based multi-modal approach to concussion prevention across the domains of policy/law change, training strategies and protective equipment.

Methods/ Results: Within the context of rugby from grassroots to the developing youth athlete, policy change has the potential to impact the greatest number of youth participating in the sport. For example, several ongoing law trials globally aimed at a reduction in the legal tackle height are being implemented, as well as discussions regarding the age of introduction to contact. Based on our data, 2 of more years of previous rugby playing experience do not protect against tackle related concussion compared with no playing experience, therefore suggesting the age of introduction could be raised without harmful consequences (Male RR: 1.58: 95%CIs: 0.71–3.53; Female RR: 1.18; 95%CIs: 0.75–1.87). Similarly, neuromuscular training (NMT) warm-ups targeted at male youth rugby players have revealed significant reductions in concussion rates of up to 59% in youth players. We will share new findings in the youth female game. The final domain of prevention involves personal protective equipment (e.g., mouthguards and headgear, and helmet fit). Importantly, the adoption of multiple sustainable solutions to minimize the risk of concussion is crucial to have a significant public health impact on concussion rates in youth rugby. The evidence for prevention strategies in isolation is consistently positive. However, the additive effect of multiple domains must be considered to maximize the concussion prevention potential.

Conclusions: Concussion in sport is complex in nature and the strategies we implement and evaluate aimed to prevent concussion occurrence must be multifactorial. Current research evidence from across youth sports informing best practice and policy in concussion prevention suggests the adoption of training programs such as neuromuscular training as standard of practice as well as widespread utility of personal protective equipment and important game wide policy/rule considerations. The prevention of concussion must adopt a multi-stakeholder and multi-modal process to maximize the welfare of youth sport participants to ensure lifelong participation.
Original languageEnglish
Article number579
Number of pages1
JournalBrain Injury
Publication statusPublished - 29 Sept 2023


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