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Selective head-and-neck cooling as a treatment method for concussions in elite male rugby union players: the Clinical Observed Outcomes with Local HEad-and-neck cooling After Diagnosed concussions (COOLHEAD) study protocol

  • James Brown
  • , Michael Dunlop
  • , Marelise Badenhorst
  • , Cameron Owen
  • , Niklas Marklund
  • , Peter Andrews
  • , Andrew Hay
  • , Marco Bazo
  • , Herman Rossouw
  • , David Hanly
  • , Craig Dyson
  • , Daniel Jones
  • , Keith Stokes
  • , Simon P T Kemp
  • , Matt Cross
  • , Ben Jones
  • Leeds Beckett University
  • Stellenbosch University
  • Edinburgh Rugby
  • United Rugby Championship
  • Auckland University of Technology
  • Rugby Football League Limited
  • England Performance Unit
  • Lund University
  • University of Edinburgh Western General Hospital
  • Zebre Parma Rugby Club
  • Vodacom Blue Bulls
  • Connacht Rugby
  • Scarlets Rugby
  • Cardiff Rugby
  • Rugby Football Union
  • London School of Hygiene & Tropical Medicine
  • PREM Rugby
  • University of Cape Town
  • Australian Catholic University

Research output: Contribution to journal › Article › peer-review

Abstract

Sports-related concussions (SRCs) typically occur when the brain is hyperthermic. Acute head-and-neck cooling should, therefore, reduce the brain’s metabolic demands, with the potential to improve recovery following an SRC. Elite ice hockey players who underwent head-and-neck cooling after sustaining a concussion (SRC) showed reduced return-to-play times, although further investigation is warranted. This paper aims to describe the methods proposed for investigating the clinical effects and feasibility of acute head-and-neck cooling in elite male rugby union players.

A quasi-experimental study will be conducted in two professional male rugby competitions (clusters): the United Rugby Championship ‘intervention group’ and the PREM Rugby ‘standard care group’. Both groups will follow World Rugby’s standardised, graduated return-to-play concussion management protocols. In addition to this, within 30 min of the SRC, the intervention group will be offered head-and-neck cooling for 45 min. The quantitative phase of the study will collect return-to-play times and clinical outcomes in both groups (sample size calculated: 100 concussions per cohort). The qualitative phase will explore the experiences of players and medical teams with the intervention. Intention-to-treat and per-protocol analyses, using appropriate regression modelling techniques, will adjust for possible confounders between the two groups, and thematic content analysis will be employed in the analysis of the respective phases.

The Clinical Observed Outcomes with Local HEad-neck cooling After Diagnosed concussions study will provide evidence regarding acute head-and-neck cooling as a potential adjunct treatment to current concussion management in elite male rugby union.
Original languageEnglish
Article numbere002915
Number of pages10
JournalBMJ Open Sport & Exercise Medicine
Volume11
Issue number4
Early online date5 Oct 2025
DOIs
Publication statusPublished - 5 Oct 2025

Data Availability Statement

No data are available.

Acknowledgements

In advance, we would like to thank the two elite competitions, URC and PREM Rugby, for being willing to participate in this study. We would like to thank World Rugby, and in particular, the chief medical officer, professor Éanna Falvey, for allowing use of the data contained within the HIA database that will provide the primary and secondary outcomes for this study.

Funding

This study is funded by PolarCool AB, the developers of PolarCap. JB receives funding from World Rugby, MD is contracted as a Doctor to Edinburgh Rugby and is a Medical Advisor to the United Rugby Championship, CO research fellowship is partly funded by the Rugby Football League. NM is currently European Editor for the J Neurotrauma and is a previous although not current scientific advisor for PolarCool, Sweden and TeqCool, Sweden, AH is employed as the Head Physiotherapist and Clinical Manager to Edinburgh Rugby, MBaz was employed as the Head Physiotherapist to Zebre Parma Rugby Club, HR is contracted as Head of Medical Bulls URC, DH is employed as Head of Physiotherapy to Connacht Rugby, CD is contracted as Head of Medical to Scarlets Rugby, DJ is employed as Head of Medical Services at Cardiff Rugby, KS is employed by the Rugby Football Union which is the national governing body for rugby union in England, SPTK is employed by the Rugby Football Union which is the national governing body for rugby union in England, MC is employed by PREM Rugby, BJ is employed in a consultancy capacity by PREM Rugby and the Rugby Football League.

Funders
PolarCool AB
Rugby Football League

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