Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 28;10(2):e001932.
doi: 10.1136/bmjsem-2024-001932. eCollection 2024.

Sanctioned illegal high tackles significantly increase concussion risk to both tacklers and ball carriers in elite men's Rugby Union

Ross Tucker  1   2 , Ben Hester  2 , Sharief Hendricks  3 , James Brown  1 , Éanna C Falvey  2   4
Affiliations

Sanctioned illegal high tackles significantly increase concussion risk to both tacklers and ball carriers in elite men's Rugby Union

Ross Tucker et al. BMJ Open Sport Exerc Med. .

Abstract

Objectives: Tackles making contact above the sternum increase concussion and head injury assessment (HIA) risk in Rugby Union. The sport has introduced harsher sanctions to change tackler behaviours to reduce this risk. This increased high tackle sanction numbers, though it is unknown whether sanction severity is associated with injury risk.

Methods: The sanction decision made by match officials for tackles resulting in 157 HIA1 removals, of which 91 were confirmed concussions, was evaluated. The propensity of sanction types, ranging from no foul play to red card, was compared after calculating concussion and HIA1 numbers per 1000 tackles of each sanction, using total tackle number of each sanction type from one season of two elite professional competitions.

Results: HIA1 removal and concussion risk increased as sanction severity increased. Red-carded tackles were 271.5 (95% CI 143.8 to 512.6) times more likely to result in concussions than legal tackles. Tacklers and ball carriers were more likely to experience concussions from sanctioned high tackles, with tackler risk 28.5 (95% CI 13.5 to 59.9) times higher for sanctioned high tackles compared with legal tackles, and ball carrier risk elevated 133.7-fold (95% CI 65.5 to 272.8) after sanctioned high tackles.

Conclusion: Sanctioned high tackles significantly increase concussion and HIA1 risk to both tacklers and ball carriers. Current decision-making frameworks that guide sanction decisions do identify tackle behaviours that elevate clinical risk. Both tacklers and ball carriers would be less likely to experience concussions and head injuries if the frequency of illegal high tackles is decreased.

Keywords: Brain; Concussion; Injury; Prevention; Rugby.

PubMed Disclaimer

Conflict of interest statement

Competing interests: RT is employed in a consulting role with World Rugby, the governing body for the sport of Rugby Union globally. JB receives research funding from and manages the global concussion monitoring system for WR. SH has received research funding from World Rugby for other research studies on the sport. BH is employed as a video analyst with World Rugby. ECF is the Chief Medical Officer of World Rugby.

Figures

Figure 1
Figure 1
Head contact process (HCP) for sanctioning of head contact during play, introduced in 2021 and modified in 2023. Used with permission. Available online 9. RC, red card; YC, yellow card.
Figure 2
Figure 2
Concussion (A) and head injury assessment (HIA) (B) propensity for tackles with a range of sanctions. Number of concussions/HIAs and total tackles are shown in the tables beneath the corresponding figure, with calculated propensity and propensity rate ratio (PRR) for sanctioned tackles versus legal tackles. RC, red card; YC, yellow card.
Figure 3
Figure 3
Odds of a concussion for sequential increases in sanction severity. The odds for each sanction type are shown below the graph, while the calculated OR, relative to legal tackles, is indicated adjacent to each symbol.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Patricios JS, Schneider KJ, Dvorak J, et al. . Consensus statement on concussion in sport: the 6th international conference on concussion in sport-Amsterdam, October 2022. Br J Sports Med 2023;57:695–711. 10.1136/bjsports-2023-106898 - DOI - PubMed
    1. Eliason PH, Galarneau J-M, Kolstad AT, et al. . Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis. Br J Sports Med 2023;57:749–61. 10.1136/bjsports-2022-106656 - DOI - PubMed
    1. Emery CA, Black AM, Kolstad A, et al. . What strategies can be used to effectively reduce the risk of concussion in sport? A systematic review. Br J Sports Med 2017;51:978–84. 10.1136/bjsports-2016-097452 - DOI - PubMed
    1. Emery CA, Black AM. Are rule changes the low-hanging fruit for concussion prevention in youth sport? JAMA Pediatr 2019;173:309–10. 10.1001/jamapediatrics.2018.5498 - DOI - PubMed
    1. Raftery M, Tucker R, Falvey ÉC. Getting tough on concussion: how welfare-driven law change may improve player safety-a Rugby Union experience. Br J Sports Med 2020;55:527–9. 10.1136/bjsports-2019-101885 - DOI - PMC - PubMed

LinkOut - more resources