The Concussion Epidemic in Rugby

Mike Brown concussion v Italy 14th Feb ’15

















The amount of concussions in rugby is on a worrying increase over the last few years there are a number of reasons, below I have outlined the main factors being the increasing weight and sheer size of players and proof of the epidemic which professional athletes of the contact sport are facing.

A research study carried out, by Stephen W. Marshall and Richard J. Spencer in the Journal of Athletic Training, to determine the incidence of concussion in high school rugby players in the U.S found that “seventeen concussions were recorded, accounting for 25% of all reported injuries. The incidence rate for concussion was 3.8 per 1000 athlete-exposures (95% confidence interval, 2.0–5.7) or 11.3 per 100 player-seasons (95% confidence interval, 5.9–16.7). Of the 17 concussions, 14 were Cantu grade 1, 2 were grade 2, and 1 was grade 3. Concussions accounted for 25% of all days lost from rugby participation due to injury.”

Based on the study’s findings it was said that, “previous epidemiologic studies of rugby injury have probably underestimated the incidence of concussion in rugby, in some cases by a wide margin. Efforts to better prevent, recognize, and manage these injuries need to be implemented in the game of rugby. Developing accurate incidence data will assist us in raising awareness of the problem of concussion in rugby.” (Marshall & Spencer, 2001, P.334-338) If we look at the study’s results it says that only “seventeen concussions were recorded” (Marshall & Spencer, 2001, P.334-338), this means we can assume many other cases of concussion went either unnoticed or unreported.

These are shocking results and clearly more must be done to ensure players’ safety and welfare. Such injuries need to be spotted and dealt with as soon as they occur, coaches and medical staff need to be trained to the highest quality to be able to do this.

In the book “The Heads-up on Sport Concussion” the authors reference the report by The Centres for Disease Control and Prevention (CDC 1997) saying “there are as many as 300,000 sports-related concussions annually in the United States. This number yields an average of 822 sport concussions per day. Seventy-five percent of these concussions are classified as mild, but 9% of individuals are hospitalized… Many believe this is an underestimation of the incidence of concussion” (Solomon, Gary S., Johnston, Karen M., Lovell, Mark R. “The Heads-up on Sport Concussion” (2006) Human Kinetics). Although the book refers to a study done in the U.S, so by default the number of concussions will be higher than in Ireland, it was carried out a good few years ago and as the sport of rugby has grown in popularity and physicality we can only assume the number will be on the increase in every country.  There is plenty of proof that the game is a lot more injury-prone and physical than before it became professional as players are bigger and stronger than in previous years even at schools level. Irish rugby players in recent years dwarf those of the team 30 years ago.

“The 1980 Irish side that played England averaged 13st 12lb (88kg) per man. The 2014 team to play England? Close to 16st 7lb (105kg). Ireland’s average forward in 2014 weighed 16 per cent more than his 1980 counterpart, while the backs, even including (in international terms) a relatively small pairing in Brian O’Driscoll and Gordon D’Arcy, were on average 22 per cent heavier than those 34 years previously” (McGeady, Aidan (2015, February 7), How big has become beautiful in modern rugby. The Irish Times).

So we can see the trend of even the smaller players, I use this term loosely, are considerably bigger than those of the 80s and 90s. This would contribute to the concussion epidemic as one simple tackle can cause severe concussion.

This research study was sparked by the recent incident of George North not being removed from the field of play after receiving his second knock to the head during Wales’ 6 Nations defeat to England. During the first half, the winger took an accidental boot to the head from England lock Dave Attwood and the mandatory concussion assessment was carried out. He was temporarily replaced by Liam Williams but returned to the field relatively quickly.  It was the failure to remove the player on the second occasion of injury which left the player lying still on the field for a minute or so after colliding with team mate Richard Hibbard. A very good example of medics and coaches not noticing concussion in their players. More recently, a worrying number of players have also suffered concussion thus far into the 2015 6 Nations such as George North and Samson Lee (Wal v Eng 6th Feb), Mike Brown (Eng v Ita 14th Feb), Gordon Reid and Sam Hidalgo-Clyne were treated for mild symptoms of concussion (Sco v Wal 15th Feb) and Sean O’Brien and Jared Payne (Ire v Eng 1st March).



Marshall, S. W., & Spencer, R. J. (2001). Concussion in Rugby: The Hidden Epidemic. Journal of Athletic Training, 36(3), P.334–338.

Solomon, Gary S., Johnston, Karen M., Lovell, Mark R. “The Heads-up on Sport Concussion” (2006) Human Kinetics.

McGeady, Aidan (2015, February 7), How big has become beautiful in modern rugby. The Irish Times

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