Concussion in Rugby Union and the Role of Biomechanics

Abstract

Due to the physical and high-impact nature of rugby, head impacts can occur within the game which can result in concussion injuries as well as other moderate-to-severe head injuries ¹. Concussion has been defined as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces”¹ and was found to be one of the more common brain injuries throughout the world.² This is particularly true in sport; it has been estimated that over half of all concussions are sports related.³ A systematic review of the incidence of concussion in contact sports found that rugby union has a higher incidence rate compared with other sports such as American football and soccer.⁴

Unlike other sports injuries, detecting a concussion is difficult as the neuropathological changes cannot be recognized on standard neuroimaging technology.^5,6 \Therefore, if a player is suspected of having a concussion, they are removed from play for a Head Injury Assessment (HIA). The HIA is a standardized tool for the medical assessment of concussion injuries in rugby and aims to improve detection and patient education.⁷ The HIA assesses a range of degenerative concussive symptoms including memory, cognitive ability, balance and player discomfort. This concussion diagnosis protocol therefore relies heavily on side-line medical staff to identify if a player is exhibiting concussive symptoms. A major disadvantage to this is that concussion has a variable natural history, with transient, fluctuating, delayed and evolving signs or symptoms.⁸) This means that symptoms can take up to 48 hours to become apparent.⁸ It has therefore been acknowledged that the content of the HIA will be modified as the research around concussion diagnosis evolves.⁸

The reliance on side-line medical staff to accurately identify concussive symptoms means that there is a possibility a concussed player may remain on the field; this is one problem that biomechanical research into concussion is trying to overcome.  This study will give an overview of concussion in rugby union with a focus on incidence, severity and protection strategies. It will discuss current biomechanical research and further biomechanical research required in the area of concussion injuries in rugby union.