Background The rate and severity of head injuries are of particular interest in contact sports but are under-researched in amateur rugby union.

Objective To investigate the epidemiology of head injuries in English community rugby union.

Design Using a prospective cohort design, information was collected for head injuries resulting in a ‘time-loss’ absence of 8 days or greater from match play and those requiring a ‘medical attendance’ during match play.

Setting English community rugby union, during seasons 2009/10 (n=46 clubs), 2010/11 (n=67 clubs) and 2011/12 (n=76 clubs) resulting in 92700 player hours.

Participants All consenting players of participating clubs' first team squads.

Independent variables Match exposure.

Main outcome measurements Head injury incidence and severity.

Results All time-loss head injuries incidence was 2.1 injuries per 1000 player match hours (95% CI 1.8–2.3) with a mean severity of 4.4 weeks missed (95% CI 3.8–5.0) (median of 3 weeks). Concussion incidence was 1.2 per 1000 hours (95% CI 1.0–1.4) with a mean of 3.4 weeks missed (95% CI 2.7–4.0) (median of 3 weeks). The tackle was associated with 66% of all head injuries (76% of all concussions). Medical attendances for head injuries (55 per 1000 hours; 95% CI 54–57) accounted for 24% of all attendances with a mean of one attendance for a head injury per team per match. The most common head attendances were for lacerations (39% of all head injuries), bruise/haematomas (29%) and neural injuries (including potential concussions; 12%).

Conclusions Concussions are the most common time-loss head injury in community rugby with players on average adhering to recovery guidelines by resting for three weeks. The tackle is the most commonly associated event. With one attendance per team per match for a head injury, the importance of having pitch side medical staff who are trained to recognise symptoms of concussion is clear.