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Risk factors for head injury events in professional rugby union: a video analysis of 464 head injury events to inform proposed injury prevention strategies
  1. Ross Tucker1,
  2. Martin Raftery1,
  3. Simon Kemp2,
  4. James Brown3,
  5. Gordon Fuller4,
  6. Ben Hester1,
  7. Matthew Cross1,5,
  8. Ken Quarrie6
  1. 1 World Rugby, Dublin, Ireland
  2. 2 Rugby Football Union, Twickenham, UK
  3. 3 University of Cape Town, Cape Town, South Africa
  4. 4 University of Sheffield, Sheffield, UK
  5. 5 Department for Health, University of Bath, Bath, UK
  6. 6 New Zealand Rugby, Wellington, New Zealand
  1. Correspondence to Dr Ross Tucker, World Rugby Pty (Ltd), Dublin, Ireland; ross.tucker{at}


Objectives The tackle is responsible for the majority of head injuries during rugby union. In order to address head injury risk, risk factors during the tackle must first be identified. This study analysed tackle characteristics in the professional game in order to inform potential interventions.

Methods 464 tackles resulting in a head injury assessment (HIA) were analysed in detail, with tackle type, direction, speed, acceleration, nature of head contact and player body position the characteristics of interest.

Results Propensity to cause an HIA was significantly greater for active shoulder tackles, front-on tackles, high speeder tackles and an accelerating tackler. Head contact between a tackler’s head and ball carrier’s head or shoulder was significantly more likely to cause an HIA than contact below the level of the shoulder (incident rate ratio (IRR) 4.25, 95%–CI 3.38 to 5.35). The tackler experiences the majority (78%) of HIAs when head-to-head contact occurs. An upright tackler was 1.5 times more likely to experience an HIA than a bent at the waist tackler (IRR 1.44, 95% CI 1.18 to 1.76).

Conclusions This study confirms that energy transfer in the tackle is a risk factor for head injury, since direction, type and speed all influence HIA propensity. The study provides evidence that body position and the height of tackles should be a focus for interventions, since lowering height and adopting a bent at the waist body position is associated with reduced risk for both tacklers and ball carriers. To this end, World Rugby has implemented law change based on the present data.

  • rugby
  • concussion
  • injury prevention
  • injury
  • head

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  • Contributors RT, MR, MC and SK conceptualised the research study and its hypotheses. Data collection was performed by RT and BH. RT and MC performed analysis. The manuscript was written and edited by RT, MR, KQ, JB, GF, MC and SK.

  • Competing interests RT, MR are employed by World Rugby, the global governing body for the sport of Rugby Union. SK and MC are employed by the RFU, the governing body for Rugby Union in England. KQ is an employee of the NZRU, the governing body for the sport in New Zealand.

  • Patient consent Obtained.

  • Ethics approval World Rugby Internal Ethics Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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