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Tackling concussion in professional rugby union: a case–control study of tackle-based risk factors and recommendations for primary prevention
  1. Matthew J Cross1,2,
  2. Ross Tucker3,
  3. Martin Raftery3,
  4. Ben Hester3,
  5. Sean Williams2,
  6. Keith A Stokes2,
  7. Craig Ranson4,5,
  8. Prav Mathema5,
  9. Simon Kemp1
  1. 1 Professional Rugby Department, Rugby Football Union, Twickenham, London, UK
  2. 2 Department for Health, University of Bath, Bath, UK
  3. 3 World Rugby, Dublin, Ireland
  4. 4 Sports Injury Research Group, Cardiff Metropolitan University, Cardiff, UK
  5. 5 Welsh Rugby Union, Cardiff, UK
  1. Correspondence to Matthew J Cross, Professional Rugby Department, Rugby Football Union, Twickenham TW2 7BA, UK; m.cross{at}


Background/aim Concussion, the most common injury in professional rugby union, occurs most commonly during the tackle. Thus, we investigated the association between tackle characteristics and concussion.

Methods 182 video clips of tackles leading to clinically diagnosed concussion and 4619 tackles that did not were coded across three professional rugby union competitions. A variable selection process was undertaken to identify the most important variables for interpretation. A multivariate generalised linear model was used to model the association between retained variables and concussion risk. Magnitude-based inferences provided an interpretation of the real-world relevance of the outcomes.

Results The four retained variables were: accelerating player, tackler speed, head contact type and tackle type. Overall, 70% of concussions occurred to the tackler and 30% to the ball carrier. There was a higher risk of concussion if the tackler accelerated into the tackle (OR: 2.49, 95% CI 1.70 to 3.64) or the tackler was moving at high speed (OR: 2.64, 95% CI 1.92 to 3.63). Head contact with the opposing player’s head (OR: 39.9, 95% CI 22.2 to 71.1) resulted in a substantially greater risk of concussion compared with all other head contact locations.

Conclusions Interventions that reduce the speed and acceleration of the tackler and reduce exposure to head-to-head contact would likely reduce concussion risk in professional rugby union.

  • concussion
  • risk factor
  • sporting injuries
  • prevention
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  • Twitter Matt Cross @mattjcrossie

  • Contributors MJC, SK, MR and RT conceived and designed the study and coding template. BH coded all video clips for analysis, and MJC, SW and KAS analysed and interpreted the data. MJC prepared the first draft of the manuscript and then all authors made substantial contributions to the various iterations of the manuscript resulting in the final version.

  • Competing interests MJC and SK are employed by the Rugby Football Union. MR, BH and RT are employed by World Rugby. CR and PM are employed by the Welsh Rugby Union and have previously received research funding from World Rugby. SW and KAS are employed by the University of Bath and have previously received research funding from the Rugby Football Union.

  • Ethics approval Research Ethics Approval Committee for Health (REACH) at the University of Bath.

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

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