Original researchConcussion history and reporting rates in elite Irish rugby union players
Introduction
Rugby union is a dynamic contact sport requiring players to perform a variety of open and closed skill activities in a game environment. Worldwide, there are 3.5 million participants, with 118 Unions participating as members governed by the International Rugby Board (IRB) (IRB, 2010). The sport is particularly popular in Ireland, where there are over 150,000 registered participants across all levels of play (IRFU, 2011). Owing to the physical nature of the game, players are at risk for concussion.
The incidence of concussion in rugby union across various levels of play has been shown to range from 4.5% to 25% of all injuries (Bathgate et al., 2002, Bird et al., 1998, Marshall and Spencer, 2001, McIntosh et al., 2010). In a comparison study between collegiate American football players and club-level rugby union players from New Zealand, Marshall and colleagues reported that rugby union players sustained three times as many injuries (Marshall, Waller, Dick, Pugh, Loomis, & Chalmers, 2002). In addition, the most common injury in these players was to the head, accounting for 19% of all injuries.
Investigations of elite-level rugby union players in South Africa, Australia, and New Zealand have reported concussion rates of 5–23% per season (Holtzhausen et al., 2006, Seward et al., 1993, Shuttleworth-Edwards et al., 2008). In addition, concussion rates in male professional sports were reported highest among rugby union players at 9.05 concussions per 1000 player exposures (Tommasone & Valovich McLeod, 2006). A recent survey of U-20 rugby union players in Ireland observed that 48% reported a history of sustaining at least one concussion during the season investigated (Baker, Devitt, Green, & McCarthy, 2013).
The risk of sustaining a concussion in rugby union has been shown to vary by position. For instance, it has been reported that forwards, who partake in the more physical aspects of the game including set pieces, rucks, and mauls, are more prone to concussion injuries (Bathgate et al., 2002, Best et al., 2005, Bird et al., 1998, Bottini et al., 2000, Fuller, Brooks et al., 2007, Quarrie et al., 2001). However, other investigations have found that backs, who are involved in high-speed tackles and collisions due to the nature of their role in play, demonstrate a greater rate of concussion compared to forwards (Brooks et al., 2005a, Kemp et al., 2008, Quarrie and Hopkins, 2008). The severity of injury, as measured by days out of play, and player position has also been examined with Brooks et al. reporting that backs had higher concussion incidence rates (4.9/1000) compared to forwards (4.0/1000); however, forwards had more severe concussions (14 days absent from play) compared to backs (10 days absent from play) (Brooks et al., 2005a).
Concern has been expressed regarding the underreporting of concussion among players, which has been documented to be as high as 53–62% in sports such as soccer and American football (Broglio et al., 2010, McCrea et al., 2004). A study examining concussion in high school rugby union players determined that of the 62% of athletes who sustained a concussion, 20% did not report their injury (Sye, Sullivan, & McCrory, 2006). Baker and colleagues found that 48% of U-20 Irish rugby union players believe they had sustained a previous concussion; however, 44% of them failed to report their injury (Baker et al., 2013). Previous investigations have found that the most common reasons for failing to report a concussion include: not thinking it was serious enough; not wanting to leave the game; believing that concussions are part of the game; not realizing it was a concussion; and not wanting to let down their teammates (Broglio et al., 2010, McCrea et al., 2004).
Although the rate of concussion in elite rugby union players has been examined in other countries, there are currently no reported concussion statistics for these players in Ireland. Therefore, the objectives of the current investigation were to examine the self-reported rates of concussion and reporting practices among elite-level players affiliated to the Irish Rugby Football Union (IRFU). In addition, we wanted to determine whether player position was related to concussion rates and severity.
Section snippets
Methods
This study was conducted following international ethical guidelines for biomedical research involving human subjects as outlined by the World Health Organization (CIOMS, 2002). Institutional Review Board approval was granted prior to the commencement of the study. Participants for this investigation included players from the four professional-level provincial teams representing each of the provinces of Ireland that comprise the IRFU (Connacht, Leinster, Munster and Ulster). The European rugby
Results
One hundred and seventy-two players from the four professional teams representing the four provinces that comprise the IRFU participated in this investigation. This represented 80.4% (N = 214) of all professional-level players affiliated with the IRFU at the time of this investigation. Not all of these players answered every question of the survey. Therefore, the data presented are relative to the valid responses. Participants included 36 (20.9%) players from Team 1, 49 (28.5%) from Team 2, 50
Discussion
This is the first investigation conducted to examine concussion among elite rugby union players in Ireland in an attempt to gain an understanding of the number of concussions sustained during one season and the reporting practices of players. Our findings indicate a self-reported concussion rate of 44.9% of players who participated in the 2010–2011 IRFU season. These self-reported figures exceed those from previous investigations of self-reported concussion in rugby union (Bird et al., 1998,
Conclusions
This study examined the rate of concussion and the reporting practices of elite Irish rugby union players. Our findings demonstrate high rates of self-reported concussion among players. The concussion rate is higher among back positions, but concussion severity was greater for forwards. Furthermore, the findings indicate that many players fail to seek proper advice and medical input regarding their concussions. The need for further education is required to inform players about the significant
Conflicts of interest
The authors report no conflicts of interest.
Ethical approval
Elmhurst College Institutional Review Board: This study was conducted following international ethical guidelines for biomedical research involving human subjects. Institutional Review Board approval was granted prior to the commencement of the study. All participants provided informed consent prior to participation in the study.
Funding
No funding was received for this investigation.
References (34)
- et al.
Consensus statement on concussion in sport–the 3rd international conference on concussion in sport, held in Zurich, November 2008
Journal of Clinical Neuroscience
(2009) - et al.
Concussion among under 20 rugby union players in Ireland: incidence, attitudes and knowledge
Irish Journal of Medicine and Science
(2013) - et al.
A prospective study of injuries to elite Australian rugby union players
British Journal of Sports Medicine
(2002) - et al.
Rugby World Cup 2003 injury surveillance project
British Journal of Sports Medicine
(2005) - et al.
The avoidability of head and neck injuries in ice hockey: an historical review
British Journal of Sports Medicine
(2002) - et al.
The New Zealand rugby injury and performance project: V. Epidemiology of a season of rugby injury
British Journal of Sports Medicine
(1998) - et al.
Incidence and nature of the most common rugby injuries sustained in Argentina (1991–1997)
British Journal of Sports Medicine
(2000) - et al.
Concussion occurrence and knowledge in Italian football (soccer)
Journal of Sports Sciences
(2010) - et al.
Epidemiology of injuries in English professional rugby union: part 1 match injuries
British Journal of Sports Medicine
(2005) - et al.
Epidemiology of injuries in English professional rugby union: part 2 training injuries
British Journal of Sports Medicine
(2005)
History of multiple self-reported concussions is not associated with reduced cognitive abilities
Neurosurgery
International ethical guidelines for biomedical research involving human subjects
Physical game demands in elite rugby union: a global positioning system analysis and possible implications for rehabilitation
Journal of Orthopaedic Sports and Physical Therapy
Investigating baseline neurocognitive performance between male and female athletes with a history of multiple concussion
Journal of Neurology Neurosurgery and Psychiatry
Contact events in rugby union and their propensity to cause injury
British Journal of Sports Medicine
Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union
Clinical Journal of Sport Medicine
Association between recurrent concussion and late-life cognitive impairment in retired professional football players
Neurosurgery
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