Serious injuries in rugby

I have been railing about the serious dangers to participants in American football, especially with the rise in evidence of CTE, the long-term brain injury that results from repeated collisions that can cause concussions. It is thought that the repeated accumulation of concussions, even small ones during practices, is what leads to later serious cognitive decline in players. I feel the evidence is already compelling enough that I no longer watch games and also think that schools and colleges should no longer offer this as a sports option to their students. It is an activity that should be left for adults to choose to participate in, though they should be made aware of the risks.

Americans tend to view rugby as pretty much the same as American football, except without the protective helmets and body padding and hence think that it must be much more dangerous. I used to tell them that it was not so, that there were differences that made rugby safer. One is that there is evidence that the protective gear actually gives players a false sense of safety and encourages them to do dangerous things that they would not do without it. Another is that in rugby, it is only the player who has the ball that can be tackled, thus any given player faces far fewer collisions per game. A third is that any collision that results in contact with a player’s head results in an immediate yellow card that requires the offender to be off the field for ten minutes, to sit in a chair that is quaintly called a ‘sin bin’. If, during that time, an off-field review shows no mitigating factors, it is upgraded to a red card and the player cannot return to the game.

But in following the recent rugby World Cup, I have come to realize that I have been viewing rugby through rose-tinted glasses based on the fact that, before this tournament, I had not seen a full rugby game for about five decades, with the last ones in Sri Lanka and mostly featuring school teams. In the World Cup, I was shocked at how many players were seriously injured, bleeding extensively from the ears, nose, mouth and other parts of the head and requiring medical attention and bandaging. There were also many bodily injuries arising from tackles and the piling on top of players. When one watches the highlights, as I had been doing up to now, these are almost never shown, the focus instead being on the fast-moving action.

I noticed that there were many differences in the game from what I remembered. One is that there far fewer of the classical tackles, where the defender stops the ball carrier by wrapping their arms around the players legs below the knees. This causes the ball carrier to fall forward to the ground. Now there seem to be more of the kind of ‘hits’ on sees in American football, where the defender throws their full body at the ball carrier. This kind of hit causes the ball carrier to be thrown backward, creating a greater risk of whiplash and brain concussion.

One big threat of injury occurs when a player holding the ball is brought to the ground and the other players crowd around and pile on top in what are called ‘rucks’. In such situations, the ball carrier must release the ball but the other players are not allowed to pick up the ball with their hands but must use their feet to get the ball out of the pile before it can be picked up. So one can imagine the beating that the poor players at the bottom receive as the cleated boots of players hack away at them, trying to get the ball out.

There is a new book Concussed: Sport’s Uncomfortable Truth by Sam Peters that argues that concussions and other injuries in rugby are a much greater problem than the authorities are letting on, and that this is a consequence of professionalism and the drive for more money, and that they are manipulating and fudging the data to hide the scale of the problem.

As a reporter, Peters interviewed former players whose lives had been irrevocably altered by concussions and other injuries, which were aggravated or outright caused by lax rules, regulations and attitudes encouraged from the top down. The RFU and other prominent organisations in the sport shot down any attempt to question the status quo – rather bullishly, it seems.

Peters makes the case for how professional rugby has become more dangerous and explains how the risk to players’ health has increased dramatically since turning professional in 1995.

He believes the need to appeal to a wider audience became an “unhealthy obsession” in the years after the sport became professional. Rules were rewritten in order to attract more viewers, in pursuit of more sponsorship and advertising. “Laws were constantly tweaked to speed up the game and improve the spectacle,” he says. “Collisions replaced contacts, hits replaced tackles. Passes became offloads. Tackles were more frequent, scrums reduced, hits got bigger. Money rolled in. Audiences grew.”

By 2022, however, organisations began to change their stance. The RFU conceded a potential connection between repeated head trauma and CTE. Paul McCrory, “this century’s most influential sports doctor” and a key critic of the link, was exposed as a serial plagiarist, misrepresenting data and using other researchers’ work as his own. McCrory was the lead on the Concussion in Sport Group, from which the RFU took its advice about concussions. Among other changes, independent matchday doctors were employed at international games.

Today there is a legal case against World Rugby, the RFU and the Welsh Rugby Union, with more than 300 ex-players involved, alleging that they suffered brain injuries sustained during their careers.

One other factor that Peters points out is that rugby players are now bulking up (like American football players) which means that the hits have become more concussion-causing.

The physicality of the players changed too. Peters notes that in 1987 at the first Rugby World Cup, the average weight of the South African national team was [203 lb], while at the 2019 final, 24 years into professionalism, the average weight was [236 lb]. While previously players were taught to tackle passively, the tackle was now seen as a weapon with which to hit an opponent. “Everyone knew the sport was far more dangerous than ever before,” says Peters.

I only heard about this book after the tournament ended and it resonated with me and the above fact may well explain why my experience with the recent World Cup was so jarring. It had struck me while watching that the players were bigger and faster and the collisions were more brutal. My previous experience of seeing a full rugby game consisted of it being played by players roughly half the size of the current professional players.

There is some effort to use technology try and reduce head injuries in rugby.

World Rugby is expected to confirm within the next 48 hours that it will adopt smart mouthguard technology, which measures the G-force of every head impact in real time, in all its elite matches to help make the game safer.

The technology, which works by using bluetooth to immediately alert an independent doctor whenever a player has a big collision in a tackle or ruck, will be debuted in the WXV women’s match between Italy and Japan on 13 October. It will then be rolled out into the men’s professional game in January, in time for the Six Nations.

The new approach will ensure that anyone who experiences a crunching hit that is not spotted by TV cameras – or who does not show concussion signs and symptoms straight away – will no longer remain on the pitch.

Instead, when the mouthguard registers an acceleration above 70g and 4,000 radians per second squared for men – and 55gs and 4,000 rad/s2 for women – it will immediately ping an alert to an app that is being watched by an independent doctor.

As soon as that happens the player will be taken off and will have to undergo a head impact assessment. Even if they are cleared to play, they will be checked again after the match and two days later.

This may help. But I think that I will not watch professional rugby again. It has become too much like American professional football in terms of seeming to want to appeal to fans who like to see bone-jarring hits despite the potential harm to players. I find it hard to watch people seriously risking their health for the purposes of entertainment.


  1. sonofrojblake says

    this is a consequence of professionalism and the drive for more money

    That’s the single thing I thought when you mentioned that you hadn’t watched a full game for decades. I’d be interested to know what the difference is in propensity to injury between Union and League. Despite the fact that the stop-start nature of League is written into the rules, in practice it always looks to me to be a much more flowing game, and the fact that as soon as the ball is down all the players have to get OFF the ball carrier so that they can play it back to a team mate means there is no ruck, and much less piling on. Then again, I’ve not watched a full length game of league for a few years either, and I’m by no means a fan (despite coming from Wigan, home for a while in the 80s and early 90s to the best League side in the world (they once beat Australia)).

    League just looks safer… can’t imagine that making the news, though, even if it’s true, because all the people who read, write and own the machines that transmit the news played Union at school, and League is very much the game the plebs play oop North.

  2. Rob Grigjanis says

    [I] think that schools and colleges should no longer offer this as a sports option to their students. It is an activity that should be left for adults to choose to participate in, though they should be made aware of the risks.

    There’s a problem there. Preventing injuries at an early age could make injuries worse at a later age, since you learn ways to mitigate injury. For example, in soccer, learning to head the ball correctly. People who start the sport later in life tend to use the top of their heads rather than the forehead. Perhaps younger players could use lighter balls.

  3. Rob Grigjanis says

    sonofrojblake @1: You’re from t’ North (albeit from the sinister side of the Pennines)!

  4. Pierce R. Butler says

    …concussions and other injuries in rugby are a much greater problem than the authorities are letting on…

    Rugby jocks have it a lot easier than artillery crews:

    … many of the troops sent to bombard the Islamic State in 2016 and 2017 returned to the United States plagued by nightmares, panic attacks, depression and, in a few cases, hallucinations.

    … The cannon blasts were strong enough to hurl a 100-pound round 15 miles, and each unleashed a shock wave that shot through the crew members’ bodies, vibrating bone, punching lungs and hearts, and whipping at cruise-missile speeds through the most delicate organ of all, the brain. … as with hits in football, repeated blast exposure from firing heavy weapons … may cause irreparable injury to the brain. …

    when it came to protecting the crew the design had changed little in a century. Gun crews still worked within arm’s reach of the barrel and fired the gun by pulling a simple cord.

    The resulting blast was several times louder than a jet taking off, and unleashed a shock wave that hit the crews like a kick to the chest. Ears rang, bones shivered, vision blurred as eyeballs momentarily compressed, and a ripple shot through every neuron in the brain like a whipcrack. … Marines would wake up feeling hung over and stagger to the guns like zombies. Their sense of taste changed. Some threw up. Crews grew irritable and fights broke out.

    … Under an electron microscope, a ravaged neural landscape came into focus. Sheaths of myelin, vital for insulating the biological wiring of the brain, hung in tatters. In key parts of the brain that control emotion and executive function, large numbers of mitochondria — the tiny powerhouses that provide energy for each cell — were dead.

    I don’t know which sport -- the various kinds of football, or lobbing high explosives at people too far away to be seen or fire back -- is more popular.

  5. Jean says

    Instead, when the mouthguard registers an acceleration above 70g and 4,000 radians per second squared for men – and 55gs and 4,000 rad/s2 for women – it will immediately ping an alert to an app that is being watched by an independent doctor

    There is no logic for that. A brain is a brain and if the mechanical properties make it unsafe to have a 55g impact then it is valid regardless of gender. That difference is some macho bullshit.

  6. flex says

    As soon as that happens the player will be taken off and will have to undergo a head impact assessment.

    So, what are the odds that games will be halted because the bench isn’t deep enough?

  7. Pierce R. Butler says

    … an acceleration above 70g … for men – and 55gs … for women…

    70 or 55 times the force of gravity?!? Humans can survive that???

  8. Rob Grigjanis says

    Jean @5: I think it’s a statistical thing rather than a macho bullshit thing. Of two bodies with the same composition experiencing the same impact, the one with the greater volume (and mass) will be better at absorbing the resulting forces. I think those numbers are determined by average weight of male versus female players.

    Ideally, the mouthguards would be calibrated to the individual’s weight.

  9. Mano Singham says

    Pierce @#7,

    The point is that the accelerations last for a very short time.

    The g-value is calculated by dividing the change in velocity by the time of the impact causing the change in that velocity. These collisions are for tiny periods of time, so getting accelerations of 70g or about 700 m/sec^2 is not unusual.

    A player running at seven meters/sec who is brought to a sudden halt by a collision with time of impact of 1/100 th of a second would feel an acceleration of 70g.

  10. Pierce R. Butler says

    Mano Singham @ # 9 -- When you put it that way, it sort of makes sense. But if you could wire somebody up to an EEG while they experienced that sort of impact, I’d still expect some alarming numbers to come out.

    BTW, I neglected in my # 4 to give a hat tip to Lynna, OM at the Pharyngula Infinite Thread for that NYT link/excerpt.

    And we should also acknowledge the key role of George W. Bush in starting two wars, treating (some of) the survivors of which has dramatically accelerated brain trauma research. Says who Republicans never do anything for science?!?

  11. Silentbob says

    Mano it’s a pity Australian football is, well, Australian, because I think you’d like it. It’s much less about running into each other, and more about skill with the ball.

    You score by kicking the ball between the large upright posts, which is a goal (6 points). Or within the smaller upright posts which is a “behind” (1 point).

    The main skill is kicking the ball. You can hold it in your hands, but you can’t run with it without bouncing it on the ground; and you can’t throw it. You’re allowed to hold it in one hand and punch it with the other (a handpass).

    If you catch the ball “on the full” (after being kicked and before hitting the ground), that’s a “mark”. If you’ve marked the ball you can either “play on”, or halt play briefly giving you time to take your kick.

    The player with the ball can be tackled, but these are the rules:

    A legal tackle is where a player with the ball is tackled below the shoulders and above the knees.

    When a player is in possession of the ball and is tackled correctly they must immediately dispose of the ball by kicking or hand passing. Failure to do so, when there was an opportunity to dispose of the ball, results in a free kick to the opposition. This is also called holding the ball.

    Here’s highlights from the recent Grand Final between the Brisbane Lions and the Collingwood Magpies.:
    Scores are given as
    Goals : Behinds : Total points

    2023 Toyota AFL Grand Final Highlights | Collingwood v Brisbane -- YouTube

  12. sonofrojblake says

    @ Pierce R. Butler, 7:

    70 or 55 times the force of gravity?!? Humans can survive that???

    From the Wikipedia page on g-force:
    “The highest recorded g-force experienced by a human who survived was during the 2003 IndyCar Series finale at Texas Motor Speedway on October 12, 2003 in the 2003 Chevy 500 when the car driven by Kenny Bräck made wheel-to-wheel contact with Tomas Scheckter’s car. This immediately resulted in Bräck’s car impacting the catch fence that would record a peak of 214 g”

  13. Mano Singham says

    Silentbob @#11,

    Thanks for the information. I watched the highlights that you linked to and the game does look like fun. At first glance, it looks kind of chaotic, like Calvinball, but that is because it is hard to understand a new game by watching highlights that jump all over the place. I need to read the rules you linked to and then watch a full game with knowledgeable commentators to get a better sense of it. If you can provide such a link, that would help.

  14. Jean says

    Rob Grigjanis @8
    The mouthguard measures the acceleration of the head so the mass and volume of the rest of the body should be pretty much irrelevant, at least for the primary impact. The only mass that will matter will be the brain mass which will not be accelerated at the same time and will hit the inside of the cranium with a force proportional to the brain mass.

    Where the mass of the body may have an impact is on the rebound but then a lot of different factors will come into consideration.

    And I don’t know if there are yet enough statistical data from sensors in mouthguards to safely establish such large difference between genders. So that still looks like some sexist issue and the fact that the lower limit would be too easily reached with the larger male players (the larger mass does make a difference in generating larger impacts).

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