CHAPEL HILL – Rugby, a rough-and-tumble, high-energy contact sport similar to U.S. football but played almost worldwide, leads to far more concussions than players, coaches and medical personnel have previously thought, a new study suggests.
The study, conducted at the University of North Carolina at Chapel Hill and in Salt Lake City, showed that as many as 25 percent of rugby injuries might involve the brain-banging, life-threatening trauma. No rugby players wear hard-shell protective helmets like those worn in U.S. football, and most don’t wear soft-shell helmets -- unproven to protect heads well -- either.
“We followed two Utah rugby squads carefully for three years and were surprised at how many concussions there were,” said Dr. Stephen W. Marshall, research assistant professor of epidemiology at the UNC School of Public Health and biostatistician at the UNC Injury Prevention Research Center. “Previous studies, which were not as rigorous as ours, reported much fewer concussions in the sport although there’s no reason to think it’s different or safer in other states or countries.”
A report on the findings has just appeared in the October issue of the Journal of Athletic Training, the official journal of the National Athletic Trainers’ Association. Along with Marshall, Richard J. Spencer, a certified athletic trainer at Highland High School in Salt Lake City, wrote the paper.
Over the three years, the researchers recorded 17 concussions, including 14 relatively mild ones, according to a standardized assessment doctors and athletic trainers use, two moderate injuries and a severe one. Even mild concussions with no obvious symptoms are a concern, the two said, since they can make subsequent head trauma more likely if a player is returned to competition before symptoms resolve.
In their research, Marshall and Spencer found 11.3 concussions per 100 player-seasons. A quarter of playing days lost from rugby involved such head injuries.
By comparison, the UNC study showed a 100-fold higher incidence of concussion than an earlier investigation at an Australian high school did. The rate the new study uncovered was 40 percent higher than that in a New Zealand study and 25 percent higher than in a South African study.
“Based on our findings, we conclude that previous research probably seriously underestimated the incidence of concussion overall and seems to have frequently missed between 50 and 90 percent of those injuries,” he said. “Our study was small, however, and needs to be repeated with more subjects.”
A possible reason for the apparent under-reporting is that rugby players pride themselves on toughness, the scientist said. Another is that because players in many countries are required to sit out three weeks following heavy blows to the head, most are tempted to keep quiet about mild symptoms.
Unfortunately, much of the world’s rugby is played with minimal medical supervision, Marshall said. Those medical personnel who are available often are not well trained in recognizing and managing head injuries. Especially dangerous is second impact syndrome, a second concussion before a player has completely recovered from an earlier one.
“I’ve seen a number of these concussion deaths over the years, and I’m sick of it,” he said. “With proper management, almost all of them can be avoided.”
Rugby is popular in many countries, including New Zealand, Australia, Fiji, Japan, South Africa, Argentina, England, Wales, Scotland, Ireland and France, Marshall said. In the United States, roughly 50,000 high schoolers and club members play, and recently the sport has seen a strong upsurge in the number of women participating. About two million people play the game worldwide.
Dr. Kevin M. Guskiewicz, assistant professor of exercise and sport science at UNC, served as guest editor for the latest issue of the Journal of Athletic Training. He, Marshall and doctoral student Scott E. Ross, also of UNC, published another paper in that issue about lingering brain and nervous system deficits caused by mild concussions among 36 college athletes.
Materials provided by University Of North Carolina At Chapel Hill. Note: Content may be edited for style and length.
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