Evidence in support of the call to ban tackle and harmful contact in school rugby: a response to World Rugby

Pollock, White and Kirkwood

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In a paper published in BJSM (June 2016), World Rugby employees Ross Tucker and Martin Raftery and a third coauthor Evert Verhagen took issue with the recent call to ban tackling in school rugby in the UK and Ireland. That call (to ban tackling) was supported by a systematic review published in BJSM. Tucker et al claim that: (1) the mechanisms and risk factors for injury along with the incidence and severity of injury in youth rugby union have not been thoroughly identified or understood; (2) rugby players are at no greater risk of injury than other sports people, (3) this is particularly the case for children under 15 years and (4) removing the opportunity to learn the tackle from school pupils might increase rates of injuries. They conclude that a ban ‘may be unnecessary and may also lead to unintended consequences such as an increase in the risk of injury later in participation.’ Here we aim to rebut the case by Tucker et al. We share new research that extends the findings of our original systematic review and meta-analysis. A cautionary approach requires the removal of the tackle from school rugby as the quickest and most effective method of reducing high injury rates in youth rugby, a public health priority.

Response to: 'Don't let kids play football: a killer idea

Bullingham, White and Batten 

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In a recent BJSM editorial, it was stated that ‘shutting down youth sports programmes’ is not the answer to injury concerns in contact sport, suggesting there may be unintended consequences, such as increasing sedentary behaviour.1 With physical inactivity a leading cause of mortality, concerns about decreasing participation in physical activity are justified. This issue has even been discussed in a previous editorial in the BJSM.2 There is no evidence, however, to suggest that collision sports (specifically) are necessary to combat sedentary lifestyles of youth. There also continues to be a distinct misunderstanding of what has been called for in regards to the banning of tackling in school rugby, which will now be clarified.


From management to prevention: the new cure for sports concussion

Batten, et al.

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A recent BJSM editorial argued that ‘turning people into couch potatoes is not the cure for sports concussion’. Specifically, it was noted how heightened anxiety over sports concussion has caused participation levels to fall; that concussions are common in contact sports; and that there remains a need for the development of specific concussion management protocols targeted at each level of the game. In this response, the evidence to support each of these contentions is examined. A case for directing attention away from concussion management and towards the prevention of concussions in sport is also stated.

Preventing penalty corner injuries and head trauma in field hockey: time to consider the power play?

Batten, White, Anderson

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In an effort to pre-empt serious injury in field hockey, this editorial examines the penalty corner in the sport. Specifically, the potential risk of serious head injury is highlighted, with structural changes that could make the sport safer also discussed.

Wearing a Bicycle Helmet Can Increase Risk Taking and Sensation Seeking in Adults

Gamble, Walker

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Humans adapt their risk-taking behavior on the basis of perceptions of safety; this risk-compensation phenomenon is typified by people taking increased risks when using protective equipment. Existing studies have looked at people who know they are using safety equipment and have specifically focused on changes in behaviors for which that equipment might reduce risk. Here, we demonstrated that risk taking increases in people who are not explicitly aware they are wearing protective equipment; furthermore, this happens for behaviors that could not be made safer by that equipment. In a controlled study in which a helmet, compared with a baseball cap, was used as the head mount for an eye tracker, participants scored significantly higher on laboratory measures of both risk taking and sensation seeking. This happened despite there being no risk for the helmet to ameliorate and despite it being introduced purely as an eye tracker. The results suggest that unconscious activation of safety-related concepts primes globally increased risk propensity.

World Rugby's erroneous and misleading representation of Australian sports' injury statistics

Piggin, Pollock

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The goals of World Rugby's strategic plan, 2010 are to ‘Protect and promote Rugby, its values, spirit and ethos’ and to ‘Drive player welfare best practice’. These values are under question with the publication of misleading data on injury risks in its SportsWise Survey.

In response to calls earlier this year to the UK government for a ban on tackle and contact in the school game, World Rugby has published a report in which it states that ‘Compared with other sports and activities, rugby has a relatively low injury rate despite being known for its physicality’. The statement is misleading and should be changed.

Removing contact from school rugby will not turn children into couch potatoes

Pollock, Kirkwood

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Recently, an open letter calling for a ban on tackling in school rugby was sent to the Chief Medical Officers (CMOs) and Ministers of Sport in Education and Health in the UK and the Republic of Ireland. The Royal College of Paediatrics and Child Health (RCPCH), and the Faculty of Sports and Exercise Medicine (FSEM), have responded with statements on their respective websites. These statements mirror claims made in a commentary in the BJSM co-written by the CMO of Scotland, entitled “Turning people into couch potatoes is not the cure for sports concussion”.

Both the RCPCH and FSEM statements take an approach of denying the evidence that exists, creating a smokescreen of new initiatives that await evaluation and finally conflating the benefits of physical activity and exercise with sport and contact sport in particular.

Response to: World Rugby's erroneous and misleading representation of Australian sports' injury statistics


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As chief executive officer of World Rugby I would like to respond to Piggin and Pollock regarding their editorial titled ‘World Rugby's Erroneous and Misleading Representation of Australian Sports’ Injury Statistics’.


Systematic review of rugby injuries in children and adolescents under 21 years

Freitag, et al.

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A systematic review of rugby union and league injuries among players under the age of 21 years was carried out to calculate probabilities of match injury for a player over a season and a pooled estimate of match injury incidence where studies were sufficiently similar. The probability of a player being injured over a season ranged from 6% to 90% for rugby union and 68% to 96% for rugby league. The pooled injury incidence estimate for rugby union was 26.7/1000 player-hours for injuries irrespective of need for medical attention or time-loss and 10.3/1000 player-hours for injuries requiring at least 7 days absence from games; equivalent to a 28.4% and 12.1% risk of being injured over a season. Study heterogeneity contributed to a wide variation in injury incidence. Public injury surveillance and prevention systems have been successful in reducing injury rates in other countries. No such system exists in the UK.

Rugby injury surveillance and prevention programmes: are they effective?

Freitag, Kirkwood, Pollock

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Despite the high rates of injury in rugby, the UK government plans to focus on increasing participation in the sport in schools. Andreas Freitag, Graham Kirkwood, and Allyson Pollock discuss whether surveillance and prevention programmes from around the world have reduced rugby injuries.

Bicycling campaigns promoting health versus campaigns promoting safety: A randomized controlled online study of 'dangerization'

Gamble, Walker, Laketa

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This study tested the idea that promoting bicycle safety might inadvertently discourage bicycling by having negative effects on how the activity is perceived. It also tested the idea that stressing the health benefits of bicycling would have a positive effect on perceptions and intentions to cycle. Two-hundred and twenty-eight adults were randomly allocated to read safety-focused, health-focused, or control publicity materials and their immediate influences on bicycling perceptions were measured. Health-focused materials significantly increased bicycling׳s perceived health benefits amongst non-bicyclists and had no influence on perceived risk; the safety-focused campaign had no effect on either perceived risks or health benefits for either group. Neither campaign measurably changed intentions to bicycle nor the perceived enjoyment of bicycling, both of which were clearly higher amongst bicyclists than non-bicyclists. The study suggests that safety-focused campaigns are unlikely to have any immediate effect on people׳s perceptions and intentions to cycle, whether positive or negative; health-focused campaigns, on the other hand, make bicycling appear more beneficial to those who do not currently do it. In addition, although the possibility exists that current bicyclists are a qualitatively different sub-population, able to enjoy bicycling in non-conducive environments, their rating bicycling as more enjoyable than non-bicyclists hints that new campaigns might usefully emphasise the enjoyment of bicycling to encourage its uptake.

Concussion in youth rugby union and rugby league: a systematic review

Kirkwood, et al.

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Background Children and adolescents who play rugby are at increased risk of concussion and its effects. Competitive rugby union and rugby league feature as major sports in the school sport curriculum in the UK. There is a need for a thorough understanding of the epidemiology of concussion in youth rugby, the mechanisms involved in injuries and predisposing risk factors.

Data Sources The publication databases Pubmed, Embase and SportDISCUS were searched in April 2014 for primary research studies of child and adolescent rugby union and rugby league (under 20 years) in English language with data on concussion injuries. The review was conducted within a larger all injury systematic review on rugby union and rugby league where key words used in the search included rugby, injury and concussion with child, adolescent, paediatric and youth.

Results There were 25 studies retrieved with data on child or adolescent rugby and concussion, 20 were on rugby union, three on rugby league and in two the code of rugby was unspecified. There was significant heterogeneity in the definitions of injuries and of concussion. The incidence of child and adolescent match concussion ranged from 0.2 to 6.9 concussions per 1000 player-hours for rugby union and was 4.6 and 14.7 concussions per 1000 player-hours for rugby league, equivalent to a probability of between 0.3% and 11.4% for rugby union and of 7.7% and 22.7% for rugby league.

Conclusions There is a significant risk of concussion in children and adolescents playing rugby union and rugby league evident from the studies included in this systematic review. There is a need for reliable data through routine monitoring and reporting in schools and clubs and in hospital emergency departments in order to inform prevention. Concussion protocols should be implemented and tested.


Injury surveillance in Europe and the UK

Kirkwood, Hughes, Pollock

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The slow steady progress made in collecting injury data in Europe is in danger of being undone.

Injuries are an important international public health problem, contributing an estimated 11.2% of the world total of disability adjusted life years in 2010. In the United Kingdom, falls are the second largest cause of years lived with disability. In addition, although deaths from road traffic collisions have fallen substantially in the UK over the past 20 years, deaths from injuries in the home have risen sharply, and without high quality data we have little understanding of the causes.

Tackling Rugby: What Every Parent Should Know


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What parents should know about the sports their children play

On 29 January 2011, Benjamin Robinson was playing rugby for his school. During the match he sustained a concussion but was not taken off, and was allowed to continue with the game, in which he endured a second impact. When play ended, he collapsed, dying two days later as a result of his injuries.

Every week young children are hospitalized on the playing fields of Britain. Yet the subject is rarely investigated, injury data are not systematically collected, and as a result any real attempt to work out how to make youth rugby safer is flawed. Using meticulous, peer-reviewed research, leading public health specialist Allyson M. Pollock sets out the true risks associated with the sport, raising uncomfortable questions for politicians and the educational authorities.


i9 and the Transformation of Youth Sport


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In this article I present an analysis of how traditionally run competitive, organized team sports reproduce multiple socionegative effects for youth who play them. After explicating how the structure and culture of traditionally run competitive team sports operates in western cultures, I explain that cultural resistance toward changing sport is beginning to wane. I analyze a consumer-oriented neoliberal approach to transforming these negative outcomes of youth sport through the creation of a new sporting organization, i9 sports. I draw on this example to conclude that structural and cultural changes to youth sport are increasingly viable for at least middle and upper class parents who are critical of traditional sport options and to initiate a conversation about consumer-led social change initiatives in youth sport.

Examining Media Contestation of Masculinity and Head Trauma in the National Football League

Anderson, Kian

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American football has long been central to the construction of masculinity in the United States. Of the multiple masculine scripts promoting professional players’ hegemonic masculine status, sacrificing one’s body for the sake of sporting glory is a key tenet. Sport journalists have traditionally used their media platform to reify this social script, an act which simultaneously promotes their own masculine capital. However, this article investigates a crack in this hegemonic system. Through a media analysis of the reporting on Aaron Rodgers’ self-withdrawal (after hitting his head) from an important National Football League (NFL) game, we argue that increasing cultural awareness as to the devastating effects of concussions, in the form of chronic traumatic encephalopathy, combined with a softening of American masculinity is beginning to permit some prominent players to distance themselves from the self-sacrifice component of sporting masculinity. Concerning concussions, we conclude major sport media are beginning to support the notion of health over a masculine warrior narrative.


Communicating the risk of injury in schoolboy rugby: using Poisson probability as an alternative presentation of the epidemiology

Parekh, et al.

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Background The communication of injury risk in rugby and other sports is underdeveloped and parents, children and coaches need to be better informed about risk.

Method A Poisson distribution was used to transform population based incidence of injury into average probabilities of injury to individual players.

Results The incidence of injury in schoolboy rugby matches range from 7 to 129.8 injuries per 1000 player-hours; these rates translate to average probabilities of injury to a player of between 12% and 90% over a season.

Conclusion Incidence of injury and average probabilities of injury over a season should be published together in all future epidemiological studies on school rugby and other sports. More research is required on informing and communicating injury risks to parents, staff and children and how it affects monitoring, decision making and prevention strategies.


Rugby union injuries in Scottish schools

Nicol, et al.

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Background Rugby union is the most popular worldwide collision sport, yet concerns have been raised regarding the safety of the sport due to the physical, high impact nature and an increasing number of injuries.

Methods A prospective, cohort study of the incidence, pattern and severity of injuries in rugby players in six Scottish schools during the second half of the 2008–09 season. Definition of injury and severity of injury were taken from International Rugby Board (IRB) consensus guidelines. Injury report forms and exposure data for match play were completed by a nominated staff member.

Results Four hundred and seventy consent forms with survey information were returned. Of 37 rugby injuries in the study, 11 occurred during training. Head and face were the most injured body part and sprain/ligament injury the most common injury. Twenty injuries required attendance at Accident & Emergency with one admission. The tackle was the commonest phase of play causing injury. In the 193 matches played, the injury incidence during the match play was 10.8 injuries per 1000 player hours.

Conclusions This study confirms the feasibility of collecting relevant injury data in schools rugby in Scotland. The findings are consistent with other studies with respect to incidence and profile of injuries sustained.