Sports Medicine

, Volume 44, Issue 12, pp 1717–1731 | Cite as

A Systematic Review and Meta-Analysis of Concussion in Rugby Union

  • Andrew J. GardnerEmail author
  • Grant L. Iverson
  • W. Huw Williams
  • Stephanie Baker
  • Peter Stanwell
Systematic Review



Rugby Union, a popular full-contact sport played throughout the world, has one of the highest rates of concussion of all full-contact sports.


The aim of the current review was to systematically evaluate the available evidence on concussion in Rugby Union and to conduct a meta-analysis of findings regarding the incidence of concussion.


Articles were retrieved via a number of online databases. The current review examined all articles published in English up to May 2014 pertaining to concussion in Rugby Union players. The key search terms included ‘Rugby Union’, ‘rugby’, ‘union’, and ‘football’, in combination with the injury terms ‘athletic injuries’, ‘concussion’, ‘sports concussion’, ‘sports-related concussion’, ‘brain concussion’, ‘brain injury’, ‘brain injuries’, ‘mild traumatic brain injury’, ‘mTBI’, ‘traumatic brain injury’, ‘TBI’, ‘craniocerebral trauma’, ‘head injury’, and ‘brain damage’.


The final search outcome following the eligibility screening process resulted in the inclusion of 96 articles for this review. The meta-analysis included a total of 37 studies. The results of the meta-analysis revealed an overall incidence of match-play concussion in men’s rugby-15s of 4.73 per 1,000 player match hours. The incidence of concussion during training was 0.07 per 1,000 practice hours. The incidence of concussion in women’s rugby-15s was 0.55 per 1,000 player match hours. In men’s rugby-7s match-play, concussion incidence was 3.01 per 1,000 player match hours. The incidence of concussion varied considerably between levels of play, with elite level play recording a rate of 0.40 concussions per 1,000 player match hours, schoolboy level 0.62 concussions per 1,000 player match hours, and the community or sub-elite level recording a rate of 2.08 concussions per 1,000 player match hours. The incidence of concussion in men’s rugby-15s as a function of playing position (forwards vs. backs) was 4.02 and 4.85 concussions per 1,000 player match hours, respectively.


Concussion is a common injury sustained and reported in match play and to a lesser extent during practice by Rugby Union players. Based on the available published data, there appears to be a variation in risk of concussion across level of play, with the sub-elite level having the greatest incidence of injury. Future research focused on studying the acute consequences and best management strategies in current players, and the potential longer term outcomes of concussion in retired players, is needed. A focus on the areas of prevention, injury identification, and medical management, and risk for long-term outcomes will be of benefit to current athletes.


Chronic Traumatic Encephalopathy Rugby Player Rugby League Elite Level Player Match 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Debbie Booth from the University of Newcastle for her assistance with the initial database search and Sarah Hiles from the University of Newcastle for her assistance with methodology regarding meta-analysis. Funding was provided by the Brain Foundation, Australia; NSW Sporting Injuries Committee; and Hunter Medical Research Institute (HMRI) funded by Jennie Thomas.

Conflict of interest

The authors do not have any conflicts of interest to declare.


Andrew Gardner has a clinical practice in neuropsychology involving individuals who have sustained sports-related concussion (including current and former athletes). He has received travel funding from the Australian Football League (AFL) to present at the Concussion in Football Conference in 2013. Previous grant funding includes the New South Wales (NSW) Sporting Injuries Committee, the Brain Foundation, and the Hunter Medical Research Institute, supported by Jennie Thomas. Grant Iverson, Ph.D., has been reimbursed by the Government, professional scientific bodies, and commercial organizations for discussing or presenting research relating to mild traumatic brain injury (TBI) and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He is a co-investigator, collaborator, or consultant on grants relating to mild TBI funded by several organisations, including, but not limited to, the Canadian Institute of Health Research, Alcohol Beverage Medical Research Council, Rehabilitation Research and Development (RR&D) Service of the US Department of Veterans Affairs, Vancouver Coastal Health Research Institute, and Roche Diagnostics Canada.

Supplementary material

40279_2014_233_MOESM1_ESM.doc (214 kb)
Supplementary material 1 (DOC 215 kb)
40279_2014_233_MOESM2_ESM.doc (134 kb)
Supplementary material 2 (DOC 134 kb)


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Andrew J. Gardner
    • 1
    • 9
    Email author
  • Grant L. Iverson
    • 2
    • 3
    • 4
    • 5
  • W. Huw Williams
    • 6
  • Stephanie Baker
    • 7
  • Peter Stanwell
    • 1
    • 8
  1. 1.Centre for Translational Neuroscience and Mental Health, School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
  2. 2.Department of Physical Medicine and RehabilitationHarvard Medical SchoolBostonUSA
  3. 3.Spaulding Rehabilitation HospitalBostonUSA
  4. 4.Massachusetts General Hospital Sport Concussion ClinicBostonUSA
  5. 5.Red Sox Foundation and Massachusetts General Hospital Home Base ProgramBostonUSA
  6. 6.School of PsychologyExeter UniversityExeterUK
  7. 7.School of PsychologyCardiff UniversityCardiffUK
  8. 8.School of Health Sciences, Faculty of Health and MedicineUniversity of NewcastleCallaghanAustralia
  9. 9.Centre for Translational Neuroscience and Mental HealthLevel 5, McAuley Building, Calvary Mater HospitalWaratahAustralia

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