Rugby and Brain Injury: Understanding the Risks

Rugby is known for teamwork, speed and physical contact. Tackles, rucks and collisions are central parts of the game, but they also expose players to head injuries. A concussion can happen after direct contact with another player, the ground or a body part such as a shoulder, knee or hip.

A concussion is a type of traumatic brain injury. It may occur after a direct blow to the head or after an impact to the body causes the head and brain to move rapidly. A player does not need to lose consciousness to have a concussion. Possible symptoms include headaches, dizziness, confusion, nausea, memory problems and difficulty maintaining balance (Centers for Disease Control and Prevention [CDC], 2025a).

Why Rugby Players Are at Risk

Rugby players are involved in repeated physical contact throughout a match. Research on professional rugby has found that concussion is one of the most important match injuries. One study reported a match concussion incidence of 18.4 concussions per 1,000 player match hours in professional rugby union (Cosgrave & Williams, 2019).

The tackle is one of the main situations in which concussions occur. Research has shown that more than half of recorded match concussions in professional rugby union occurred during tackles. Both the tackler and the ball carrier may be injured, especially when the tackler makes contact in an upright position or when there is direct head-to-head contact (Cross et al., 2016).

Reported concussion rates have increased over time in professional rugby. This may partly reflect improved recognition and reporting. However, the physical speed and intensity of modern rugby also make careful injury management essential (Rafferty et al., 2019).

Recognising the Warning Signs

Some signs of concussion are easy to notice. A player may lose consciousness, fall without protecting themselves or struggle to stand. Other signs can be more difficult to recognise. A player may appear dazed, confused or unusually slow. They may forget the score or the events that happened before the impact.

The player may also report headaches, blurred vision, nausea, dizziness or sensitivity to light and noise. Changes in mood, sleep and concentration may develop after the match (CDC, 2025a).

World Rugby lists signs such as loss of consciousness, balance disturbance, confusion, unusual behaviour, convulsions and appearing clearly dazed as reasons for permanent removal from a match. Players with suspected concussion should be removed immediately and should not return to play that day (World Rugby, n.d.-a).

The Head Injury Assessment Process

In certain elite competitions, World Rugby uses the Head Injury Assessment protocol. This process includes assessments immediately after the incident, after the match and again after a delay.

The first assessment alone cannot always rule out a concussion. A player may pass an initial test but develop symptoms later. World Rugby therefore states that concussion cannot be excluded until the required later assessments have been completed and there is no remaining clinical suspicion (World Rugby, n.d.-b).

The Head Injury Assessment process is designed for professional environments with trained medical staff. It should not be interpreted as permission for amateur players to return after a quick sideline test. In community rugby, a player with suspected concussion should be removed and assessed by a healthcare professional.

Prevention Through Better Technique

Correct tackling technique can help reduce unnecessary head contact. Players should be taught to keep their heads away from the main point of contact. Upright tackles that place the tackler’s head close to the ball carrier’s head or shoulder may increase the risk.

Coaches should practise tackling in controlled situations before introducing full speed and full contact. Training should focus on body position, timing and decision making. Players should also learn how to fall and land more safely.

Contact training should be planned carefully. Full-contact sessions are not required every day. Coaches can use non-contact drills to develop fitness, positioning, passing and tactical skills. Reducing unnecessary contact during training may lower a player’s total number of head impacts over a season.

Protective equipment has limits. Rugby headguards can reduce cuts and abrasions, but they cannot completely prevent concussion. Players should not tackle more aggressively because they are wearing head protection.

Responding to a Suspected Concussion

When a concussion is suspected, the player should leave the field immediately. They should not return to the match or training session. World Rugby advises that the player must be assessed medically before returning to activity (World Rugby, n.d.-a).

The player should be monitored after the incident. Serious warning signs include repeated vomiting, seizures, increasing confusion, weakness, slurred speech and difficulty waking up. These signs require urgent medical attention (CDC, 2025a).

Recovery should be gradual. The player should return to normal daily activities before progressing to exercise, rugby training and full competition. Each stage should be completed without new or worsening symptoms. Returning too early may increase the chance of another injury (CDC, 2025b).

Creating a Safer Rugby Culture

Rugby culture often values toughness, but playing through concussion symptoms is not a sign of strength. A player with impaired balance, concentration or reaction speed may place themselves and others at risk.

Coaches should support players who report symptoms. Teammates should also speak up when another player appears confused or unsteady. Medical professionals must have the authority to remove a player without pressure from coaches, supporters or competition schedules.

Physical contact will remain part of rugby, but head injuries should never be treated as an unavoidable problem that cannot be managed. Better education, controlled training, safer tackling and correct medical care can reduce the risks while protecting the character of the sport.

References

Centers for Disease Control and Prevention. (2025a, September 15). Signs and symptoms of concussion. https://www.cdc.gov/heads-up/signs-symptoms/index.html

Centers for Disease Control and Prevention. (2025b, September 15). Returning to sports. https://www.cdc.gov/heads-up/guidelines/returning-to-sports.html

Cosgrave, M., & Williams, S. (2019). The epidemiology of concussion in professional rugby union in Ireland. Physical Therapy in Sport, 35, 99–105. https://pubmed.ncbi.nlm.nih.gov/30513491/

Cross, M., Kemp, S., Smith, A., Trewartha, G., & Stokes, K. (2016). Professional rugby union players have a 60% greater risk of time loss injury after concussion: A 2-season prospective study of clinical outcomes. British Journal of Sports Medicine, 50(15), 926–931. https://pubmed.ncbi.nlm.nih.gov/26626266/

Rafferty, J., Ranson, C., Oatley, G., Mostafa, M., Mathema, P., Crick, T., Moore, I. S., & McCarthy, C. (2019). On average, a professional rugby union player is more likely than not to sustain a concussion after 25 matches. British Journal of Sports Medicine, 53(15), 969–973. https://pubmed.ncbi.nlm.nih.gov/29530941/

World Rugby. (n.d.-a). Concussion management for the general public: Summary principles. https://passport.world.rugby/player-welfare-medical/concussion-management-for-the-general-public/summary-principles/

World Rugby. (n.d.-b). Head Injury Assessment protocol. https://passport.world.rugby/player-welfare-medical/concussion-management-for-match-day-medical-staff-using-the-hia-protocol/hia-protocol/