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Putting their heads on

the line for rugby....

Every weekend on muddy fields across Britain, the nations’ children viscously hurl each other through the air and clash heads ferociously as their parents stand by cheering. Inspired by the idols of our great four nations they put their bodies on the line for the sake of that god-given sport…. Rugby!

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As a proud welsh lady I am well versed on the benefits of playing rugby for general fitness, learning team working and it’s associated social benefits. However I cannot deny that a fair proportion of these children end up trooping groggily through our emergency departments on a Saturday or Sunday, passing through our CT scanners or doing their time on the paediatric ward for head injury observation.


Rugby union is a high impact collision sport in which the use of extreme force is often acceptable in order to maintain possession of the ball. Given this, it is surprising that it can be compulsory in some UK schools from age 8 and above. Squads often consist of children of varying stature and ability making it a hot bed for sport injuries. Studies in the UK suggest that the risk of potentially serious injury in

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rugby is 3 times that in football. Head injuries are of particular concern.

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As many as 180 out of 100000 children suffer a head injury during a sports or leisure activity each year and although we see a smattering of skull fractures and intracranial bleeds, a high number of these will be classified simply as ‘concussion’.

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So what is concussion and why does it matter? Concussion is a functional disturbance of the brain without any associated structural pathology on brain imaging (sort of like neuropraxia.…) It can result from a direct impact to the head or an acceleration-deceleration injury. Symptoms of concussion include headache, dizziness, memory disturbance and balance problems amongst others. Loss of consciousness is not a requirement for diagnosis and in fact occurs in less than 10% of concussions. The majority of symptoms resolve within 7-10 days although this period may be longer in the paediatric population.

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In adult studies, links have been found between repeat concussions and cognitive impairment. An entity of chronic traumatic encephalopathy (CTE) has also been described (a degenerative brain process found in people subject to repeat head trauma). Children and adolescents are recognised as being more susceptible to the effects of concussion, taking longer to recover and having more significant deficits in memory and mental processing than adults. They are also more at risk of a potentially fatal complication called ‘second impact’ syndrome in which a second concussive injury to an already concussed brain causes catastrophic brain swelling.

Given that on average one concussion occurs in every adult game of rugby, rugby unions are well versed in it’s management and strict guidance is available on most rugby union websites. They tend to work on the 4 R’s principle:

Treatment of concussion comprises of both physical and cognitive rest. This even includes refraining from social media for the first 24 hours following concussion! It is recommended that children or adolescents do not return to academic studies until completely symptom free.

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Unfortunately due to real life, the above rules aren’t always followed and school pressures or next week’s important game can interfere with recommendations. Therefore as a front line service treating paediatric sport-related head injuries, it’s important that we are aware of them so that we are all singing off the same hymn sheet (see further reading below).

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Good luck to all for the remainder of the world cup. Cymru am byth…

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Further Reading

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