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Rugby Headgear and Concussion Prevention: Misconceptions Could Increase Aggressive Play

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Rugby Headgear and Concussion Prevention: Misconceptions Could Increase Aggressive Play NEUROSURGICAL FOCUS Neurosurg Focus 40 (4):E12, 2016 Rugby headgear and concussion prevention: misconceptions could increase aggressive play Richard Menger, MD,1,2 Austin Menger,3 and Anil Nanda, MD, MPH1 1Department of Neurosurgery, Louisiana State University of Health Sciences, Shreveport, Louisiana; 2Harvard University John F. Kennedy School of Government, Cambridge, Massachusetts; and 3Georgetown University, Washington, DC OBJectiVe Multiple studies have illustrated that rugby headgear offers no statistically significant protection against concussions. However, there remains concern that many players believe rugby headgear in fact does prevent concus- sions. Further investigation was undertaken to illustrate that misconceptions about concussion prevention and rugby headgear may lead to an increase in aggressive play. MetHods Data were constructed by Internet survey solicitation among United States collegiate rugby players across 19 teams. Initial information given was related to club, age, experience, use of headgear, playing time, whether the rug- ger played football or wrestling in high school, and whether the player believed headgear prevented concussion. Data were then constructed as to whether wearing headgear would increase aggressive playing style secondary to a false sense of protection. ResuLts A total of 122 players responded. All players were male. The average player was 19.5 years old and had 2.7 years of experience. Twenty-three of 122 players (18.9%) wore protective headgear; 55.4% of players listed forward as their primary position. Overall, 45.8% (55/120) of players played 70–80 minutes per game, 44.6% (54/121) played foot- ball or wrestled in high school, 38.1% (45/118) believed headgear prevented concussions, and 42.2% (51/121) stated that if they were using headgear they would be more aggressive with their play in terms of running or tackling. Regression analysis illustrated that those who believed headgear prevented concussions were or would be more likely to engage in aggressive play (p = 0.001). ConcLusions Nearly 40% of collegiate rugby players surveyed believed headgear helped to prevent concussions despite no scientific evidence that it does. This misconception about rugby headgear could increase aggressive play. Those who believed headgear prevented concussion were, on average, 4 times more likely to play with increased ag- gressive form than those who believed headgear did not prevent concussions (p = 0.001). This can place all players at increased risk without providing additional protection. Further investigation is warranted to determine if headgear increases the actual measured incidence of concussion among rugby players in the United States. http://thejns.org/doi/abs/10.3171/2016.1.FOCUS15615 KEY Words rugby; concussion; head injury UGBY is the third most popular sport in the world. a given match.4 Across both academic and mainstream England boasts more than 2.5 million registered publications, medical interest in contact sports has shifted players.12 Popularity in the United States is grow- to concussion prevention and long-term neurocognitive Ring. USA Rugby has more than 450,000 registered players decline.29 Rugby is at the forefront of that discussion. with 67,000 high school student athletes. The International Concussion is a distinct and separate entity from that Rugby Board economic data have noted that USA Rugby of mild traumatic brain injury.21 The current working participation grew 350% from 2004 to 2011, and rugby is definition states that concussion is a traumatically induced noted to be the fastest growing sport in the United States.8 pathophysiological process affecting the brain. Concus- However, injuries are part of the game; on average a team sion is distinguished by its rapid onset of impairment, will have 18% of their roster unavailable due to injury for spontaneous resolution of symptoms, and its overarching SUBMITTED December 1, 2015. ACCEPTED January 26, 2016. INCLUDE WHEN CITING DOI: 10.3171/2016.1.FOCUS15615. ©AANS, 2016 Neurosurg Focus Volume 40 • April 2016 1 Unauthenticated | Downloaded 10/03/21 05:16 AM UTC R. Menger, A. Menger, and A. Nanda functional disturbance without structural abnormality. TABLE 1. Internet survey solicitation of collegiate rugby players Nearly 80%–90% of concussion symptoms resolve in the Q1: What is your age? first 7–10 days while children and adolescents may have a Q2: What college club do you play rugby for? prolonged course of recovery.11,21 Focus has moved specifi- cally toward prevention of secondary injury from a meta- Q3: How many years of rugby playing experience do you have? bolically vulnerable postconcussive period. Q4: What position do you primarily play? It is estimated that approximately 1.6–3.8 million 1) Forward sports-related brain injuries occur yearly in the United 2) Back 17 States. Concussion is the third most common injury in Q5: Have you ever worn protective headgear (scrumcap) for at least rugby; prospectively gathered data for rugby quantifies 91 80 minutes (1 game)? 4 injuries per 1000 playing hours. The incidence of injury 1) Yes is higher for organized rugby than professional hockey, 2) No soccer, or cricket. Four concussions per 1000 playing hours have been reported in the rugby “forwards” group, Q6: How much playing time do you generally have during an 80-min- with an average of 14 days of participation missed. Nearly ute match? 5 concussions per 1000 playing hours have been reported 1) 80 minutes among the rugby “backs” group with an average of 10 2) 60–70 minutes days of sport missed.4 3) 50–60 minutes Randomized prospective studies have shown that cur- 4) 40–50 minutes rent and expanded headgear is statistically unreliable for 5) <40 minutes protection against concussion.14,20,22 However, many play- ers may incorrectly believe that rugby headgear in fact Q7: Did you play organized tackle football or wrestle in high school? prevents concussions.26 This study looks to explore the be- 1) Yes havior and attitudes regarding the use of protective head- 2) No gear among collegiate rugby players in the United States. Q8: Do you believe the protective headgear (scrumcap) prevents concussions? Methods 1) Yes Data were constructed via internet survey solicitation 2) No among collegiate rugby players across 19 college clubs Q9: If wearing protective headgear (scrumcap) would you change your playing at the USA Rugby Division I–III level; men’s rug- playing style to a more aggressive form of tackling and running? by is currently not a National Collegiate Athletic Associa- 1) Yes tion (NCAA) regulated sport (http://usarugby.org/ncaa). 2) No Surveys were sent out to individual members of each club Q10: Do you wear a scrumcap because you had a concussion/or via contact information provided by team leaders. Partici- would you wear one if you had a concussion? pants answered questions providing information regard- 1) Yes ing current club, age, years of experience playing rugby, use of headgear, if having a concussion would incline 2) No them to use headgear, playing time, whether they played football or wrestled in high school, and whether they be- lieved rugby headgear prevents concussions. multivariate binary logistic regression to find the variables Protective headgear was defined as the soft cloth and that were most significant in impacting increased aggres- sive play. All statistical analyses were performed using foam scrum cap that is currently approved by the Interna- Minitab 17. All p values were held to the conventional cut- tional Rugby Board. No hard material is allowed for player off of alpha = 0.05 when hypothesis testing for statistical protection in the sport of rugby. Use of headgear was de- significance of predictors. Point estimation and confidence fined as at least 1 match (80-minute game) usage. This intervals are both presented and used in analysis. was done to intentionally incorporate as many players as possible that sought out any additional protection during at least one complete gameplay. Results Current club information gave notice to the level of com- Our survey produced 122 responses. All participants petitive rugby being played. Football and wrestling were were male. The average age was 19.5 years old (range used as markers for previous participation in the leading 18–24 years). The average player had 2.7 years of experi- American secondary school contact sports. Questions were ence with 23.7% of players being 1st-year players. Of the also asked about whether the participant would be more 122 players surveyed, 23 (18.9%) actually wore protective aggressive in tackling or running if he were using protec- headgear during a rugby match. Nearly half of the play- tive headgear. The survey is incorporated into Table 1. ers, 44.6% (54/121), were backs with 55.4% of players list- ANOVA, univariate binary logistic regression, and ing forward as their primary position; 55/120 (45.8%) of multivariate binary logistic regression were used as ap- players who responded played 70–80 minutes per game. propriate. We first performed a preliminary univariate Meanwhile, 21.7% (26/120) of players played 40 minutes binary logistic regression analysis to identify significant or less. There was a strong representation of previous con- predictors. Then, we ran the significant predictors in a tact sport experience; 44.6% (54/121) played football or 2 Neurosurg Focus Volume 40 • April 2016 Unauthenticated | Downloaded 10/03/21 05:16 AM UTC Rugby concussion prevention wrestled in high school. Complete descriptive statistics are Discussion found in Table 2. In our series, 38.1% of collegiate rugby players believed Overall, 38.1% (45/118) of USA Rugby collegiate play- that headgear prevented concussions; 32.5% of the players ers responding to our survey believed headgear (scrum surveyed stated they would begin to wear a scrum cap as a cap) prevented concussions. Nearly one-third of players, reaction to having a concussion. Most importantly, players 39/120 (32.5%) would wear a scrum cap as a result of hav- who believed that headgear prevented concussions were ing a concussion.
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