Report into Premiership reveals new tackle directives have had neglible affect on concussion rate

A widescale report into the Aviva Premiership has found that concussion is now the competition’s most common injury.

The Professional Rugby Injury Surveillance Project (PRISP) report – which is a joint venture between the Rugby Football Union (RFU), Premiership Rugby (PRL) and the Rugby Players’ Association (RPA) – found that concussion now accounts for 22 percent of all match day injuries.

The report also shows that the number of concussions requiring more than three months’ absence has increased.

“The mean severity of medically diagnosed match concussions in 2016-17 was 18 days. A rise from 2015/16, largely due to a substantial increase in the incidence of a relatively small number of concussions lasting greater than 84 days, compared with previous seasons. Compliance with the mandatory return to play protocols for concussion was again excellent, with no players returning to play in fewer than six days.”

“For the first time hamstring injuries and concussion appear alongside ACL injuries in the top three match injuries resulting in 84 or more days’ absence.”

“Concussion accounted for 19 percent of all injuries to the ball carrier and 43 percent of all injuries to the tackler, highlighting the tackle as a key game event when developing concussion reduction strategies.”

The report also suggests World Rugby’s new high tackle directives have had little effect on the incidences of concussion – in the Premiership at least.

“When considering all players in a tackle, there was no difference in the incidence of all injuries and concussion when comparing matches played prior to the introduction of World Rugby’s new directive regarding sanctions for high tackles, with those played after that date. Small changes were observed in the incidence of concussion to players when categorised as the ball carrier or tackler. These differences were not significant but will continue to be monitored, along with referee application of the directive, to understand the ongoing impact of the increased sanctions.”

The report into the 2016/17 season also showed that injuries are on the increase.

“The overall incidence (how often) of match injury in the Premiership was greater than the previous season and slightly higher than the average for the surveillance period. However it remains within the limits of expected season-to-season variation.”

The average severity of match injuries (the time taken to return to play) for the 2016/17 season was 32 days. This is the first time this figure has risen above the expected upper limit of season-to-season variation, largely driven by the increase in injuries in the three highest severity groupings.

47 percent of all match injuries are associated with the tackle, with 23 percent of all injuries associated with tackling and 24 percent associated with being tackled.

PRISP is the most comprehensive and longest-running injury surveillance study in professional rugby union and has monitored the injury risk of Premiership Rugby players in Aviva Premiership, European and national competition as well as training for the last 14 seasons.

Simon Kemp, RFU Medical Services Director said: “This study continues to be critical to our understanding of injury trends in the professional game in England. Player welfare is a priority area for us and it is important that we continue to have a collaborative approach between the RFU, Premiership Rugby, RPA and World Rugby in this area. Decisions around the management of players’ needs, where possible, to be evidence-based rather than subjective, which is why this project, delivered by the University of Bath, is so important.

“Having seen the lowest-recorded incidence of injury over the surveillance period in 2015/16, the 2016/17 season’s rise suggests that the 2015/16 was an atypical year rather than a trend towards lower overall injury incidence.

“Concussion remains a priority for us all, given the continued rise in the number of reported incidences in the professional game and uncertainty about the long-term consequences. Medical staff continue to work extremely hard to ensure that this complex injury is identified and managed well.

“We have a number of innovative ongoing studies that we hope will help both better inform our understanding of concussion and also inform approaches to improve its management. These studies have demonstrated a four-fold increase in the recognition of concussive events in the English professional game since 2012 and an eight-fold reduction in the number of concussed players continuing to play following their head injury.

“Evidence based advances in management are protecting our players but we must do more. Our focus must now be on concussion prevention and addressing the risk to players in the tackle. We need to look at identifying an effective but safe tackle technique to ensure that players can consistently deliver impactful tackles, while reducing the risk of inadvertent contact with an opponent’s head, hip or knee.”

The PRISP report also provides an update on key research projects around the utility of the King-Devick assessment in identifying concussed players, artificial turf injury risk and how best to manage athletes on artificial turf and the development of elite playing talent across the game.

In addition, other live or recently completed projects include: a salivary microRNA study running in the Aviva Premiership and Greene King IPA Championship this season, research with former England international rugby players examining the possible long-term effects of the game on brain health, a separate study with former elite players looking at long-term musculoskeletal health and an innovative piece of research into the measurement and understanding of the concussion risk in the tackle in professional rugby.

A new strategy for fighting injuries was also revealed.

The Professional Game Action Plan on Player Injuries, endorsed by the Professional Game Board (PGB), calls for the implementation of a range of linked injury prevention initiatives by game administrators, referees, coaches, conditioners, players and medical staff.

Nigel Melville, RFU Professional Rugby Director said: “We have a responsibility to look at all elements of the game. We try and take an evidence-based view, so we have looked at the data available and made decisions, alongside PRL and the RPA, built on that which form this action plan.

“All the decisions are taken with the long term interests of the game clearly in mind and the welfare of our players is absolutely central in that regard. We know that there is no game without the players. We also know that in order to effectively mitigate against risk all stakeholders need to work together. This is why we are setting out this action plan. We want to work with the players, the professional clubs and World Rugby to build a much better body of knowledge about this, so we make better, more informed decisions.”

Phil Winstanley, Rugby Director at Premiership Rugby said: “Clearly the PRISP report has identified some significant challenges for us in relation to injury and player welfare.

“Player welfare has to and will remain at the centre of everything Premiership Rugby do as an organisation and working with the RFU and RPA we have identified immediate actions which we have to take in addition to the work that we are already doing in this area.

“It is clear though that this is not just a Premiership issue: this is also a world game issue and we look forward to engaging with World Rugby to identify solutions which benefits all.”

Richard Bryan, Rugby Director at the RPA said: “The Professional Rugby Injury Surveillance Project Report remains a vitally important piece of work. As a sport, we have a responsibility to be proactive and transparent when reporting and managing injuries. The RPA and its members welcome the introduction of the new 8-point action plan. The RPA Players’ Board recognise it as an important step that goes beyond the reporting of injuries to actively address injury concerns, protecting the interests and welfare of professional players in England.”