But Headgear and Mouthguards Aren't Effective, Finds Review in Neurosurgery

Newswise — A comprehensive program combining education and rule enforcement has been effective in reducing the high rate of brain and spinal cord injuries among rugby players, reports the November issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

In contrast, wearing protective equipment—headgear and/or mouthguards—does not affect the risk of rugby-related neurological injuries, according to a study by Dr. Michael Cusimano and colleagues of University of Toronto. Protective Equipment Doesn't Lower Risk…The researchers analyzed previous studies of injury prevention strategies in rugby players, focusing on brain and spinal cord injuries. A total of ten studies were identified: six studies addressed the use of headgear and/or mouthguards, while four examined the impact of a multifaceted injury prevention program, emphasizing education. (All studies evaluated interventions used in "Rugby Union," one of two sets of rules under which rugby football is played.)

In four studies, there was no evidence that rugby headgear—consisting of a soft-shelled helmet with thin padding—reduced brain or spinal injuries. This included two studies in which players wore headgear together with a mouthguard. Studies of mouthguards produced inconclusive results—one study found a lower rate of concussion and loss of consciousness in rugby players wearing mouthguards, but another three studies showed no protective effect.

…But 'RugbySmart' Program Reduces Concussions and Spinal InjuriesIn contrast, four studies evaluating the effects of education and/or enforcement programs showed a significant reduction in neurological injuries. All four studies evaluated a program from New Zealand called "RugbySmart"—a comprehensive intervention designed to reduce rugby injuries. One study found a reduction in concussions and brain injuries related to the RugbySmart concussion management education program, which included a sideline concussion checklist.

Two studies reported significant reductions in neurological injuries after mandatory participation in the RugbySmart program by New Zealand rugby players, coaches, and referees. In the fourth study, a new scrum engagement rule implemented as part of RugbySmart led to a lower rate of spinal cord injuries.

A popular contact sport characterized by high-speed collisions, rugby is associated with a high rate of injuries, including concussions and spinal cord injuries. Rugby headgear and mouthguards have been recommended to prevent these injuries.

However, the new review finds little evidence that these types of protective equipment are effective in reducing rugby-related brain or spinal cord injuries. Some studies even suggest that rugby headgear may lead to "risk compensation"—with protective equipment leading to more aggressive play, potentially increasing the risk of injury.

In contrast, the RugbySmart injury prevention program, emphasizing education, seems to lower the risk of concussions and spinal cord injuries. Dr. Cusimano and co-authors emphasize that the good results were achieved when the multifaceted RugbySmart program was "implemented in a mandatory fashion across a whole country." They conclude, "Given the increasing popularity of rugby and the high rates of neurological injuries, better designed randomized controlled studies with sufficient power and across different settings should be performed to understand the role of protective equipment and educational, legal, and economic interventions."

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