Rugby

Is rugby safe?

Rugby rarely kills, but it hurts a lot of people. On data from South Africa, which kept a full register of serious rugby injuries from 2008 to 2011, an adult player faced about 14 micromortsMicromortA one-in-a-million chance of death. It lets you compare the risk of very different activities on one scale.More in the glossary of risk over a season. Spread over a typical season of matches, that is about half a micromort a game, similar to a day of skiing or a horse ride.

The bigger issue is injury. In English community rugby, a man playing a full match has about a 1 in 26 chance of an injury that keeps him out for more than a week. In the professional Premiership it is about 1 in 10. And the most common of those injuries is concussion.

This page covers rugby union. Rugby league has similar collision risks and injury patterns.

How rugby players die

Deaths come from three causes, and the South African register saw all of them: 3 spinal cord injuries, 4 brain injuries and 2 cardiac events in four seasons, among about 650,000 registered players. Seven of the nine deaths were adults, who are far more exposed than juniors to the forces of a senior scrum and tackle.

Brain injuries include second impact syndrome, a rare and disputed condition in which a second blow before a concussion has healed causes the brain to swell. The best-known case is Rowan Stringer, a 17-year-old Canadian player who died in 2013 after hiding symptoms of two recent head injuries. Her death led to Canada's first concussion law.

Neck injuries in the scrum were once the most feared catastrophe in rugby. In France, catastrophic cervical spine injuries fell from 1.8 to 1.0 per 100,000 players a year between 2006 and 2013, after a prevention programme and changes to how scrums engage. Hookers still carry an outsized share: in South Africa, 46% of permanent spinal cord injuries happened to players in that position, most of them in the scrum.

How often rugby players are injured

England has run injury surveillance in professional rugby since 2002 and in community rugby since 2009. The two projects count injuries that keep a player out of training or matches.

Level (England)	Match injuries per 1,000 player-hours	Concussion share
Premiership, 2022–23	76	24%
Community men, 2021–22	29.2	17%
Community women, 2021–22	32.4	22%

The community figures count only injuries lasting more than seven days. The tackle caused 59% of injuries for men and 70% for women. Professional injuries kept players out for 38 days on average in 2022–23, and concussion has been the most common match injury in the Premiership for 12 seasons running.

The long-term brain question

The concern that has changed rugby most in recent years is not death on the pitch but what repeated head impacts do over decades. A Scottish study followed 412 former international players and compared them with 1,236 men of the same age and background. The rugby players were more than twice as likely to be diagnosed with neurodegenerative disease (11.4% against 5.4%), even though they lived longer than the comparison group up to age 70.

That is a finding about elite players with long careers. Nobody yet knows how much the risk applies to a club player who plays for ten seasons.

How to play more safely

1. Learn to tackle low and with your head to the side. Several unions, including Scotland's, have lowered the legal tackle height in community rugby; early data show fewer head-to-head contacts.
2. Report every suspected concussion, even your own. Follow the graduated return-to-play protocol, and never play with a headache, dizziness or blurred vision.
3. Do the neck and conditioning work. Front-row players in particular should follow the union's scrum training programme before playing in a contested scrum.
4. Play at your level and age group. Adults and late-teen players face much higher forces than juniors; mismatches in size and skill increase risk.
5. Wear a gumshield. It protects teeth; it does not prevent concussion, and neither does soft headgear.
6. Know your club's emergency plan. Someone should know the nearest hospital with a trauma unit and how to keep a player with a suspected neck injury still.

How we scored it

Fatality risk (86) is low, at about half a micromortMicromortA one-in-a-million chance of death. It lets you compare the risk of very different activities on one scale.More in the glossary per adult match on South African data. Serious injury risk (35) is the weakest factor because time-loss injuries and concussions are common. Controllability (50) reflects that technique and laws help but collisions are the game. Rescue (85) is close at hand on most pitches. Compare boxing, where blows to the head are the aim of the sport, and horse riding, with a similar overall score.