Intended for healthcare professionals

Rapid response to:


The unknown risks of youth rugby

BMJ 2015; 350 doi: (Published 08 January 2015) Cite this as: BMJ 2015;350:h26

Rapid Response:

Re: The unknown risks of youth rugby

Eighteen months after this excellent editorial the school rugby season is once more approaching. In response to safety concerns raised by Michael Carter in this editorial and by other eminent health professionals such as Professor Pollock, we conducted a questionnaire survey targeted at rugby playing schools in the UK. Our aim was to look at compulsion to play, informed consent, safety precautions, and schools’ approach to recording and auditing of rugby injuries.

A structured questionnaire was distributed to 447 rugby-playing schools in Autumn 2015, with the help of the Good Schools Guide. Only a quarter of schools (116) returned the questionnaire (perhaps itself an indicator of attitudes to safety). Many expressed concerns about anonymity and publicity.

Rugby was compulsory in 77% of responding schools, with nearly all playing contact rugby. Half introduced contact rugby after an introductory period playing tag rugby. Introduction of contact rugby varied in age from 8 until 13. In 12 schools, students were allowed to choose between tag and contact rugby.

Only 9% of schools required express parental consent for children’s participation in contact rugby, while 6% required this only if a boy played against children from an older age band. Many schools felt that consent was implied when children were registered with the school or by the signing of a general sports consent form.

87 schools (75%) had clear protocols for recognition and management of concussion, either their own or RFU/SRU models, while the remainder had none, or non-specific instructions - for example, to ‘ask parents to take the child to their GP’. While 90% of responding schools playing contact rugby recorded rugby injuries, only 44% had a clear process for reviewing injuries. This translates to 10% not maintaining any records of rugby-related injuries at all. Poor recording of rugby injuries by schools and medical institutions was raised in this editorial as a key blocker to understanding the true incidence of rugby-related injuries amongst school children. This was reflected in our study, illustrated by the lack of systematic auditing of rugby injuries in 56% of the responding schools.

All but one school had basic measures in place to reduce risk and optimise safety in lessons and matches, with an emphasis on teaching good technique, checking the state of the pitch, and first aid training for staff. To their credit, a minority had advanced measures, such as coaches obtaining a 1st4Sport Level 3 certificate in coaching Rugby Union and mandatory annual RugbyReady courses. Some had medically-trained personnel attending matches.

Most provided staff with concussion recognition training, ranging from online e-learning to regular updates on rugby-specific head and spinal injuries. A minority were working with the University of Bath in a collaboration to increase fitness training and reduce injuries in youth rugby.

The introduction of weight / physique matching is moving up the agenda, especially where coaches have seen it working well in New Zealand’s schools. However, while 19 (16%) followed the common New Zealand practice of matching children by weight rather than age during training, only 2 schools did so formally for matches, with a quarter of schools volunteering that an RFU directive prevented weight-matching.

The government’s plan was to increase financial provision for rugby in state schools, and the RFU’s All Schools project aims to increase the number of secondary state schools playing rugby union. This would be an opportune time to expand the discussion to ensure robust safety systems are in place and that injuries are carefully audited before implementation.

The Department of Education places the duty of care firmly on schools. We feel that compulsion to play, lack of informed consent and poor auditing of injuries by many schools should be urgently addressed before placing a larger number of children at increased risk of long-term injury. Until we have strict auditing of school rugby injuries and choice to play in a sport that carries a significant risk of injury, with strict safety precautions in place, parents and schools must not be complacent as children continue to be injured, sometimes seriously.

Pollock AM. Tackling rugby; what every parent should know about injuries. Verso Press, 2014.
Pfister T et al. The incidence of concussion in youth sports: a systematic review and meta-analysis.. Br J Sports Med 2016;50 292-297.

Competing interests: No competing interests

10 August 2016
Dr Polly Nyiri
General Practitioner
Dr Judith Eling, Dept of Public Health, Imperial College Healthcare NHS Trust, London
Guys and St Thomas' NHS Foundation Trust
Pavilion Medical Centre, 9 Brighton Terrace, London SW9 8DJ