 is an important aspect in formulating effective injury prevention strategies.5 ,6 Over a 3-year period, 18 concussions were recorded, and only 10 were available for analysis due to the poor quality of the video footage. This small sample of concussion events over 3 years highlights the challenge with conducting a study of this nature. Owing to the small sample size, the study should be considered preliminary, and therefore any conclusive remarks are difficult to make. That said, the study provides insight into the injury mechanism of concussion in youth rugby, where otherwise data would not exist, and the data can be interpreted in the context of the current injury prevention strategies for concussion.
Situational factors associated with concussion
In describing the situational factors associated with concussion, all injuries occurred as a result of contact ‘with opponent’. The ability to tolerate and engage in frequent physical contact with the opponent is a prerequisite for participation in rugby. Therefore, it is not surprising that contact with an opponent is a major feature in the series of events leading to concussion. For the concussive events analysed, the players were unaware of the impending contact. This finding is in line with Garraway et al23 who found that tackle injury was more likely to occur when the player was unaware of opponents’ movements. An explanation for this is that a player can sustain far greater forces without injury if the cervical muscles are tensed, which occurs when the athlete anticipates the collision. It is postulated that activating the neck and posterior shoulder muscles reduces the risk of concussion by mobilising the head, thereby decreasing the resultant acceleration of impact to the head.24
Coaching players to increase awareness and anticipation of ensuing contact may therefore be a worthwhile preventative measure for concussion.24
Match period and concussion
The majority of concussive events took place in the fourth quarter. This finding is consistent with previous literature, highlighting the role of fatigue in concussion risk.25 ,26 A reduction in tackle technique proficiency has also been associated with fatigue in rugby league players, increasing the potential for unsafe tackles.27 In ice hockey, in-game fatigue was a significant predictor of concussion.26 This may warrant the need to coach contact technique during a state of fatigue for safe and effective execution during match play.27
Tackle contact techniques and concussion
The tackle situation contributed 50% of concussion injuries, which is higher than previously reported.28 ,29 The low sample size of this study, however, needs to be considered. The majority of injurious tackles were classified as ‘front-on’ with injury occurring to the tackler, a finding consistent with others who found that tackles from the front resulted in more injuries.8–10 While the nature of the game necessitates a high frequency of this type of tackle, the coaching of safe and effective techniques for all tackle types must be emphasised.
‘Head up and facing the ball-carrier before contact’, that is, ‘up and forward’, is specified in the list of instructions for safe and effective contact techniques.16 ,19 In this study, concussed players displayed a precontact position of head ‘up and forward’. However, on contact, the majority of players displayed a ‘down’ or ‘away’ head position. When a player tucks his chin on his chest into the ‘down’ position during a tackle, the risk for head or neck injury increases.10 This may be a target area for coaching interventions as players need to ensure that the ‘up and forward’ head position is maintained into contact and not only in preparation for contact.
Concussive impact may occur when a person's body and head are travelling at a particular speed and strike a solid object or when a head at rest is struck by a moving object.30 In 7 of the 10 concussive events, the injured player was either stationary or moving at a pace categorized as ‘slow’. In particular, most injured tacklers were categorised as either 