Is it really protection?

Just what are the benefits from wearing head guards or scrum caps when playing rugby?

There has recently been a great deal of speculation around a particular type of head guard designed for rugby. The speculation is aimed at claims that it dissipates forces by up to 75% and reduces injury risk, specifically mentioning concussive events. Such statements initiate controversy around the product, as has occurred here with World Rugby issuing a statement "World Rugby has confirmed that the XXX head guard may not be used in any level of the game as the product has not yet been independently and rigorously trialled or tested in a competition environment. It does not currently comply with World Rugby Regulation 12 or Law 4."

There have been many claims made regarding head guard effectiveness. However, with the issue of concussion being in the news, this is the main focus of any interest. The problem is with the term used “head guard” and its potential for ambiguity. American football helmets are sometimes referred to as head guards and research into these devices has shown they can decrease the probability of catastrophic injury. However, scrum caps are not helmets, therefore what can this type of head guard protect against? There has been a great deal of research into this and it generally shows that head guards do not prevent serious head injuries.

Head guards, however do a satisfactory job with cuts, grazes and the good old “cauliflower ear” and as Jones et al., (2003) reported. The general conclusion is that they are great for superficial head injuries. 

So we may well ask, are we going backwards in head injuries and not forward? Boxing has made a positive move forward and have banned head gear from male competitors (no research in female boxers performed so they have not changed yet). By way of explanation, the AIBA issued the following statement: 'All available data indicated that the removal of head guards in Elite Men would result in a decreased number of concussions.'

There are currently a couple of theories behind why wearing headgear would lead to more concussions rather than in a preventative method. Two instances spring to mind: peripheral vision (can you see the impact coming) can be affected, or reckless abandon to “go in” with your head. Learning is often helped if it includes pain, learning to avoid or anticipate painful stimuli can form a powerful incentive to help programme the reflexes needed to protect your head. Wearing a helmet or head guard can give a false sense of invulnerability, which might inadvertently result in less honed reflexes. Additionally, the sense of invulnerability can be taken to the extremes, so often shown in American Football, where the head can be used as a weapon in its own rights!

Some of the latest research on concussive events has shown that maintaining peripheral vision as well as active cervical range of motion (ACROM: the movement in your neck) and neck muscle strength relate to a decrease in the number of concussive events (Hendricks et al., 2016).

So, why are we not concentrating on neck movement and postural strength at grassroots level? Are we simply adding head protection as a quick and easy fix in the belief it could offer some protection to the brain?

We would like to suggest that the only safe way to prevent brain injury is to avoid impacts to the skull. We are not suggesting the prevention of impact sports, simply a rethink to the training and development of those wishing to take part. Like strength training to the shoulders, knees and other extremities we need to be considering how best to enhance the reflexes and muscle strength associated with the neck, in order to protect it, as well as all of its’ delicate structures (nerves, spinal cord, brain stem) and the skull on top.

 Dr Bianca Zietsman DC is the current head of medical at Beddau RFC and is working alongside Professor Peter McCarthy, a neurophysiologist with an interest in the effects of participation in sport on neck function. Their mutual interest is prevention of neck and head injury via pre-habilitative exercises and education. They are currently piloting a studying of neck pre-habilitation in semi-elite male rugby union players. Their pilot research has been accepted for presentation to the IOC Injury prevention and illness conference in Monaco 2017