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Sam Underhill, Concussion & Scrum Caps

Which Tyler

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Post on the Bath fans FB page about Underhill's concussion issues (4 within 12 months)
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Has seen the old myth about scrum caps being a useful took against concussion has re-surfaced. I know we're generally better than that here, but it always bears repeating (especially for those who've missed previous conversations).

Please note, scrum caps DO NOT reduce risk of concussion, it's not even what they're for (cuts, abrasions, soft tissue injuries). What they can do, is provide a false sense of security that results in increased risk taking, and slightly INCREASE risk of concussion.

The brain is made of soft tissue, which is cushioned by spinal fluid and encased in the protective shell of the skull. When you sustain a concussion, the impact can shake your brain, literally causing it to move around, impacting the inside of your skull. The trauma is suffered by the brain itself, and can be suffered without direct trauma to the head.
Blows to the head that involve an element of traction to the neck, rotation of the head, or setting up a whiplash-type movement are those most likely to result in concussion.
As concussion is an injury sustained inside the skull, padding the outside of the skull (eg a scrum cap) provides no protection from concussion – no more so than padding the back of a cricket bat makes the front any less solid. It is worth noting that you can lose consciousness without suffering concussion, and can suffer concussion without losing consciousness. It is also worth noting that the victim is often the least reliable person to say if a loss of consciousness occurred – remember, amnesia is another sign of concussion. Loss of consciousness itself is considered to mean concussion until proven otherwise, but is far from the only sign to look out for.

If you want to reduce concussion, look at tackle technique, strengthen the neck, improve motor control of the neck muscles and work on your proprioception. Just don't think that 5mm of padding in the wrong place is going to help.


https://pubmed.ncbi.nlm.nih.gov/11375874/
Conclusions: Although there is some controversy about the desirability of wearing protective headgear in [rugby] football, this pilot study strongly suggests that current headgear does not provide significant protection against concussion in rugby union at a junior level.

https://pubmed.ncbi.nlm.nih.gov/19127196/
Conclusions: Padded headgear does not reduce the rate of head injury or concussion. The low compliance rates are a limitation. Although individuals may choose to wear padded headgear, the routine or mandatory use of protective headgear cannot be recommended.

https://pubmed.ncbi.nlm.nih.gov/27032915/
Conclusions: Nearly 40% of collegiate rugby players surveyed believed headgear helped to prevent concussions despite no scientific evidence that it does. This misconception about rugby headgear could increase aggressive play. Those who believed headgear prevented concussion were, on average, 4 times more likely to play with increased aggressive form than those who believed headgear did not prevent concussions. This can place all players at increased risk without providing additional protection.

https://pubmed.ncbi.nlm.nih.gov/29081983/
Background/aim: Concussions in rugby union pose a major threat to player welfare. Research has found protective headgear offers no significant protection against concussions but suggests a large proportion of players perceive headgear to be effective in preventing concussions. This study aimed to explore UK rugby union players' attitudes towards wearing protective headgear.
Conclusions: There appears to be a good awareness in UK players that protective headgear is not effective at preventing concussions.

https://pubmed.ncbi.nlm.nih.gov/33607666/
Conclusions: Wearing headgear was not associated with lower odds of concussions or a reduced number of days' absence following a concussion.

https://pubmed.ncbi.nlm.nih.gov/34949511/
Conclusions: Headgear use was not associated with reduced risk of suspected sports-related concussion, non-sports-related concussion head injury or injuries to other body regions.


Of course, there's always one, who sees that evidence, and then insists that scrum caps be encouraged, and rubbishes the research because it doesn't fit his preconception.
 
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New study looking at new headgear
Interesting.
Plenty of headgear has been shown to reduce peak linear acceleration - and it's yet to make a difference when worn by humans.
Yes, it's theorised (I think, may be proven) that rotational and tractional forces are more important - so if this reduces one of those (rotational) then it's good news.

But I won't get my hopes up until tested in the real world.
 
Just looked it up £125 for adults £99 for kids.

Arguably that's a small price to pay if it is genuinely that much more effective, but still about 3x the price of standard ones which is going to limit the uptake.

They need to find a way of making it cheaper if they want it to really take off.

Also it sounds silly, but if they gave an option of colours etc. they might even find more people are willing to shell out.
 
Is it independently tested and proven or just tested by their own marketing?

If they do reduce concussion dramatically, do you dictate all teams wear them in training? Is a draconian law to help everyone the correct thing?
 
Is it independently tested and proven or just tested by their own marketing?

If they do reduce concussion dramatically, do you dictate all teams wear them in training? Is a draconian law to help everyone the correct thing?
If they are proven to work it would be reckless not to.
 
Is it independently tested and proven or just tested by their own marketing?

If they do reduce concussion dramatically, do you dictate all teams wear them in training? Is a draconian law to help everyone the correct thing?
I'm not a fan of such dictats to informed and consenting adults who are only risking their own health.
But it would sure be tempting
 
I'm sceptical of their claims, tbh

5mm of foam, no matter how strategically placed, isn't going to do much to stop inertia causing your brain to smush into the inside of your skull

I remember a couple years ago another company was claiming the very same thing, and had a scientific study they linked to to back it up...which showed it reduced the force of the impact on the point of impact more than previous scrumcaps, so good if you don't want bruises, but they didn't do any tests into whether it actually does anything to stop what causes concussion (presumably because they knew it wouldn't be the results they wanted)
 
I keep hearing that players mistakenly think scrum caps protect from concussions but I don't know any actual rugby players who think that. Maybe someone who has never played a game.
I wear one and will continue to wear one, (when playing in the forwards) to protect my ears.
 
Yeah in sceptical just because we've been burnt before on this.

Honestly I see more promise in the approach Quins (most publicly) have adopted with the smart mouth guards. If that can end up accurately identifying likely concussion incidents and tallying them then it gives a far more accurate pitcture of when enough is enough for a player. Obviously that only works at the highest levels, but that is where is is generally most serious
 
I'm not a fan of such dictats to informed and consenting adults who are only risking their own health.
But it would sure be tempting
If you're talking about the professional game, all kinds of jobs have mandatory safety kit to combat known risks. This would just be another one of those. Maybe a different story at lower levels.

When helmets became compulsory in bike racing 20 years ago there was a 10 minute kerfuffle among riders, but they were rapidly accepted and no-one has batted an eyelid at them for years. Slightly different, granted, in that those are aimed more at mitigating immediate trauma - riders were literally dying on the road - than cumulative build up.

But there still seems to be a fair way to go before any product can definitively said to offer protection against concussion.
 
Yeah in sceptical just because we've been burnt before on this.

Honestly I see more promise in the approach Quins (most publicly) have adopted with the smart mouth guards. If that can end up accurately identifying likely concussion incidents and tallying them then it gives a far more accurate pitcture of when enough is enough for a player. Obviously that only works at the highest levels, but that is where is is generally most serious
Yup, as well as Falcons (and maybe Saracens?) using the patches behind the ear

Realistically there's no way to eradicate risk of concussion in a sport like Rugby so, as you said, getting collision data/accurately analysing it/adjusting players workloads as a result is a smart way to go about it
 
Yeah I'm very sceptical and I'm not a fan of draconian rules but if it helps players avoid the stigma of wearing them and helps promote safety as the players are role models I'm all for it……if they actually work.

I used to wear one or tape to protect my ears. I did however hear players so they reduced concussion though unfortunately.
 
Yeah in sceptical just because we've been burnt before on this.

Honestly I see more promise in the approach Quins (most publicly) have adopted with the smart mouth guards. If that can end up accurately identifying likely concussion incidents and tallying them then it gives a far more accurate pitcture of when enough is enough for a player. Obviously that only works at the highest levels, but that is where is is generally most serious
There's also talk of developing a test using saliva, which would be amazing if it was accurate and affordable.

 
I keep hearing that players mistakenly think scrum caps protect from concussions but I don't know any actual rugby players who think that. Maybe someone who has never played a game.
I wear one and will continue to wear one, (when playing in the forwards) to protect my ears.
2 of my 6 links above are on exactly that (though, for some reason, the links have hyperlinked themselves back through facebook and don't work, despite looking like the url).

https://pubmed.ncbi.nlm.nih.gov/27032915/

2016 (Australia)

Rugby headgear and concussion prevention: misconceptions could increase aggressive play

RESULTS A total of 122 players responded. All players were male. The average player was 19.5 years old and had 2.7 years of experience. Twenty-three of 122 players (18.9%) wore protective headgear; 55.4% of players listed forward as their primary position. Overall, 45.8% (55/120) of players played 70-80 minutes per game, 44.6% (54/121) played football or wrestled in high school, 38.1% (45/118) believed headgear prevented concussions, and 42.2% (51/121) stated that if they were using headgear they would be more aggressive with their play in terms of running or tackling. Regression analysis illustrated that those who believed headgear prevented concussions were or would be more likely to engage in aggressive play.


https://pubmed.ncbi.nlm.nih.gov/29081983/

2017 (UK)

Rugby headgear and concussion prevention: misconceptions could increase aggressive play

Results: 37% of players believed that headgear was effective in preventing head injuries. Playing group was found to be inversely associated with headgear effectiveness (∆R2 =0.01, B=-0.13, p=0.02), with youth players holding stronger beliefs that headgear is effective at preventing head injuries compared with all senior groups. The main reasons cited for wearing headgear related to protection from minor injuries (55%) with only 10% of responses related to concussion prevention.


Beyond that, anecdotally, every time I have this conversation at a rugby club it comes as a surprise to people - including some coaches. I brought it up again here as a post on the Bath FB page about Underhill's concussion brought up 3 suggestions that he wear a scrum cap, out of 20 comments; 1 of whom remained adamant in the face of both an attempt to reason, and a showing of evidence.
Instinctively, that feels about right for my personal experience, and broadly correlates with the 10% found in the second study above.

In this thread, we've got an article about Caelan Doris (and other professionals) loving their scrum caps, and being convinced that they protect against concussion.

If you're talking about the professional game, all kinds of jobs have mandatory safety kit to combat known risks. This would just be another one of those. Maybe a different story at lower levels.

When helmets became compulsory in bike racing 20 years ago there was a 10 minute kerfuffle among riders, but they were rapidly accepted and no-one has batted an eyelid at them for years. Slightly different, granted, in that those are aimed more at mitigating immediate trauma - riders were literally dying on the road - than cumulative build up.

But there still seems to be a fair way to go before any product can definitively said to offer protection against concussion.
Fair, very fair.
 

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