Head Injuries in Women’s Rugby: A Growing Concern

Picture this: your brain is like jelly in a jar. A scrum cap, that soft, padded headgear many rugby players wear, works like a fabric sleeve around the jar. It’s great for preventing scrapes and protecting the ears. But if you shake the jar, the jelly still sloshes and twists inside. That sloshing is what happens to the brain during a hard tackle, a collapsed scrum, or a chaotic ruck.

This is the reality for many rugby players, especially women, as the Women’s Rugby World Cup kicks off this August. Rugby is a sport celebrated for its grit, strategy, and camaraderie, but also one where tackles, scrums, and rucks are part of every game. Those moments bring excitement to fans, but also a significant risk to players’ head health.

And unlike a knee injury that heals with rest, head injuries can leave behind invisible, lasting damage.

Why women’s rugby deserves its own safety conversation

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Research shows that this isn't due to any lack of skill or toughness, it's biology. Women typically have less neck muscle mass relative to head size, creating what sports scientists call a "bobblehead effect." 

Additionally, hormonal fluctuations throughout the menstrual cycle can influence recovery times and symptom severity. Estrogen, while protective in many ways, can actually prolong concussion symptoms and delay return-to-play timelines. The data bears this out: what looks like similar injury rates masks a more complex reality where women face longer, more complicated recoveries.

The Risks: Tackles, Scrums, and Rucks

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In women’s rugby, tackles cause 70% of all injuries,  split between being tackled (39%) and tackling (31%). Most concussions (58%) also happen here. Tackles combine high speed, force, and unpredictability, making them the sport’s biggest danger zone.

Rucks and scrums cause fewer injuries overall but still pose concussion risks when body positions collapse or unexpected contact occurs.

The “compounding interest” problem

Concussions are not just one-and-done. Prior concussion raises the risk of another, especially in youth and young adults, so exposures can “compound”.  That’s why early recognition and honest recovery plans are so vital (PubMed).

And while the headlines often jump straight to Chronic Traumatic Encephalopathy (CTE), here’s the evidence-based middle ground: repeated head impacts (even without symptoms) are a growing concern, and CTE can only be definitively diagnosed after death. Responsible messaging matters, panic helps no one, but dismissing risk isn’t acceptable either.

But here's the hidden danger: nearly 28% of rugby players who suffer concussions don't report at least one of them. This silent epidemic means the exponential risk is often invisible to coaches, medical staff, and even the players themselves.

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Building Safer Pathways: What actually helps, and what doesn’t

Evidence-based strategies are emerging to protect players. At Power of Patients, we advocate for approaches grounded in science, not wishful thinking.

• Recognise & Remove"If in doubt, sit them out." No same-day return to play. Elite rugby's Head Injury Assessments have a 90% success rate, but most community levels lack these protocols.
  

• Lowering the TackleThe biggest breakthrough: research shows concussion risk is 4.2 times higher when the tackler's head is above the ball carrier's sternum. Trials lowering tackle height to below the sternum showed 64% fewer head-on-head contacts and 23% fewer suspected concussions. Multiple countries implemented this change in 2024.
  

• Smart TechnologyInstrumented mouthguards now alert medical staff when impacts exceed dangerous thresholds. World Rugby became the first sport to integrate these devices into concussion protocols in 2024. Scotland's George Turner was the first player removed due to a smart mouthguard alert during Six Nations.
  

• Creating an Honest CultureNearly 28% of rugby players don't report at least one concussion. Players need to understand that reporting symptoms isn't weakness, it's leadership.
  

  What Doesn't Work:
  

• Scrum caps: Protect against cuts but don't prevent concussions
  

• Playing through symptoms: Each unreported concussion increases risk exponentially
  

• One-size-fits-all approaches: Women's rugby requires gender-specific safety protocols

The role of Power of Patients: Sallie™ and IISS™

Head injuries don’t stop being a problem once a player leaves the field. Recovery is a day-to-day process, and tracking symptoms over time can be the difference between a smooth return and a setback. That’s where Power of Patients® comes in, offering two powerful tools: Sallie™ and the Impact Injury Severity Score (IISS™).

Sallie™ is an AI-powered virtual therapy dog, designed to aid individuals recovering from head injuries. The app guides users through symptom tracking, management, and rehabilitation, helping patients document their daily symptoms, identify patterns, and share these insights with caregivers and clinicians.

IISS™ goes a step further by giving a personalized, data-driven assessment of concussion severity. Built with input from neurology, sports medicine, and MIT data scientists, IISS™ combines patient-reported symptoms, cognitive testing, and physical activity monitoring into one objective score. That score supports on-field triage, guides treatment plans, and can even identify patterns that increase concussion risk, so preventive steps can be taken before the next hit.

Together, Sallie™ and IISS™ bridge the gap between sideline care and long-term brain health, empowering athletes, families, and coaches with the information they need to protect players today, and for seasons to come.