OCTOBER 2024

IMG protocols

We are now well into the global rollout of Instrumented Mouth Guards (IMG) as part of the HIA protocol, with the URC and PRL coming on board with the change in the last two weeks.  This innovation is allowing us to produce one of the most valuable data resources in global sport, and we have now collected data from over 150,000 head acceleration events in men’s and women’s rugby.

It is fair to say that there have been some technical challenges with the addition of IMG alerts to screen.  Early on, these necessitated a slight modification in the HIA Protocol, where we allowed the first screen after a significant head acceleration event to be delayed to either half-time or after the match.  This was a result of confusion that was being caused by delays in transmitting the IMG alert to the Match Day Doctor. 

This was never intended to be a permanent change, however.  We recognize and value that the sooner a player is assessed by a doctor after significant head impact, the better, and so the intention was always to return to the normal protocol, which removes the player immediately for the off-field screen.  To achieve that, we worked closely with Prevent to develop technology that boosts the signal from the mouthguard, so that it reaches the MDD’s iPad almost instantly.

Once we were confident that delays had all but been eliminated, we reverted back to the original HIA protocol, which means that players who reach the IMG threshold are now being removed as soon as the MDD receives the alert, and screened using the off-field screen (or removed as Criteria 1 cases if the situation warrants it).

Figure 1 below summarizes the IMG data we have from two competitions – Men’s Six Nations and Super Rugby.  When we announced the introduction of IMG alerts as a criteria to remove players for an Off-Field Screen, we based our initial thresholds on a dataset of approximately 55,000 Head Acceleration Events (HAEs) in men and 20,000 HAEs in women.  These two competitions alone, in the first six months of 2024, have produced almost 94,000 HAEs in men and another 11,000 HAEs in women.  By the end of the recently-begun European competitions, we anticipate 300,000 additional HAEs!

Reflecting on these numbers, we have achieved our objective of identifying the most significant head acceleration events without causing unnecessary disruption – in the 99 matches of Six Nations and the Super Rugby regular season, we recorded 66 IMG alerts – two every three matches.  These alerts have come from an average of 34 players per match in Six Nations and 31 players per match in Super Rugby wearing the IMG, who have combined to produce an average of 1,058 and 927 HAEs per match, respectively. That means our “hit rate” is 1 IMG alert every 1421 HAEs, which is a little less frequent than the one per match and 1 in 1000 HAEs we were targeting.

Setting the thresholds to remove players was no easy task – had they been too low, players would have been removed more frequently, with the potential for false removals causing frustration, ultimately leading players and coaches to reject the intervention.  Setting them too high would mean too few players with significant head accelerations are placed into our medical screening process.  The early indications are that we are close to achieving the necessary balance.

Despite the positive high-level picture, we are working at improving the utility of the IMG.  We are involved in a number of collaborations with academic partners, who are exploring whether different metrics from the IMG, as well as different ways to put them together to create removal thresholds, can identify more cases of players who should be assessed by medical staff.

Player load management

Another topic related to player welfare that has been in the news recently is player load.  At the Shape of the Game meeting earlier this year, an expert group dedicated to understanding player load, and then to developing recommendations to Member Unions and competitions, was formed.  Early on, this group identified a need for better tools with which to track player load.  That is, do we simply count match appearances or minutes, or can we introduce greater detail that tracks a player’s contact load and match involvements?  Can we identify relationships between these load elements and injury risk?  Are Test-level players exposed to significantly more load either side of and during international windows?  How does load over a season differ in a foreign vs local player in the elite club competitions?

To allow us to ask and answer questions like this, we have been working with our Game Systems and Data Scientist teams to develop a comprehensive database that will allow us to ask and answer these types of questions.  The process has been complex, with multiple data sources being identified, and the expert group guiding the identification of the key metrics that need to be incorporated.  We have now reached the stage where the database has been created, and the next phase is the optimization of various tools that allow comparisons between tournaments, Unions and players.  These tools will be provided to the Expert Player Load Group to enhance their discussions with the ultimate intention of delivering robust, evidence-based recommendations to the global game, and then to continue to use the Load databases to report on the global situation.

Annual Medical Conference

Our Annual Medical Commission Conference happens in October this year, and we are heading to Lisbon, Portugal, where we will welcome Chief Medical Officers, Researchers and members of our various working groups for a three day event. 

We also, as has become traditional, host our meeting alongside the Rugby Science Network (RSN) meeting, which this year covers broad themes of player health and wellbeing, research in the women’s game, and has a session dedicated to the tackle, which will include the first ever sharing of data from the global trials lowering the legal tackle height in community rugby.

The Medical Commission Conference, as always, kicks off with Updates from the various World Rugby Working groups, and then has sessions dedicated to the IMG use in the game and potential innovations that may improve our management of head impacts.  We are particularly excited by our guest speaker line-up this year, which includes collaborators from the NFL, FIFA, IOC and various Member Unions.  You can find the programme and register HERE

Thank you for reading.

Prof Éanna Falvey