{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T20:07:14Z","timestamp":1774469234962,"version":"3.50.1"},"reference-count":21,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T00:00:00Z","timestamp":1719532800000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Sport Exerc Med"],"accepted":{"date-parts":[[2024,5,28]]},"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Tackles making contact above the sternum increase concussion and head injury assessment (HIA) risk in Rugby Union. The sport has introduced harsher sanctions to change tackler behaviours to reduce this risk. This increased high tackle sanction numbers, though it is unknown whether sanction severity is associated with injury risk.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The sanction decision made by match officials for tackles resulting in 157 HIA1 removals, of which 91 were confirmed concussions, was evaluated. The propensity of sanction types, ranging from no foul play to red card, was compared after calculating concussion and HIA1 numbers per 1000 tackles of each sanction, using total tackle number of each sanction type from one season of two elite professional competitions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>HIA1 removal and concussion risk increased as sanction severity increased. Red-carded tackles were 271.5 (95% CI 143.8 to 512.6) times more likely to result in concussions than legal tackles. Tacklers and ball carriers were more likely to experience concussions from sanctioned high tackles, with tackler risk 28.5 (95% CI 13.5 to 59.9) times higher for sanctioned high tackles compared with legal tackles, and ball carrier risk elevated 133.7-fold (95%\u2009CI 65.5 to 272.8) after sanctioned high tackles.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Sanctioned high tackles significantly increase concussion and HIA1 risk to both tacklers and ball carriers. Current decision-making frameworks that guide sanction decisions do identify tackle behaviours that elevate clinical risk. Both tacklers and ball carriers would be less likely to experience concussions and head injuries if the frequency of illegal high tackles is decreased.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsem-2024-001932","type":"journal-article","created":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T19:15:15Z","timestamp":1719602115000},"page":"e001932","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Sanctioned illegal high tackles significantly increase concussion risk to both tacklers and ball carriers in elite men\u2019s Rugby Union"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4294-4822","authenticated-orcid":false,"given":"Ross","family":"Tucker","sequence":"first","affiliation":[{"name":"Institute of Sport and Exercise Medicine, Department of Exercise, University of Stellenbosch, Stellenbosch, South Africa"},{"name":"World Rugby, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"Hester","sequence":"additional","affiliation":[{"name":"World Rugby, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3416-6266","authenticated-orcid":false,"given":"Sharief","family":"Hendricks","sequence":"additional","affiliation":[{"name":"Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport, Department of Human Biology, University of Cape Tow, Observatory, Western Cape, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7778-7783","authenticated-orcid":false,"given":"James","family":"Brown","sequence":"additional","affiliation":[{"name":"Institute of Sport and Exercise Medicine, Department of Exercise, University of Stellenbosch, Stellenbosch, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3961-1805","authenticated-orcid":false,"given":"\u00c9anna C","family":"Falvey","sequence":"additional","affiliation":[{"name":"World Rugby, Dublin, Ireland"},{"name":"Department of Medicine, University College Cork, Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,6,28]]},"reference":[{"key":"2025083109563724000_10.2.e001932.1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2023-106898"},{"key":"2025083109563724000_10.2.e001932.2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2022-106656"},{"key":"2025083109563724000_10.2.e001932.3","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-097452"},{"key":"2025083109563724000_10.2.e001932.4","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1001\/jamapediatrics.2018.5498","article-title":"Are rule changes the low-hanging fruit for concussion prevention in youth sport?","volume":"173","author":"Emery","year":"2019","journal-title":"JAMA Pediatr"},{"key":"2025083109563724000_10.2.e001932.5","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1136\/bjsports-2019-101885","article-title":"Getting tough on concussion: how welfare-driven law change may improve player safety-a Rugby Union experience","volume":"55","author":"Raftery","year":"2020","journal-title":"Br J Sports Med"},{"key":"2025083109563724000_10.2.e001932.6","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-097895"},{"key":"2025083109563724000_10.2.e001932.7","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-097912"},{"key":"2025083109563724000_10.2.e001932.8","unstructured":"World Rugby . Decision making framework for high tackles. Available: https:\/\/passport.world.rugby\/media\/0w1dhpp1\/2019-playerwelfare-hightackledecision_v2_en.pdf [Accessed 11 Jan 2024]."},{"key":"2025083109563724000_10.2.e001932.9","unstructured":"World Rugby . Head contact process. 2023. Available: https:\/\/passport.world.rugby\/media\/j5senlan\/2303-update-head_contact_process_en.pdf [Accessed 11 Jan 2024]."},{"key":"2025083109563724000_10.2.e001932.10","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-095959"},{"key":"2025083109563724000_10.2.e001932.11","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-101293"},{"key":"2025083109563724000_10.2.e001932.12","unstructured":"Kirkwood BR , Sterne J . Medical statistics (Version 2). Oxford, UK, 2003:173\u20136."},{"key":"2025083109563724000_10.2.e001932.13","unstructured":"Finch CF , Hayden A . Sports injury research. In: Verhagen E , Van Mechelen W , eds. Statistics used in effect studies. Oxford Publishers: London, 2010: 187\u20138."},{"key":"2025083109563724000_10.2.e001932.14","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-097883"},{"key":"2025083109563724000_10.2.e001932.15","doi-asserted-by":"crossref","DOI":"10.3389\/fspor.2023.1080356","article-title":"A case-control study of tackle based head impact event (HIE) risk factors from the first three seasons of the National Rugby League women\u2019s competition","volume":"5","author":"McLeod","year":"2023","journal-title":"Front Sports Act Living"},{"key":"2025083109563724000_10.2.e001932.16","doi-asserted-by":"crossref","DOI":"10.1186\/s40798-021-00377-9","article-title":"A case\u2013control study of tackle-based head injury assessment (HIA) risk factors in the National Rugby League","volume":"7","author":"Gardner","year":"2021","journal-title":"Sports Med Open"},{"key":"2025083109563724000_10.2.e001932.17","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-101557"},{"key":"2025083109563724000_10.2.e001932.18","doi-asserted-by":"publisher","DOI":"10.1136\/ip-2022-044714"},{"key":"2025083109563724000_10.2.e001932.19","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jsams.2023.10.011","article-title":"Tackling the tackle 1: a descriptive analysis of 14,679 tackles and risk factors for high tackles in a community-level male amateur Rugby Union competition during a lowered tackle height law variation trial","volume":"27","author":"van Tonder","year":"2024","journal-title":"J Sci Med Sport"},{"key":"2025083109563724000_10.2.e001932.20","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1519\/SSC.0000000000000400","article-title":"Technical skill training framework and skill load measurements for the Rugby Union tackle","volume":"40","author":"Hendricks","year":"2018","journal-title":"Strength & Conditioning Journal"},{"key":"2025083109563724000_10.2.e001932.21","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2023-107020"}],"container-title":["BMJ Open Sport &amp; Exercise Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsem-2024-001932","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T16:56:43Z","timestamp":1756659403000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopensem.bmj.com\/lookup\/doi\/10.1136\/bmjsem-2024-001932"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6]]},"references-count":21,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,6,28]]},"published-print":{"date-parts":[[2024,6]]}},"alternative-id":["10.1136\/bmjsem-2024-001932"],"URL":"https:\/\/doi.org\/10.1136\/bmjsem-2024-001932","relation":{},"ISSN":["2055-7647"],"issn-type":[{"value":"2055-7647","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6]]}}}