The British & Irish Lions tour to Australia will be remembered as much for Garry Ringrose’s admirable admission that he had concussion symptoms before pulling himself out of the second Test as for the actual outcome of the series.
Now the spotlight turns to the women’s game ahead of the Rugby World Cup in England, with research in recent years showing that female athletes respond differently to concussions than their male counterparts.
A study in 2021 carried out by Tracey Covassin, a professor at Michigan State University, showed that female athletes are twice as likely to suffer a concussion in football, while also experiencing differing symptoms — prolonged headaches, mental fatigue and poor concentration. Recovery times on average for female adolescents competing in sports including football and American football were also longer at 76 days than for male adolescents, who took 50 days.
One reason behind female athletes potentially being more susceptible to concussions comes down to neck strength, according to Dr Marshall Garrett, Honorary Senior Lecturer at University of Glasgow Medical School.
“If you actually look at the ratio of neck muscle bulk to head and neck mass, women have a much poorer ratio of neck muscle bulk, and you can conflate that into less muscle strength,” Garrett said.
“If women have poorer neck strength and poorer neck resilience they are more likely to have greater head and neck acceleration for a set impact [leading to a concussion].”
Still raw is the memory of former international Siobhan Cattigan, who suffered two concussions on Scotland duty. Her family said undetected rugby-related brain damage caused her tragic death in November 2021.
Improving awareness of the long-term risks from concussions remains paramount. A study by The Physician and Sportsmedicine journal last year found that out of 230 female rugby players across the Premiership, Championship, British Universities & Colleges Sport and club level, 41% admitted to deliberately failing to report a suspected rugby concussion.
The same study found that the prevalence of concussion did not differ by position or playing level.
Garrett in addition has called for the mandatory stand-down period after a concussion at the elite level of the sport to be extended from 12 days back to the original 28-day period. The current stand-down period at grassroots level is 21 days.
“We have a 12-day return to play for elites because they’re being monitored by elite doctors,” Garrett said. “I’ve been in the game for 40-something years, and I can’t tell you precisely how badly your brain is damaged, because it’s microscopic. There is no clinical basis on which that [12-day period] was chosen, you know? It’s an arbitrary figure. The longer [recovery], the better.”
The Observer can reveal that 19 female players from rugby union and rugby league are part of 1,200 athletes involved in a class-action lawsuit against sports authorities, seeking damages and claiming that the governing bodies were negligent in failing to protect them from serious brain injuries. That contingent includes the former England prop Teresa O’Reilly, Wales international Non Evans and Canada’s Meghan Mutrie.
Research into the effects of concussion on female rugby players is belatedly increasing, with the use of smart mouthguards monitoring head impacts along with the trial of a saliva test to diagnose concussion. World Rugby’s latest call for funding applications also included a request for women’s specific research. The biggest Rugby World Cup in the history of the women’s game will lead to more attention on the sport and head injuries than ever before.
“Be overly cautious with a brain and you’ll never regret it,” Garrett said. “All you will regret is not being cautious enough.”
“I had a seizure on the pitch – I get migraines now that I never used to”
Former England rugby wing Kat Merchant’s career was punctuated by concussions – here she reveals the concerns that she had during that time
Officially I had 11 concussions in my career but, to be honest, I probably had more than that when you realise what a concussion actually is. At the time I didn’t even really know, and some would definitely have been missed.
I was fully knocked out maybe five times and the symptoms each time became worse. The first time I was sick that night, I went to A&E and was cleared, then the next day I was absolutely fine.
The concussions were spaced out over my career, which is why I am not too concerned. Concussions in quick succession are a lot more dangerous for you.
The last one I experienced led to four months of just not feeling normal. Lights were too bright, noises were too loud in my head. It made me want to sit alone in the dark and not interact with anyone because you were scared of making it worse. You are told to try to relax, but you can’t read because it makes the headache worse.
I felt like I was constantly on a ferry, as if you are moving around but you’re not. It was horrible. When you reach that point at four months you start to think: “Am I ever going to feel normal again?”
You want to get back to playing and you don’t know if you will, which builds up anxiety, especially in 2014 when I was worried about making the Rugby World Cup with the England team.
From the studies I have seen, women are more likely to have a concussion, and unfortunately after you have one, you are then three times more likely to have another. It spirals. People will either have never had a concussion, or had five.
With the last concussion I actually had a seizure on the pitch, which was pretty scary for people. That one really changed how people viewed me. They were genuinely looking at me and asking: “Why are you coming back?”
When I completely detached my elbow — my arm was the wrong way round — everyone asked when I was coming back, whereas the seizure made people ask: “Should you be playing again?” When your own team-mates are asking that, then it becomes pretty serious.
I never used to get migraines but I do since the concussions. I had one a month ago and it was horrible. General life is fine. I’ve had two check-ups since where they have done MRIs and memory checks and I’m where you would expect someone my age to be.
Fortunately they have not found anything significant.
Photograph by PA Images/Alamy