Article Text

Download PDFPDF

Tackling sport-related concussion: effectiveness of lowering the maximum legal height of the tackle in amateur male rugby – a cross-sectional analytical study
  1. Riaan van Tonder1,2,
  2. Lindsay Starling3,
  3. Sean Surmon4,
  4. Pierre Viviers1,5,
  5. Wilbur Kraak6,
  6. Pieter-Henk Boer7,
  7. Esme Jordaan8,9,
  8. Sharief Hendricks10,11,
  9. Keith A Stokes3,12,
  10. Wayne Derman1,2,
  11. James Craig Brown1,2
  1. 1Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  2. 2IOC Research Centre, Cape Town, South Africa
  3. 3Department for Health, University of Bath, Bath, UK
  4. 4Maties Sport, Stellenbosch University, Stellenbosch, South Africa
  5. 5Campus Health Service, Stellenbosch University, Stellenbosch, South Africa
  6. 6Division of Sport Science, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
  7. 7Department of Human Movement Science, Cape Peninsula University of Technology, Wellington, South Africa
  8. 8Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
  9. 9Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
  10. 10Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  11. 11Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
  12. 12Medical Services, Rugby Football Union, London, UK
  1. Correspondence to Dr Riaan van Tonder, Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; riaanvt{at}


Objective Rugby union (‘rugby’) is popular globally, with most of its participants being amateur. Concern regarding sport-related concussion (SRC) sustained during rugby is increasing. SRC occurs most frequently in the tackle, yet few interventions have aimed to mitigate this risk factor. This study investigated the influence of a lowered legal tackle height on SRC incidence in amateur rugby.

Design Cross-sectional analytical study: 2018 (control—standard tackle height) and 2019 (intervention—lowered legal tackle height) seasons.

Setting South African collegiate student rugby competition.

Participants Between 800 and 900 male amateur student players (age: 20±1.6 years) in each year.

Intervention Maximum legal tackle height lowered from line of the shoulder on the ball carrier to the line of the armpit.

Outcome measures Number of overall (medical attention) and time-loss (≥1 day lost) injuries, head injuries and SRCs in 2018 and 2019 (dependent variables); events associated with injury incidents (independent variables).

Results There was no statistically significant difference in incidences of time-loss injuries (IRR: 0.79; 95% CI: 0.6 to 1.1; p=0.13), head injuries (IRR: 0.83; 95% CI: 0.5 to 1.3; p=0.42) and SRC (IRR: 0.69; 95% CI: 0.4 to 1.2; p=0.20). In 2018 and 2019, most time-loss head injuries (57%, n=43) and SRCs (55%, n=26) occurred during the tackle.

Conclusions Despite a trend towards reducing injuries, head injuries and SRC, lowering maximum legal tackle height to armpit level did not change SRC incidence in this amateur male rugby cohort. Most time-loss head injuries and SRCs occurred during the tackle. Further tackle-related interventions to reduce SRC incidence require investigation.

  • concussion
  • traumatic brain injury
  • recreation / sports

Data availability statement

No data are available.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

No data are available.

View Full Text


  • Twitter @RiaanvanTonder1, @jamesbrown06

  • Correction notice This article has been corrected since it was first published. The open access licence has been updated to CC BY.

  • Contributors The study was designed by JCB, KAS, WD, SH, LS and RvT. Data collection was carried out by RvT, LS, JCB and PV. Data analysis was carried out by RvT, JCB, SH, P-HB, EJ and KAS. The first draft of the manuscript was prepared by RvT. All authors contributed to revisions of the manuscript and approved the submitted version. RvT acts as guarantor.

  • Funding This study was supported by funding from World Rugby and the South African Medical Research Council.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.