I have served as a team physician for USA Rugby since 2013, traveling once or twice a year with the team during their tours domestically and internationally for test match competition. I view each tour as an opportunity to learn about how an international governing body in sports and a national team care for their athletes. This tour to Japan for the 2024 Pacific Nations Cup was no exception. The tournament participants included The Pacific Island Nations of Tonga, Samoa, and Fiji, in addition to Japan, Canada, and the United States. The US team was led by visionary coach Scott Lawrence and a team of experts in their fields, including assistant coaches with national team coaching and playing experience for Samoa and the famed New Zealand All Blacks, as well as a strength and conditioning team with past professional and national team care, including for the Pumas of Argentina. This wealth of experience, coupled with World Rugby’s continued focus on player welfare, provided innumerable opportunities to learn and gain experience to bring back to my local community of athletes, but I took away a few key pearls.
Instrumented Mouth Guards
I had already recognized World Rugby as an organization at the forefront of player welfare, particularly in the prevention, recognition, and treatment of concussions. For many years, World Rugby has instituted a state-of-the-art approach to concussion management called Head Injury Assessment. In this system, all athletes complete validated baseline testing of symptoms consistent with concussion, and of immediate and delayed recall, concentration, and balance. Matches are monitored carefully using multi-angle video analysis by an experienced, independent Match Day Doctor (MDD). The MDD, referees, team doctor, or physiotherapist can call for an in-game Head Injury Assessment. With this system, the team is given 12 minutes to allow for careful evaluation without losing a substitution. In-game testing is compared to baseline data to determine whether the athlete should be removed from play. Similar testing is repeated after the match and two days later to assist in the recognition of persistent or late-onset signs and symptoms consistent with concussion. It is a thoughtful, deliberate, evidence-based approach that provides team medical staff with the tools necessary to protect their athletes from the consequences of unrecognized concussions. However, this recognition can still be a challenge during a rugby match. Therefore, World Rugby recently introduced instrumented mouthguards. These mouthguards have sensors to measure the head’s linear and angular kinematics, such as acceleration and velocity. Any measurement that registers above a certain threshold during training or competition would trigger a head injury assessment. This technology now serves as an invaluable supplement to direct observation and video analysis.
