Rugby Union has attracted increased scrutiny because of concerns over head acceleration events (HAEs), particularly regarding their frequency, severity and potential long-term health implications. While substantial efforts by governing bodies have focused on reducing head impact risks through education, regulatory changes and the introduction of instrumented mouthguards, limited data exist for the community rugby context, especially across different age grades and playing positions. We aimed to quantify HAE across playing positions, age grades and contact phases in community rugby and to identify match scenarios associated with high-magnitude head loading. A prospective observational cohort study included 259 male players across U13, U15, U19, and Premier senior men’s grades. Players were fitted with instrumented mouthguards, and match play was video recorded for verification. Head acceleration events were identified from instrumented mouthguard-triggered sensor acceleration events > 5 g and coded for match context, player position and contact event characteristics. Statistical models evaluated differences in HAE frequency, incidence rates and head kinematics (peak linear acceleration, peak angular acceleration, rotational velocity change index) across grades, positions and contact scenarios. A total of 7358 HAEs were verified from 8593 sensor acceleration events across 72 matches. Tackles and rucks accounted for 60

This study simulated the effect of reducing contact training duration on overall in-season head acceleration event (HAE) exposure within men’s and women’s rugby union. Players (n = 982) from two professional men’s and two semi-professional women’s competitions wore instrumented mouthguards in training and match-play for one season. Generalised linear mixed models were used to estimate the in-season weekly HAE exposures per position, sex and contact type. Simulation of modelled estimates evaluated the impact of reducing contact load guidelines by 25

Objectives: The EyeGuide Focus system is a simple, portable, test of visual tracking with potential use for concussion screening. This study investigated the repeatability, reproducibility, distribution, and modifiers of EyeGuide Focus measurements in healthy elite Rugby players. Design: Cross sectional repeated measures study and controlled pre-test post-test sub-study. Methods: EyeGuide Focus testing was performed in a medical room at rest. Test-retest repeatability (within-subject standard deviation (Sw), coefficient of variation (CV), repeatability coefficient (RC)) and reliability intra-class correlation coefficient (ICC A,1) of 3 test results were evaluated. The distribution of best score across replicates was then examined using summary statistics, and the influence of subject characteristics investigated. A controlled pre-test post-test sub-study examined the effect of exercise on best EyeGuide Focus score using an analysis of covariance (ANCOVA). Results: A total of 769 elite male Rugby players underwent EyeGuide Focus testing. Repeated test scores demonstrated positively skewed distributions. Test-retest repeatability (Sw 1.46, CV 46.0 %, RC 2.85, natural log transformed data) and reliability (ICC 0.41, natural log transformed data) were low. The distribution of best EyeGuide Focus score was unaffected by previous concussion, eye conditions, or age. No learning or exercise effects were apparent in the controlled pre-test post-test sub-study (ANCOVA, n = 89, p = 0.69). Conclusions: EyeGuide Focus test-retest repeatability and reliability were low and could limit diagnostic accuracy. Best test score achieved across repeated measurements is a possible metric for operationalisation and future research is required to determine if this differs in patients with concussion compared to normal subjects. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of Sports Medicine Australia. This is an open access article under the CC BY license(http://creativecommons.org/licenses/by/4.0/).

In elite rugby union, suspected concussions lead to immediate removal from play for either permanent exclusion or a temporary 12-min assessment as part of the Head Injury Assessment 1 (HIA1) protocol. The study aims to retrospectively identify a head acceleration event (HAE) severity measure associated with HIA1 removals in elite rugby union using instrumented mouthguards (iMGs). HAEs were recorded from 215 men and 325 women, with 30 and 28 HIA1 removals from men and women, respectively. Logistical regression was calculated to identify whether peak power, maximum principal strain (MPS) and/or the Head Acceleration Response Metric (HARM) were associated with HIA1 events compared to non-cases. Optimal threshold values were determined using the Youden Index. Area under the curve (AUC) was compared using a paired-sample approach. Significant differences were set at p < 0.05. All three severity measures (peak power, HARM, MPS) were associated with HIA1 removals in both the men’s and women’s game. Peak power performed most consistent of the three severity measures for HIA1 removals based on paired-sample AUC comparisons in the men’s and women’s games. The HARM and MPS were found to perform lower than peak linear acceleration in the women’s game based on AUC comparisons (p = 0.006 and 0.001, respectively), with MPS performing lower than peak angular acceleration (p = 0.001). Peak power, a measure based on fundamental mechanics and commonly communicated in sports performance, was the most effective metric associated with HIA1 removals in elite rugby. The study bridges the gap by identifying a consistent HAE severity measure applicable across sexes.

This study aimed to quantify the frequency of individual and team contact events during rugby union match play in top domestic and international men's and women's competitions. Analyst-coded player individual and team contact event types (tackles, carries, attacking rucks and defensive rucks, lineouts, scrums and mauls) from the 2022/2023 rugby union season were analysed from top domestic and international competitions across the world using generalised linear mixed models. For both women's and men's rugby, competitions generally had similar numbers of contact events per playing position. Where differences were observed, most ranged between 0.5 and six per contact event per full game equivalent (FGE). Similar trends were observed when comparing women's to men's rugby. However, within-game accumulation of these different contact events for certain positional groups may have a significant impact (e.g., a front five player called up from a Farah Palmer Cup team to play in WXV1 could be involved in as much as 6 more attacking rucks, 3 more tackles and 5 more mauls per game on average). Furthermore, the small differences between competitions per FGE may accrue across matches and thus result in far greater exposures across a season (e.g., a front five player in Premiership Rugby may make 48 more tackles over 20 matches than in Top 14 on average). Although a high proportion of contact events per FGE were similar between competitions and sexes per playing position, differences that were observed may have important implications for players transitioning between competitions and the long-term exposure of players to higher-risk contact events.

This study aimed to quantify contact-events and associated head acceleration event (HAE) probabilities in semi-elite women's rugby union. Instrumented mouthguards (iMGs) were worn by players competing in the 2023 Farah Palmer Cup season (13 teams, 217 players) during 441 player-matches. Maximum peak linear acceleration (PLA) and peak angular acceleration (PAA) per-event were used as estimates of in vivo HAE (HAEmax), linked to video analysis-derived contact-events and analysed using mixed-effects regression. Back-rows had the highest number of contact-events per full-match (44.1 [41.2 to 47.1]). No differences were apparent between front-five and centres, or between half-backs and outside-backs. The probability of higher HAEmax occurring was greatest in ball-carries, followed by tackles, defensive rucks and attacking rucks. Probability profiles were similar between positions but the difference in contact-events for each position influenced HAEmax exposure. Overall, most HAEmax were relatively low. For example, the probability of a back-row experiencing a PLA HAEmax ≥25g was 0.045 (0.037-0.054) for ball carries (1 in every 22 carries), translating to 1 in every 2.3 full games. This study presents the first in-depth analysis of contact-events and associated HAEmax in semi-elite women's rugby union. The HAEmax profiles during contact-events can help inform both policy and research into injury mitigation strategies.

ABSTRACT This study aimed to quantify and compare mean head acceleration event (HAE) incidence within and between men's and women's rugby union competitions; quantify the incidence of HAEs during all contact‐events and describe individual player incidence. Players competing during the 2022/2023 season in women's (337 players; Premiership Women's Rugby, Farah Palmer Cup) and men's (371 players; Premiership Rugby, Currie Cup and Super Rugby) competitions wore instrumented mouthguards (iMGs). Mean HAE incidences using peak linear (PLA) and peak angular acceleration (PAA) were quantified by sex, positional groups and individual players per competition and for contact‐events across a range of magnitude thresholds. Within positional groups, there was high between‐player variability, with some players experiencing up to a 3‐fold greater mean HAE incidence than their positional average. Per full‐game equivalent (FGE), men had significantly higher HAE incidences in most positional groups and HAE magnitude thresholds compared to women ranging from approximately 0.11–3.44 HAEs per FGE. Incidence of HAEs (PLA > 25 g) per FGE was lowest in scrums (0.00–0.04/FGE) and highest for tackles and ball carries (0.21–1.97/FGE) in both women and men, whereas mauling was a frequent source of HAEs for men's back row (0.95/FGE). No significant differences were observed between competitions for most positional groups and HAE magnitude thresholds in both men and women. Per FGE, HAE incidences were similar within, but significant differences were apparent between men's and women's players. The scrum had the lowest HAE incidence of all contact‐events. Individual players can show large variation from the mean, emphasising the importance of HAE mitigation strategies that include individual player monitoring and management processes.

Head acceleration events (HAEs) are an increasing concern in collision sports owing to potential negative health outcomes. The objective of this study is to describe the probabilities of HAEs in tackles of differing heights and body positions in elite men’s and women’s rugby union. Instrumented mouthguards (iMGs) were worn in men’s (n = 24 teams, 508 players, 782 observations) and women’s (n = 26 teams, 350 players, 1080 observations) rugby union matches. Tackle height (i.e. point of contact on ball-carrier) and body positions of tacklers and ball-carriers were labelled for all tackles in which a player wore an iMG. HAEs from the initial impact were identified. Mean player, tackler and ball-carrier exceedance probabilities for various peak linear and angular acceleration thresholds were estimated from ordinal mixed-effects models. Contact with ball-carriers’ head/neck resulted in the highest mean HAE probabilities for both sexes. The probability of an HAE to the ball-carrier decreased as tackle height lowered. The highest probability for the tackler was initial contact to the ball-carriers upper leg. Body position influenced the probability of HAEs, with falling/diving ball-carriers resulting in higher mean probabilities. When a player, regardless of role, was bent-at-waist, elevated HAE probabilities were observed in men’s competitions. Women’s data demonstrated similar probabilities of an HAE for all body positions. Initial contact to the ball-carrier’s head/neck had the highest chance of an HAE, whilst role-specific differences are apparent for different tackle heights and body positions. Future player-welfare strategies targeting contact events should therefore consider HAE mechanisms along with current literature.

Head acceleration events (HAEs) are a growing concern in contact sports, prompting two rugby governing bodies to mandate instrumented mouthguards (iMGs). This has resulted in an influx of data imposing financial and time constraints. This study presents two computational methods that leverage a dataset of video-coded match events: cross-correlation synchronisation aligns iMG data to a video recording, by providing playback timestamps for each HAE, enabling analysts to locate them in video footage; and post-synchronisation event matching identifies the coded match event (e.g. tackles and ball carries) from a video analysis dataset for each HAE, this process is important for calculating the probability of match events resulting in HAEs. Given the professional context of iMGs in rugby, utilising commercial sources of coded match event datasets may expedite iMG analysis. Accuracy and validity of the methods were assessed via video verification during 60 rugby matches. The accuracy of cross-correlation synchronisation was determined by calculating synchronisation error, whilst the validity of post-synchronisation event matching was evaluated using diagnostic accuracy measures (e.g. positive predictive value [PPV] and sensitivity). Cross-correlation synchronisation yielded mean synchronisation errors of 0.61–0.71 s, with all matches synchronised within 3 s’ error. Post-synchronisation event matching achieved PPVs of 0.90–0.95 and sensitivity of 0.99–1.00 for identifying correct match events for SAEs. Both methods achieved high accuracy and validity with the data sources used in this study. Implementation depends on the availability of a dataset of video-coded match events; however, integrating commercially available video-coded datasets offers the potential to expedite iMG analysis, improve feedback timeliness, and augment research analysis.

IntroductionSmooth pursuit eye movements may be affected by head impacts. The EyeGuide Focus system is a simple, portable, test of visual tracking. This study investigated the diagnostic accuracy of EyeGuide measurements for detection of concussion during elite Rugby matches.MethodsA prospective diagnostic case-control study was performed in the elite 2021/2022 United Rugby Championship competition. The study population comprised consecutive players identified with match-related head impact events during the World Rugby Head Injury Assessment process, randomly chosen uninjured players, and players with match-related musculoskeletal injuries. The index test was blinded EyeGuide assessment performed by independent assessors. The reference standard was concussion diagnosed by the team doctor. Distributions of EyeGuide scores were compared between concussed and non-concussed players and receiver operator characteristic curves constructed.ResultsEyeGuide testing was performed in 262 cases, comprising 55 concussed players and 207 non concussed players (33 head impact events, 97 uninjured controls, and 79 musculoskeletal injury controls). The distributions of EyeGuide score were similar between concussed and non-concussed cases (medians 20,120 Vs 21,522, p = 0.3; difference -1,402, 95% CI -5,332-3,865). The c-index for the receiver operating characteristic curve was 0.46 (95% CI 0.36-0.55).ConclusionsEyeGuide Focus scores did not appear to discriminate between concussed and non-concussed players in a cohort of elite Rugby players.

OBJECTIVES:To describe tackle characteristics associated with increased risk of Head Injury Assessment (HIA) removals in elite women's Rugby Union. DESIGN:Case-control study. METHODS:145 instances of player removal for head injury assessments with video footage were identified in elite women's rugby. 114 cases occurred during tackles, which were analyzed to describe the influence of foul play, tackle type, tackle height, head contact location, and body position on injury risk. The relative proportion of tackles resulting in head injury removals was compared to the proportion of each tackle characteristic in a control cohort of 1763 tackles that did not result in head injuries to assess risk of each characteristic. RESULTS:Proximity of the tackler's head with the ball carrier's head and shoulder occurred in 72.1 % of HIA1-inducing tackles, compared to 25.0 % of non-HIA1 tackles. Head and shoulder contact was 9.79 (95 % CI 5.95-16.90) times more likely to cause HIA removals than head-to-torso contact and proximity. Upright tackles and active shoulder tackles had increased HIA1 risk for both players. Illegal tackles were 21.42 (95 % CI 11.49-39.93) more likely to cause HIA1s than legal tackles. CONCLUSIONS:Risk factors for head injury removals from tackles are similar in women as has been described in men, with higher contact, upright tacklers, dominant tackles and foul play increasing head injury risk. Strategies to lower tackle height and reduce the prevalence of head-to-head and shoulder contact should be explored to reduce head injury incidence in the elite women's game.

ObjectivesConcussion is a common injury in rugby union ('rugby') and yet its diagnosis is reliant on clinical judgment. Oculomotor testing could provide an objective measure to assist with concussion diagnosis. NeuroFlex (R) evaluates oculomotor function using a virtual-reality headset. This study examined differences in NeuroFlex (R) performance in clinician-diagnosed concussed and not concussed elite male rugby players over three seasons.MethodsNeuroFlex (R) testing was completed alongside 140 head injury assessments (HIAs) in 122 players. The HIA is used for suspected concussion events. Of these 140 HIAs, 100 were eventually diagnosed as concussed, 38 were not concussed (2 were unclear) Eight of the 61 NeuroFlex (R) metrics were analysed as they were comparable at all time points. These eight metrics, from three oculomotor domains (vestibulo-ocular reflex, smooth pursuit and saccades), were tested for their ability to distinguish between concussed and not concussed players using mean difference / odds ratios and corresponding 95% confidence intervals (CI's). General and generalised linear mixed models, accounting for baseline test performance, were used to determine any meaningful differences in concussed and not concussed players. The diagnostic accuracy of these differences was provided by the area under the receiver operating curve (AUC).ResultsOnly one of the eight metrics (number of saccades, smooth pursuit domain) had clear differences in performance between concussed and not concussed players at the HIA during the match (odds ratio: 0.76, 95%CI: 0.54-0.98) and after 48 hours (0.74, 95%CI: 0.52-0.96). However, the direction of this difference was contrary to clinical expectations (concussed performed better than not concussed) and the AUC for this outcome was also poor (0.52).ConclusionNeuroFlex (R) was unable to distinguish between concussed and not concussed players in this elite male cohort. Future research could study other cohorts, later time points before return to play, and the tool's role in rehabilitation.

The rapid growth of women's rugby union has underscored the need for female-specific player welfare protocols, particularly regarding the risk of head injuries. Instrumented mouthguards (iMGs) play a vital role in gathering comprehensive data on head acceleration events (HAEs), including their frequency, magnitude, and spatial distribution during games and training. By doing so, iMGs offer valuable context for circumstances in women's matches that may increase player risk. The study aimed to contextualize HAEs in female community rugby players using instrumented mouthguards and video review. This prospective, observational cohort study involved 332 female rugby players across 38 matches and 80 training sessions during the 2021/2022 seasons. Players were representative of four playing grades: U13 (N = 9), U15 (N = 111), U19 (N = 95) and Premier women (N = 115). HAEs were recorded using boil-and-bite iMGs, with a single-axis recording threshold of 5 g. The incidence and prevalence of HAEs was expressed by grade, years of experience, playing positions, and session types (match or training). The effect of playing grade and previous playing experience on HAE propensity during tackles and rucks was also examined. Throughout the study, 9151 iMG events over 5 g were recorded, with 80

Objective To evaluate acute changes in measures of (1) Symptom Severity Score (2) Cervical spine strength (3) and Buffalo Concussion Treadmill Test (BCTT) following concussion and throughout recovery. Design Prospective cohort study Setting Primary Care Centre, Dublin, Ireland Participants 135 male Senior Cup schoolboy rugby union players [16.7(±0.8)] from 5 schools. Interventions (or Assessment of Risk Factors) N/A Outcome Measures Participants completed the Sport Concussion Assessment Tool (SCAT3), cervical spine maximal strength testing (Newtons/kilogram) and BCTT at pre-season, acutely following concussion and weekly to the time of medical clearance to return to rugby. Main Results Of the 135 participants included in this study, 16 were diagnosed with a sport-related concussion (defined as per the consensus on concussion in sport) [Incidence rate= 11.85/100 players/season (95% CI; 6.9, 18.5)]. SCAT3 symptom severity scores increased from baseline to week one post-concussion by a median of 11.00 (95%CI; 7.0,30.5)(z=3.184,p=.001, n=14). Post injury to symptom burden scores decreased a median of 16.0 (95%CI;-46.0, -6.0)(z=2.81,p= <.005, n=11) points. The median change in composite neck strength score (n/kg) from baseline to post-concussion was -1.08n/kg (95%CI;-1.89, -0.54)(z=2.79, p=.005, n=14); and post-concussion to recovery increased a median of 1.79n/kg, 95%CI (-0.13,2.27)(z=2.31, p=.021, n=9). BCTT MAX HR from baseline to post-concussion decreased a median of 40.0bpm (95%CI; -72.0, -9.0)(z=-3.08, p=.002, n=14) and from post-concussion to recovery increased a median of 40.0bmp (95%CI; 23.0,91)(z+2.52, p=.012, n=8). Conclusions Symptom burden, cervical spine strength and BCTT outcomes all worsened following concussion and improved from initial post injury scores to the time of clearance.

The aim of this study was to compare the incidence, severity, and burden of injury in starting and replacement players from professional men’s teams of five rugby unions. Match injuries of greater than 24 h time-loss (including data on the severity, match quarter, event, body region) and player minutes of match exposure data were collated for all starting and replacement players in the men’s English Premiership, Welsh Pro14 (both 2016/17–2018/19 seasons), and Australian, New Zealand, and South African Super Rugby (all 2016–2018 seasons) teams. Injury incidences and mean injury burden (incidence × days missed) were calculated, and rate ratios (RRs) (95

OBJECTIVES:Describe head acceleration events (HAEs) experienced by professional male rugby union players during tackle, ball-carry, and ruck events using instrumented mouthguards (iMGs). DESIGN:Prospective observational cohort. METHODS:Players competing in the 2023 Currie Cup (141 players) and Super Rugby (66 players) seasons wore iMGs. The iMG-recorded peak linear acceleration (PLA) and peak angular acceleration (PAA) were used as in vivo HAE approximations and linked to contact-event data captured using video analysis. Using the maximum PLA and PAA per contact event (HAEmax), ordinal mixed-effects regression models estimated the probabilities of HAEmax magnitude ranges occurring, while accounting for the multilevel data structure. RESULTS:As HAEmax magnitude increased the probability of occurrence decreased. The probability of a HAEmax ≥15g was 0.461 (0.435-0.488) (approximately 1 in every 2) and ≥45g was 0.031 (0.025-0.037) (1 in every 32) during ball carries. The probability of a HAEmax >15g was 0.381 (0.360-0.404) (1 in every 3) and >45g 0.019 (0.015-0.023) (1 in every 53) during tackles. The probability of higher magnitude HAEmax occurring was greatest during ball carries, followed by tackles, defensive rucks and attacking rucks, with some ruck types having similar profiles to tackles and ball carries. No clear differences between positions were observed. CONCLUSION:Higher magnitude HAEmax were relatively infrequent in professional men's rugby union players. Contact events appear different, but no differences were found between positions. The occurrence of HAEmax was associated with roles players performed within contact events, not their actual playing position. Defending rucks may warrant greater consideration in injury prevention research.

Background:Return to play（RTP） in elite rugby is managed using a 6-stage graduated RTP protocol,which can result in clearance to play within1 week of injury.We aimed to explore how symptom,cognitive,and balance presentation and evolution during concussion screens 2 h（head injury assessment（HIA） 2） and 48 h（HIA3） after injury were associated with time to RTP) to identify whether a more conservative graduated RTP may be appropriate.Methods:A retrospective cohort study was conducted in 380 concussed rugby players from elite men’s rugby over 3 consecutive seasons.Players were classified as shorter or longer returns,depending on whether RTP occurred within 7 days（allowing them to be considered to play the match1 week after injury） or longer than 8 days,respectively.Symptom,cognitive,and balance performance during screens was assessed relative to baseline（normal or abnormal） and to the preceding screen（improving or worsening）.Associations between sub-test abnormalities and RTP time were explored using odds ratios（OR,longer vs.shorter）.Median day absence was compared between players with abnormal or worsening results and those whose results were normal or improving.Results:Abnormal symptom results during screens 2 h and 48 h after concussion were associated with longer return time（HIA2:OR=2.21,95%confidence interval（95%CI）:1.39-3.50;HIA3:OR=3.30,95%CI:1.89-5.75）.Worsening symptom number or severity from the time of injury to 2 h and 48 h post-injury was associated with longer return(HIA2:OR=2.49,95%CI:1.36-4.58;HIA3:OR=3.34,95%CI:1.10-10.15.Median days absence was greater in players with abnormal symptom results at both HIA2 and HIA3.Cognitive and balance performance were not associated with longer return and did not affect median days absence.Conclusion:Symptom presentation and evolution within 48 h of concussion were associated with longer RTP times.This may guide a more conservative approach to RTP,while still adhering to individualized concussion management principles.

OBJECTIVES: To (1) provide position-specific normative data for isometric cervical muscle strength and endurance in professional, male rugby players and (2) assess the relationship between age, height, weight, and playing position with cervical muscle strength and endurance. DESIGN: Cross-sectional study. METHODS: Professional rugby players completed peak isometric cervical strength testing followed by a test of cervical muscle endurance. Descriptive statistics for continuous variables with strength normalized to body weight were performed. Multiple linear regression was used to estimate associations between strength measurements. RESULTS: In total, 136 players participated including front-row forwards (27%), other forwards (28%), and backs (45%). Front-row forwards had significantly greater peak isometric cervical muscle strength than other position groups, with backs having the lowest strength. Extension produced the highest force for all 3 position groups (429 N ± 104 N), whereas flexion produced the least (275 N ± 65 N). Age was associated with increased isometric cervical muscle strength. There was a statistically significant relationship between peak flexion strength and flexion endurance (P = .003). The average time for the endurance tests were 55.7 (±17.1) seconds and 52.9 (±20.1) seconds for extension and flexion, respectively. Other forwards had lower cervical extension muscle endurance than backs and front-row forwards. CONCLUSIONS: Normative values for peak and endurance isometric strength in professional rugby players illustrate significant differences between playing position. Consider age, body weight, and intraindividual variability when interpreting cervical strength and endurance results. J Orthop Sports Phys Ther 2024;54(3):1-8. Epub 29 January 2024. doi:10.2519/jospt.2024.11830.

Background Concussion is the most common injury in women's rugby union, although limited research has investigated head acceleration events (HAEs) using instrumented mouthguards (iMGs). Objective Describe and compare the incidence of HAEs and the proportion of tackles and carries resulting in HAEs in elite level women's rugby union using iMGs and video analysis. Design Prospective cohort. Setting Professional rugby players from one women's competition (Farah Palmer Cup). Participants Ninety-three professional female rugby union players across 643 player-matches. Main Outcome Measurements Incidence rates were calculated as the number of HAEs (as recorded by iMGs) per player-hour. Proportions were calculated as the percentage of tackles and ball-carries resulting in an HAE. Values are reported across a range of peak linear acceleration thresholds with 95% confidence intervals (CI) for the Poisson distribution. Results The incidence (CI) of HAEs per player-hour for forwards vs backs was 2.18 (0.00–5.00) vs 1.75 (0.00–5.00) between 20–40g (p=0.002), 0.22 (0.00–1.00) vs 0.26 (0.00–2.00) between 40–60g (p<0.001), and 0.04 (0.00–1.00) vs 0.05 (0.00–1.00) >60g (p=0.747). The proportion (CI) for tackles vs ball-carries to result in a HAE was 10.29% (5.00–17.00%) vs 8.56% (3.00–15.00%) for HAE >20g (p=0.022), 1.36% (0.00–4.00%) vs 1.26% (0.00–4.00%) for HAE >40g (p=0.733) and 0.22% (0.00–1.00%) vs 0.23% (0.00–1.00%) for HAE >60g (p=0.934). Conclusions Forwards experienced a significantly higher rate of HAEs across a range of PLA magnitudes. A small proportion of tackles and ball-carries result in a HAE >20g, which can be used to identify and reduce high magnitude events.