When a female rugby player sustains a head injury during a professional match, the current threshold for removing her from the field for a medical assessment is based on standards set for male players — adjusted by just 12 per cent lower, since women’s brains are physiologically more vulnerable to impact trauma.
It’s a concerning gap in gender-specific concussion research that may leave many women at risk of lasting harm.
But now, researchers at Cardiff University are trying to come up with the first ever scientifically-supported head impact assessment protocol in women’s rugby.
Medical engineers from the university’s school of engineering spent a year tracking the university’s female rugby team during training and matches, collecting the impact data from instrumented mouth guards worn by players, cognitive tests, MRI scans, and computer modelling.
Players from Cardiff women’s rugby team took part in hours-long MRI and other imaging scans at Cardiff’s brain research imaging centre.
They had personally moulded, Bluetooth-enabled mouthguard that tracked impact on the players’ teeth, which is used to determine impact on the head and brain. After each game, the players’ balance and short-term memory were assessed so researchers could later determine whether the results correlated with head impacts recorded by the mouthguards and MRI scans taken before and after matches.
According to the researchers, this is the first time such a study has been conducted on the same group of individuals. They hope it will lead to the first academic insights into the relative long-term risks of female contact sport.
It marks a significant breakthrough in a field where the gender gap in sports and exercise research has long remained wide.
A 2020 study revealed that only 6 per cent of sport science research focused specifically on female athletes. Another study published in 2023 found that over nine in 10 first (or lead) authors were men, and that women made up merely 13 per cent of authors.
Cardiff’s lead researcher Dr Peter Theobald said: “Women’s sports research is historically underrepresented, and with most research we can look 10, 15, 20 years into the past for data, but not with women’s rugby; it hardly existed.”
“The female brain is softer and more vulnerable to concussion … what we don’t know yet is whether that translates to a greater risk of the effects of subconcussive brain injury.”
Dr Theobald insisted that the goal of the study is not to dissuade women and girls from taking up rugby, rather, to “shed light on the risks so people can make an informed decision”.
Fellow researcher and medical engineering PhD student Freya Butcher told the Guardian: “Women’s and men’s rugby are played quite differently, and their brains are different anyway, so looking at what happens in the men’s game doesn’t mean we understand the impact on women’s brains and bodies.”
She and her colleagues will also evaluate how musculoskeletal health, strength and fatigue are influenced by menstruation, and breast health, issues that Butcher said remain taboo:
“Sometimes the girls have huge bruises on their breasts and sides after games, and they agree that if it was elsewhere, they wouldn’t hesitate to get it looked at,” she said.
“Compression and impact on the breast may be linked to problems lactating and breastfeeding. But right now, female players don’t have adequate protective wear or strategies for dealing with that.”
Ffion James, a law student and member of the Cardiff women’s rugby team said she feels safer “knowing there’s going to be more research.”
“Before I step on the pitch, I never think I’m going to get injured, it’s only when you see someone down you think about it,” she admitted. “I feel like I can be part of the change. Even if it’s a small part, it’s exciting, and hopefully in years to come it will make a change for women in sport and women in rugby.”
“[The study] helps me be less worried. I always think, if I have daughters, I know that with this research and hopefully more in years to come, they are going to feel safer stepping on to a rugby pitch … my parents were terrified, but hopefully, I won’t have to experience that.”
“I want my daughters to be able to run on to that pitch and think: ‘I’m going to be OK.’”
Teammate Cleo Pallister-Turley added, “Any injury would be worth the game for me. The reason I play is for my teammates; all my best friends have come through rugby. The group environment is so accepting and so much fun … it’s love of the game.”
The researchers expect the study to be formally published towards the end of the year.
Multiple studies have linked repeated head impacts in former male rugby players to increased risks of neurodegenerative diseases, dementia and symptoms associated with chronic traumatic encephalopathy (CTE), a progressive degenerative disease. Male rugby players have a 14 per cent higher risk of CTE for every additional year played.
An ongoing case that began in 2023 involved hundreds of former football, rugby league and rugby union players in the UK who are suing the Welsh Rugby Union, the Rugby Football Union and World Rugby, alleging they suffered brain injuries as a result of playing the sport.