Existing headgear and mouth guards will not stop concussions from happening to rugby players, says Michael Cusimano, a neurosurgeon at St. Michael's Hospital in Toronto.
And serious concussions - impacts on the brain - will not be stopped by the current generation of protective equipment in other sports. Headgear and mouth guards are not designed for that purpose, say other specialists in brain trauma.
"Our study was the first to summarize what did and what did not work," said Cusimano, following a review of 10 previous papers on head injury. His findings are published in the November issue of the journal Neurosurgery.
Cusimano didn't mince words this week at a news conference to unveil new research into the shocking frequency of concussions in junior hockey.
"You can cut the pie any way you want, a concussion is a brain injury," he said, adding sport is supposed to be a way to keep people healthy, yet people are getting seriously hurt. "We have to wake up to this."
Education and rule changes have been effective in other sports and "should be made available to all rugby players so that these athletes can spend more time playing on the field than recovering off of the field."
U.S. concussions expert Robert Cantu agrees. The doctor said helmets do a good job protecting against skull fractures, "but they're not being made to a standard to prevent concussion and they probably never will be able to prevent all of them."
Making a bigger helmet in some sports such as football and hockey "is not a good idea for the neck and not a good idea for the players. The bottom line, I think helmets are a pretty minor part of the total solution. … Education and rule changes are where you're going to get the greatest amount of good occurring."
Cusimano still recommends rugby players wear mouth guards and protective headgear because of the strong evidence they reduce mouth and face injuries and scalp lacerations. He urged equipment companies to develop more sophisticated headgear to further reduce injury risk.
Rugby headgear is occasionally worn by some players. Soft-shelled and thinly padded, it is primarily designed to protect the ears and the back of the head from superficial injury.
But concussion typically happens inside the skull, when an impact shears fragile connections and makes the brain smack against the inside of the skull.
Figures furnished by Cusimano's home base of St. Michael's Hospital indicate professional rugby players suffer 91 injuries per 1,000 player hours, with each injury requiring an average of 18 days to recover and return to play. Concussion is the third most common match injury in rugby, accounting for 2 per cent.
Cusimano said the number of concussions in rugby may be underreported - as they are in ice hockey - because of the International Rugby Board rule that athletes can't return to play for three weeks after suffering a concussion unless they are cleared by a neurologist.
Spinal injuries account for 9 per cent of time lost to match injuries by professional English players, occurring at a rate of up to 10.9 per 1,000 player hours.
New Zealand, a leader in the sport and a giant in competitive international rugby, developed an injury prevention and recovery plan nine years ago. The 10-point program known as RugbySmart resulted in a 13-per-cent decrease in neck, back and spine injuries and a reduction in the mean number of days between an injury and a player seeking treatment (4.27 days, down from six).