Pioneering study aims to find out how repeated blows to head in women’s rugby affects brain | Sports science

Cleo Pallister-Turley, fullback for the Cardiff University women’s rugby team, grimaces as she remembers two major concussions while playing rugby. “Girls ask me, ‘Aren’t you afraid of getting hurt?’” the biomedical sciences student said. “I enjoy the physical side and the intensity. For me, no other sport is comparable.”

Women’s rugby has experienced significant growth in recent years. Women now make up a quarter of the world’s players, according to World Rugby, and more than 400 clubs offer rugby to women and girls across the UK; in the 1990s, there were only a handful.

However, this growing popularity has not been matched by investment in research aimed at keeping female rugby players safe, despite the now well-known long-term health risks associated with the repetitive head impacts of the game.

At a professional level, the current bar for removing a woman from the field for a head injury assessment is just 12% lower than the impact threshold that has been calculated for men – a potentially dangerous gap in gender research that medical engineers at Cardiff University are trying to fill with a groundbreaking new study.

Researchers from the university’s School of Engineering and world-leading research brain imaging center aim to produce the first ever head impact assessment protocol in women’s rugby, supported by scientific evidence. The team believes this work will also provide the first-ever academic insights into the relative long-term risks of women’s contact sport.

Medical engineers followed the university’s women’s rugby team in practices and matches throughout the academic year, drawing on impact data from the players’ instrumented mouthguards, cognitive testing, MRI scans and computer modeling – the first time, to the researchers’ knowledge, that the four different strands of the research have been conducted on the same group of people.

The results of the study, entitled “Towards clear brain health guidelines for women’s rugby”, are expected to be published by the end of 2026.

Dr Peter Theobald, lead researcher on the project, said: “Research into women’s sport is historically underrepresented, and for most research we can go back 10, 15, 20 years to get data, but not with women’s rugby; he barely existed.

“The female brain is softer and more vulnerable to concussion…what we don’t know yet is whether this translates into a higher risk of subconcussive brain injury effects.”

The aim of the study is not to dissuade women and girls from taking up rugby, Theobald added, but to “shed light on the risks so people can make an informed decision”.

Taking part in hours of MRIs and other imaging scans at the Cardiff Brain Research Imaging Center last week, Pallister-Turley and teammate Ffion James said they were delighted to take part in the study, despite the demands on their time just before the summer exam period and the annual university match against Swansea.

Players donned magenta hospital gowns before technologists helped them climb up to the machines, bare legs and feet sticking out as the Disney movie The Incredibles played on a monitor inside the room to entertain them.

The state-of-the-art machines – one of the systems at the Cardiff facility is one of four in the world – buzzed and whirred as the rugby players moved from one scan to the next.

“I feel safer knowing there will be more research,” said James, a law student, perched on a chair in an exam room during a break between exams. “Before I go on the pitch I never think I’m going to get injured, it’s only when you see someone down that you think about it.”

“I feel like I can be part of the change. Even if it’s just a small part, it’s exciting, and I hope that in the years to come it will bring change for women in sport and women in rugby.”

Pallister-Turley said: “Any injury would be worth the game to me. The reason I play is for my teammates; all my best friends are from rugby. The group environment is so welcoming and so much fun… it’s the love of the game.”

The results might not make for comforting reading. To date, studies show that male rugby players are at a 14% higher risk of chronic traumatic encephalopathy (CTE), a progressive degenerative disease, for each additional year of playing. Male players with long careers are also at increased risk of dementia and neurodegenerative diseases.

In 2023, more than 300 former football, rugby league and rugby union players in the United Kingdom announced legal action against the Welsh Rugby Union, England’s Rugby Football Union and World Rugby over brain injuries they claim they suffered while playing the game. The case is ongoing.

Freya Butcher, a medical engineering doctoral student working on the study, said: “It’s not as simple as introducing helmets or changing the rules of the sport, because other problems would then arise when players compensate for this.

“Women’s and men’s rugby are played very differently, and their brains are different anyway, so looking at what’s happening in men’s football doesn’t mean we understand the impact on women’s brains and bodies.”

The gender gap in sport and exercise research remains vast. In 2020, an audit found that only 6% of sports science research relates specifically to female athletes; another, in 2023, found that more than nine out of 10 first (or principal) authors were men and that women made up only 13% of authors.

The work undertaken by Theobald and Butcher with the rugby team will also assess how musculoskeletal health, strength and fatigue are influenced by menstruation and breast health – another area of ​​sports science that Butcher says is extremely understudied.

“It’s still a taboo subject. Sometimes girls get huge bruises on their breasts and sides after matches, and they agree that if it was anywhere else, they wouldn’t hesitate to get checked out,” she says.

“Compression and impact on the chest may be linked to lactation and breastfeeding problems. But currently, players do not have adequate protective clothing or strategies to deal with it.”

Pitchside at Cardiff Arms Park before the annual varsity match against Swansea, each player in the Cardiff women’s rugby team grabbed their personally molded, Bluetooth-enabled mouthguard, recognizable by the initials on the case.

As the whistle blew and the match began, Theobald and Butcher studied a tablet screen that tracked the impact on players’ teeth, used to determine impact on the head and brain.

Cardiff beat their visitors 81-0, in a match which saw two Swansea players withdraw through injuries. Before the celebrations began, the study participants’ balance and short-term memory were tested so that researchers could later determine whether the results correlated with head impact measured by mouthguards and MRI scans taken in the days before and after the game.

“[The study] helps me to be less worried,” James said. “I always think that if I have daughters, I know that with this research and hopefully more in the years to come, they will feel safer walking on a rugby field… my parents were terrified, but I hope I don’t have to experience that.

“I want my daughters to be able to run on that field and think, ‘Everything is going to be OK.’”