Epidemiology of head injuries among football and rugby players — A systematic review with meta-analysis

OBJECTIVES: This review primarily aimed to compare the incidence rate of head injuries, and of sport-related concussions only, between football and rugby players, according to sex, age, level of participation, and setting. A secondary aim was to examine within-sport differences in incidence rates, considering the same independent variables. DESIGN: Systematic review and meta-analysis. METHODS: Three electronic databases (EBSCOhost, Web of Science, PubMed) were searched for studies published between 2001 and August 2025. Studies reporting the incidence of head injuries and/or sport-related concussions per 1000 h in players aged 12 years and older, were included. Four authors independently evaluated the studies' eligibility and quality. Data on head injuries and sport-related concussions were pooled in two meta-analyses. RESULTS: The search yielded 6848 results, with 43 rugby and 26 football studies included. Overall, rugby players showed significantly higher incidence rates than football players for sport-related concussions (6.8 vs. 0.3; p < 0.001), a finding consistent across subgroups (sex, age, and level of participation). Only sport-related concussion training incidence rates were not significantly different between sports (0.2 vs. 0.1). The sole significant difference in incidence rate ratios of sport-related concussions, within sports, was the match/training ratio: rugby (47; 95% confidence interval: 18-123) and football (10; 95% confidence interval: 8-13). CONCLUSION: A considerably higher rate of head injuries and sport-related concussions in rugby compared to football has been shown overall and for all investigated subgroups of the sports. This difference is most likely due to the different injury mechanisms and frequency of contact events between the two sports.