Getting smart with mouthguards
The push for player safety is supported but there are some concerns over the new mouthguards being introduced in Super Rugby this week. Iain Payten of the Sydney Morning Herald reports.
Identifying concussions during contact sport has come a long way, but it has relied more on sharp observation and medical expertise than cold hard data.
That will change this week when Australia’s professional rugby players run out in the opening round of the Super Rugby Pacific competition wearing smart mouthguards, which can detect a high-impact collision and prompt the removal of a player from the field for a head injury assessment (HIA).
The smart mouthguards, which are known as “instrumented mouthguards” (IMGs), have been made mandatory in elite competitions by World Rugby after years of studies and trials, and as part of a global rollout that began with the Six Nations competition in Europe this month.
But while supportive of steps to address the risks of concussion, Australian players have expressed dissatisfaction with the rushed introduction of the compulsory mouthguards, which have been with clubs for only a few weeks and have led to some players struggling to breathe given the pieces are slightly chunky.
HOW DOES THE SMART MOUTHGUARD WORK?
It has long been known that the head and brain can experience significant force during a tackle but it became accurately measurable with the development of smart mouthguards.
After engaging with US company Prevent Biometrics, World Rugby began trialling smart mouthguards over eight years and collecting data in multiple countries.
If a player on the field suffers a highimpact collision, their mouthguard sends an alert to the sidelines. With Bluetooth technology, data from the mouthguard is transmitted to a computer or tablet to measure head orientation, position, velocity and acceleration of impact.
“Not liking wearing a mouthguard is not a reason to not wear it.”
Rugby Australia chief medical officer Warren McDonald
The mouthguards, at almost A$500 each, have an in-built accelerometer and gyroscope, and are buried on the back, left side inside the rubber material. World Rugby has budgeted to spend A$2.7 million on providing smart mouthguards this year.
The NRL and AFL have been trialling similar smart mouthguard technology with Australian company HitIQ for years but rugby is the first to roll it out in competition.
“What they have been able to determine is that if you have had an impact that results in force either in a straight line or a rotational direction, above a certain threshold, then the vast majority of those people need an HIA,” Rugby Australia chief medical officer Warren McDonald said.
“If the IMG registers an impact that exceeds that threshold, then whether you are showing signs and symptoms or not, you are going to be removed for an HIA assessment.”
The force levels deemed to be potentially concussive were set at 70g and 4000 radians per second squared, with lower thresholds of 55g and 4000 rad/s² for women players. World Rugby-funded studies in New Zealand showed most head collisions in rugby are under 10g.
For context, a 70g collision is similar in force to Formula One drivers crashing into a wall, but World Rugby says the comparison is not “apples with apples”, and the force was set high enough so that multiple lower-force collisions aren’t sent for HIAs.
A ping is sent via Bluetooth to an app being monitored by the match-day doctor on the sideline.
Most concussive collisions are already picked up by the usual methods of spotting symptoms, but the ping ensures unsighted moments are also caught.
“They have been well considered, and the expectation is there might be one additional HIA per game,’’ McDonald said. ‘‘The technology has been well tested and put through a rigorous process to ensure we are not getting false readings.”
Players also have to wear the mouthguards during all contact-training sessions, and the collected data will help understand whether midweek contact levels should be reduced in the future.
HOW PLAYERS HAVE RESPONDED
Despite the obvious risks, some elite players have chosen not to wear mouthguards in the past. But short of a medical exemption, which must be approved by World Rugby, players must now wear the smart mouthguard to be eligible for the HIA1 protocol.
Put simply, if a player chooses not to wear the mouthguard during games – even during a training week – and is spotted with a suspected concussion during a Super Rugby game, they will not be eligible for an HIA check and a possible return. Instead, they will be removed and not allowed back on.
“Not liking wearing a mouthguard is not a reason to not wear it,” McDonald said.
Super Rugby coaches, then, want all players wearing smart mouthguards. But after fittings, Australian clubs began receiving their mouthguards only this month.
A deal with the Rugby Union Players’ Association was struck where they had to have two weeks to get used to the mouthguards before wearing them in competition. Queensland received their shipment only last week, so potentially may not wear them in round one.
Players at most clubs have been asking for adjustments to make the mouthguards less chunky.
“As a whole, the boys understand it’s for the safety of our game but it has to be comfortable,” Brumbies captain Allan Alaalatoa said.
“It’s normal, it’s just a little bit chunky where the chip is. I think they can shave it off to make it comfortable. I was a part of the research.
“I’m more than happy to try this one. Some boys have worn the mouthguard for five minutes and think it makes them struggle to breathe.”
Waratahs captain Jake Gordon, who experienced a concussion layoff last year, said: “I think what is important is player welfare and it’s important they are introducing something like this. I think there is going to be a teething issue around it being introduced quite late.”
Queensland’s Tate McDermott said he was seeking a medical exemption.
“A lot of boys can see what they’re doing and it’s a step in the right direction … but I mean, let’s be honest, it’s pretty rushed,” McDermott said.
“I can’t breathe out of my nose, so the mouthguard has restricted my mouth breathing. I’ve never used a mouthguard.”