Protect the Player, Protect the Game: Reflections from Ex-Professional Rugby Union Players on Law Changes, Protective Equipment, and Duty of Care in the Professional Game.

The emphasis of this study was to interview ex-professional male rugby union players ( = 23, mean age 35.5 ± 4.7 years) and discuss concussion management during their careers. In this study, two major themes were identified: (1) the duty of care to professional rugby union players by medical personnel, coaching staff, and owners of professional clubs and (2) the use of protective equipment and law changes to enhance player safety. In total, twenty-three ex-professional rugby union players were interviewed, and the majority (61%) had represented their countries at international test-level rugby. These interviews highlighted the belief that medical teams should be objective, independent entities within a professional rugby club. Furthermore, medical teams should not be in a position of being pressurised by head coaches, members of the coaching team, or club owners regarding return-to-play (RTP) protocols specific to concussion. The interviewees believed that they were pressured by coaches or members of the coaching team to play with concussion or concussive symptoms and other physical injuries. The results indicated that they had manipulated concussion testing themselves or with assistance to pass standard concussion testing protocols. The interviewees indicated that club owners have a duty of care to players even in retirement due to the high incidence of physical and mental injuries endured as a professional rugby player. Most participants indicated that a reduction in match playing time and reducing the amount of time engaged in contact training (workload volume) may assist in reducing concussion incidence. The participants suggested that changes to the current laws of the game or the use of protective equipment did not mitigate against concussion risk in the game of rugby union. The main limitation to the study is that participants had retired in the past ten years, and conditions for players may have changed. This study has highlighted that additional efforts are required by professional clubs to ensure the highest duty of care is delivered to current players and recently retired players.