I won't let you down; why 20% of Men's and Women's Super League players underreported suspected concussions

Journal article

Tadmor, Daniel, Till, Kevin, Phillips, Gemma, Brown, James, Fairbank, Laura, Hendricks, Sharief, Johnston, Rich D., Longworth, Thomas, Stokes, Keith and Jones, Ben. (2023). I won't let you down; why 20% of Men's and Women's Super League players underreported suspected concussions. Journal of Science and Medicine in Sport. 26(12), pp. 688-693. https://doi.org/10.1016/j.jsams.2023.09.015
AuthorsTadmor, Daniel, Till, Kevin, Phillips, Gemma, Brown, James, Fairbank, Laura, Hendricks, Sharief, Johnston, Rich D., Longworth, Thomas, Stokes, Keith and Jones, Ben
Abstract

Objectives
Quantify and identify factors associated with concussion underreporting in Super League rugby league players.

Design
Cross sectional survey.

Methods
During the 2022 season preseason, 422 Men's and Women's Super League players completed an online survey quantifying player demographics, rugby playing history, concussion history, prevalence of, and reasons for underreporting concussion, concussion knowledge and long-term implications and perceptions of concussion.

Results
Overall, 20% of respondents stated they did not report concussion-related symptoms to medical staff during the 2020 and 2021 seasons. The two most common reasons for underreporting concussion were ‘didn't want to be ruled out of a match’ (35%) and ‘didn't want to let down team’ (24%). 65% of players reported an appropriate level of knowledge about concussion and potential long-term implications at the start of their senior rugby career, versus 89% now. In relation to concussion knowledge, symptoms were correctly identified on 74% of occasions. 57% of players surveyed were concerned about the potential long-term implications from concussion, and 11% of players would encourage their/family members' children to not play rugby league.

Conclusions
The proportion of Super League players who did not report concussion symptoms was similar to rugby league players in Australia. The main reasons for not reporting concussion appeared to be due to perceptions of what is beneficial for the team, suggesting both performance and medical staff should collectively encourage players to report concussion. A player's attitude towards concussion is potentially an individual modifiable risk factor and should be considered within the concussion management of players.

Keywordsconcussion; rugby; rugby league; TBI; diagnosis; player welfare
Year2023
JournalJournal of Science and Medicine in Sport
Journal citation26 (12), pp. 688-693
PublisherElsevier Ltd
ISSN1440-2440
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jsams.2023.09.015
PubMed ID37813720
Scopus EID2-s2.0-85147875678
Open accessPublished as ‘gold’ (paid) open access
Page range688-693
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online27 Sep 2023
Publication process dates
Accepted18 Sep 2023
Deposited28 Apr 2025
Additional information

© 2023 The Authors. Published by Elsevier Ltd on behalf of Sports Medicine Australia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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Quantifying the movement characteristics of Australian Football League women's competition
Thornton, Heidi R., Armstrong, Cameron R., Gamble, Tiernan, Rigby, Alex, Johnston, Rich D. and Duthie, Grant M.. (2022). Quantifying the movement characteristics of Australian Football League women's competition. Journal of Strength and Conditioning Research. 36(12), pp. 3415-3421. https://doi.org/10.1519/jsc.0000000000003810
Peak movement and technical demands of professional Australian Football competition
Johnston, Rich D., Murray, Nick B., Austin, Damien J. and Duthie, Grant. (2021). Peak movement and technical demands of professional Australian Football competition. Journal of Strength and Conditioning Research. 35(10), pp. 2818-2823. https://doi.org/10.1519/JSC.0000000000003241
Physical demands of female collegiate lacrosse competition : Whole-match and peak periods analysis
Calder, Alexander R., Duthie, Grant M., Johnston, Richard D. and Engel, Heather D.. (2021). Physical demands of female collegiate lacrosse competition : Whole-match and peak periods analysis. Sport Sciences for Health. 17(1), pp. 103-109. https://doi.org/10.1007/s11332-020-00659-x
The validity and reliability of wearable microtechnology for intermittent team sports : A systematic review
Crang, Zachary L., Duthie, Grant, Cole, Michael H., Weakley, Jonathon, Hewitt, Adam and Johnston, Rich D.. (2021). The validity and reliability of wearable microtechnology for intermittent team sports : A systematic review. Sports Medicine. 51(3), pp. 549-565. https://doi.org/10.1007/s40279-020-01399-1
The validity and reliability of commercially available resistance training monitoring devices : A systematic review
Weakley, Jonathon, Morrison, Matthew, García-Ramos, Amador, Johnston, Rich, James, Lachlan and Cole, Michael H.. (2021). The validity and reliability of commercially available resistance training monitoring devices : A systematic review. Sports Medicine. 51(3), pp. 443-502. https://doi.org/10.1007/s40279-020-01382-w
Preparing for an Australian Football League Women's League season
Thornton, Heidi Rose, Armstrong, Cameron R., Rigby, Alex, Minahan, Clare L., Johnston, Rich D. and Duthie, Grant Malcolm. (2020). Preparing for an Australian Football League Women's League season. Journal of Strength and Conditioning Research. 2, p. Article 608939. https://doi.org/10.3389/fspor.2020.608939
Validity of real-time ultra-wideband global navigation satellite system data generated by a wearable microtechnology unit
Johnston, Rich D., Hewitt, Adam and Duthie, Grant. (2020). Validity of real-time ultra-wideband global navigation satellite system data generated by a wearable microtechnology unit. Journal of Strength and Conditioning Research. 34(7), pp. 2071-2075. https://doi.org/10.1519/JSC.0000000000003059
Criterion validity, and interunit and between-day reliability of the FLEX for measuring barbell velocity during commonly used resistance training exercises
Weakley, Jonathon, Chalkley, Daniel, Johnston, Rich, García-Ramos, Amador, Townshend, Andrew, Dorrell, Harry, Pearson, Madison, Morrison, Matthew and Cole, Michael. (2020). Criterion validity, and interunit and between-day reliability of the FLEX for measuring barbell velocity during commonly used resistance training exercises. Journal of Strength and Conditioning Research. 34(6), pp. 1519 - 1524. https://doi.org/10.1519/JSC.0000000000003592
Validity of real-time ultra-wideband global navigation satellite system data generated by a wearable microtechnology unit
Johnston, Rich D., Hewitt, Adam and Duthie, Grant. (2019). Validity of real-time ultra-wideband global navigation satellite system data generated by a wearable microtechnology unit. Journal of Strength and Conditioning Research. 34(7), pp. 2071-2075. https://doi.org/10.1519/JSC.0000000000003059
The influence of pre-season training loads on in-season match activities in professional Australian football players
Johnston, Rich D., Murray, Nicholas B. and Austin, Damien J.. (2019). The influence of pre-season training loads on in-season match activities in professional Australian football players. Science and Medicine in Football. 3(2), pp. 143-149. https://doi.org/10.1080/24733938.2018.1501160
Sub-maximal heart rate is associated with changes in high-intensity intermittent running ability in professional rugby league players
Hulin, Billy T., Gabbett, Tim J., Johnston, Rich D. and Jenkins, David G.. (2019). Sub-maximal heart rate is associated with changes in high-intensity intermittent running ability in professional rugby league players. Science and Medicine in Football. 3(1), pp. 50-56. https://doi.org/10.1080/24733938.2018.1475748
Rating of perceived challenge as a measure of internal load for technical skill performance
Hendricks, Sharief, Till, Kevin, Oliver, Jon L., Johnston, Rich D., Attwood, Matthew J., Brown, James Craig, Drake, David, MacLeod, Simon, Mellalieu, Stephen D. and Jones, Ben. (2019). Rating of perceived challenge as a measure of internal load for technical skill performance. British Journal of Sports Medicine. 53(10), pp. 611-613. https://doi.org/10.1136/bjsports-2018-099871
Using microtechnology to quantify torso angle during match-play in field hockey
Warman, Geoffrey Ernest, Cole, Michael H., Chalkley, Daniel, Johnston, richard and Pepping, Gert-Jan. (2019). Using microtechnology to quantify torso angle during match-play in field hockey. Journal of Strength and Conditioning Research. 33(10), pp. 2648 - 2654. https://doi.org/10.1519/JSC.0000000000003238
The influence of contextual factors on running performance in female Australian football match-play
Black, Georgia M., Gabbett, Tim, Naughton, Geraldine, Cole, Michael H., Johnston, Richard and Dawson, Brian. (2019). The influence of contextual factors on running performance in female Australian football match-play. Journal of Strength and Conditioning Research. 33(9), pp. 2488 - 2495. https://doi.org/10.1519/JSC.0000000000002142
Influence of physical characteristics and match outcome on technical errors during rugby league match play
Johnston, Richard. (2019). Influence of physical characteristics and match outcome on technical errors during rugby league match play. International Journal of Sports Physiology and Performance. 14(8), pp. 1043 - 1049. https://doi.org/10.1123/ijspp.2018-0354
The peak duration-specific locomotor demands and concurrent collision frequencies of European Super League rugby
Weaving, Dan, Sawczuk, Thomas, Williams, Sean, Scott, Tannath, Till, Kevin, Beggs, Clive, Johnston, Rich D. and Jones, Ben. (2019). The peak duration-specific locomotor demands and concurrent collision frequencies of European Super League rugby. Journal of Sports Sciences. 37(3), pp. 322-330. https://doi.org/10.1080/02640414.2018.1500425
Technical skill training framework and skill load measurements for the rugby union tackle
Hendricks, Sharief, Till, Kevin, Oliver, Jon L., Johnston, Rich D., Attwood, Matthew, Brown, James, Drake, David, MacLeod, Simon, Mellalieu, Stephen D., Treu, Paul and Jones, Ben. (2018). Technical skill training framework and skill load measurements for the rugby union tackle. Strength and Conditioning Journal. 40(5), pp. 44-59. https://doi.org/10.1519/SSC.0000000000000400
Applied sport science of Australian football: A systematic review
Johnston, Richard, Black, Georgia M., Harrison, Peter W., Murray, Nick B. and Austin, Damien J.. (2018). Applied sport science of Australian football: A systematic review. Sports Medicine. 48(7), pp. 1673 - 1694. https://doi.org/10.1007/s40279-018-0919-z
Changes in rugby league tackling ability during a competitive season : The relationship with strength and power qualities
Speranza, Michael J. A., Gabbett, Tim J., Greene, David A., Johnston, Rich D. and Sheppard, Jeremy M.. (2017). Changes in rugby league tackling ability during a competitive season : The relationship with strength and power qualities. Journal of Strength and Conditioning Research. 31(12), pp. 3311-3318. https://doi.org/10.1519/JSC.0000000000001540
Wearable microtechnology can accurately identify collision events during professional rugby league match-play
Hulin, Billy T., Gabbett, Tim J., Johnston, Rich D. and Jenkins, David G.. (2017). Wearable microtechnology can accurately identify collision events during professional rugby league match-play. Journal of Science and Medicine in Sport. 20(7), pp. 638-642. https://doi.org/10.1016/j.jsams.2016.11.006
Influence of physical maturity status on sprinting speed among youth soccer players
McCunn, Robert, Weston, Matthew, Hill, John KA, Johnston, Richard and Gibson, Neil V.. (2017). Influence of physical maturity status on sprinting speed among youth soccer players. Journal of Strength and Conditioning Research. 31(7), pp. 1795 - 1801. https://doi.org/10.1519/JSC.0000000000001654
Effect of different repeated-high-intensity-effort bouts on subsequent running, skill performance, and neuromuscular function
Johnston, Rich D., Gabbett, Tim J., Jenkins, David G. and Speranza, Michael J.. (2016). Effect of different repeated-high-intensity-effort bouts on subsequent running, skill performance, and neuromuscular function. International Journal of Sports Physiology and Performance. 11(3), pp. 311-318. https://doi.org/10.1123/ijspp.2015-0243
Are three contact efforts really reflective of a repeated high-intensity effort bout?
Johnston, Rich D., Gabbett, Tim J., Walker, Shane, Walker, Ben and Jenkins, David G.. (2015). Are three contact efforts really reflective of a repeated high-intensity effort bout? Journal of Strength and Conditioning Research. 29(3), pp. 816-821. https://doi.org/10.1519/JSC.0000000000000679
The influence of physical fitness and playing standard on pacing strategies during a team-sport tournament
Johnston, Rich, Gabbett, Tim and Jenkins, David. (2015). The influence of physical fitness and playing standard on pacing strategies during a team-sport tournament. International Journal of Sports Physiology and Performance. 10(8), pp. 1001 - 1008. https://doi.org/10.1123/ijspp.2015-0005
Fatigue and pacing in rugby league players
Johnston, Richard. (2015). Fatigue and pacing in rugby league players [Thesis]. https://doi.org/10.4226/66/5a9cbe35b0b9e
Influence of playing standard and physical fitness on activity profiles and post-match fatigue during intensified junior rugby league competition
Johnston, Rich, Gabbett, Tim and Jenkins, David. (2015). Influence of playing standard and physical fitness on activity profiles and post-match fatigue during intensified junior rugby league competition. Sports Medicine - Open. 1(18), pp. 1 - 10. https://doi.org/10.1186/s40798-015-0015-y
Relationship between a standardized tackling proficiency test and match-play tackle performance in semiprofessional Rugby League players
Speranza, Michael, Gabbett, Tim, Johnston, Rich and Sheppard, Jeremy. (2015). Relationship between a standardized tackling proficiency test and match-play tackle performance in semiprofessional Rugby League players. International Journal of Sports Physiology and Performance. 10(6), pp. 754 - 760. https://doi.org/10.1123/ijspp.2015-0044
Muscular strength and power correlates of tackling ability in semiprofessional Rugby League players
Speranza, Michael, Gabbett, Tim, Johnston, Richard and Sheppard, Jeremy. (2015). Muscular strength and power correlates of tackling ability in semiprofessional Rugby League players. Journal of Strength and Conditioning Research. 29(8), pp. 2071 - 2078. https://doi.org/10.1519/JSC.0000000000000897
Applied sport science of Rugby League
Johnston, Rich, Gabbett, Tim J. and Jenkins, David. (2014). Applied sport science of Rugby League. Sports Medicine: reviews of applied medicine and science in sport and exercise. 44(8), pp. 1087 - 1100. https://doi.org/10.1007/s40279-014-0190-x
Influence of Physical Contact on Pacing Strategies During Game-Based Activities
Johnston, Rich, Gabbett, Tim, Seibold, Anthony and Jenkins, David. (2014). Influence of Physical Contact on Pacing Strategies During Game-Based Activities. International Journal of Sports Physiology and Performance. 9(5), pp. 811 - 816. https://doi.org/10.1123/ijspp.2013-0424
Physiological responses to an intensified period of rugby league competition
Johnston, Rich D., Gibson, Neil V., Twist, Craig, Gabbett, Tim. J., MacNay, Sophie A. and MacFarlane, Niall G.. (2013). Physiological responses to an intensified period of rugby league competition. Journal of Strength and Conditioning Research. 27(3), pp. 643-654. https://doi.org/10.1519/JSC.0b013e31825bb469
Relationship between measures of aerobic fitness, speed and repeated sprint ability in full and part time youth soccer players
Gibson, Neil V., Currie, J., Johnston, Richard and Hill, J.. (2013). Relationship between measures of aerobic fitness, speed and repeated sprint ability in full and part time youth soccer players. Journal of Sports Medicine and Physical Fitness. 53(1), pp. 9 - 16.
Influence of an intensified competition on fatigue and match performance in junior rugby league players
Johnston, Richard, Gabbett, Timothy and Jenkins, David. (2013). Influence of an intensified competition on fatigue and match performance in junior rugby league players. Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2012.10.009