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Smart mouthguards show what can't be seen

SPOTLIGHT: Data collected during last year’s Currie Cup by World Rugby on their new smart mouthguard technology added to the decision for the roll-out of this part of the Head Injury Assessment (HIA) protocols this year.


Since its roll-out at elite levels like the Six Nations and Super Rugby, there have been mixed reactions about the efficacy of the mouthguard technology with coaches like Gregor Townsend, Dave Rennie and players like Scott Barrett voicing their concerns.

But Lindsay Starling, project manager of the smart mouthguards at World Rugby and one of the world experts on them, says this technology is a game changer for player welfare and is ‘absolutely’ not going away.

Rugby365 sat down with Starling after a week of intense criticism from coaches and players alike about the use of the mouthguards and how effective the spike alerts were that were recorded, resulting in players being pulled off the field to undergo the sideline HIA (Head Injury Assessment) protocols.

Starling acknowledged that, while these smart mouthguards are not in the testing phase anymore – that was done over the last three years – they were still experiencing some teething problems with the devices.

But she reiterated that the whole reasoning behind this technology was for the betterment of player welfare.

“At World Rugby player welfare is our number one priority, it always has been and it always will be. This technology gives us an insight into the game that we’ve never had, it gives us insight into player welfare that we’ve never had before.


“So it is a game changer, we are only implementing this for the best interest of player welfare. We appreciate that it is something that will take some time for people to get used to.

“It has some teething issues and if anything, we want to work with the players, with the unions, with the competitions to iron those out so that it works best for them and not how we think it’s going to work,” she said.

Starling explained why it was so necessary to educate all involved to better understand that the long-term goal will always be for the brain health of the players.

“This Head Injury Assessment (HIA) protocol that everybody is so familiar with now, and everybody fully accepts – the player goes off the field with an HIA, we might see him back on, we might not – that was introduced ten years ago and there was the same kind of response.


“People were asking why is the player going off, we don’t understand it, he looks fine. And it took some ironing out, it took some working with competitions and players and now it is completely accepted.

“All of this is still very new, like anything in life it takes a bit of adjustment, a bit of getting used to. It’s a big piece being rolled out, it’s a change. A lot of time people aren’t comfortable with change immediately and obviously, there’s a huge amount of education to go into this.

“There definitely were some teething issues. I think we would all agree with that. There have been some things in the media, but overall in terms of where we are to date, we are very confident in the technology.

“I do believe with the instrumented mouthguards, it will be a case where we will sit here in a few years and it will be in the same place of being accepted,” she explains.

In South Africa, the Currie Cup was one of the competitions where the technology was rolled out and players made use of the mouthguards.

“There’s been testing of the technology for the last three years, we rolled this out in competitions last year and the Currie Cup was one of the competitions where the players made use of the mouthguards.

“So we had all the English men’s and women’s Premiership teams, the Currie Cup men’s teams, and the Farah Palmer Cup teams in New Zealand that were all part of this really big research study last year.

“That data is some of the data that helped us feed into actually making this decision to now roll it out into the game.

“And so because the Currie Cup is one of the elite level competitions that make use of HIA, they immediately now fall into this bracket.

“If anything, I would say that I hope the Currie Cup will be slightly better set-up for this year because they wouldn’t have acted on any in-game alerts if they didn’t have that in place last year. But in terms of just being comfortable with the technology, the coaches and medical staff know how they can use that to look after their players.

“They will hopefully be a step ahead of some of the other competitions.”

The mouthguards contain technology to measure the impact of head acceleration events on the tooth – using gyroscopes and accelerometers – and send data via Bluetooth to the team doctor who is monitoring on the sideline.

If the data spikes, game officials are informed and players are asked to go to the sideline to undergo HIA protocols.

Starling explained how vitally important education is in the bigger scheme of things. And why this technology will remain a top priority as it helps to understand what exactly is happening to a player that has had a really big knock on the head.

“The reason why we’ve introduced these mouthguards is because it helps us understand things that we can’t see with our own eyes.

“From where the thresholds are set, we know that that player has had a really big knock. They’ve had a knock in the top percentage of sizes of knocks and therefore is worth them being checked out.

“Ultimately this is not a diagnosis or a concussion detection tool. We have no confidence in that, and we are not saying that we think a player being removed for an impact over a certain threshold will relate to having a concussion.

“All this alert from the mouthguard is saying is that this player has had one of the top 0.1 percent of impacts. He has had a big knock, it’s worth that player being sussed out and entered into this HIA process.”

She pointed out that there have only been seven alerts in the Six Nations thus far in 2024.

“All the data from the Six Nations have come in, and there have been around 9500 head acceleration events, but only seven alerts. So that is saying that the biggest seven impacts out of 9500 resulted in those players getting brought off. So it is a small number of players that we are speaking about. That is the top crux, only six out of 9500.”

“We are still in a place where we are figuring out how best to use the information that is collected from the mouthguards.

“We are very confident that the threshold is set at a place that is most appropriate to bring off players as they need to be seen. Ultimately, as we keep collecting more data, that threshold might change as it becomes better informed.”

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