There is no empirical evidence that soft-padded headgear is protective against head injury risk in rugby. However, studies that have assessed purported protective effects have not accounted for rates of contact. The aim of this study was to compare head injury rates while considering tackle-event exposure in players with and without headgear. In the 2018 and 2019 professional men's SuperRugby season, video analysts recorded headgear use, playing position, match time and head injury assessments (proxy for head injury risk) for each player. Tackle-event involvements for each player were obtained from third-party video analysis provider. Tackle-related head injury rates were calculated per 1000 h (incidence) and per 1000 tackle-events (propensity), and compared between headgear and non-headgear wearers using incidence rate ratios (IRRs) with 95% confidence intervals and Poisson regression models. Players wearing headgear were involved in more tackles per match than players without headgear (IRR 1.07, 95% CI 1.05-1.09). Head injury incidence (IRR: 1.78 95% CI: 1.11-2.70) and propensity (IRR: 1.66 95% CI: 1.04-2.52) were higher in players wearing headgear. However, statistical models found no difference in this risk between positional groups. A lack of protective effect is consistent with previous studies and could be explained by World Rugby's headgear design regulations while increased risk may be a result of greater injury susceptibility. As World Rugby's headgear regulations change and further advancements in headgear is made, it is important to continue to examine their effect on head injury risk at an individual level.
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