'Non-existent in the women's game': Men urged to follow women's lead by chief

World Rugby Chief Medical Officer Prof Éanna Falvey has urged men to follow the lead set by the women’s game in their adoption of smart mouthguards.

The latest development in instrumented mouthguard (iMG) technology will be rolled out at the Women’s World Cup later this month following a trial in Major League Rugby, which will see LED lights flash red in a mouthguard after a high ‘head acceleration event’.

Save for two players who wear braces, and therefore unable to wear the mouthguards, Falvey has said that the new iMGs have a “full opt-in” for the World Cup, which begins on Friday, August 22, when England host the USA.

Speaking at a player welfare briefing at Twickenham’s Allianz Stadium recently, Falvey described the discrepancy between the men’s and women’s games in uptake of the iMGs, which first became part of the Head Injury Assessment procedure in 2024 after debuting in WXV in 2023.

Fixture

Women's Rugby World Cup

England Women

69 - 7

Full-time

USA Women

All Stats and Data

“The women’s teams are far more likely to say, ‘yeah, we’d love to be involved in this process. We’d love to be involved in this research or we’d love to help work with you,'” he said.

“Right now, if you want to be involved in the off-field assessment, you need to be wearing an instrumented mouthguard. So there are male players who opt out of getting an off-field HIA because they don’t want to wear an iMG. We’ve got players who decided that they don’t like the fact that it’s a Bluetooth device, we’ve had players that feel it’s uncomfortable, we’ve had players who don’t want to know. They can have an off-field assessment, HIA 2 and HIA 3, but we don’t have the information, so they don’t have an HIA 1.

“We’ve had several men’s players across leagues around the world decide that they just aren’t going to partake in that. That’s virtually non-existent in the women’s game.”

“Across the world it’s in the mid to high 80s [the percentage of players wearing mouthguards in the men’s game], so it’s very high, but still, it’s more than you would expect not wearing it. The number of opt-outs is small, mainly from people who have difficulty with a gag reflex and don’t generally wear a mouthguard. What people don’t realise is that across the world, depending on leagues, somewhere between six and 15 per cent of players don’t wear a mouthguard at all. The only country in the world where you have to wear a mouthguard is New Zealand, and even there, there’s a percentage of players that don’t wear one.

“You can imagine, you’ve played all your career, you’re in your mid-30s, and someone’s telling you that you have to wear a mouthguard. You might just say, ‘I’m not having it.'”

Falvey concedes that it is hard for him in his position to make players wear a mouthguard, but looks to former players like double World Cup-winning All Black Conrad Smith to influence the current generation of professional players.

“Conrad Smith said, ‘I would have loved to have worn one of these mouthguards when I was playing because I would have liked to have known what was happening,'” Falvey said.

“That’s the best message you can get. There’s no point me saying something, but from a former player saying to these guys, ‘When I was playing, I would have loved this information.’ At the end of the day, there’s what happens in the game, but in reality, this is more about what happens in their career.”

He added: “I’d love to [make iMGs compulsory], I think it would be great for the game, but personal choice is an important thing. Autonomy is an important thing. The way it is going, it will be ubiquitous soon because as people see and come on the journey with this. When you tell someone to do something, there’s a proportion of them that will push back and there’ll be a proportion of them that say that they want to do it. Those proportions change with time. It’s very hard to make people do stuff, but there are precedents in other sports.”

While smart mouthguards have only been widely used in the elite game for the past 18 months, Falvey explained how the data received so far has been “really helpful” in understanding head injuries.

“From last year’s Six Nations, preliminary data now shows us that even within positions – so if you take back-rows playing in the Six Nations – there’s a big difference in the number of head acceleration events that occur and then in a player, there’s a big difference between games,” he said.

“So in the Six Nations game they played in, there were a very different number of head acceleration events. So that kind of information, you could not have guessed, you couldn’t. Because that’s independent of the number of tackle events, the number of rucks. The old way of knowing, which was looking at videos, doesn’t give you this kind of information. So, where we’re moving into this space of looking at things like player load, this is where this gets really helpful.”

Falvey explained how rugby is working with the NFL in sharing data, while the NRL and AFL have pilot programmes with iMGs, adding that it is rugby union’s oft-maligned traditions that have actually helped bring change.

He said: “Everyone gives out about rugby being old and stuffy, but the traditions are exactly why we’ve been able to do this, because everybody gets together and helps each other out. We have a game where everybody is actually prepared to band together and go ‘alright, this is a bit uncomfortable, but we’re going to do it because it’s for the good of the game,’ that’s the goal.”