By Richard B. Gibson & Anna Nelson

While concern about the long-term health consequences of head injuries obtained during rugby matches and training is not a new issue, it is one which has been garnering increased attention in recent years.

In June 2024, researchers found that retired rugby players who had suffered multiple concussions had “abnormal levels of certain proteins in their blood”, which may render them more prone to develop “diseases such as motor neurone disease” than the average person. A similar narrative—one linking rugby-related concussions to long-term debilitating neurological and cognitive diseases—is playing out in an ongoing legal case against three of Rugby’s biggest authorities (World Rugby, the RFU (which governs the game in England) and the Welsh Rugby Union. In this case, hundreds of former players are accusing the bodies of negligence regarding their duty to protect players from harm, specifically concerning the game’s potential for causing neurological damage. The case has garnered sufficient attention that, in September 2024, the BBC broadcast Rugby on Trial, a documentary exploring the subject in detail.

Against this background, when watching this year’s Six Nations tournament, we noted with interest a recent innovation in the attempts to monitor on-pitch head impact and mitigate the potential herms thereof; ‘instrumented’ or ‘smart’ mouthguards. These devices, worn by players during training and games, have embedded sensors which deliver real-time alerts about ‘head acceleration events’. In other words, the mouthguards let those privy to the data they produce know, as things happen, the forces to which players’ heads, and thus their brains, are subject when involved in a collision. The idea is that with more accurate and rapid monitoring of professional and amateur player health, serious harm, and perhaps even death, can be avoided more easily, and player health can be better protected.

Of course, we welcome moves to understand and reduce potential long-term physical harm to rugby players. In our paper, however, we argue that this new avenue for collecting information about player performance and health also carries a number of ethical risks which cannot be ignored.

Our paper addresses four of the most notable ethical concerns: device and data efficacy, player choice, the inherent issues of this data’s existence, and the harmful consequences of this data’s usage and exposure. We argue that these concerns are worthy of attention and must be considered and addressed in detail. Doing so would help ensure that using smart mouthguards to reduce the risk of physical harm resulting from collisions does not have the unintended consequences of causing other forms of harm (related, for example, to autonomy, bodily integrity and/or privacy).  Ultimately, smart mouthguards represent one example in an ever-growing field of data-tracking devices being deployed in elite sports and beyond. And this is, in and of itself, not a bad thing as more data means more information upon which to make decisions. Nevertheless, in a world increasingly perceived, understood, and shaped via digital data, it is essential that we do not assume that data collection is inherently good or even neutral. Instead, we need to understand that data collection of the kind enabled by smart mouthguards can have real implications for people’s lives—and, in turn, has the potential to cause actual harm if not carefully considered and managed.

Paper title: Smart Mouthguards and Contact Sport: The Data Ethics Dilemma

Authors: Richard B. Gibson, Anna Nelson

Affiliations: RBG: Aston University; AN: University of Sheffield

Competing interests: None declared

Social media accounts of post authors: RBG: @RichardBGibson; AN: @Anna_Nelson95