Objectives: In this study, the incidence of head, neck and facial injuries in youth rugby was determined, and the associated risk factors were assessed. Design: Data were extracted from a cluster randomised controlled trial of headgear with the football teams as the unit of randomisation. No effect was observed for headgear use on injury rates, and the data were pooled. Setting: General school and club-based community competitive youth rugby in the 2002 and 2003 seasons. Participants: Young male rugby union football players participating in under-13, under 15, under 18 and under 21 years competitions. Eighty-two teams participated in year 1 and 87 in year 2. Main outcome measures: Injury rates for all body regions combined, head, neck and face calculated for game and missed game injuries. Results: 554 head, face and neck injuries were recorded within a total of 28 902 h of rugby game exposure. Level of play and player position were related to injury risk. Younger players had the lowest rates of injury; forwards, especially the front row had the highest rate of neck injury; and inside backs had the highest rate of injuries causing the player to miss a game. Contact events, including the scrum and tackle, were the main events leading to injury. Conclusion: Injury prevention must focus on the tackle and scrum elements of a youth rugby game.Rugby union football is a popular international team sport played by both sexes and all age groups. In recent years, there has been a focus on the injury risks in professional rugby; however, the majority of rugby participants are not professional. [1][2][3][4] Internationally, there has been substantial interest in the causes and management of sporting head injuries. [5][6][7][8] There are unambiguous head and neck injury risks in rugby: head injury accounts for between 15% and 30% of all injury; 15% of injury cases are concussion; serious head injuries are rare; and spinal cord injury rates are very small, but of concern because of the resultant impairment.