Recent Trends in Rugby Union Injuries

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Rugby union has changed in recent years because of several rule modifications and the 1995 advent of professionalism. Trends in rugby union injury epidemiology include: higher incidence of injury than other team sports, an apparent increase in injury risk in professional and amateur games since the advent of professionalism, reduction in injury incidence with decreasing age and competitive level, significantly higher incidence of injuries during matches compared with training, and a high proportion of tackle injuries. The commonest high-risk injury sites are the shoulder, knee, thigh, ankle, and head. Although injury research publications have increased since 1995, studies investigating risk factors for specific high-risk injuries (including nonfatal catastrophic injury) and to assess the effects of discrete prevention strategies need prioritizing.

Section snippets

Rugby Union Injury Literature Methodologies

Rugby union injury literature to date has been dominated by epidemiological studies [18], [21], [22], [23], [24], [25], [26], case reports [27], [28], [29], [30], [31], [32], and reports of nonfatal catastrophic spinal injuries [5]. Prospective epidemiological studies are particularly useful for identifying injuries of highest incidence and severity, and more importantly, those of highest risk (a product of incidence and severity) [33], [34] in different cohorts of players. These injuries can

Injuries Sustained During Matches

Match injuries constitute the largest proportion of the rugby-related injuries reported in epidemiological studies, typically contributing 80% to 90% of all injuries [18], [23], [25], [37], [45], [48], although the proportion depends on a number of factors, but predominately the ratio of training to match play. The risk of sustaining an injury in a rugby union match appears to be higher than in many other sports [4], [41], irrespective of the definition of injury (Fig. 3, Fig. 4); however,

Injuries Sustained During Training

A large number of rugby union players spend a greater proportion of time taking part in training activities for rugby than playing matches. Nevertheless, training injuries typically only constitute between 10% and 20% of all injuries in senior rugby union [18], [23], [25], [37], [45], [48], although the proportion appears to be higher in schoolboy rugby union (21%–37%) [41], [58], [59]. This difference may be because of the greater proportion of time spent in higher risk game-related training

Injury Severity, Injury Risk, and Injury Risk Factors

Reporting trends in the frequency of injuries in rugby union injury epidemiology (the incidence) without taking account of the severity of injuries may fail to highlight the injuries of greatest concern. Although a large proportion of the injuries reported in rugby union epidemiology allow a player to return to play within 7 days [12], [18], [25], [37], it is often the more severe injuries that together cause the greatest total absence. Therefore a measure of injury risk that considers the days

Padded Equipment and Mouth Guards

One potential method of reducing injury risk is by the wearing of padded equipment and mouth guards; although there is no stipulation that this equipment must be worn in the rules of the game. Shoulder pads, headgear, and chest pads that are worn during matches must be no thicker than 1 cm when uncompressed (0.5 cm for padding on other areas) and be no denser than 45 kg per cubic meter [3]. Helmets, padded headgear, and shoulder pads are used in many other collision and contact sports to

Catastrophic Spinal Injuries

Little is known about noncatastrophic spinal injuries [99], [100]; however, “nonfatal catastrophic (spinal) injuries” [6] have received considerable focus in the medical literature over several decades [5], [123], [124], [125], [126], [127], [128], [129], [130], [131], [132], [133], [134], [135], [136], [137], [138], [139], [140], [141], [142], [143] because of their devastating consequences. Nevertheless, these injuries are extremely rare (reported to be around 1 per 10,000 players per season

Long-term Health Implications

Few studies have been published and very little is known about the long-term health impact of rugby union injuries [145], [146], [147], [148]. In a 4-year follow-up study of amateur players, it was revealed that 26% of those who had ceased playing had done so because of a rugby injury (the largest category of retired players), with the knee (35%), back (14%), and shoulder (9%) the most common injury locations [148]. Furthermore, 35% of men who sustained an injury in the original epidemiological

Injury Research in the Future

The recently published IRB consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union should allow future research to be more consistent and comparable than is currently the case [6]. Our understanding of the etiology and epidemiology of rugby union injuries has improved with the increase in published research post-professionalism; however, there are still a number of major gaps, and further research is required to progress our understanding:

Summary

The game of rugby union has evolved over nearly 2 centuries, and is now one of the world's most popular participation team sports. Recent drivers for change in the way the game is played have included rule modifications aimed to both reduce the risk of serious injury and to keep the ball in play longer, and the advent of professionalism in 1995. Trends from published studies show a high incidence of injury compared with other team sports; an apparent increase in injury risk since the advent of

Acknowledgement

The authors would like to thank Ed Morrison (Rugby Football Union Elite Referee Development Officer) for his assistance in documenting rugby union law changes.

References (157)

  • J.P. Nicholl et al.

    The epidemiology of sports and exercise related injury in the United Kingdom

    Br J Sports Med

    (1995)
  • K.L. Quarrie et al.

    Rugby union injuries to the cervical spine and spinal cord

    Sports Med

    (2002)
  • C.W. Fuller et al.

    Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union

    Br J Sports Med

    (2007)
  • P.J. Maud et al.

    The US national rugby team: a physiological and anthropometric assessment

    Phys Sportsmed

    (1984)
  • B.R. Carlson et al.

    Physique and motor performance characteristics of US national rugby players

    J Sports Sci

    (1994)
  • D.J. Holmyard et al.

    Seasonal variations in the anthropometric and physiological characteristics of international rugby union players

  • R.J. Tong et al.

    The effect of pre-season training on the physiological characteristics of international rugby union players

    J Sports Sci

    (1995)
  • Bell W, Cobner D, Cooper S-M, et al. Anaerobic performance and body composition of international rugby union players....
  • J.H.M. Brooks et al.

    A prospective study of injuries and training amongst the England 2003 rugby World Cup squad

    Br J Sports Med

    (2005)
  • Rigg P, Reilly T. A fitness profile and anthropometric analysis of first and second class rugby union players. In:...
  • C.W. Nicholas et al.

    Anthropometric and physiological characteristics of first and second class rugby union players

    J Sports Sci

    (1995)
  • G. Casagrande et al.

    Somatotype of Italian rugby players

    J Sports Med Phys Fitness

    (1993)
  • K.L. Quarrie et al.

    The New Zealand rugby injury and performance project iii. Anthropometric and physical performance characteristics of players

    Br J Sports Med

    (1995)
  • J.H.M. Brooks et al.

    Epidemiology of injuries in English professional rugby union: part 1 match injuries

    Br J Sports Med

    (2005)
  • International Rugby Board (IRB). Rugby World Cup 2003 statistical review and match analysis, 2003. Available at:...
  • Quarrie KL, Hopkins WG. Changes in player characteristics and match activities in Bledisloe Cup rugby union from 1972...
  • H. Seward et al.

    Football injuries in Australia at elite level

    Med J Aust

    (1993)
  • D.C. Hughes et al.

    A prospective survey of injuries to first-grade rugby union players

    Clin J Sport Med

    (1994)
  • Y.N. Bird et al.

    The New Zealand rugby injury and performance project: V. epidemiology of a season of rugby injury

    Br J Sports Med

    (1998)
  • I. Jakoet et al.

    A high rate of injury during the 1995 rugby World Cup

    S Afr Med J

    (1998)
  • A. Bathgate et al.

    A prospective study of injuries to elite Australian rugby union players

    Br J Sports Med

    (2002)
  • J.P. Best et al.

    Rugby World Cup 2003 injury surveillance project

    Br J Sports Med

    (2005)
  • S.P.T. Kemp et al.

    Injury to the first rib synchondrosis in a rugby footballer

    Br J Sports Med

    (1999)
  • I.-H. Jeon et al.

    Traumatic humeral articular cartilage shear (THACS) lesion in a professional rugby player: a case report

    Br J Sports Med

    (2004)
  • A.J. Walsh et al.

    Paraplegia secondary to fracture-subluxation of the thoracic spine sustained playing rugby union football

    Br J Sports Med

    (2004)
  • A.H. Mirza et al.

    Posterior sternoclavicular dislocation in a rugby player as a cause of silent vascular compromise: a case report

    Br J Sports Med

    (2005)
  • J. Dearing et al.

    Soft tissue neck lumps in rugby union players

    Br J Sports Med

    (2006)
  • C.W. Fuller et al.

    The application of risk assessment in sport

    Sports Med

    (2004)
  • J.H.M. Brooks et al.

    The influence of methodological issues on the results and conclusions from epidemiological studies of sports injuries: illustrative examples

    Sports Med

    (2006)
  • W. van Mechelen et al.

    Incidence, severity, aetiology and prevention of sports injuries. A review of concepts

    Sports Med

    (1992)
  • W.H. Meeuwisse

    Assessing causation in sport injury: a multifactorial model

    Clin J Sport Med

    (1994)
  • S.G.R. Targett

    Injuries in professional rugby union

    Clin J Sport Med

    (1998)
  • L.J. Holtzhausen et al.

    The incidence and nature of injuries in South African rugby players in the rugby Super 12 competition

    S Afr Med J

    (2006)
  • E. Bottini et al.

    Incidence and nature of the most common rugby injuries sustained in Argentina (1991–1997)

    Br J Sports Med

    (2000)
  • Z. Babic et al.

    Croatian rugby project. Part ii: injuries

    J Sports Med Phys Fitness

    (2001)
  • A. Junge et al.

    Injuries in youth amateur soccer and rugby players—comparison of incidence and characteristics

    Br J Sports Med

    (2004)
  • M. Wekesa et al.

    Injury surveillance in a rugby tournament

    Br J Sports Med

    (1996)
  • T.E. Durkin

    A survey of injuries in a 1st class rugby union football club

    Br J Sports Med

    (1977)
  • J.E. Davies et al.

    Injuries in rugby union football

    Br Med J

    (1978)
  • J.H.M. Brooks et al.

    Epidemiology of injuries in English professional rugby union: part 2 training injuries

    Br J Sports Med

    (2005)
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