Match injury incidence during the Super Rugby tournament is high: a prospective cohort study over five seasons involving 93 641 player-hours

Twenty year analysis of professional men's rugby union knee injuries from the English premiership shows high rates and burden

OBJECTIVES

To determine the rates, severity and burden of knee injuries in professional male rugby union from the English Premiership.

METHODS

Injury and exposure data were captured over 20 seasons using a prospective cohort design. Knee injury incidence, days' absence and burden were recorded for each injury type and by pitch surface type for match and training.

RESULTS

The rate of knee injury in matches was 9.8/1000 hours (95% CIs 9.3-10.3). Mean days lost were 50 (95% CI 46 to 53) in matches and 51 (95% CI 44 to 57) in training. In matches, medial collateral ligament injuries were the most common, while anterior cruciate ligament (ACL) injuries had the highest mean severity and burden. There was no significant change in the count of knee injuries over time; however, average severity increased significantly (annual change: 2.18 days (95% CI 1.60 to 2.77); p<0.001). The incidence of match knee injury was 44% higher on artificial pitches than grass pitches (incidence rate ratio: 1.44 (95% CI 1.21 to 1.69); p<0.01), with no significant difference in severity between surfaces. In matches, the tackle was the event most commonly associated with knee injuries for all diagnoses, except ACL injuries (running). In training, running was a more common injury event than the tackle.

CONCLUSION

Knee injuries in matches are common and severe in English professional men's rugby union. Despite an increased focus on player conditioning and injury prevention throughout the study period, rates of knee injury remained stable, and resulting days' absence increased. New strategies for the prevention of knee injuries should be considered a priority.

A high incidence of injury among male university student rugby players requires urgent injury prevention strategies

OBJECTIVES

Determine the epidemiology and clinical characteristics of training and match injuries in university student rugby players over a two-season period.

DESIGN

Prospective cohort.

SETTING

Varsity Cup (VC) and Young Guns (YG) rugby tournaments (2018 and 2019).

PARTICIPANTS

171 male university student rugby players.

MAIN OUTCOME MEASURES

For time-loss injuries: injury incidence (injuries per 1000 player-hours), injured player proportion (% of injured players) and the frequency (n, %) of injury characteristics (new or recurrent, anatomical region, body area, severity.

RESULTS

The injury incidence was 2.4 per 1000 player-hours for training injuries and 131.1 per 1000 player-hours for match injuries. The overall injured player proportion was 59.6%. New injuries (83.9%) were more frequent than recurrent injuries. Most injuries occurred in the lower limb involving muscle/tendon (56.7%) and ligament/joint capsule (27.2%). The shoulder (19.6%) and ankle (15.7%) were the most common body areas of injury during matches and training, respectively.

CONCLUSIONS

There was a high injured player proportion and match injury incidence among university student rugby players. Most injuries were new. Lower limb injuries were most common in training whereas upper limb injuries were most common in matches. These findings highlight the need to prioritise future injury prevention among university student rugby players.

Tackling sport-related concussion: effectiveness of lowering the maximum legal height of the tackle in amateur male rugby - a cross-sectional analytical study

OBJECTIVE

Rugby union ('rugby') is popular globally, with most of its participants being amateur. Concern regarding sport-related concussion (SRC) sustained during rugby is increasing. SRC occurs most frequently in the tackle, yet few interventions have aimed to mitigate this risk factor. This study investigated the influence of a lowered legal tackle height on SRC incidence in amateur rugby.

DESIGN

Cross-sectional analytical study: 2018 (control-standard tackle height) and 2019 (intervention-lowered legal tackle height) seasons.

SETTING

South African collegiate student rugby competition.

PARTICIPANTS

Between 800 and 900 male amateur student players (age: 20±1.6 years) in each year.

INTERVENTION

Maximum legal tackle height lowered from line of the shoulder on the ball carrier to the line of the armpit.

OUTCOME MEASURES

Number of overall (medical attention) and time-loss (≥1 day lost) injuries, head injuries and SRCs in 2018 and 2019 (dependent variables); events associated with injury incidents (independent variables).

RESULTS

There was no statistically significant difference in incidences of time-loss injuries (IRR: 0.79; 95% CI: 0.6 to 1.1; p=0.13), head injuries (IRR: 0.83; 95% CI: 0.5 to 1.3; p=0.42) and SRC (IRR: 0.69; 95% CI: 0.4 to 1.2; p=0.20). In 2018 and 2019, most time-loss head injuries (57%, n=43) and SRCs (55%, n=26) occurred during the tackle.

CONCLUSIONS

Despite a trend towards reducing injuries, head injuries and SRC, lowering maximum legal tackle height to armpit level did not change SRC incidence in this amateur male rugby cohort. Most time-loss head injuries and SRCs occurred during the tackle. Further tackle-related interventions to reduce SRC incidence require investigation.

Longitudinal study of six seasons of match injuries in elite female rugby union

ObjectiveTo establish match injury rates and patterns in elite female rugby union players in England.

METHOD

We conducted a six-season (2011/2012-2013/2014 and 2017/2018-2019/2020) prospective cohort study of time-loss match injuries in elite-level female players in the English Premiership competition. A 24-hour time-loss definition was used.

RESULTS

Five-hundred and thirty-four time-loss injuries were recorded during 13 680 hours of match exposure. Injury incidence was 39 injuries per 1000 hours (95% CIs 36 to 42) with a mean severity of 48 days (95% CIs 42 to 54) and median severity of 20 days (IQR: 7-57). Concussion was the most common specific injury diagnosis (five concussions per 1000 hours, 95% CIs 4 to 6). The tackle event was associated with the greatest burden of injury (615 days absence per 1000 hours 95% CIs 340 to 1112), with 'being tackled' specifically causing the most injuries (28% of all injuries) and concussions (22% of all concussions).

CONCLUSIONS

This is the first multiple-season study of match injuries in elite women's rugby union players. Match injury incidence was similar to that previously reported within international women's rugby union. Injury prevention strategies centred on the tackle would focus on high-burden injuries, which are associated with substantial player time-loss and financial costs to teams as well as the high-priority area of concussions.

Contributors to negative biopsychosocial health or performance outcomes in rugby players (CoNBO): a systematic review and Delphi study protocol

The importance of contributors that can result in negative player outcomes in sport and the feasibility and barriers to modifying these to optimise player health and well-being have yet to be established. Within rugby codes (rugby league, rugby union and rugby sevens), within male and female cohorts across playing levels (full-time senior, part-time senior, age grade), this project aims to develop a consensus on contributors to negative biopsychosocial outcomes in rugby players (known as the CoNBO study) and establish stakeholder perceived importance of the identified contributors and barriers to their management. This project will consist of three parts; part 1: a systematic review, part 2: a three-round expert Delphi study and part 3: stakeholder rating of feasibility and barriers to management. Within part 1, systematic searches of electronic databases (PubMed, Scopus, MEDLINE, SPORTDiscus, CINAHL) will be performed. The systematic review protocol is registered with PROSPERO. Studies will be searched to identify physical, psychological and/or social factors resulting in negative player outcomes in rugby. Part 2 will consist of a three-round expert Delphi consensus study to establish additional physical, psychological and/or social factors that result in negative player outcomes in rugby and their importance. In part 3, stakeholders (eg, coaches, chief executive officers and players) will provide perceptions of the feasibility and barriers to modifying the identified factors within their setting. On completion, several manuscripts will be submitted for publication in peer-reviewed journals. The findings of this project have worldwide relevance for stakeholders in the rugby codes. PROSPERO registration number CRD42022346751.

Impact, incidence and prevalence of musculoskeletal injuries in senior amateur male rugby: epidemiological study

OBJECTIVES

Exposure to different types of injuries in rugby union is common. It is important to know about the injury epidemiology for medical teams care in order to optimize players´ performance and the treatment of common injuries, but there is limited specific information related to amateur rugby union. The purpose of this study is to determine the incidence, prevalence, injury burden, severity, nature of injuries sustained by senior amateur male rugby players from three clubs in Argentina during a given season.

METHODS

An observational, analytical, prospective, multicenter study was developed. Data collection was conducted from 15 March 2019 to 2 November 2019, during a complete season under the applicable standards of the Rugby Injury Consensus Group according to the Orchard Sports Injury and Illness Classification System.Incidence (injuries/1000 player-match-hours), prevalence (%), severity (time loss), injury burden (days lost/1000 player-match-hours), injured location and type of injury (%) were estimated.

RESULTS

250 players and 180 injuries were assessed. Injury prevalence was 52.4%. Incidence rate per match and training was 30.9/1000 player-match-hours, and 0.77/1000 player-training-hours, respectively.The median injury severity score was 23 (IQR 12.7-52) days lost accounting for an injury burden of 97.3/1000 player-hours. Of the total, 113 (62.8%) injuries were contact injuries. The lower limbs were the most commonly affected (58.9%). Hamstring strain injury had the highest incidence and anterior cruciate ligament tear was the most severe injury.

CONCLUSION

The prevalence, incidence, and injury burden reported in this study are unprecedented and would add knowledge for the amateur rugby union community. Trainers, physicians, and physical therapists, should consider it to improve their clinical practice.

Injury and Illness Incidence in 2017 Super Rugby Tournament: A Surveillance Study on a Single South African Team

Background

Professional rugby presents significant injury and illness risks to players, which need to be regularly assessed to monitor the effects of interventions and competition rules changes.

Hypothesis/Purpose

The purpose of this study was to determine the incidence and nature of time-loss injuries and illness during the pre-season and competition period of the 2017 Super Rugby tournament in a single South African team.

Study Design

Descriptive Epidemiology Study.

Methods

Forty-five adult players were recruited from one 2017 Super Rugby South African team, with 39 included in the final data set. Daily injury and illness data were routinely collected during the season by support staff over a 28-week period (January to July 2017), based on standardized injury and illness definitions. Retrospective analyses of the data were performed.

Results

The incidence of match injuries (241.0 per 1000 player hours) was significantly higher than training injuries (3.3 per 1000 player hours). Twenty one percent of all injuries occurred during the tackle; 37.5% of all injuries were of a "moderate" severity. The proportion of players who sustained a time-loss injury was 76.9% (n=30). The overall incidence of illness was 1.8 per 1000 player days. Acute respiratory tract infection (28.6%) was the most common diagnosis, and the majority of illnesses (64.3%) did not result in time-loss.

Conclusion

This study presented a longer study period than previous research by including the pre-season training, but represented only one single team. The incidence of match injuries was significantly higher than previously reported in Super Rugby tournaments, whereas illness rates were significantly lower. Support staff in professional rugby need to be trained on the standardized Orchard System of Classifications to ensure good quality data that can be compared to other teams within the same or other sporting codes.

Level of evidence

Level 3.

Injuries in Elite Men's Rugby Union: An Updated (2012-2020) Meta-Analysis of 11,620 Match and Training Injuries

BACKGROUND

The most recent meta-analytic review of injuries in elite senior men's Rugby Union was published in 2013. The demands of the game at the elite level are continually changing alongside law amendments and developments in player preparation. As such, an updated meta-analysis of injury data in this setting is necessary.

OBJECTIVE

To meta-analyse time-loss injury data in elite senior men's Rugby Union between 2012 and 2020.

METHODS

Electronic databases were searched using the keywords 'rugby' and 'inj*'. Nineteen studies met the inclusion criteria. Injury incidence rate data were modelled using a mixed-effects Poisson regression model. Days missed data were modelled using a general linear mixed model.

RESULTS

The included data encompassed a total of 8819 match injuries and 2801 training injuries. The overall incidence rate of injuries in matches was 91 per 1000 h (95% confidence interval (CI) 77-106). The estimated mean days missed per match injury was 27 days (95% CI 23-32). The overall incidence rate of match concussions was 12 per 1000 h (95% CI 9-15). The overall incidence rate of training injuries was 2.8 per 1000 h (95% CI 1.9-4.0). Playing level was not a significant effect modifier for any outcome.

CONCLUSIONS

The injury incidence rate and mean days missed per injury in the present meta-analysis were higher, but statistically equivalent to, the 2013 meta-analysis (81 per 1000 h and 20 days, respectively). The injury incidence rate for match injuries in elite senior men's Rugby Union is high in comparison to most team sports, though the training injury incidence rate compares favourably. The tackle event and concussion injuries should continue to be the focus of future preventative efforts.

A blood biomarker and clinical correlation cohort study protocol to diagnose sports-related concussion and monitor recovery in elite rugby

Introduction

In professional rugby, sports-related concussion (SRC) remains the most frequent time loss injury. Therefore, accurately diagnosing SRC and monitoring player recovery, through a multi-modal assessment process, is critical to SRC management. In this protocol study, we aim to assess SRC over multiple time points post-injury to determine the value of multi-modal assessments to monitor player recovery. This is of significance to minimise premature return-to-play and, ultimately, to reduce the long-term effects associated with SRC. The study will also establish the logistics of implementing such a study in a professional setting to monitor a player's SRC recovery.

Methods and analysis

All players from the participating professional rugby club within the Irish Rugby Football Union are invited to participate in the current study. Player assessment includes head injury assessment (HIA), neuropsychometric assessment (ImPACT), targeted biomarker analysis and untargeted biomarker analysis. Baseline HIA, ImPACT, and blood draws are performed prior to the start of playing season. During the baseline tests, player's complete consent forms and an SRC history questionnaire. Subsequently, any participant that enters the HIA process over the playing season due to a suspected SRC will be clinically assessed (HIA and ImPACT) and their blood will be drawn within 3 days of injury, 6 days post-injury, and 13 days post-injury.

Ethics and dissemination

Ethical approval was attained from the Science and Engineering Research Ethics Committee, University of Limerick (Approval Code: 2018_06_11_S&E). On completion of the study, further manuscripts will be published to present the results of the tests and their ability to measure player recovery from SRC.

Trial registration number

NCT04485494.

Trends in match injury risk in professional male rugby union: a 16-season review of 10 851 match injuries in the English Premiership (2002–2019): the Professional Rugby Injury Surveillance Project

Objectives

The Professional Rugby Injury Surveillance Project is the largest and longest running rugby union injury surveillance project globally and focuses on the highest level of rugby in England.

Methods

We examined match injuries in professional men’s rugby over the period 2002/2003 to 2018/2019 and described trends in injuries over this time.

Results

Over the period 2002/2003–2018/2019, 10 851 injuries occurred in 1 24 952 hours of match play, equating to a mean of 57 injuries per club per season and one injury per team per match. The mean incidence, severity (days absence) and burden (days absence/1000 hours) of injury were 87/1000 hours (95% CI 82 to 92), 25 days (95% CI 22 to 28) and 2178 days/1000 hours (95% CI 1872 to 2484), respectively. The tackle accounted for 43% injuries with running the second most common activity during injury (12%). The most common injury location was the head/face with an incidence of 11.3/1000 hours, while the location with the highest overall burden was the knee (11.1 days/1000 hours). Long-term trends demonstrated stable injury incidence and proportion of injured players, but an increase in the mean and median severity of injuries. Concussion incidence, severity and burden increased from the 2009/2010 season onwards and from 2011 to 2019 concussion was the most common injury.

Conclusion

The rise in overall injury severity and concussion incidence are the most significant findings from this work and demonstrate the need for continued efforts to reduce concussion risk as well as a greater understanding of changes in injury severity over time.

Lay of the land: narrative synthesis of tackle research in rugby union and rugby sevens

Objectives

The purpose of this review was to synthesise both injury prevention and performance tackle-related research to provide rugby stakeholders with information on tackle injury epidemiology, including tackle injury risk factors and performance determinants, and to discuss potential preventative measures.

Design

Systematic review and narrative synthesis.

Data sources

PubMed, Scopus and Web of Science.

Eligibility criteria

Limited to peer-reviewed English-only publications between January 1995 and October 2018.

Results

A total of 317 studies were identified, with 177 in rugby union and 13 were in rugby sevens. The tackle accounted for more than 50% of all injuries in rugby union and rugby sevens, both at the professional level and at the lower levels, with the rate of tackle injuries higher at the professional level (mean 32/1000 player-hours) compared with the lower levels (mean 17/1000 player-hours). A player’s tackle actions and technical ability were identified as major risk factors for injury and a key determinant of performance.

Summary/conclusion

Evidence-based education, progressive tackle technique training with a high potential to transfer and law changes have been proposed as key modifiers of player tackle actions and technical ability. Conceivably, all three modifiers working in unison (as opposed to separately) will have a higher potential at reducing tackle injury risk while enhancing performance. With the guidance of tackle injury and performance studies, as well as stakeholder engagement, experiential and explorative tackle research has the potential to inspire innovative injury prevention and performance strategies.

Orthopaedic and brain injuries over last 10 seasons in the National Football League (NFL): number and effect on missed playing time

Objective

To examine trends in number and seriousness of major injuries in the National Football League (NFL) over seasons 2010–2019 and the effect of rule changes to injuries to the leg, back, arm and head.

Methods

We calculated, from publicly available weekly injury reports, the number of players that were injured and playing time missed, that is, the number of weeks on average that an injured player had to sit out, as a function of injury to a specific body part. Using classical time series analysis techniques, we fitted injury data with linear and non-linear functions.

Results

The number of major injuries to the leg, back, arm and head has not declined over the last 10 years. During this time period, time missed because of injuries to the head has shown a significantly increasing trend. Rule changes designed specifically to protect arm or head have, respectively, succeeded in shortening the time that the injured player misses, but the impact lasts only over a single season.

Conclusions

Overall, our data support the argument that new, well-intentioned rules adopted every season by the NFL have been proven to be too weak to make the NFL game safer. Broad-based management of brain and orthopaedic injuries and adoption of preventative measures to reduce the number of players injured and the seriousness of their injuries are required in the modern NFL.

High Concussion Rate in Student Community Rugby Union Players During the 2018 Season: Implications for Future Research Directions

Collision sports, such as Rugby Union (“Rugby”) have a particularly high risk of injury. Of all injuries common to collision sports, concussions have received the most attention due to the potentially negative cognitive effects in the short- and long-term. Despite non-professional Rugby players comprising the majority of the world’s playing population, there is relatively little research in this population. Stellenbosch Rugby Football Club (“Maties”), the official rugby club of Stellenbosch University, represents one of the world’s largest non-professional Rugby clubs, making this an ideal cohort for community-level injury surveillance. The aim of this study was to describe the incidence and events associated with concussion in this cohort. Baseline demographics were obtained on the 807 male student Rugby non-professional players who registered for the 10-week long 2018 season, which comprised 101 matches and 2,915 of exposure hours. All match-related injuries were captured by the medical staff of Stellenbosch Campus Health Service on an electronic form developed from the consensus statement for injury recording in Rugby. The mean age, height and weight of this cohort were 20 ± 2 years, 182 ± 7 cm and 88 ± 14 kg, respectively. Overall, there were 89 time-loss injuries, which equated to an injury rate of 30.6 per 1,000 match hours [95% confidence intervals (CIs): 24.2–36.9], or about one injury per match. The most common injury diagnosis was “concussion” (n = 27 out of 90 injuries, 30%), at a rate of 9.3 per 1,000 match hours (95% CIs: 5.8–12.8). The three most common mechanisms of concussion in the present study were performing a tackle (33%), accidental collision (30%) and being tackled (11%). Concussion was the most common injury in this population, at a rate that was six times higher than the most comparable study from the UK, which had far more exposure time over six seasons and wider range of player ability, from recreational to semi-professional. This might be explained by the training and vigilance of the club’s first aiders observing all matches for concussion. Future studies should try to explain this high rate and subsequently reduce these concussions. The addition of video surveillance data would assist in identifying the etiology of these concussions injuries in order to develop specific targeted interventions.