Injury Profile of American Women's Rugby-7s

Paving the path for injury prevention in rugby-7s: A systematic review and meta-analysis

This review and meta-analysis aimed to describe the current rugby-7s injury epidemiological literature by examining injury data from both sexes, all levels of play, and their associated risk factors. Studies published up until March 2024 were included. These studies were retrieved from six databases using search terms related to rugby-7s or sevens, tackle, collision, collision sport, injury, athlete, incidence rate, mechanism, and risk factor. Only peer-reviewed original studies using prospective or retrospective cohort designs with a clearly defined rugby-7s sample were considered. Included studies needed to report one injury outcome variable. Non-English and qualitative studies; reviews, conference papers, and abstracts were excluded. Twenty studies were included. The meta-analysis used the DerSimonian-Laird continuous random-effects method to calculate the pooled estimated means and 95% confidence interval. The estimated mean injury incidence rate for men was 108.5/1000 player-hours (95% CI: 85.9-131.0) and 76.1/1000 player-hours (95% CI: 48.7-103.5) for women. The estimated mean severity for men was 33.9 days (95% CI: 20.7-47.0) and 44.2 days (95% CI: 32.1-56.3) for women. Significantly more match injuries occurred in the second half of matches, were acute, located at the lower limb, diagnosed as joint/ligament, and resulted from being tackled. Fatigue, player fitness, and previous injuries were associated with an increased risk of injury. There were no statistically significant differences between women's and men's injury profiles. However, the inherent cultural and gendered factors which divide the two sports should not be ignored. The findings from this review will help pave the way forward beyond the foundational stages of injury prevention research in rugby-7s.

Median Time to Return to Sports After Concussion Is Within 21 Days in 80% of Published Studies

PURPOSE

To perform a systematic review of the literature and evaluate the return to play (RTP) time frame after a concussion diagnosis. Our secondary purpose was to analyze and compare different prognostic variables affecting concussions, time to return to school, time to symptom resolution of concussive symptoms, and time each patient spent in the RTP protocol.

METHODS

A PubMed, Scopus, Medline, Embase, and Cochrane Library database literature review was performed in August 2022. The studies needed to report, in days, the length of time a patient/athlete was removed from play due to concussion management. The Risk of Bias in Non-Randomized Studies of Interventions tool was used for risk of bias for each study, and Methodological Index for Non-Randomized Studies criteria were used for quality assessment.

RESULTS

There were 65 studies included in the systematic review and a total of 21,966 patients evaluated. The RTP time intervals ranged from 1 to 1,820 days, with 80.7% of the median RTP time frames for each study within 21 days. Preconcussion risk factors for prolonged RTP included female sex, younger age, presence of psychiatric disorders, and history of previous concussion. Postconcussion risk factors included severe symptom scores at initial clinic visit, loss of consciousness, nonelite athletes, and delayed removal from competition. The most common sports resulting in concussion were contact sports, most commonly football and soccer. Median time to return to school was 3 to 23 days. Median time to symptom resolution ranged from 2 to 11 days. Median time in RTP protocol was 1 to 6 days.

CONCLUSIONS

Median time to return to sports after concussion is within 21 days in 80% of published studies.

LEVEL OF EVIDENCE

IV, systematic review of Level I to IV studies.

Drop Test Kinematics Using Varied Impact Surfaces and Head/Neck Configurations for Rugby Headgear Testing

World Rugby employs a specific drop test method to evaluate headgear performance, but almost all researchers use a different variation of this method. The aim of this study was, therefore, to quantify the differences between variations of the drop testing method using a Hybrid III headform and neck in the following impact setups: (1) headform only, with a flat steel impact surface, approximating the World Rugby method, (2 and 3) headform with and without a neck, respectively, onto a flat MEP pad impact surface, and (4) headform and neck, dropped onto an angled MEP pad impact surface. Each variation was subject to drop heights of 75-600 mm across three orientations (forehead, side, and rear boss). Comparisons were limited to the linear and rotational acceleration and rotational velocity for simplicity. Substantial differences in kinematic profile shape manifested between all drop test variations. Peak accelerations varied highly between variations, but the peak rotational velocities did not. Drop test variation also significantly changed the ratios of the peak kinematics to each other. This information can be compared to kinematic data from field head impacts and could inform more realistic impact testing methods for assessing headgear.

Applied sports science and sports medicine in women’s rugby: systematic scoping review and Delphi study to establish future research priorities

Objectives

In part 1, the objective was to undertake a systematic scoping review of applied sports science and sports medicine in women’s rugby, and in part 2 to develop a consensus statement on future research priorities.

Design

In part 1, a systematic search of PubMed (MEDLINE), Scopus and SPORTDiscus (EBSCOhost) was undertaken from the earliest records to January 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, the PRISMA extension for Scoping Reviews, and the PRISMA extension protocols were followed. In part 2, 31 international experts in women’s rugby (ie, elite players, sports scientists, medical clinicians, sports administrators) participated in a three-round Delphi consensus method. These experts reviewed the findings from part 1 and subsequently provided a list of priority research topics in women’s rugby. Research topics were grouped into expert-based themes and expert-based subthemes via content analysis. Expert-based themes and expert-based subthemes were ranked from very low to very high research priority on a 1–5 Likert scale. Consensus was defined by ≥70% agreement. The median research priority agreement and IQR were calculated for each expert-based theme and subtheme.

Data sources

PubMed (MEDLINE), Scopus and SPORTDiscus (EBSCOhost).

Eligibility criteria for selecting studies

Studies were eligible for inclusion if they investigated applied sports science or sports medicine in women’s rugby.

Results

In part 1, the systematic scoping review identified 123 studies, which were categorised into six sports science and sports medicine evidence-based themes: injury (n=48), physical performance (n=32), match characteristics (n=26), fatigue and recovery (n=6), nutrition (n=6), and psychology (n=5). In part 2, the Delphi method resulted in three expert-based themes achieving consensus on future research priority in women’s rugby: injury (5.0 (1.0)), female health (4.0 (1.0)) and physical performance (4.0 (1.0)).

Summary/Conclusion

This two-part systematic scoping review and Delphi consensus is the first study to summarise the applied sports science and sports medicine evidence base in women’s rugby and establish future research priorities. The summary tables from part 1 provide valuable reference information for researchers and practitioners. The three expert-based themes that achieved consensus in part 2 (injury, female health and physical performance) provide clear direction and guidance on future research priorities in women’s rugby. The findings of this two-part study facilitate efficient and coordinated use of scientific resources towards high-priority research themes relevant to a wide range of stakeholders in women’s rugby.

The Incidence, Cost, and Burden of Concussion in Women's Rugby League and Rugby Union: A Systematic Review and Pooled Analysis

Background

The extent of concussion injury in the rugby codes for women is unclear.

Objective

Our aim was to review all published studies reporting concussion injuries from match and training participation in rugby codes and report the pooled data estimates for rugby league and union concussion injury epidemiology.

Methods

We conducted a systematic literature analysis of concussion in rugby league and rugby union for published studies from January 1990 to July 2021. Data from 16 studies meeting the inclusion criteria were extracted for women’s concussion injuries and were subsequently pooled. Costs from Accident Compensation Corporation (ACC) data were attributed to the results to provide cost estimates.

Results

The pooled analysis match injury incidence of women’s concussion was higher for rugby league (10.3 per 1000 match hours) than rugby 15 s (2.8 per 1000 match hours) or rugby 7 s (8.9 per 1000 match hours). There was a fourfold difference in the pooled incidence of concussion in women’s rugby league (risk ratio [RR] 4.53, 95% confidence interval [CI] 1.8–11.3]; p = 0.0001) when compared with rugby 15 s. There was also a ninefold higher risk of a concussion during match participation compared with training participation for women’s rugby 15 s (RR 9.3, 95% CI 1.29–66.78; p = 0.0070). The total estimated costs for the concussions reported were NZ$1,235,101. For rugby 7 s, the pooled concussive injury burden was 33.2 days.

Conclusions

Our pooled analysis clarified the extent of concussion injury and the possible associated costs at several levels of the game for women’s rugby codes. The pooled mean days lost because of concussions was 33 days. As this was considerably longer than the 7- to 10-day expected timeframe outlined in the Concussion in Sport Consensus statement, these guidelines need to be updated to include sex-specific differences.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-022-01645-8.

Potential of Soft-Shell Rugby Headgear to Mitigate Linear and Rotational Peak Accelerations

Rugby union is a popular sport played across the world. The physical contact inherent in the game means that players are at increased risk of concussive injury. In 2019, World Rugby created a new category of permitted headgear under Law 4 as a medical device. This established a pathway for headgear designed to reduce peak accelerations to be worn in matches. Investigations of the potential of soft-shelled protective headgear to reduce head impact accelerations have been mostly limited to the analysis of linear kinematics. However rotational head impact accelerations have long been implicated as far more injurious. The aim of this study, therefore, was to assess the linear and rotational acceleration reduction brought about by soft-shelled rugby headgear. A Hybrid III headform and neck were dropped onto a modular elastomer programmer impact surface, impacting at four different velocities (1.7–3.4 m/s) in five different impact orientations. Impact surface angles were 0°, 30°, and 45°. Peak linear and rotational accelerations, PLA and PRA respectively, were recorded. All headgear significantly reduced PLAs and PRAs when compared to a no headgear scenario. The new generation, headgear reduced all measures significantly more than the older generation of headgear. Impact locations offset from the center of mass of the headform resulted in the highest PRAs measured. As the impact surface angle increased, both PLAs and PRAs decreased. The study demonstrated that headgear tested lowered PLAs by up to 50%, and PRAs by up to 60% compared to the bare headform. Our data suggest that new generation headgear could make a difference on the field in reducing injurious impact accelerations in a collision.

Potential of Soft-Shelled Rugby Headgear to Reduce Linear Impact Accelerations

The purpose of this study was to examine the potential of soft-shelled rugby headgear to reduce linear impact accelerations. A hybrid III head form instrumented with a 3-axis accelerometer was used to assess headgear performance on a drop test rig. Six headgear units were examined in this study: Canterbury Clothing Company (CCC) Ventilator, Kukri, 2nd Skull, N-Pro, and two Gamebreaker headgear units of different sizes (headgears 1-6, respectively). Drop heights were 238, 300, 610, and 912 mm with 5 orientations at each height (forehead, front boss, rear, rear boss, and side). Impact severity was quantified using peak linear acceleration (PLA) and head injury criterion (HIC). All headgear was tested in comparison to a no headgear condition (for all heights). Compared to the no headgear condition, all headgear significantly reduced PLA and HIC at 238 mm (16.2-45.3% PLA and 29.2-62.7% HIC reduction; P < 0.0005, η p 2 = 0.987-0.991). Headgear impact attenuation lowered significantly as the drop height increased (32.4-5.6% PLA and 50.9-11.7% HIC reduction at 912 mm). There were no significant differences in PLA or HIC reduction between headgear units 1-3. Post hoc testing indicated that headgear units 4-6 significantly outperformed headgear units 1-3 and additionally headgear units 5 and 6 significantly outperformed headgear 4 (P < 0.05). The lowest reduction PLA and HIC was for impacts rear orientation for headgear units 1-4 (3.3 ± 3.6%-11 ± 5.8%). In contrast, headgear units 5 and 6 significantly outperformed all other headgear in this orientation (P < 0.0005, η p 2 = 0.982-0.990). Side impacts showed the greatest reduction in PLA and HIC for all headgear. All headgear units tested demonstrated some degree of reduction in PLA and HIC from a linear impact; however, units 4-6 performed significantly better than headgear units 1-3.

Considering Biological Sex in Traumatic Brain Injury

Published epidemiological studies of traumatic brain injury (TBI) of all severities consistently report higher incidence in men. Recent increases in the participation of women in sports and active military service as well as increasing awareness of the very large number of women who sustain but do not report TBI as a result of intimate partner violence (IPV) suggest that the number of women with TBI is significantly larger than previously believed. Women are also grossly under-represented in clinical and natural history studies of TBI, most of which include relatively small numbers of women, ignore the role of sex- and age-related gonadal hormone levels, and report conflicting results. The emerging picture from recent studies powered to detect effects of biological sex as well as age (as a surrogate of hormonal status) suggest young (i.e., premenopausal) women are more likely to die from TBI relative to men of the same age group, but this is reversed in the 6th and 7th decades of life, coinciding with postmenopausal status in women. New data from concussion studies in young male and female athletes extend this finding to mild TBI, since female athletes who sustained mild TBI are significantly more likely to report more symptoms than males. Studies including information on gonadal hormone status at the time of injury are still too scarce and small to draw reliable conclusions, so there is an urgent need to include biological sex and gonadal hormone status in the design and analysis of future studies of TBI.

Rugby-related adult maxillofacial trauma injuries: a NEISS database study

PURPOSE

The primary objective of this study is to delineate the data on maxillofacial trauma in rugby utilizing the National Electronic Injury Surveillance System (NEISS) database. Specifically, we want to establish the prevalence of facial rugby injuries in terms of age, mechanism of injury, and degree of injury in order to develop ways to limit facial trauma in the future.

METHODS

The NEISS database was accessed in February 2020 in order to identify adult patients (> 19 years of age) presenting to the emergence department (ED) for rugby-related head and facial injuries from the previous 10 years (2009-2018). Descriptive statistics were organized and presented. Chi-squared testing (χ²) was performed to compare categorical variables, and ANOVA was performed to compare continuous variables.

RESULTS

A total of 507 patients (national estimate = 18,952) from 2009 to 2018 were identified as appropriate for study inclusion. The most common injuries were those to the facial region including the eyelid, eye area, and nose (59.4%). The most frequently encountered facial fracture while playing rugby was the nasal bone (58.6%). Overall, 98.4% of patients who presented to the ED with rugby injuries were treated and released, 1.2% were admitted or observed, and 0.4% left against medical advice.

CONCLUSIONS

When evaluating a patient with a rugby-related injury, one should expect injuries to the eyelid, eye area, or nose. The most common fracture pattern will most likely be nasal bone. Despite these injuries, the vast majority of patients will be treated and released.

Recurrent and Subsequent Injuries in Professional and Elite Sport: a Systematic Review

BACKGROUND

Injury surveillance in professional sport categorises injuries as either "new" or "recurrent". In an attempt to make categorisation more specific, subsequent injury categorisation models have been developed, but it is not known how often these models are used. The aim was to assess how recurrent and subsequent injuries are reported within professional and elite sport.

METHODS

Online databases were searched using a search strategy. Studies needed to prospectively report injury rates within professional or elite sports that have published consensus statements for injury surveillance.

RESULTS

A total of 1322 titles and abstract were identified and screened. One hundred and ninety-nine studies were screened at full text resulting in 81 eligible studies. Thirty studies did not report recurrent injuries and were excluded from data extraction. Within the studies that reported recurrent injuries, 21 reported the number and percentage; 13 reported only the proportion within all injuries; three reported only the number; five reported the number, percentage and incidence; and two only reported the incidence. Seven studies used subsequent injury terminology, with three reporting subsequent injury following concussion, one using an amended subsequent injury model and three using specific subsequent injury categorisation models. The majority of subsequent injuries (ranging from 51 to 80%) were categorised as different and unrelated to the index injury. The proportion of recurrent injuries (exact same body area and nature related to index injury) ranged from 5 to 21%.

CONCLUSIONS

Reporting recurrent or subsequent injuries remains inconsistent, and few studies have utilised subsequent injury models. There is limited understanding of subsequent injury risk, which may affect the development of injury prevention strategies.

TRIAL REGISTRATION

CRD42019119264.

United States Under-19 Rugby-7s: Incidence and Nature of Match Injuries During a 5-year Epidemiological Study

Background

There is a lack of injury data for the new Olympic sport of Rugby-7s, particularly for involved youth.

Objective

To determine injury rates and characteristics for players participating in U.S. Rugby-7s U19 (under 19 years of age) tournaments.

Methods

Injury data were collected, using the Rugby Injury Survey & Evaluation report methodology, at 24 U.S. Rugby-7 s U19 tournaments over 30 tournament days (2010–2014). Tournament medical-attention injuries and time-loss injuries (days absent before return to training/competition including post tournament) were recorded.

Results

During the 2101 playing hours (3072 males, aged 17.2 ± 1.5 years; 732 females, 16.6 ± 1.3 years of age), there were 173 tournament injuries with an overall injury incidence of 82.4/1000 player-match-hours (ph) (CI 70.5–95.6). Acute injuries (79.5/1000 ph) occurred during tackling (56.2/1000 ph) and involved joints/ligaments (32.8/1000 ph) of lower extremities (31.9/1000 ph). Head and neck injuries, including concussions, were common (males 21.9/1000 ph; females 22.0/1000 ph). Medical-attention injury incidences (49.5/1000 ph; n = 104; 95% CI 40.5–60.0) were higher than time loss (32.8/1000 ph; n = 69; 95% CI 25.5–41.6). Overall, injury incidences found no difference between sex (RR 0.78; p = 0.369). Time-loss injuries resulted in an average of 35.5 d to return to sport.

Discussion

This study is the first to report match injury incidences for U19 participants in Rugby-7s. Overall, match injury incidence among U.S. U19 Rugby-7s tournaments was similar compared to adult U.S. community Rugby-7s. Recurrent injury risk was notable in this population. Community injury surveillance studies are essential to understand risk from participation in amateur sports. Knowledge of these injury patterns in U19 Rugby-7s will help identify areas to direct resources to enable growth of Rugby-7s in youths and emerging countries being exposed to Rugby-7 s. Age-based injury frequency and patterns in rugby and its various formats are needed for the development of evidence-based, sport-specific, and population-specific injury prevention initiatives.

Conclusions

The match injury incidence of U19 participants in U.S. Rugby-7s was similar to the incidence among adult participants. Recurrent match injury risk was high at 23%. There were no significant differences in injury incidences between males and females. The first three matches of a tournament day result in the most injuries.

Match and Training Injuries in Women's Rugby Union: A Systematic Review of Published Studies

BACKGROUND

There is a paucity of studies reporting on women's injuries in rugby union.

OBJECTIVE

The aim of this systematic review was to describe the injury epidemiology for women's rugby-15s and rugby-7s match and training environments.

METHODS

Systematic searches of PubMed, SPORTDiscus, Web of Science Core Collection, Scopus, CINAHL(EBSCO) and ScienceDirect databases using keywords.

RESULTS

Ten articles addressing the incidence of injury in women's rugby union players were retrieved and included. The pooled incidence of injuries in women's rugby-15s was 19.6 (95% CI 17.7-21.7) per 1000 match-hours (h). Injuries in women's rugby-15s varied from 3.6 (95% CI 2.5-5.3) per 1000 playing-h (including training and games) to 37.5 (95% CI 26.5-48.5) per 1000 match-h. Women's rugby-7s had a pooled injury incidence of 62.5 (95% CI 54.7-70.4) per 1000 player-h and the injury incidence varied from 46.3 (95% CI 38.7-55.4) per 1000 match-h to 95.4 (95% CI 79.9-113.9) per 1000 match-h. The tackle was the most commonly reported injury cause with the ball carrier recording more injuries at the collegiate [5.5 (95% CI 4.5-6.8) vs. 3.5 (95% CI 2.7-4.6) per 1000 player-game-h; χ²₍₁₎ = 6.7; p = 0.0095], and Women's Rugby World Cup (WRWC) [2006: 14.5 (95% CI 8.9-23.7) vs. 10.9 (95% CI 6.2-19.2) per 1000 match-h; χ²₍₁₎ = 0.6; p = 0.4497; 2010: 11.8 (95% CI 6.9-20.4) vs. 1.8 (95% CI 0.5-7.3) per 1000 match-h; χ²₍₁₎ = 8.1; p = 0.0045] levels of participation. Concussions and sprains/strains were the most commonly reported injuries at the collegiate level of participation.

DISCUSSION

Women's rugby-7s had a higher un-pooled injury incidence than women's rugby-15s players based on rugby-specific surveys and hospitalisation data. The incidence of injury in women's rugby-15s and rugby-7s was lower than men's professional rugby-15s and rugby-7s competitions but similar to male youth rugby-15s players. Differences in reporting methodologies limited comparison of results.

CONCLUSION

Women's rugby-7s resulted in a higher injury incidence than women's rugby-15s. The head/face was the most commonly reported injury site. The tackle was the most common cause of injury in both rugby-7s and rugby-15s at all levels. Future studies are warranted on injuries in women's rugby-15s and rugby-7s.

PROSPERO REGISTRATION NUMBER

CRD42018109054 (last updated on 17 January 2019).

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.

A 2-Year Prospective Study of Injury Epidemiology in Elite Australian Rugby Sevens: Exploration of Incidence Rates, Severity, Injury Type, and Subsequent Injury in Men and Women

BACKGROUND

Injuries are common in rugby sevens, but studies to date have been limited to short, noncontinuous periods and reporting of match injuries only.

PURPOSE

To report the injury incidence rate (IIR), severity, and burden of injuries sustained by men and women in the Australian rugby sevens program and to provide the first longitudinal investigation of subsequent injury occurrence in rugby sevens looking beyond tournament injuries only.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Ninety international rugby sevens players (55 men and 35 women) were prospectively followed over 2 consecutive seasons (2015-2016 and 2016-2017). All medical attention injuries were reported irrespective of time loss. Individual exposure in terms of minutes, distance, and high-speed distance was captured for each player for matches and on-field training, with the use of global positioning system devices. The IIR and injury burden (IIR × days lost to injury) were calculated per 1000 player-hours, and descriptive analyses were performed.

RESULTS

Seventy-three players (81.1%) sustained 365 injuries at an IIR of 43.2 per 1000 player-hours (95% CI, 43.0-43.3). As compared with male players, female players experienced a lower IIR (incidence rate ratio, 0.91; 95% CI, 0.90-0.91). Female players also sustained a higher proportion of injuries to the trunk region (relative risk, 1.75; 95% CI, 1.28-2.40) but a lower number to the head/neck region (relative risk, 0.58; 95% CI, 0.37-0.93; P = .011). The majority (80.7%) of subsequent injuries were of a different site and nature than previous injuries. A trend toward a reduced number of days, participation time, distance, and high-speed distance completed before the next injury was observed after successive injury occurrence.

CONCLUSION

Female players have a lower IIR than male players, with variation of injury profiles observed between sexes. With a surveillance period of 2 years, subsequent injuries account for the majority of injuries sustained in rugby sevens, and they are typically different from previous types of sustained injuries. After each successive injury, the risk profile for future injury occurrence appears to be altered, which warrants further investigation to inform injury prevention strategies in rugby sevens.