Epidemiology of Injuries Sustained by Elite Under-18 Rugby Players

Injury data collection and utilisation practices in university sports teams: A cross-sectional study

OBJECTIVES

This study aimed to examine injury surveillance practices in a variety of university sports teams and barriers and facilitators for injury data collection and utilisation.

DESIGN

Cross-sectional study.

SETTING

University sports teams in Japan.

PARTICIPANTS

Medical, coaching, and other staff (non-medical/-coaching staff) of the university sports teams in Japan.

MAIN OUTCOME MEASURES

The survey included 31 questions that examined the barriers and facilitators for injury data collection, and the type of data on injury and exposure collected.

RESULTS

Injury data were collected during matches for 69 teams (48.3%) and training for 61 teams (42.7%). Injuries were primarily captured by athletic trainers in teams with medical staff, coaching staff and athletes in teams without medical staff. Common barriers in collecting and utilising injury data included limited funding for trained personnel and lack of time for medical staff to record data. Facilitating factors included clarification of the methods employed in recording and utilising injury data for teams with medical staff and the deployment of trained personnel to record injuries for teams without medical staff.

CONCLUSIONS

Approximately half of the Japanese university teams collected injury data. Considering barriers and facilitators is crucial to facilitate the collection and utilisation of injury data.

Injury Rates, Mechanisms, Risk Factors and Prevention Strategies in Youth Rugby Union: What's All the Ruck-Us About? A Systematic Review and Meta-analysis

BACKGROUND

Rugby Union is a collision team sport played globally. Despite this, significant concerns have been raised regarding the sport's safety, particularly in youth players. Given this, a review of injury rates, risk factors and prevention strategies is required across different youth age groups as well as in males and females.

OBJECTIVE

The objective of this systematic review (SR) and meta-analysis was to investigate injury and concussion rates, risk factors and primary prevention strategies in youth rugby.

METHODS

To be included, studies were required to report either rates, risk factors or prevention strategies in youth rugby and to have a randomised controlled trial, quasi-experimental, cohort, case control, or ecological study design. Exclusion criteria included non-peer-reviewed grey literature, conference abstracts, case studies, previous systematic reviews and studies not written in English. Nine databases were searched. The full search strategy and list of sources are available and pre-registered on PROSPERO (Ref: CRD42020208343). Each study was assessed for risk of bias using the Downs and Black quality assessment tool. Meta-analyses were conducted using a DerSimonian Laird random effect model for each age group and sex.

RESULTS

Sixty-nine studies were included in this SR. The match injury rates (using a 24-h time-loss definition) were 40.2/1000 match hours (95% CI 13.9-66.5) in males and 69.0/1000 match hours (95% CI 46.8-91.2) in females. Concussion rates were 6.2/1000 player-hours (95% CI 5.0-7.4) for males and 33.9/1000 player-hours (95% CI: 24.1-43.7) for females. The most common injury site was lower extremity (males) and the head/neck (females). The most common injury type was ligament sprain (males) and concussion (females). The tackle was the most common event associated with injury in matches (55% male, 71% females). Median time loss was 21 days for males and 17 days for females. Twenty-three risk factors were reported. The risk factors with the strongest evidence were higher levels of play and increasing age. Primary injury prevention strategies were the focus of only eight studies and included law changes (n = 2), equipment (n = 4), education (n = 1) and training (n = 1). The prevention strategy with the most promising evidence was neuromuscular training. The primary limitations included a broad range of injury definitions (n = 9) and rate denominators (n = 11) used, as well as a limited number of studies which could be included in the meta-analysis for females (n = 2).

CONCLUSION

A focus on high-quality risk factor and primary prevention evaluation should be considered in future studies. Targeting primary prevention and stakeholder education remain key strategies in the prevention, recognition and management of injuries and concussions in youth rugby.

Epidemiology of the Injuries Sustained by Elite Spanish under-18 and under-20 Rugby Players

This study examines the injuries suffered by players (n=166) of the Spanish national men's under-18 and under-20 rugby teams between 2015 and 2017, and identifies the actions involved in their occurrence. All injuries (total n=78) sustained during matches and training were recorded as recommended by World Rugby, and injury incidence rates per 1000 player-hours (ph) calculated for both types of activity. Injuries occurred more commonly during matches than during training (incidence 105.3 [95% CI: 78.7-131.9] per 1000 [ph] of match play, vs 1.16 [95% CI: 0.69-1.62] per 1000 ph of training), and most days absent per 1000 ph during matches with<3 days rest since the previous match (4209.2 [95% CI: 3516.2-4902.1] per 1000 ph of match play, vs 1947.4 [95% CI: 1511.8-2382.9] per 1000 ph of match play in matches with>3 days rest). These results provide information that may be useful in the development of strategies aimed at reducing the incidence of injuries.

2021/22 Rugby Europe Injury Surveillance Report: SuperCup, Under-20, and Under-18 Championship

We conducted a prospective cohort study to determine the incidence rate and characterization of the injuries sustained by players during the 2021/22 season of the Rugby Europe SuperCup, Under-20, and Under-18 championships. Team medics reported the injuries, using an online platform. Ethical approval and informed consent were obtained. The overall incidence of injuries ranged from 33.33 (95% CI: 18.97-54.60) in the under-18s to 83.33 (95% CI: 60.34-112.40) in the under-20s, while in the SuperCup it was 41.35 (95% CI: 30.30-55.18) injuries per 1000 player-match-hours. Injury severity (mean days) was higher in the SuperCup (38.33) and lower in the Under-18 tournament (28.50). Lower limb and soft tissue were the most common type of injuries. Tackles caused almost two-thirds of all injuries. Concussion accounted for 10.0% to 25.6% of all injuries. Our data are consistent with previous reports for similar levels of competition and age grades. The injury incidence was higher in the senior competitions (Under-20s and SuperCup). However, for the under-20s, injury rates were higher than in the SuperCup. This might be related to the competition format; however, more studies need to be conducted in the future. Concussion is a common injury and the protocols used at this level seems to be effective to identify it.

It Takes Two to Tango: High Rates of Injury and Concussion in Ball Carriers and Tacklers in High School Boys' Rugby

OBJECTIVE

To examine injury and concussion rates, mechanisms, locations, and types of injury in Canadian high school male rugby.

DESIGN

Prospective cohort study.

SETTING

High school male rugby.

PARTICIPANTS

A total of 429 high school players (2018: n = 225, 2019: n = 256) were recruited from 12 teams in 7 schools in Calgary, Canada.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Injury surveillance included baseline questionnaires, weekly exposure, and injury reports. Injuries included those requiring medical attention, resulted in time loss and/or inability to complete a session. Concussion was defined as per the fifth Consensus on Concussion in Sport, and all players with a suspected concussion were referred to a study sport medicine physician.

RESULTS

A total of 134 injuries were captured, leading to an injury incidence rate (IR) of 57.9/1000 hours [95% confidence intervals (CIs): 45.4-73.8]. Median time loss was 6 days (range: 0-90). Injuries to the head were the most common (40%), followed by shoulder (12%) and ankle (10%). The concussion IR was 22.0/1000 hours (95% CIs: 15.9-30.4), which was the most common injury type (38%), followed by sprain (20%) and strain (15%). Sixty-five percent of injuries occurred in the tackle (ball carrier 35%, tackler 30%) and 76% of concussions (ball carrier 41%, tackler 35%).

CONCLUSIONS

The rate of injury and concussion in Canadian youth high school male rugby is high, with tackle-related injuries and concussions the most common. Given this, there is a critical need for implementation of prevention strategies, in particular targeting concussion and the tackle event (eg, neuromuscular, tackle training, and law changes).

Injuries and Illnesses Across 10 Years of Canada Games Competitions: 2009 - 2019

Background

The Canada Games are a national level competition held every two years alternating between Summer and Winter Games. Participation in elite level athletics, like the Canada Games, have an inherent risk of injury and illness.

Purpose

To analyze the incidence and characteristics of injuries and illnesses during Canada Games competitions from 2009-2019 (primarily) and to understand sex differences in odds of musculoskeletal injury for Summer and Winter Canada Games athletes (secondarily).

Study Design

Descriptive Epidemiology Study.

Methods

Using a retrospective cohort, data were abstracted from medical incident reports generated during Canada Games from 2009 - 2019. Data were coded for body part injured and injury type or illness system; injuries were also categorized as acute or chronic.

Results

Across all 10 years of competition, 3160 injuries reported in 8710 male athletes and 3272 injuries reported in 8391 female athletes. Injury incidence was 362.8 and 389.9 and illness incidence was 47.8 and 64.5 per 1000 male and female athletes, respectively. Female athletes had a 1.12 (95% CI: 1.06; 1.19) greater odds of injury and 1.37 (95% CI: 1.20; 1.57) greater odds of illness compared to male athletes. Overall, injury (399.31 vs. 360.31; p < 0.001) and illness (68.67 vs. 47.30; p < 0.001) incidences were higher in Winter Games, compared to Summer Games, per 1000 athletes. When comparing male and female athletes participating in similar sports, sex specific differences exist in odds of both injury and illness.

Conclusions

Male and female athletes competing in Canada Games competitions demonstrate differences in injury and illness incidence and odds of injury. This suggests a need to examine if additional modifiable risk factors may exist, which could contribute to prevention strategies to reduce injury and illness during Canada Games competition.

Level of Evidence

3.

Match Injuries in the Spanish Rugby Union Division de Honor

OBJECTIVE

To describe the injury rate, severity, cause, anatomical location (tissue damaged), recurrence, place and time during matches throughout a season in the Spanish Rugby Union Division de Honor.

METHODS

Observational, prospective and descriptive study conducted in the competition of the Spanish División de Honor de Rugby with 258 players. The data were reported by the medical services of the previously formed clubs.

RESULTS

Total exposure was 4100 h, during which 220 injuries occurred. The average number of sick days was 36.8. The total injury rate was 53.6 injuries/1000 h of exposure. Three quarters suffered 93 injuries and the forwards sustained a total of 127 injuries, with a total of 48.6 and 58.1 injuries/1000 h of exposure, respectively. Moderate injuries were the most frequent. Specifically, ligament injury was the most frequent, and dislocation was the injury that caused the most sick days. The most injuries occurred in the third quarter of the match, and the most serious injuries occurred in the second quarter.

CONCLUSIONS

The injury rate of Spanish rugby competitors is 53.6 injuries/1000 match hours, with an average of 36.8 sick days. Contact injuries are the most frequent, taking place especially when tackling or being tackled.

Sports Injury Surveillance Systems and Guidelines in Japan: A Systematic Review

This systematic review aimed to identify sports injury surveillance systems (ISSs) and injury surveillance guidelines (ISGs) developed and currently used in Japan. Additionally, the extent to which ISSs and ISGs developed overseas are employed in Japan was also examined. A systematic search of electronic databases was performed in March 2021. Prospective studies that investigated sports injuries and targeted Japanese athletes or sports in Japan were included to identify the following: (1) details of the ISSs or ISGs developed among sports in Japan, and (2) characteristics of studies focusing on sports in Japan employing ISSs or ISGs developed overseas and the method of use. A total of five ISSs developed among sports in Japan were included, most of which were based on insurance benefits or condolence payment systems. In total, 23 studies used ISSs or ISGs developed overseas, more than half of which were used as a resource for the development of other data collection tools or methods, indicating that the definition of injury and/or classification of items are modified based on the needs among sports in Japan. This review highlights the necessity of establishing club-based or organisational ISSs and ISGs that are appropriate for sports in Japan.

The Epidemiology of Injuries in Spanish Rugby Union División de Honor

BACKGROUND

We describe and analyze injury incidence, severity, cause of injury, anatomical location, damaged tissue, injury recurrence, and the time and place at which injuries occur over the course of a season.

METHODS

An observational, descriptive, prospective, nomothetic, and multidimensional study was conducted during the 2018-2019 season with 258 players of the top semiprofessional rugby league in Spain (División de Honor de Rugby). Data were reported by the clubs' medical services. Reported time-loss injuries were collected.

RESULTS

Overall exposure was 4100 h (137 matches), over 35 weeks of competition. A total of 288 injuries were reported, with three of these leading to withdrawal from the sport. A total average of 35.63 days was lost to injury. Overall time-loss injury incidence was 3.41 injuries/1000 h of exposure. Backs suffered 119 injuries corresponding to 3.80 injuries/1000 h of exposure, whilst forwards suffered 169 injuries with 4.27 injuries/1000 h of exposure. Severe injuries were the most frequent injury type.

CONCLUSIONS

Outcomes confirm that more injuries take place during competition, with these also being more severe in nature. Contact injuries were most frequently suffered, above all, due to tackling or being tackled.

Men's Lacrosse Injuries in the 2018 International World Championship Play

Background:

Limited data exist on injuries in men’s lacrosse at the international level. As lacrosse’s popularity grows rapidly across the globe, health care providers must understand how to treat lacrosse athletes.

Purpose:

To analyze injury data from the 2018 Men’s World Lacrosse Championship.

Study Design:

Descriptive epidemiology study.

Methods:

This study prospectively observed injuries that occurred during the 2018 Men’s World Lacrosse Championship. The medical staff of each team completed injury report forms, and data were categorized into body part injury, type, mechanism, time, and location of injury.

Results:

Over 11 days, 1019 athletes competed in 170 games, resulting in a total of 7147 athlete-exposures (AEs). A total of 140 injuries were recorded during the tournament for an injury rate of 19.6 per 1000 AEs (95% CI, 16.4-22.7). Overall, there were more contact injuries (n = 99; 70.7%) than noncontact injuries (n = 41; 29.3%) (P < .0001). Contact injuries most commonly affected the upper extremity, while noncontact injuries most commonly affected the lower extremity. Contusions were the most commonly reported injury type in the tournament (n = 41; 29.3%), followed by ligament sprains (n = 32; 22.9%) and muscle strains (n = 21; 15.0%). Although there was no difference between the first and second half of gameplay, the injury rate increased in the latter portion of each half (the first and third quarters vs the second and fourth quarters) (P < .0001). A total of 4 injuries required trips to the hospital.

Conclusion:

Lacrosse has a unique injury profile, as it includes both overhead and collision activity as well as multidirectional, cutting movements. Understanding common injury patterns may help with treatment and prevention. Fatigue may play a role in injury rate, and future research of within-game and within-tournament fatigue should explore this relationship.