Cervical injury in rugby football--a New Zealand survey.

In a study of cervical injury in New Zealand rugby football in the years 1973 to 1978 inclusive, 54 cases of injury were identified of which five were fatal. There is no evidence that the incidence of these injuries is increasing. Incomplete figures for the season of 1979/80 include two deaths and 14 cases of permanent cord compression or temporary quadriplegia. The scrum is confirmed as a danger area but the danger occurring during the formation of the scrum is seen to be greater than was previously thought. Young players appear to be particularly vulnerable in scrums. The ruck and maul are danger areas. One-third of the accidents occurred during training or social games. It is concluded that the incidence of injury could be reduced by appropriate player selection, better coaching and amendment of the laws. Since only one player was aware of his danger at the time of his accident, it would seem that coaching with an emphasis on awareness and precautionary measures would be effective in prevention of cervical injury.     

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

Objectives: To assess the aetiology, incidence, severity, and causes of injuries to England rugby union players during preparation for and participation in the 2003 Rugby World Cup.

Method: A 63 week prospective design was employed to study the training practices and injuries of England rugby players. The team physician reported all training and match injuries and provided details of the location, diagnosis, severity, and mechanism of each injury. The team fitness coach reported details of the number and duration of training sessions and the time dedicated to rugby and conditioning training. Players' stature, body mass, and skinfolds were measured at the beginning and end of the study period.

Results: The overall incidence of injury was 17 injuries/1000 h of exposure (match: 218 injuries/1000 h; training: 6.1 injuries/1000 h). The major locations of injuries were the lower (60%) and upper (17%) limbs and the most common diagnoses were muscle and tendon (50%) and joint (non-bone) and ligament (41%) injuries. The highest incidences of match injuries occurred whilst being tackled (50 injuries/1000 h) and in a ruck or maul (35 injuries/1000 h), whilst the greatest incidences of training injuries occurred during endurance running (24 injuries/1000 h) and contact activities (20 injuries/1000 h). Players' average body mass increased and skinfold measurement decreased significantly over the study period.

Conclusions: The incidence of match injuries at international level was found to be higher than previously reported. The tackle, ruck, and maul elements of match play and the endurance running and contact elements of training presented the highest risk of injury for all players.

     

Injuries of the spine sustained during rugby.

A comparison was made between the number of rugby injuries seen between 1956 and 1982 (67) and the number of rugby injuries seen between 1982 and 1987 (20). The standards, the positions, the mechanics of injury and the fitness of the players were analysed. It was concluded that the law changes had resulted in a dramatic fall in the number of players injured, that it was the less fit and less skilled players that were getting injured, and that the laws were adequate but were not being enforced.     

Catastrophic rugby injuries of the spinal cord: changing patterns of injury.

In reports from the UK and New Zealand, it is noted that the incidence of rugby injuries to the cervical spinal cord has dropped and that the percentage of players injured in the tackle has similarly decreased. In contrast, this does not appear to be the pattern in South Africa and an analysis has therefore been made of 40 rugby players sustaining injuries to the spinal cord during the period 1985 to 1989. The radiological appearances on admission have been correlated with the circumstances of injury, associated orthopaedic injuries and neurological deficits. The tackle was responsible for the majority of injuries, causing more than the scrum. Tackles were also responsible for more cases of complete, permanent quadriplegia than the scrum. The commonest cause of injury in players being tackled was the high tackle around the neck, while the commonest cause of injury in players making the tackle was the dive tackle. This survey has shown that the tackle is now the major cause of spinal cord injury in South African rugby, in contrast to earlier analyses in which the scrum was identified as the most common cause.     

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

Objectives: To undertake a detailed, large scale epidemiological study of match injuries sustained by professional rugby union players in order to define their incidence, nature, severity, and causes. Methods: A two season prospective design was used to study match injuries associated with 546 rugby union players at 12 English Premiership clubs. Team clinicians reported all match injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury. Match exposures for individual players were recorded on a weekly basis. Loss of time from training and match play was used as the definition of an injury. Results: The overall incidence of injury was 91 injuries/1000 player-hours, and each injury resulted on average in 18 days lost time. Recurrences, which accounted for 18% of injuries, were significantly more severe (27 days) than new injuries (16 days). Thigh haematomas were the most common injury for forwards and backs, but anterior cruciate ligament injuries for forwards and hamstring injuries for backs caused the greatest number of days absence. Contact mechanisms accounted for 72% of injuries, but foul play was only implicated in 6% of injuries. The ruck and maul elements of the game caused most injuries to forwards, and being tackled caused most injuries to backs. The hooker and outside centre were the playing positions at greatest risk of injury. Conclusions: On average, a club will have 18% of their players unavailable for selection as a consequence of match injuries.     

A prospective study of injuries to elite Australian rugby union players

OBJECTIVES: To assess injury patterns and incidence in the Australian Wallabies rugby union players from 1994 to 2000. To compare these patterns and rates with those seen at other levels of play, and to see how they have changed since the beginning of the professional era. METHODS: Prospective data were recorded from 1994 to 2000. All injuries to Australian Wallabies rugby union players were recorded by the team doctor. An injury was defined as one that forced a player to either leave the field or miss a subsequent game. RESULTS: A total of 143 injuries were recorded from 91 matches. The overall injury rate was 69/1000 player hours of game play. The injury rates in the periods before (1994-1995) and after (1996-2000) the start of the professional era were 47/1000 player hours and 74/1000 player hours respectively. The lock was the most injured forward, and the number 10 the most injured back. Most injuries were soft tissue, closed injuries (55%), with the head being the most commonly injured region (25.1%). The phase of play responsible for most injuries was the tackle (58.7%). Injuries were more likely to occur in the second half of the game, specifically the third quarter (40%). The vast majority of injuries were acute (90%), with the remainder being either chronic or recurrent. CONCLUSIONS: Injury rate increases at higher levels of play in rugby union. Injury rates have increased in the professional era. Most injuries are now seen in the third quarter of the game, a finding that may reflect new substitution laws. There is a need for standardised collection of injury data in rugby union.     

The New Zealand Rugby Injury and Performance Project: V. Epidemiology of a season of rugby injury

OBJECTIVE: To describe the incidence, nature, and circumstances of injury experienced by a cohort of rugby union players during a full competitive club season. METHODS: A prospective cohort study followed up 356 male and female rugby players throughout the 1993 competitive club season. Players were interviewed by telephone each week to obtain information on the amount of rugby played and the injury experienced. RESULTS: Detailed information was collected for 4403 player-games and 8653 player-practices. A total of 671 injury events were reported, of which 569 were rugby related. The injury rate for games was higher than that for practices (rate ratio 8.3). At 10.9 injuries per 100 player- games, males had a higher rate of injury than females at 6.1 injuries per 100 player-games (p<0.001). Injury rates varied by position, with male locks (13.0 injuries per 100 player-games) and female inside backs (12.3 injuries per 100 player-games) having the highest rate in their respective sexes. The lower limb was the body region most often injured in games (42.5%) and practices (58.4%). Sprains/strains were the most common type of injury in games (46.7%) and practices (76.1%). In games the tackle was the phase of play in which the most injuries occurred (40%), followed by rucks (17%) and mauls (12%). Thirteen per cent of game injury events were the result of foul play. CONCLUSIONS: Rugby injury was common among the study subjects and varied according to grade and gender. Identifying the causes of injuries in the tackle, lower limb injuries, and dealing with the issue of foul play are priority areas for the prevention of rugby injury.


     

Evaluation of RugbySmart: A rugby union community injury prevention programme

RugbySmart, a rugby union injury prevention programme, was launched in New Zealand in 2001. It was compulsory for all coaches and referees to complete RugbySmart requirements annually in order to continue coaching or refereeing. After 5 years of implementation the programme partners, Accident Compensation Corporation and New Zealand Rugby Union, evaluated RugbySmart to determine its effectiveness in reducing injuries. The purpose was to evaluate the effect of RugbySmart on reducing injury rates per 100,000 players and resulting injury prevention behaviours. The RugbySmart programme was associated with a decrease in injury claims per 100,000 players in most areas the programme targeted; the programme had negligible impact on non-targeted injury sites. The decrease in injury claims numbers was supported by results from the player behaviour surveys pre- and post-RugbySmart. There was an increase in safe behaviour in the contact situations of tackle, scrum and ruck technique.     

Effectiveness of rugby headgear in preventing soft tissue injuries to the head: a case-control and video cohort study

OBJECTIVE: To determine if headgear use by rugby players was associated with a reduced risk of head or facial laceration, abrasion, or fracture. METHODS: An emergency department based case-control study in South Wales, UK, with cases being rugby players treated for superficial head and facial injuries and controls being their matched opponents during the game. A review of videos of the 41 games in the 1999 Rugby World Cup was also carried out to compare with the case-control study. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to measure association between exposure (headgear wearing) and outcome (head and facial injuries). RESULTS: In the case-control study, 164 pairs were analysed, with headgear worn by 12.8% of cases and 21.3% of controls. Headgear use was associated with substantial but non-significant reductions in superficial head (OR = 0.43, 95% CI 0.13 to 1.19) and facial (OR = 0.57, 95% CI 0.21 to 1.46) injuries. The video study followed 547 players over 41 games, during which there were 47 bleeding injuries to the head. Headgear use significantly reduced the risk of bleeding head injury in forwards (OR = 0.14, 95% CI 0.01 to 0.99, p = 0.02), but not in backs. There was also a higher risk of facial injury among forwards, but this was not significant. CONCLUSIONS: The combined results suggest that headgear can prevent certain types of superficial head injuries in players at all levels of the game, but the evidence is strongest for superficial head injury in elite forwards. A randomised controlled trial would be the best way to study this further.     

Incidence of sporting injury in New Zealand youths aged 6-15 years

OBJECTIVE: To document the incidence of injury in 6-15 year olds playing rugby union, rugby league, and netball, and to identify the common mechanisms, sites, severity, and time of injury. METHODS: Cross sectional data were collected by trained observers who watched 258 games of rugby union, netball, and rugby league over a four week period. The condition of the injured participants was monitored until recovery. RESULTS: In total, 5174 players were observed and an injury rate of 18 per 1000 player hours was calculated. Of all observed injuries, 29% required some form of medical treatment. A significant difference (p<0.05) in the distribution of injury over the four quarters of the games was recorded, most occurring in the first three quarters. In total, 81% of the injuries were classified as contact injuries, and these mainly occurred through direct contact with the opposition. Of all observed injuries, 27% were recurrent. CONCLUSIONS: The incidence of injury in rugby union, netball, and rugby league is low for children aged between 6 and 15 years relative to adult rates.


     

The fair sex? Foul play among female rugby players

Rugby, a full contact sport, exposes participants to a high risk of injury. While several studies have explored injuries among male rugby players, few have investigated injuries among females. We conducted a cross-sectional study of United States of America (USA) female rugby players to assess the players' perception of foul play and the referee response to foul play and to evaluate the association between players' perception of foul play and injury. An anonymous, self-administered questionnaire reporting injury status, history of player perceived foul play and referee response was administered to 258 players recruited at a women's rugby tournament. The overall rate of injury was 4.4 injuries/100 matches, 0.2 injuries/100 practices and 1.4 injuries/100 total rugby exposures (matches and practices), with 107 (41.5%) players classified as injured. While 16.5% of players admitted to perpetrating foul play without an assessed penalty and 13.8% to being penalised for foul play, a smaller proportion reported being sent to the 'sin bin' (temporarily removed from play) or being ejected from a match (3.3% and 1.3% respectively). Of the 107 injured, 24.3% believed they had been injured as a result of foul play. Among all 258 players, self-perception of having been hurt due to unpenalised foul play was associated with study-defined injury (OR = 2.4, 95% CI = 1.0-5.9, p = 0.046). To make the sport safer, efforts should be made to minimise foul play. Suggested preventive methods include educating referees, coaches and players about the prevalence of foul play in women's rugby and the association between foul play and injury.     

Shoulder injuries in rugby players: Mechanisms,examination, and rehabilitation

BackgroundThe sport of rugby is growing in popularity for players at the high school and collegiate levels.ObjectiveThis article will provided the sports therapist with an introduction to the management of shoulder injuries in rugby players.SummaryRugby matches results in frequent impacts and leveraging forces to the shoulder region during the tackling, scrums, rucks and maul components of the game. Rugby players frequently sustain contusion and impact injuries to the shoulder region, including injuries to the sternoclavicular, acromioclavicular (AC), and glenohumeral (GH) joints. Players assessed during practices and matches should be screened for signs of fracture, cervical spine and brachial plexus injuries. A three phase program will be proposed to rehabilitate players with shoulder instabilities using rugby specific stabilization, proprioception, and strengthening exercises. A plan for return to play will be addressed including position-specific activities.     

Impact of professionalism on injuries in rugby union

OBJECTIVES: To measure the frequency and nature of injuries occurring in competitive matches since professionalism was introduced in rugby union. METHODS: The cohort study previously conducted in players from senior rugby clubs in the Scottish Borders in 1993-1994 when rugby union was an entirely amateur sport was repeated in 1997-1998. The same injury definition, outcome criteria, and method of calculating playing hours were used. In total, 803 (84%) of 960 eligible players participated, including all 30 adult players who played professionally for the Scottish Rugby Union or Border Reivers District. The 576 injury episodes in 381 of these players in competitive matches were compared with the 373 injuries in 266 players out of 975 (94%) who were eligible and registered with the same senior rugby clubs in 1993-1994. Outcomes were the occurrence of injury episodes, days away from playing or training for rugby, and time lost to employment or attendance at school/college as a consequence of being injured. RESULTS: The proportion of players who were injured almost doubled from 1993-1994 to 1997-1998, despite an overall reduction of 7% of the playing strength of participating clubs. Period prevalence injury rates rose in all age specific groups, particularly in younger players. This translated into an injury episode every 3.4 matches in 1993-94, rising to one in every 2.0 matches in 1997-1998. An injury episode occurred in a professional team for every 59 minutes of competitive play. Professional players sustained a higher proportion of recurrent injuries, particularly in the early part of the season. Some 56% of all their days lost to the game were caused by injuries to the muscles, ligaments, and joints of the knee, hip, and thigh. CONCLUSIONS: The introduction of professionalism in rugby union has coincided with an increase in injuries to both professional and amateur players. To reduce this, attention should be focused on the tackle, where many injuries occur. The International Rugby Board should place a moratorium on the use of protective equipment in competitive matches until its contribution to player morbidity has been fully assessed.     

Injury consequences from participation in professional rugby league: a preliminary investigation.

OBJECTIVE: To conduct a preliminary investigation to determine if injuries sustained while playing professional rugby league have long term consequences for players after retirement from their playing careers. METHOD: Twenty eight retired players, who had competed in the professional Australian Rugby League competition, responded to a 23 item survey. Respondents were asked to recall all injuries that resulted in them being unable to play for five or more consecutive games. The survey asked players to provide information about age, playing weight, number of games played, position played, number and type of major injuries sustained during their career, and the effects of these injuries both during their career and after retirement. RESULTS: Within the limitations of this study's small sample, it is suggested that players with long term consequences of injury may experience a variety of detrimental effects into retirement, including job limitations, reduced income earning potential, and increased personal medical costs. CONCLUSION: Although research relating to the type and severity of injuries sustained while playing rugby league has been previously undertaken, investigation into the effect injuries sustained during a professional career have on players after retirement has been neglected. This preliminary investigation suggests that retired professional rugby league players may have at least one long term consequence of injuries sustained during their playing career.     

Unfälle bei großen Mannschaftsballsportarten

Soccer injuries result primarily from the competitive tackling character of this sports discipline. The predominant injuries are contusion trauma, followed by ankle sprains, knee distortions and heading injuries. Particularly serious injuries are caused by sliding tackles. Because of the smaller distances and space in indoor soccer, more goalkeepers are injured due to parrying than in outdoor soccer. Soccer disability cases are primarily injuries to the knee joint caused by various mechanisms, such as twisting of the knee with and without an external influence, falling injuries, unfortunate collisions and sliding tackles. In principle traumatic deaths may occur in any team ball game sport if there is unfortunate body contact between players. Fatal skull and brain trauma injuries in soccer can be differentiated into unfortunate heading actions, the head being directly hit by the ball and direct head-to-head contact with another player as well as collisions against goalposts and other pieces of equipment. Contusion accidents also dominate in handball. Here the so-called rapid counterattack may result in serious injuries due to the high forces involved. Handball disability cases mainly concern the knee joint and severe invalidity is primarily caused by external influences (i.e. the opponent). In volleyball and basketball ankle sprains are the dominating injury types (in volleyball often when stepping on an opponent’s foot), followed by playing the ball, where primarily the fingers are affected. In the USA eye injuries were frequently registered in basketball, due to finger or elbow contact with the opposing players. Severe injuries in rugby affect the head and neck in approximately one-third of the cases, in rare cases with spinal cord involvement. In American football serious injuries resulted especially from a direct attack on the opponent (tackling). After optimization of the football helmet design in the early 1970s, a clear reduction of skull and brain injuries was observed, but unfortunately a massive increase in neck injuries was also registered, because the helmeted head was now used as a weapon in tackling. After changes to the rules in 1978 these injury mechanisms have now declined again.     

Injury patterns in women's intramural flag football

A prospective study of women's flag football injuries was carried out over a 4 year period at Mississippi State University. Data was gathered on 114 injuries. Organized intramural flag football activities caused 93% of the injuries observed (7% were injured in pick-up games). The finger accounted for 39%, knee for 16%, and ankle for 8% of these injuries. The type of injury was closely distributed among sprains, fractures, contusions, and strains. Collisions, with other players and objects, resulted in 64% of these injuries. Offensive ball handlers (running backs and receivers) had the greatest probability of being injured. From this data, it is obvious that women's injury patterns are not the same as men's and that varsity injury data cannot be extrapolated to recreational injuries.     

Croatian rugby project. Part II: injuries

BACKGROUND: Studies of rugby injuries in countries where rugby is not popular are rare. The aim of the study was to analyze the epidemiology and other characteristics of injuries in the first Croatian-Slovenian rugby league (CSRL) and the influence of anthropometric characteristics, body composition and constitution on the epidemiology of injuries. METHODS: Eleven anthropometric measures for the assessment of anthropometric characteristics, body composition and constitution were obtained in a sample of 111 voluntarily participating rugby players from the CSRL in the middle of the season 1996/97. After the season a questionnaire about injuries sustained in the past season was retrospectively filled up by 106 players who finished the first part of the study. Injuries were classified according to Garraway and Macleod and the 9th revision of the International Classification of Diseases. RESULTS: The incidence of injuries was 1.24 per 1000 hours of rugby training and 28.22 per 1000 hours of playing in matches. Low club position in rugby division (statistically significant, p<0.05), age from 25 to 34 years, forwards position in a team, being tackled, and beginning of autumn or spring season were identified as risk factors for injuries. The most frequent sites of injury were legs. The most frequent injuries were dislocations, strains and sprains of ankle and foot. CONCLUSIONS: The incidence of injuries in matches was more than two times higher than in more developed Scottish rugby, statistically positively correlating with the team position in division. There are no statistically significant differences in anthropometric characteristics, body composition and constitution of injured and uninjured players.     

Registration of cruciate ligament injuries in Norwegian top level team handball. A prospective study covering two seasons

All cruciate ligament injuries in the three upper divisions for men and women (3392 players) in Norwegian team handball in the 1989-90 and 1990–91 seasons were registered. A questionnaire was mailed to all injured players. Ninety-three cruciate ligament injuries were registered; 87 in the anterior cruciate ligament (ACL), and six in the posterior cruciate ligament (PCL). Among women, 1.8% were injured compared with 1.0% of the men. In the first division, the risk of being injured was considerably higher: 4.5% of the players had a cruciate ligament injury. There were 0.97 cruciate ligament injuries per 1000 playing hours in the three divisions taken together. Seventy-five per cent of the injuries occurred during games. Ninety-five per cent involved no contact between players. Activities in which the friction between shoe and floor was significant caused 55% of the injuries. Injuries caused by running into another player contributed to only 5% of the injuries. No significant differences were observed in injury incidence during matches between different types of floors (parquet, Pulastic and other synthetic sufaces).     

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

OBJECTIVE: To study the incidence of the most commonly sustained injuries in Argentine rugby and analyse them according to type, position and age of the players, and phase and time of play. METHODS: A prospective registry of injuries was constructed in different provincial unions of Argentina. Data were collected during a whole weekend each year from 1991 to 1997. Chi2 with Yates correction test, contingency tables, odds ratios (OR), and 95% confidence intervals (CI) were calculated (Epi Info Version 6.04a). RESULTS: A total of 924 injuries were registered in 1296 rugby games, involving 38 933 players. The mean (SD) incidence per weekend was 2.4 (0.2)% (95% CI 2.22 to 2.53), and the number of injuries per season was 24,188. Overall, senior players suffered more injuries than those in younger divisions (OR = 1.53; 95% CI 1.34 to 1.76; p<0.0001). The most common type of injury was pulled muscles of the lower limbs (11.7%, p<0.0001). Overall, the knee was the most susceptible to injury (14.1%, p<0.0001). Senior players suffered more pulled muscles of the lower limbs (OR = 2.99; 95% CI 2.01 to 4.46; p<0.0001), ankle ligament distension (OR = 1.69; 95% CI 1.12 to 2.53; p = 0.01), knee trauma (OR = 1.69; 95% CI 1.06 to 2.68; p = 0.02), bleeding wounds on the face (OR = 3.86; 95% CI 2.24 to 6.70; p<0.0001), and knee ligament distension (OR = 2.14; 95% CI 1.16 to 3.96; p = 0.01). Younger players had a greater risk of suffering muscular or ligament injuries of the cervical column (OR = 3.0; 95% CI 1.05 to 10.08; p = 0.04). The forwards had a higher risk of injury (OR = 1.41; 95% CI 1.23 to 1.61; p<0.0001). The most commonly injured player was the flanker (15.5%, p<0.01), and the most common mechanism was in open play (33%). More injuries were sustained in the second half (OR = 1.17; 95% CI 1.03 to 1.34; p = 0.01). CONCLUSIONS: Injuries are the cause of significant morbidity among rugby players in Argentina. A more thorough investigation and a greater understanding of the mechanisms are crucial in order to update the rugby laws and reduce this high injury incidence.     

A comparison of facial protection and the incidence of head, neck, and facial injuries in Junior A hockey players. A function of individual playing time.

A cohort of 282 elite amateur ice hockey players were analyzed to 1) record the number, type, location, and severity of head, neck, and facial injuries sustained during games; 2) examine the relationship between injuries and the type of facial protection (none, partial, or full) according to individual playing time; and 3) determine whether full or partial facial protection is associated with an increased incidence of concussions, eye injuries, and neck injuries. Fifty-two injuries (158.9 per 1000 player-game hours) occurred in players wearing no facial protection, 45 (73.5 per 1000 player-game hours) in players wearing partial facial protection (half shield), and 16 (23.2 per 1000 player-game hours) in players wearing full facial protection (full cage or shield). Players wearing no protection were injured at a rate more than twice that of players wearing partial protection and almost seven times higher than those wearing full protection. Concussions occurred in four players wearing no protection, five players wearing partial protection, and two players wearing full protection; these differences were not significant. The risk of eye injury was 4.7 times greater for players wearing no protection compared with those wearing partial protection. No eye or neck injuries occurred in players wearing full protection. This study demonstrates that both full and partial facial protection significantly reduce injuries to the eye and face without increasing neck injuries and concussions.