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.     

No effect of a video-based awareness program on the rate of soccer injuries

BACKGROUND: The injury rate in soccer is high, and effective injury prevention methods are needed. PURPOSE: To test the effect of a video-based awareness program on the incidence of acute injuries in soccer. STUDY DESIGN: Randomized control trial; Level of evidence, 1. METHODS: Participants were elite male soccer players from the top 2 divisions in Iceland. Fifteen of 20 teams completed the study: 7 intervention teams (127 players) and 8 control teams (144 players) chosen by random. Just before the start of the 2000 soccer season, the intervention teams were visited with an intervention program. The program included a 15-minute presentation with information on the injury risk of playing elite soccer, typical injuries, and their mechanisms. Then the players worked together in pairs and analyzed video sequences to develop preventive strategies. The 12 video sequences were selected from the previous Icelandic soccer season, representing 3 typical injury mechanisms that accounted for more than half of all incidents recorded. During the season, team physical therapists prospectively recorded all acute injuries, and coaches recorded training exposure on a special form. Injury incidence was compared between groups and between the 1999 and 2000 seasons for teams that participated in both seasons. RESULTS: No difference was observed in injury incidence between the intervention (6.6 +/- 0.7 injuries per 1000 player hours) and control groups (6.6 +/- 0.7 injuries per 1000 player hours). Furthermore, there was no difference in injury location or type. CONCLUSION: The video-based injury awareness program showed no effect on injury rate.     

Incidence of injury in junior and senior rugby league players

Rugby league is an international collision sport played at junior, amateur, semi-professional and professional levels. Due to the high numbers of physical collisions and tackles, musculoskeletal injuries are common. A large percentage of injuries result in long-term employment and study limitations, medical costs and loss of income. Review articles addressing the applied physiology of rugby league and common rugby league injuries have been published. However, both of these review articles have focused on the professional rugby league player. This review addresses the extent of the injury problem in rugby league in all levels of competition (i.e. junior, amateur, semi-professional and professional). The incidence of rugby league injuries typically increases as the playing level is increased. The majority of studies have shown that the head and neck is the most common site of match injuries in senior rugby league players, while knee injuries are the most common site of injury in junior rugby league players. Muscular injuries are the most common type of injury sustained by senior rugby league players, while junior rugby league players more commonly sustain fractures. Injuries are most commonly sustained in tackles, by the tackled player. Thigh and calf strains are the most common injuries sustained during rugby league training, while overexertion is the most common cause of training injuries. Player fatigue may influence the incidence of injury, with most sub-elite (amateur and semi-professional) rugby league injuries occurring in the second half of matches or the latter stages of training sessions. The majority of training injuries occur in the early stages of the season, while match injuries occur in the latter stages of the season, suggesting that changes in training and playing intensity may influence the incidence of injury in rugby league. Injury prevention studies are required to reduce the incidence, severity and cost of rugby league injuries. These injury prevention strategies could include coaching on defensive skills, correct tackling technique, correct falling technique and methods to minimise the absorption of impact forces in tackles. Game-specific attacking and defensive drills practised before and during fatigue may also encourage players to make appropriate decisions under fatigued conditions and apply learnt skills during the pressure of competitive matches. Further studies investigating risk factors for injury in junior and senior rugby league players, injuries sustained by specific playing positions and the influence of injuries on playing performance are warranted.     

Prevention of soccer injuries: a prospective intervention study in youth amateur players

BACKGROUND: Risk factors for soccer injuries and possibilities for prevention have been discussed by several authors, but only a few have investigated the effectiveness of preventive interventions. PURPOSE: The aim of the present study was to evaluate the effects of a prevention program on the incidence of soccer injuries in male youth amateur players. STUDY DESIGN: Prospective controlled intervention study. METHODS: Seven soccer teams took part in a prevention program that focused on education and supervision of coaches and players, while seven other teams were instructed to train and play soccer as usual. Over 1 year all injuries were documented weekly by physicians. Complete weekly injury reports were available for 194 players. RESULTS: The incidence of injury per 1000 hours of training and playing soccer was 6.7 in the intervention group and 8.5 in the control group, which equates to 21% fewer injuries in the intervention group. The greatest effects were observed for mild injuries, overuse injuries, and injuries incurred during training. The prevention program had greater effects in low-skill than in high-skill teams. CONCLUSIONS: The incidence of soccer injuries can be reduced by preventive interventions, especially in low skill level youth teams. Coaches and players need better education regarding injury prevention strategies and should include such interventions as part of their regular training.     

Training injuries in New Zealand amateur rugby league players

This study investigated the incidence, site, nature and severity of training injuries in a New Zealand amateur rugby league team. The incidence of injuries was prospectively studied in a senior amateur rugby league club over one domestic season. All injuries sustained during training sessions were recorded. Injury data was collected from a total of 77 training sessions. Information recorded included the date, time, site, nature, cause and severity of injury. A total of 66 training injuries were recorded. The total injury incidence was 22.4 per 1000 training hours. Injuries resulting in missed training sessions were 16.9 per 1000 h. The most common injury site was the thigh for both overall injuries and injuries resulting in missed training weeks. The incidence of overexertion injuries peaked immediately prior to the commencement of the competitive season. The high rates of overexertion injuries suggest that an increase in intensity may contribute to training injuries in amateur rugby league players. An understanding of the demands of training, and the effects that injuries have on players is essential for the identification of injury prevention strategies.     

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.     

Incidence of injury in amateur rugby league sevens

OBJECTIVES: To investigate the incidence, site, and nature of injuries sustained in amateur rugby league sevens tournaments. METHODS: A total of 168 players competing in three amateur rugby league sevens tournaments were studied. All injuries sustained during matches were recorded. Information recorded included the name of the injured player and the time, cause, anatomical site, and nature of the injury. RESULTS: The incidence of injury was 283.5 per 1000 playing hours. Some 40% (113.4 per 1000 playing hours) of all injuries sustained were to the lower limb (chi(2) = 5.3, df = 1, p<0.05). Contusions were the most common type of injury (113.4 per 1000 hours, 40%, chi(2) = 9.5, df = 4, p<0.05), with most (198.4 per 1000 hours, 70%, chi(2) = 31.5, df =4, p<0.001) occurring in physical collisions and tackles. An increasing injury incidence was observed over the first (99.2 per 1000 hours), second (198.4 per 1000 hours), third (347.2 per 1000 hours), and fourth (694.4 per 1000 hours) matches played during the tournaments (chi(2) = 9.2, df = 3, p<0.05). CONCLUSIONS: The results of this study suggest that amateur rugby league sevens tournaments, which require players to compete repeatedly on the same day, may hasten the onset of fatigue and predispose to injury.     

Epidemiology and traumatology of injuries in elite soccer: a prospective study in Finland

A prospective study of male soccer injuries among 12 teams playing at the highest competition level was carried out in Finland in 1993. Overall, two out of three players were injured during the whole season. The injury incidence per 1000 playing hours among injured players and all players during games was higher than during practice, 14.2 vs. 11.3 and 2.3 vs. 1.8, respectively. The lower extremity was involved in 76% of the injuries. Thigh injuries were most frequent (22%), whereas overuse injuries were scarce (6%). Eighteen per cent of the injured players needed surgery and in most cases (58%) the reason for surgery was a knee injury. Sixteen per cent of all injured players were absent from soccer for more than 1 month after the injury. The mean absence time was 17 days for all and 84 days for operatively treated players.     

Injuries in team sport tournaments during the 2004 Olympic Games

BACKGROUND: Several authors have analyzed the incidence of injuries in a given sport, but only a few have examined the exposure-related incidence of injuries in different types of sports using the same methodology. PURPOSE: Analysis of the incidence, circumstances, and characteristics of injuries in different team sports during the 2004 Olympic Games. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: During the 2004 Olympic Games, injuries in 14 team sport tournaments (men's and women's soccer, men's and women's handball, men's and women's basketball, men's and women's field hockey, baseball, softball, men's and women's water polo, and men's and women's volleyball) were analyzed. After each match, the physician of the participating teams or the official medical representative of the sport completed a standardized injury report form. The mean response rate was 93%. RESULTS: A total of 377 injuries were reported from 456 matches, an incidence of 0.8 injuries per match (95% confidence interval, 0.75-0.91) or 54 injuries per 1000 player matches (95% confidence interval, 49-60). Half of all injuries affected the lower extremity; 24% involved the head or neck. The most prevalent diagnoses were head contusion and ankle sprain. On average, 78% of injuries were caused by contact with another player. However, a significantly higher percentage of noncontact (57%) versus contact injuries (37%) was expected to prevent the player from participating in his or her sport. Significantly more injuries in male players (46%) versus female players (35%) were expected to result in absence from match or training. The incidence, diagnosis, and causes of injuries differed substantially between the team sports. CONCLUSION: The risk of injury in different team sports can be compared using standardized methodology. Even if the incidence and characteristics of injuries are not identical in all sports, prevention of injury and promotion of fair play are relevant topics for almost all team sports.     

Epidemiology of injuries in Australian junior rugby league players

ObjectivesConduct a large-scale epidemiological study of injury characteristics (location, type, mechanism, severity, burden) and incidence in community junior rugby league.DesignProspective cohort epidemiology study.MethodsInjury surveillance was conducted in three district leagues (Penrith, Canberra, Melbourne) in under 6 (U6) to under 18 years (U18) age groups across the 2016 season. Club sports trainers recorded all match/training medical-attention injuries using a commercial electronic application which recorded injury circumstances and characteristics.ResultsA total of 13,169 players from 897 teams participated and 408 (89% male) players sustained 485 injuries, 94% of which were match related. The overall injury incidence was 5.9 injuries/1000 player hours and highest in U13–U18 female players (22.2 injuries/1000 player hours). The mean injury severity of 16 ± 31 days missed training/match-play caused an overall injury burden of 94.2 days missed/1000 player hours). Tackles accounted for 84% of injuries. Joint and contusion injuries were the most prevalent injury type and the head (35% total injuries, primarily bruising and bleeding) was the most injured body site.ConclusionsThis is the first study to report injuries across a large cohort of all-age Australian community junior rugby league players over one season. Injury prevalence was lower than previously reported in junior rugby league suggesting the sport has not become more dangerous for junior players. These findings provide an evidence-base to inform or revise policy, training and injury prevention programs and athlete development pathways in relation to game-wide safety and develop best-practice protocols in injury management for rugby league athlete support personnel.     

Soccer injuries among elite female players

Injuries occurring in two female elite soccer teams were recorded during 1 year. Of 41 players, 33 (80%) sustained 78 injuries. The incidence of injury during games was 24/1000 hours, while the incidence during training was 7/1000 hours. The majority (88%) of injuries were localized to the lower extremities, with equal occurrence in the left and right legs. Forty-nine percent of the injuries occurred in the knee or ankle. Most of the injuries were minor (49%), while 36% were moderate and 15% were major. Of the major injuries (N = 12), 10 were due to trauma and 7 (58%) were knee ligament or meniscal tears. Overuse injuries constituted 28% of all injuries and occurred mainly during preseason training and at the beginning and end of the competitive season. Traumatic injuries (72%) occurred mainly during games with a predominance at the beginning of the competitive season. Almost 80% of the traumatic injuries occurred during physical contact with an opponent. Extrinsic factors such as weather, playing surface, temperature, or the position of the player within the team did not influence the injury rate. We conclude that female elite soccer players sustain a high incidence of injury. Few injuries were major, but 17% of the players sustained a major knee injury during the year.     

Training injury incidence in an amateur women’s rugby union team in New Zealand over two consecutive seasons

ObjectivesTo describe the training injury incidence in amateur women’s rugby union in New Zealand over two consecutive seasons.DesignA prospective cohort observational studyMethodsA total of 69 amateur women’s rugby 15s team playerswere observed. Training exposure and training injury incidence were calculated.ResultsThe 38 training injuries resulted in a total injury incidence of 11.4 (8.3–15.6) per 1,000 training-hours. There were 12 injuries that resulted in a time-loss injury incidence of 3.6 (95% CI: 2.0–6.3) per 1,000 training-hours. Forwards recorded more total (RR: 1.8 [95% CI: 0.9–3.5]; p = 0.0516) and time-loss (RR: 2.0 [95% CI: 0.6–6.6]; p = 0.2482) injuries than Backs. The tackle was the most common injury cause for total (3.0 [95% CI: 1.6–5.6] per 1,000 training-hours.) injuries, but collisions (1.5 [95% CI: 0.6–3.6] per 1,000 training-hours.) with the ground or another person were the most common cause for time-loss injuries.The training injuries occurred most often to the lower limb and during the latter part of training sessions. These injuries were mostly minor in nature resulting in minimal time-loss away from training.DiscussionThe time-loss injury incidence (3.6 per 1,000 training-hours.) for the amateur women’s rugby 15s team players was higher than that reported for National (1.2 per 1,000 training-hours.) and Rugby World Cup for women (0.2 to 3.0 per 1,000 training-hours.) competitions.ConclusionThe training injury incidence in amateur women’s rugby union in New Zealand was higher than that reported for national and international rugby union injury incidences.     

Intraarticular injuries associated with anterior cruciate ligament tear: findings at ligament reconstruction in high school and recreational athletes. An analysis of sex-based differences

BACKGROUND: Despite research on the increased risk of anterior cruciate ligament tears in female athletes, few studies have addressed sex differences in the incidence of associated intraarticular injuries. HYPOTHESIS: When patients are stratified by sport and competition level, no sex differences exist in either the mechanism of injury or pattern of intraarticular injuries observed at anterior cruciate ligament reconstruction. STUDY DESIGN: Prospective cohort study. METHODS: Two hundred twenty-one athletes undergoing anterior cruciate ligament reconstruction met our inclusion criteria of anterior cruciate ligament tear as a singular event without reinjury or history of prior injury or surgery in either knee. Data were collected on competition level (high school, amateur), sport (basketball, soccer, skiing), mechanism of injury, articular cartilage injuries, and meniscal tears. Data were statistically analyzed by sex with the chi-square test and Student's t-test. RESULTS: High school athletes had no significant sex differences in mechanism of injury. Female soccer athletes had fewer medial meniscal tears than did male athletes, and female basketball players had fewer medial femoral condyle injuries. At the amateur level, female basketball players had more contact injuries, an earlier onset of swelling, and fewer lateral meniscal tears than did male players. CONCLUSION: At the high school level, male and female athletes shared a common mechanism of injury, and yet the female athletes had fewer intraarticular injuries in basketball and soccer. If such intraarticular injuries prove to be a significant risk factor for poor long-term outcome, women may enjoy a better prognosis after reconstruction.     

Incidence of injury in semi-professional rugby league players

OBJECTIVES: To investigate the site, nature, cause, and severity of injuries in semi-professional rugby league players. METHODS: The incidence of injury was prospectively studied in one hundred and fifty six semi-professional rugby league players over two competitive seasons. All injuries sustained during matches and training sessions were recorded. Injury data were collected from a total of 137 matches and 148 training sessions. Information recorded included the date and time of injury, site, nature, cause, and severity of injury. RESULTS: During the two seasons, 1,694 playing injuries and 559 training injuries were sustained. The match injury incidence was 824.7 per 1,000 player-position game hours and training injury incidence was 45.3 per 1,000 training hours. Over 20% of the total training (17.4 per 1,000) and playing (168.0 per 1,000) injuries sustained were to the thigh and calf. Muscular injuries (haematomas and strains) were the most common type of injury sustained during training (22.0 per 1,000, 48.7%) and matches (271.7 per 1,000, 32.9%). Playing injuries were most commonly sustained in tackles (382.2 per 1,000, 46.3%), while overexertion was the most common cause of training injuries (15.5 per 1,000, 34.4%). The majority of playing injuries were sustained in the first half of matches (1,013.6 per 1,000, 61.5% v 635.8 per 1,000, 38.5%), whereas training injuries occurred more frequently in the latter stages of the training session (50.0 per 1,000, 55.3% v 40.5 per 1,000, 44.7%). Significantly more training injuries were sustained in the early half of the season, however, playing injuries occurred more frequently in the latter stages of the season. CONCLUSIONS: These results suggest that changes in training and playing intensity impact significantly upon injury rates in semi-professional rugby league players. Further studies investigating the influence of training and playing intensity on injuries in rugby league are warranted.     

Do mismatches between teams affect the risk of injury in the Rugby World Cup?

The aim of this study was to assess whether differences in competing teams’ body mass and playing performance affected the risk of injury in rugby union. The study was a prospective, whole population survey of players representing all countries competing at the Rugby World Cup in 2007. The study design followed the consensus statement for epidemiological studies in rugby with the main outcome measures being the incidence and severity of match injuries. Differences in players’ average body mass and mismatches in the teams’ overall and match performances did not create greater risks of injury for the lighter or less successful teams competing at Rugby World Cup 2007.     

Recent trends in rugby union injuries

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

Incidence of injury in junior rugby league players over four competitive seasons

While several studies have documented the incidence of injury in senior rugby league players, information on the injury rates of junior rugby league players is limited. In addition, all of the injury surveillance studies performed on junior rugby league players have been performed over a limited time frame (typically one season). The purpose of this study was to document the incidence of injury in junior rugby league players over four competitive seasons. Injury data were collected from 84 matches. An injury was defined as one that occurred in a match and resulted in the player missing a subsequent match. The overall incidence of injury was 56.8 (95% CI, 42.6–70.9) per 1000 playing hours. The majority of injuries were sustained to the shoulder (15.6 [95% CI, 8.2–23.0] per 1000 playing hours). Sprains were the most common type of injury (24.7 [95% CI, 15.4–34.1] per 1000 playing hours). Injuries were most commonly sustained while being tackled (19.2 [95% CI, 11.0–27.5] per 1000 playing hours) and while tackling (10.1 [95% CI, 4.1–16.0] per 1000 playing hours). While there was a tendency towards differing injury rates over the four competitive seasons (χ² = 6.3, d.f. = 3), the differences were not statistically significant (p = 0.10). These findings demonstrate that the incidence of junior rugby league injuries is similar to previously reported for senior competitors. A long-term collaborative effort to reduce the incidence of injury in junior rugby league players is warranted.