Validity of the SMS,Phone, and medical staff Examination sports injury surveillance system for time‐loss and medical attention injuries in sports

The accurate measurement of sport exposure time and injury occurrence is key to effective injury prevention and management. Current measures are limited by their inability to identify all types of sport‐related injury, narrow scope of injury information, or lack the perspective of the injured athlete. The aims of the study were to evaluate the proportion of injuries and the agreement between sport exposures reported by the SMS messaging and follow‐up telephone part of the SMS , Phone, and medical staff Examination (SPE x) sports injury surveillance system when compared to measures obtained by trained on‐field observers and medical staff (comparison method). We followed 24 elite adolescent handball players over 12 consecutive weeks. Eighty‐six injury registrations were obtained by the SPE x and comparison methods. Of them, 35 injury registrations (41%) were captured by SPE x only, 10 injury registrations (12%) by the comparison method only, and 41 injury registrations (48%) by both methods. Weekly exposure time differences (95% limits of agreement) between SPE x and the comparison method ranged from −4.2 to 6.3 hours (training) and −1.5 to 1.0 hours (match) with systematic differences being 1.1 hours (95% CI 0.7 to 1.4) and −0.2 (95% CI −0.3 to −0.2), respectively. These results support the ability of the SPE x system to measure training and match exposures and injury occurrence among young athletes. High weekly response proportions (mean 83%) indicate that SMS messaging can be used for player measures of injury consequences beyond time‐loss from sport. However, this needs to be further evaluated in large‐scale studies.     

Substantial injuries influence ranking position in young elite athletes of athletics,cross‐country skiing and orienteering

The relationship between injury and performance in young athletes is scarcely studied. The aim of this study was therefore to explore the association between injury prevalence and ranking position among adolescent elite athletes. One hundred and sixty‐two male and female adolescent elite athletes (age range 15‐19), competing in athletics (n = 59), cross‐country skiing (n = 66), and orienteering (n = 37), were monitored weekly over 22‐47 weeks using a web‐based injury questionnaire. Ranking lists were collected. A significant (P  = .003) difference was found in the seasonal substantial injury prevalence across the ranked athletes over the season, where the top‐ranked (median 3.6%, 25‐75th percentiles 0%‐14.3%) and middle‐ranked athletes (median 2.3%, 25‐75th percentiles 0%‐10.0%) had a lower substantial injury prevalence compared to the low‐ranked athletes (median 11.3%, 25‐75th percentiles 2.5%‐27.1%), during both preseason (P  = .002) and competitive season (P  = .031). Athletes who improved their ranking position (51%, n = 51) reported a lower substantial injury prevalence (median 0%, 25‐75th percentiles 0%‐10.0%) compared to those who decreased (49%, n = 49) their ranking position (md 6.7%, 25‐75th percentiles 0%‐22.5%). In the top‐ranked group, no athlete reported substantial injury more than 40% of all data collection time points compared to 9.6% (n = 5) in the middle‐ranked, and 17.3% (n = 9) in the low‐ranked group. Our results provide supporting evidence that substantial injuries, such as acute and overuse injuries leading to moderate or severe reductions in training or sports performance, influence ranking position in adolescent elite athletes. The findings are crucial to stakeholders involved in adolescent elite sports and support the value of designing effective preventive interventions for substantial injuries.     

Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective

Many risk factors for injury are presented in the literature, few of those are however consistent and the majority is associated with adult and not adolescent elite athletes. The aim was to identify risk factors for injury in adolescent elite athletes, by applying a biopsychosocial approach. A total of 496 adolescent elite athletes (age range 15‐19), participating in 16 different sports, were monitored repeatedly over 52 weeks using a valid questionnaire about injuries, training exposure, sleep, stress, nutrition, and competence‐based self‐esteem. Univariate and multiple Cox regression analyses were used to calculate hazard ratios (HR) for risk factors for first reported injury. The main finding was that an increase in training load, training intensity, and at the same time decreasing the sleep volume resulted in a higher risk for injury compared to no change in these variables (HR 2.25, 95% CI, 1.46‐3.45, P<.01), which was the strongest risk factor identified. In addition, an increase by one score of competence‐based self‐esteem increased the hazard for injury with 1.02 (HR 95% CI, 1.00‐1.04, P=.01). Based on the multiple Cox regression analysis, an athlete having the identified risk factors (Risk Index, competence‐based self‐esteem), with an average competence‐based self‐esteem score, had more than a threefold increased risk for injury (HR 3.35), compared to an athlete with a low competence‐based self‐esteem and no change in sleep or training volume. Our findings confirm injury occurrence as a result of multiple risk factors interacting in complex ways.     

Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union

BACKGROUND: The incidence of hamstring muscle injuries in professional rugby union is high, but evidence-based information on risk factors and injury-prevention strategies in this sport is limited. PURPOSE: To define the incidence, severity, and risk factors associated with hamstring muscle injuries in professional rugby union and to determine whether the use of hamstring strengthening and stretching exercises reduces the incidence and severity of these injuries. STUDY DESIGN: Cohort study (prevention); Level of evidence, 3. METHODS: Team clinicians reported all hamstring muscle injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury; loss of time from training and match play was used as the definition of an injury. Players' match and training exposures were recorded on a weekly basis. RESULTS: The incidence of hamstring muscle injuries was 0.27 per 1000 player training hours and 5.6 per 1000 player match hours. Injuries, on average, resulted in 17 days of lost time, with recurrent injuries (23%) significantly more severe (25 days lost) than new injuries (14 days lost). Second-row forwards sustained the fewest (2.4 injuries/1000 player hours) and the least severe (7 days lost) match injuries. Running activities accounted for 68% of hamstring muscle injuries, but injuries resulting from kicking were the most severe (36 days lost). Players undertaking Nordic hamstring exercises in addition to conventional stretching and strengthening exercises had lower incidences and severities of injury during training and competition. CONCLUSION: The Nordic hamstring strengthening exercise may reduce the incidence and severity of hamstring muscle injuries sustained during training and competition.     

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.     

The association between early specialization and performance level with injury and illness risk in youth elite athletes

A trend is observed towards more specialized training and selection into talent programs at an early age for youth athletes. Little is known how this might influence the risk of illness and injury. The aim of the study was to assess whether, in a group of youth elite athletes, those specializing early or performing best were at increased risk of incurring injury or illness after entering a specialized Sport Academy High School program. We enrolled 259 16‐year‐old elite athletes. They completed a baseline web‐based questionnaire covering their age at specialization, single‐ versus multi‐sport involvement during the previous 2 years and current performance level (rated by themselves and their coach). Subsequently, the Oslo Sports Trauma Research Centre (OSTRC) questionnaire on health problems was used to self‐report injuries and illnesses weekly for 26 weeks from October to May. In this specialized Sport Academy High School program, 39% of the athletes reported early specialization (at 12 years or younger). However, early specialization did not increase the risk of injury or illness during the 26 weeks, nor did being a single‐sport athlete the previous two years increase this risk. The best performing athletes at the time of enrollment were not at greater risk of becoming injured or ill during the 26 weeks. In conclusion, in a group of youth elite athletes entering a specialized Sport Academy High School program neither early single‐sport specialization nor performance level appears to represent risk factors for injury or illness after enrollment.     

Physical collisions and injury during professional rugby league skills training

This study described the number and intensity of collisions experienced by professional rugby league players during pre-season and in-season skills training sessions using microtechnology (e.g. accelerometers, gyroscopes). Short, medium, and long recovery periods between matches were accounted for and the incidence of collision injuries sustained in the training environment was also assessed. Thirty professional rugby league players (mean ± SD age, 23.6 ± 3.8 yr) participated in this study. The number and intensity of collisions and the incidence of collision injuries were monitored during 117 skills training sessions. Over the course of the season, an average of 77 collisions occurred per player, per session. The average number of mild, moderate, and heavy collisions performed by each member of the squad per session was 24, 46, and 7, respectively. A total of 37 collision injuries were recorded during training over the season, equating to an injury incidence of 6.4 per 10,000 collisions. Over half (54.1%) of all collision injuries resulted in no loss of training time, and less than 14% of collision injuries resulted in a missed match. The greatest number of collisions occurred during training sessions in the weeks with the longest recovery between matches (10 days). The incidence of collision injuries also peaked during the 10 day between match recovery cycle. These findings demonstrate that while significant physiological demands are placed on rugby league players as a result of the large number and intensity of physical collisions performed in training, these collisions are associated with minimal injury risk.     

The SMS,Phone, and medical Examination sports injury surveillance system is a feasible and valid approach to measuring handball exposure,injury occurrence,and consequences in elite youth sport

Current methods of sports injury surveillance are limited by lack of medical validation of self‐reported injuries and/or incomplete information about injury consequences beyond time loss from sport. The aims of this study were to (a) evaluate the feasibility of the SMS, Phone, and medical Examination injury surveillance (SPEx ) system (b) to evaluate the proportion of injuries and injury consequences reported by SPEx when compared to outcomes from a modified version of the Oslo Sports Trauma Research Centre (OSTRC ) Overuse Injury Questionnaire. We followed 679 elite adolescent handball players over 31 weeks using the SPEx system. During the last 7 weeks, we also implemented a modified OSTRC questionnaire in a subgroup of 271 players via telephone interviews. The weekly response proportions to the primary SPEx questions ranged from 85% to 96% (mean 92%). SMS responses were received from 79% of the participants within 1 day. 95% of reported injuries were classified through the telephone interview within a week, and 67% were diagnosed by medical personnel. Comparisons between reported injuries from SPEx and OSTRC demonstrated fair (κ = 39.5% [25.1%‐54.0%]) to substantial prevalence‐adjusted bias‐adjusted kappa (PABAK  = 66.8% [95% CI 58.0%‐75.6%]) agreement. The average injury severity score difference between SPEx and the OSTRC approach was −0.2 (95% CI −3.69‐3.29) of possible 100 with 95% limits of agreement from(−14.81‐14.41). These results support the feasibility and validity of the SPEx injury surveillance system in elite youth sport. Future studies should evaluate the external validity of SPEx system in different cohorts of athletes.     

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.     

Risk factors for football injuries in young players aged 7 to 12 years

Football (soccer) is very popular among children. Little is known about risk factors for football injuries in children. The aim was to analyze potential injury risk factors in 7‐ to 12‐year‐old players. We collected prospective data in Switzerland and the Czech Republic over two seasons. Coaches reported exposure of players (in hours), absence, and injury data via an Internet‐based registration system. We analyzed time‐to‐injury data with extended Cox models accounting for correlations on team‐ and intra‐person levels. We analyzed injury risk in relation to age, sex, playing position, preferred foot, and regarding age‐independent body height, body mass, and BMI . Further, we analyzed injury risk in relation to playing surface. In total, 6038 player seasons with 395 295 hours of football exposure were recorded and 417 injuries occurred. Injury risk increased by 46% (Hazard Ratio 1.46 [1.35; 1.58]; P  < .001) per year of life. Left‐footed players had a higher injury risk (Hazard Ratio 1.53 [1.07; 2.19]; P  = .02) for training injuries compared to right‐footed players. Injury risk was increased in age‐adjusted taller players (higher percentile rank). Higher match‐training ratios were associated with a lower risk of match injuries. Injury risk was increased on artificial turf (Rate Ratio 1.39 [1.12; 1.73]; P  < .001) and lower during indoor sessions (Rate Ratio 0.68 [0.52; 0.88]; P  < .001) compared to natural grass. Age is known as a risk factor in older players and was confirmed to be a risk factor in children's football. Playing surface and leg dominance have also been discussed previously as risk factors. Differences in injury risks in relation to sex should be investigated in the future.     

Incidence and risk factors of injuries in Brazilian elite handball players: A prospective cohort study

The aim of this study was to investigate the incidence and risk factors for handball injuries in Brazilian elite handball players. Overall, 339 athletes from 21 handball teams who participated in the two main Brazilian championships were followed up during a season. In total, 312 injuries were reported by 201 athletes. The injury incidence rate during training was 3.7/1000 h, and during matches was 20.3/1000 matches. Ankle (19.4%, n = 46) and knee (13.5%, n = 32) were the body regions most affected by traumatic injuries. Shoulders (44.0%, n = 33) and knee (26.7%, n = 20) were the body regions most affected by overuse injuries. Muscle injuries (27.1%, n = 68) was the traumatic injury type most reported. Tendinopathy (91.8%, n = 56) was the overuse injury type most observed. Previous injury (OR: 2.42, CI 95%: 1.51–3.89) and an additional match per week (OR: 1.31, CI 95%: 1.05–1.62) were associated with a higher risk of overuse injury. Female athletes (OR: 1.56, CI 95%: 1.08–2.25) and an additional hour of training per week (OR: 1.09, CI 95%: 1.02–1.15) were associated with a higher risk of traumatic injury. This study showed that athletes with previous injury have shown a high risk of developing an overuse injury.     

The epidemiology of back injuries in elite Gaelic football athletes: An 8-year prospective study

ObjectivesTo describe the epidemiology of back injury in elite male Gaelic football athletes between 2008 and 2016.DesignProspective cohort study.SettingInjury data from the National GAA Injury Surveillance Database.ParticipantsElite male Gaelic football athletes.Main outcome measuresIncidence of injury as a rate per 1000 h of exposure.Results38 datasets were analysed. Out of a total of 1606 time-loss injuries, 76 were back injuries (4.73%, 95% CI 3.80%–5.88%). The incidence of back injuries in match play was 1.72 (CI 95% 1.21 to 2.45) and in training was 0.2 (CI 95% 0.14 to 0.28) injuries per 1000 h of exposure. The majority of back injuries (63.16%, CI 95% 51.93–73.12) were new, as opposed to recurrent (35.53% CI 95% 25.7–46.74). Most back injuries were acute (51.32%, CI 95% 40.29–62.22), compared to chronic (31.58%, CI 95% 22.23–42.7) or overuse (11.84%, CI 95% 6.36–21.00). The majority of back injuries occurred during non-contact player activities (n = 60, 78.94% CI 95% 68.50–86.60).ConclusionsBack injury rates in Gaelic football are similar to soccer and Australian football but less than rugby union. Further research is needed to understand the factors leading to the onset and recurrence of back injury in Gaelic football athletes.     

Injuries in youth amateur soccer and rugby players--comparison of incidence and characteristics

OBJECTIVES: In reviewing the literature on sports injuries, few studies could be found in which exposure related incidences of injury in different types of sport were compared. These studies indicated that ice hockey, handball, basketball, soccer, and rugby are popular team sports with a relatively high risk of injury. The aim of the study was to compare the characteristics and incidence of injuries in male youth amateur soccer and rugby players. METHODS: This prospective cohort study comprised an initial baseline examination to ascertain the characteristics of the players and their level of performance, and a one season observation period during which a physician visited the team weekly and documented all occurring injuries. Twelve soccer and 10 rugby school teams with male amateur players aged 14-18 years were selected for the study. 145 soccer and 123 rugby players could be followed up over one season. RESULTS: Comparison of the incidence of soccer and rugby injuries indicated that rugby union football was associated with a significantly higher rate of injury than soccer. The differences were pronounced for contact injuries, injuries of the head, neck, shoulder, and upper extremity, as well as for concussion, fractures, dislocations, and strains. Rugby players incurred 1.5 times more overuse and training injuries in relation to exposure time, and 2.7 times more match injuries than soccer players. Three rugby players but no soccer players had to stop their participation in sport because of severe injury. CONCLUSION: The incidence of injury in New Zealand school teams playing soccer or rugby union is high, probably in part because of the low ratio of hours spent in training relative to hours spent playing matches. The development and implementation of preventive interventions to reduce the rate and severity of injury is recommended.     

The association between physical fitness level and number and severity of injury and illness in youth elite athletes

Youth elite athletes often double their training and competition load after enrollment into specialized sport academy high school programs. The least fit athletes may be exposed to an excessive and too rapid increase in training load, with negative adaptations such as injury and illness as a consequence. In this study, our aim was to determine whether these least fit athletes were at greater risk of injury or illness during their first school year. Participants were 166 youth elite athletes (72% boys) from a variety of team, technical, and endurance sports newly enrolled into specialized sport academy high schools. The Oslo Sports Trauma Research Center Questionnaire on Health Problems was used to self‐report injuries and illnesses weekly for 26 weeks. Athletes completed the Ironman Jr physical fitness test battery at baseline, evaluating endurance, strength, agility, and speed properties. We ranked the athletes based on their combined test scores and identified the least fit quartile. The main outcome was the number and severity of health problems, comparing the least fit quartile of athletes to the rest of the cohort. Overall, the least fit quartile of athletes did not report more health problems (mean 3.7, 95% CI 3.0‐4.4) compared with the rest of the cohort (3.6, 3.2‐3.9). In conclusion, we demonstrated no association between low physical fitness level and number and severity of injury and illness in youth elite athletes after enrollment into a specialized sport academy high school program.     

Trunk muscle strength and lumbo‐pelvic kinematics in adolescent athletes: Effects of age and sex

Considering their potential relevance for low‐back pain, we investigated trunk muscle strength, sagittal lumbo‐pelvic alignment while standing and lumbo‐pelvic ratio during trunk flexion in adolescent athletes with regard to the effects of age and sex. Twenty‐two early adolescent (EA: 13‐15 years, 10 females) and 28 late adolescent (LA: 16‐19 years, 14 females) high‐level athletes (training duration more than 12 hours per week) participated in the study. We measured trunk extension and trunk flexion moments during maximum voluntary isometric contractions using a dynamometer. Further, we examined lumbo‐pelvic kinematics in the upright standing position and during forward trunk bending using two 3‐dimensional accelerometers. Using a lineal regression model in which the flexion moment from each participant was used as predictor for the corresponding extension moment, we found higher residuals (P < 0.001) in the EA compared to LA, indicating greater imbalances in the trunk muscle strength in EA. We found a higher lordosis in the upright position, greater pelvic rotation, and greater lordotic posture during the forward bending in females (P < 0.01). These age‐related imbalances and sex‐related characteristics in lumbo‐pelvic kinematics might affect the neuromuscular control of trunk stability and the magnitude of spine loading. We recommend the implementation of specific coordination and stabilization programs for muscle groups that contribute to lumbo‐pelvic kinematics and training routines that support a balanced strength development within the trunk muscles in adolescent athletes.     

Epidemiological patterns of musculoskeletal injuries and physical training.

PURPOSE: The purpose of this study was to identify rates of diagnosis-specific musculoskeletal injuries in U.S. Marine Corps recruits and to examine the association between patterns of physical training and these injuries. METHODS: Subjects were 1,296 randomly selected male Marine recruits, ages 17 to 28 yr, who reported to Marine Corps Recruit Depot San Diego for boot camp training between January 12 and September 14, 1993. Recruits were followed prospectively through 12 wk of training for injury outcomes. Injury patterns were examined in relation to weekly volumes and types of vigorous physical training. RESULTS: The overall injury rate was 39.6% (number of recruits injured/population at risk), with 82% of injuries occurring in the lower extremities. Overuse injuries accounted for 78% of the diagnoses. The most frequent site of injury was the ankle/foot region (34.3% of injuries), followed by the knee (28.1%). Ankle sprains (6.2%, N = 1,143), iliotibial band syndrome (5.3%, N = 1,143), and stress fractures (4.0%, N = 1,296) were the most common diagnoses. Injury rates were highest during the weeks with high total volumes of vigorous physical training and the most hours of running and marching. Weekly injury rates were significantly correlated with hours of vigorous physical training (overuse injuries r = 0.667, P = 0.018; acute injuries r = 0.633, P = 0.027). CONCLUSIONS: The results of this controlled epidemiological investigation indicate that volume of vigorous physical training may be an etiologic factor for exercise-related injuries. The findings also suggest that type of training, particularly running, and abrupt increases in training volume may further contribute to injury risk.     

Sport specialization and sport participation opportunities and their association with injury history in female high school volleyball athletes

ObjectiveDetermine the association of sport specialization in female volleyball athletes with previous injury history and determine the association of sport specialization with volleyball participation opportunities.DesignCross-sectional.SettingRecruitment occurred from 83 Wisconsin high schools during the 2018 volleyball season.ParticipantsFemale volleyball athletes (N = 1,588, grades 9–12, age = 15.6 ± 1.1 years).Main outcomesParticipants completed a pre-season questionnaire soliciting information regarding 1) demographics, 2) sport specialization, 3) sport participation, and 4) sport-related injuries in the previous 12 months. Univariable logistic regression models were used to identify associations with previous injury. Chi-square analyses were used to investigate associations between sport specialization classification and other sport participation opportunities.ResultsBoth moderately and highly specialized athletes were more likely to report a previous injury compared to low specialized athletes (moderate OR: 1.84 [1.29–2.62]; p < 0.001 and high OR: 2.30 [1.64–3.24]; p < 0.001). Highly specialized athletes were more likely to report participating in club volleyball, summer tournaments, and training camps in the past 12 months. Participants who reported participating in club volleyball, summer competitions, and training camps last year were more likely to report an injury.ConclusionsSpecialization was associated with injury history and year-round volleyball opportunities among female adolescent volleyball athletes.     

Modeling the impact of players’ workload on the injury‐burden of English Premier League football clubs

The loss of players through injury is known to affect team performance in many sports; it is important, therefore, for professional teams to be able to quantify the likely injury‐burden that will be encountered throughout a season. A kinetic model, based on the rates at which match and training injuries are sustained and resolved, a team's squad size and the 2017/2018 season fixture schedule for teams competing in the English Premier League, is used to produce daily forecasts of injury‐burden experienced by a typical team. The incidences and median severities of match (incidence: 26.9 injuries/1000 player‐match hours, 95% CI : 21.5‐33.7; severity: 17.5 days, 95% CI : 13.0‐28.0) and training (incidence: 4.3 injuries/1000 player‐training hours, 95% CI : 3.4‐5.5; severity: 14.0 days, 95% CI : 11.0‐22.0) injuries were determined using data collected from four English Premier League football clubs during the 2016/2017 season. Time‐to‐recovery curves for the match and training injuries sustained in the Premier League closely matched the time‐to‐recovery curves predicted by the kinetic model used in this study. The kinetic model predicted higher match and lower training injury burdens and a higher overall injury burden for successful teams competing in both national and European club competitions compared to teams competing only in national competitions. The model also showed that, in terms of injury‐burden, there were no benefits in adopting a 4‐week mid‐season break during the season: reducing the number of clubs competing in the Premier League would, however, reduce the overall injury burden during a season.     

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.