Half a million hours of rugby football. The injuries.

In 30 seasons at Rugby School half a million hours of Rugby football have led to 9,885 injuries, an incidence of 197.7 injuries per 10.000 player hours. This incidence is compared with those from other school games, and with those of other series of Rugby football injuries. The injuries are compared regionally with those of other series, and the more important are listed.     

Epidemiology of concussion in collegiate and high school football players

Despite evolutionary changes in protective equipment, head injury remains common in football. We investigated concussion in football and associated epidemiologic issues such as 1) incidence of injury, 2) common signs and symptoms, and 3) patterns in making return-to-play decisions. We received 242 of 392 surveys (62%) that were sent to high school and collegiate certified athletic trainers at the beginning of three football seasons. Of the 17,549 football players represented, 888 (5.1%) sustained at least one concussion, and 131 (14.7% of the 888) sustained a second injury during the same season. The greatest incidence of concussion was found at the high school (5.6%) and collegiate division III (5.5%) levels, suggesting that there is an association between level of play and the proportion of players injured. Players who sustained one concussion in a season were three times more likely to sustain a second concussion in the same season compared with uninjured players. Contact with artificial turf appears to be associated with a more serious concussion than contact with natural grass. Only 8.9% of all injuries involved loss of consciousness, while 86% involved a headache. Overall, 30.8% of all players sustaining a concussion returned to participation on the same day of injury.     

Influence of injuries on team playing performance in Rugby League.

All injuries have the potential to impact on individual sporting performance and as a result may influence team playing performance. However, the influence of injuries on team playing performance is unclear. The purpose of this study was to investigate the influence of injuries on team playing performance in Rugby League. All injuries sustained by one semi-professional first grade Rugby League team were prospectively studied during the 2001 competitive season. An injury was defined as any pain or disability suffered by a player during a match. Team playing performance for each match was estimated from the metres gained while in possession of the football, points scored, points conceded, the final points differential and the completion rates of attacking sets of tackles. A total of 294 injuries were recorded. The average metres gained for all matches was 1471 (95% confidence interval, CI: 1383 to 1559) m. The team averaged 42 (95% CI: 32 to 51) points in attack each match and conceded an average of 15 (95% CI: 9 to 21) points in defence. The average completion rate for the season was 65.3 (95% CI: 60.6 to 70.0)%. There was no significant association (p>0.05) between the number of injuries sustained and team-playing performance. These findings suggest that injuries have minimal impact on team-playing performance in Rugby League. Further research on a larger sample (including winning and losing teams), is required to provide a detailed analysis of the influence of injuries on team playing performance in Rugby League.     

Risk factors for injury in high school football players

BACKGROUND: Many studies have reported the frequency and types of injuries in high school football players. However, few have assessed the relationship between player characteristics and risk of injury. PURPOSE: To describe the epidemiologic characteristics of and risk factors for injury in high school football players and to determine whether players' characteristics could be used to predict subsequent injury. STUDY DESIGN: Prospective cohort study. METHODS: This study was part of a 2-year prospective investigation (1998 to 1999) of risk factors for injury in 717 (343 in the 1998 season and 374 in the 1999 season) high school football players in the Oklahoma City, Oklahoma, School District. Player characteristics (playing experience, position, injury history) and physical parameters (body mass index, weight, height, grip strength) were measured at the beginning of each season. Logistic regression analysis was used to determine whether any of the baseline variables were associated with the odds of subsequent injury. RESULTS: The physical characteristics of players, such as body mass index and strength, were not associated with risk of injury. More playing experience and a history of injury in the previous season were significantly related to increased risk. Linemen were at the highest risk of injury, particularly knee injuries and season-ending injuries. CONCLUSIONS: Future research should focus on decreasing the risk of injury to linemen.     

Presentation and mechanisms of concussion in professional Rugby League Football.

The present study prospectively recorded the circumstances, incidence, mechanisms, injury detection and presentation of concussion in Rugby League. Forty-three consecutive concussions were recorded over three competitive seasons in 175 professional Rugby League players. Data showed (i) the incidence of concussion ranged from 5.9 to 9.8 injuries/1000 player hours across grades - except when age-group players were mismatched (18.4): (ii) 'head-high tackles' accounted for a significant number of concussions; (iii) concussion rarely involved a loss of consciousness with the most common indicators of concussion being amnesia, headache and unsteadiness, with the mechanism of injury often missed: and (iv) concussion often occurs concurrently with other injuries. Concussion (including repeated episodes) is a common injury in Rugby League. Systematic mental status questioning is warranted whenever concussion is suspected. Coaches, trainers and players need more education in the recognition and management of concussion. Stricter penalties for illegal 'head-high' tackling are strongly recommended.     

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 of padded headgear with concussion and injury risk in junior Australian football: A prospective cohort study

ObjectivesTo assess whether padded headgear was associated with incidence of suspected sports-related concussion, non-sports-related concussion head injury, and injuries to other body regions in junior Australian football.DesignProspective cohort injury surveillance.MethodsThere were 400 junior players (42.5% female) enrolled across two seasons. Suspected sports-related concussion was defined by detection of observable signs on the field and medical assessment or missed match(es) due to suspected sports-related concussion. Non-sports-related concussion head injury and injuries to other body regions were defined as those that received medical assessment or resulted in a missed match.ResultsThere were 20 teams monitored over 258 matches. 204 players (2484 player hours) wore mandated headgear throughout the season and 196 (2246 player hours) did not. The incidence rate of suspected sports-related concussion was 3.17 (95% confidence interval: 3.04–3.30) per 1000 player-hours and no differences were observed between males and females (risk ratio 1.11; 95% confidence interval: 0.40–3.06). Headgear use was not associated with suspected sports-related concussion (risk ratio 1.09; 95% confidence interval: 0.41–2.97), non-sports-related concussion head injury (risk ratio 0.27; 95% confidence interval: 0.06–1.31), or injuries to other body regions (risk ratio 1.41; 95% confidence interval: 0.79–2.53).ConclusionsHeadgear use was not associated with reduced risk of suspected sports-related concussion, non-sports-related concussion head injury or injuries to other body regions. There was no difference in the rate of suspected sports-related concussion in female compared to male players, however, rates of non-sports-related concussion head injury and injuries to other body regions were higher in male players.     

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.     

Risk factors for injury in middle school football players

BACKGROUND: Little is known about the frequency of or risk factors for injuries in middle school or junior high school football players. PURPOSE: To examine the associations of player characteristics (injury history, conditioning, player position, special equipment) and physical parameters (body mass index, weight, height, grip strength) with risk of injury. STUDY DESIGN: Prospective cohort study. METHODS: We documented risk factors for injury in 646 middle school football players, 10 to 15 years of age, in the Oklahoma City, Oklahoma, school district during the 1998 and 1999 seasons. Player characteristics and physical parameters were measured at the beginning of both seasons. Logistic regression methods were used to determine whether baseline variables were associated with the odds of subsequent injury. RESULTS: More playing experience was the only variable significantly associated with the risk of injury in multivariate analyses. This association was observed regardless of the type of injury and even after indirectly controlling for time at risk of injury by restricting analyses to first-string players. Increasing age was significantly associated with the risk of fractures. CONCLUSIONS: Results suggest that physical characteristics play a minor role in risk of injury from football in this age group.     

Assessment of player performance following return to sport after hamstring muscle strain injury

OBJECTIVE: To determine if there is any decrease in playing performance of athletes following return to sport after recovery from hamstring muscle strain injury. DESIGN: Prospective cohort study. PARTICIPANTS: One professional Australian football team over two playing seasons. METHODS: For every game, the team coach rated player performance proportional to time spent on the ground playing (an integer score out of a maximum of 10). Player performance ratings were compared pre- and post-hamstring muscle strain injury to assess player performance upon return to sport. RESULTS: Thirteen athletes had hamstring injuries and the required player ratings were available. The mean player performance rating for the entire playing season in which the player was injured was 6.9. The mean player performance rating for the two games prior to injury was 6.8 as opposed to 5.4 for the two games after return to sport. Athletes had a significantly lower player performance rating immediately upon return to sport when compared to ratings for the entire season (p<0.001) and when compared to ratings from the two games prior to injury (p<0.001). CONCLUSIONS: Following return to sport from hamstring injury, player performance as assessed by the team coach is reduced. This suggests that some athletes may return to sport prior to complete resolution of the injury.     

Stress fractures in elite male football players

The objective was to investigate the incidence, type and distribution of stress fractures in professional male football players. Fifty‐four football teams, comprising 2379 players, were followed prospectively for 189 team seasons during the years 2001–2009. Team medical staff recorded individual player exposure and time‐loss injuries. The first team squads of 24 clubs selected by UEFA as belonging to the 50 best European teams, 15 teams of the Swedish Super League and 15 teams playing their home matches on artificial turf pitches were included. In total, 51 stress fractures occurred during 1 180 000 h of exposure, giving an injury incidence of 0.04 injuries/1000 h. A team of 25 players can therefore expect one stress fracture every third season. All fractures affected the lower extremities and 78% the fifth metatarsal bone. Stress fractures to the fifth metatarsal bone, tibia or pelvis caused absences of 3–5 months. Twenty‐nine percent of the stress fractures were re‐injuries. Players that sustained stress fractures were significantly younger than those that did not. Stress fractures are rare in men's professional football but cause long absences. Younger age and intensive pre‐season training appear to be risk factors.     

Influence of the limited interchange rule on injury rates in sub-elite Rugby league players

This study investigated the incidence of injury in sub-elite Rugby League players before and after the introduction of the limited interchange rule. The incidence of injury was prospectively studied in one sub-elite Rugby League club over three competitive seasons. Two seasons were played under the unlimited interchange rule, while the third season was played under the limited interchange rule. Players participated in 91 matches under the unlimited interchange rule and 44 matches under the limited interchange rule. Injury was defined as any pain, disability or injury that occurred as a result of a competition game that caused the player to miss a subsequent game. The relative risk (RR) of injury significantly decreased (RR = 0.70 [0.65 to 0.75], P<0.05) following the introduction of the limited interchange rule, with the incidence of injury decreasing from 72.5 (58.2 to 86.8) per 1000 playing hr under the unlimited interchange rule to 51.0 (33.8 to 68.1) per 1000 playing hr under the limited interchange rule. The risk of sustaining thigh and calf injuries (RR= 0.27 [0.12 to 0.59], P < 0.05), muscular strains (RR= 0.23 10.17 to 0.31]., P<0.05), and high intensity running injuries (RR= 0.16 [0.04 to 0.691, P<0.05) was significantly reduced following the introduction of the limited interchange rule. These findings demonstrate that the risk of injury in sub-elite Rugby League players is significantly reduced following the introduction of the limited interchange rule. The reduced injury risk may reflect a fatigue-induced reduction in match speed and impact forces associated with physical collisions and tackles.     

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.     

Rugby World Cup 2003 injury surveillance project

Objectives: To study match injury patterns and incidence during the Rugby World Cup 2003 (RWC 2003); to compare these patterns and rates with comparative rugby injury data; and to assess differences between teams playing at different levels (eight finalists v 12 non-finalists). Methods: Data were collected prospectively during the tournament. All injuries were recorded by the 20 participating team physicians. These were submitted to the tournament medical officer. An injury was defined as an event which forced a player either to leave the field or to miss a subsequent game or both. Results: 189 injuries were recorded over 48 matches. This corresponds to 97.9 injuries per 1000 player-hours. Pool matches yielded a higher injury rate than non-pool matches. The 12 non-finalist teams sustained significantly higher injury rates than the eight finalist teams. The player positions open side flanker, inside centre, and number 8 were the most frequently injured positions. There was a low concussion rate, which may reflect under-reporting. The non-finalist teams had a higher rate of recurrent injury. Conclusions: The injury rate was higher than comparative data. Mismatches in the areas of skill, fitness, and the availability of resources for medical care of players may explain these differences.     

The association football medical research programme: an audit of injuries in professional football

OBJECTIVES: To undertake a prospective epidemiological study of the injuries sustained in English professional football over two competitive seasons. METHODS: Player injuries were annotated by club medical staff at 91 professional football clubs. A specific injury audit questionnaire was used together with a weekly form that documented each club's current injury status. RESULTS: A total of 6,030 injuries were reported over the two seasons with an average of 1.3 injuries per player per season. The mean (SD) number of days absent for each injury was 24.2 (40.2), with 78% of the injuries leading to a minimum of one competitive match being missed. The injury incidence varied throughout the season, with training injuries peaking during July (p<0.05) and match injuries peaking during August (p<0.05). Competition injuries represented 63% of those reported, significantly (p<0.01) more of these injuries occurring towards the end of both halves. Strains (37%) and sprains (19%) were the major injury types, the lower extremity being the site of 87% of the injuries reported. Most injury mechanisms were classified as being non-contact (58%). Re-injuries accounted for 7% of all injuries, 66% of these being classified as either a strain or a sprain. The severity of re-injuries was greater than the initial injury (p<0.01). CONCLUSIONS: Professional football players are exposed to a high risk of injury and there is a need to investigate ways of reducing this risk. Areas that warrant attention include the training programmes implemented by clubs during various stages of the season, the factors contributing to the pattern of injuries during matches with respect to time, and the rehabilitation protocols employed by clubs.     

An examination of the frequency and severity of injuries and incidents at three levels of professional football

OBJECTIVE: To assess the risk of injury to professional footballers during European international and English Premier and First Division league matches. METHODS: Videotaped recordings of 29, 49, and 93 matches from the 1996 European Championship, 1996/1997 English Premier season and 1994 to 1997 English First Division seasons respectively were analysed. During each match, several relevant variables, including the number of fouls, injuries, time of incident, player identity, and injury mechanism, were recorded. RESULTS: Significantly more free kicks were awarded during international matches than during league matches; however, there were no significant differences between the numbers of free kicks awarded over the three First Division seasons assessed. Between 1.7 and 3.0% of fouls resulted in a player requiring treatment for injury, but only 15-28% of all injuries resulted from foul play. In all "non-foul" situations, in which injury resulted, at least 60% still involved player to player contact. No significant differences in injury frequency were observed between playing positions or match halves. CONCLUSIONS: The results equate to a total of 808 players per season from the estimated 2600 players in the four English professional football leagues sustaining a match injury that caused them to miss at least one game. The large number of underlying "non-injury" incidents is identified as the reason for this level of injury rather than a higher ratio of "injury" to "non-injury" incidents in professional football compared with other occupations.


     

Does the way concussion is portrayed affect public awareness of appropriate concussion management: the case of rugby league

It is important to identify factors that might adversely affect appropriate medical consultation and management of concussion. One factor that might present a barrier to timely intervention is media portrayal of concussion in sporting events, such as professional rugby league. Accordingly, the current study employed a surveillance method of publicly available broadcast information to establish the incidence rate of probable concussion in the National Rugby League's Telstra Premiership 2010 season and examined how these injury events were shown to be managed with respect to return-to-play procedures. The incident rate for probable concussion was higher than previously reported: 11.10\1000 player hours (95% CI 5.78 to 16.40) and was likely underestimated. Importantly, most injured players were shown to continue playing or return to play despite being visibly concussed and described as such by the commentary team. Although 'return-to-play decisions' for professional players are guided by medical assessment, the authors discuss whether the way concussion is portrayed might affect public awareness of appropriate concussion management.     

The incidence of head/neck/orofacial injuries in non-elite Australian Football

Injuries to the head/neck/orofacial region are common in contact and collision sports such as Australian Football. A total of 294 players who did not wear headgear from 23 teams from a large metropolitan community football league in Victoria, Australia, were monitored for head/neck/orofacial injuries over one playing season. This short report describes the incidence of head/neck/orofacial injuries in this cohort. Overall, there were 37 head/neck/orofacial injuries reported at a rate of 2.6 injuries/1000 participation hours. Over 70% of these were the result of being struck by another player through inadvertent contact during competitive play. Facial lacerations were most common (0.97/1000 player hours), followed by concussion (0.49/1000 player hours). Nine of the cases were referred to hospital for further treatment.     

Single season re-injury risk after concussion and lower extremity injury among male,collision sport,high school athletes

ObjectivesResearch suggests that a recent concussion increases subsequent lower extremity injury risk; however, data in high school athletes is limited. This study evaluates the association between concussion and subsequent injury risk among male, collision sport, high school athletes over a single season.DesignRetrospective cohort study.MethodsData were obtained from 2005/06–2014/15 in the High School Reporting Information Online database. A two stage, multi-method matching process was used to identify athletes who suffered multiple injuries over a single athletic season. Demographics and injury characteristics were compared with Chi square and Student's t-tests. Multiple Cox Proportional Hazards regression analysis was used to test whether index injury type was associated with hazard of subsequent injury following return to play from index injury.ResultsOverall 1364 HS athletes sustained 2 injuries over a single athletic season (subsequent injury within 45 days of the index injury). Index injuries included 686 (50.2%) lower extremity injuries, 417 (30.6%) upper extremity injuries, and 261 (19.1%) concussions. Hazard of subsequent concussion was increased in the index concussion group relative to the index lower extremity injury group [hazard ratio (HR): 1.60, 95% CI: 1.15–2.23, p = 0.0052]. Hazard of a subsequent lower extremity injury was not significantly different for the index lower extremity injury group relative to the index concussion group [HR: 1.27, 95% CI: 0.98–1.65, p = 0.0728].ConclusionsHistory of recent concussion or recent lower extremity injury are both risk factors for subsequent lower extremity injury in male, collision sport, high school athletes.