Rugby injuries: Research and Advice

Rugby injuries

Hookers beware

Rugby (union and league) is one of the most popular professional team sports in the world, and whether you are watching the Six Nations or a Super League play-off, it will come as no surprise that it also has one of the highest rates of injury. In 2005 three different studies were published looking at the incidence of match injuries sustained by professional rugby players in domestic and international competition.

In the first study researchers from the Rugby Football Union and University of Leicester, UK, examined players from 12 clubs competing in the English Premiership over 98 weeks during the 2002/03 and 2003/04 seasons (‘Epidemiology of Injuries in English professional rugby union: part 1 – match injuries’, British Journal of Sports Medicine 2005; 39:757- 766). This research is of particular interest because prior to this only a handful of studies had investigated injury rates in the professional game, and their findings were restricted because of the small size of the study samples (49 to 145 players). By comparison this study is huge, with 546 players taking part.

Team clinicians reported all match injuries on a weekly basis and provided details of the location, diagnosis, severity and mechanism of each injury. The study counted all injuries that forced players to refrain from normal training or match play for more than one day after sustaining their injury.

The researchers discovered that the overall incidence of injuries was 91 per 1,000 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 lost) than new injuries (16 days).

Forwards and backs most commonly sustained thigh haematomas, but the longest absences from play resulted from anterior cruciate ligament damage for forwards and hamstring injuries for backs. Contact accounted for 72% of injuries, but foul play was implicated in 6% of injuries (unlike soccer where foul tackles have been shown to be responsible for 44% of all injuries).

Not surprisingly the ruck and maul elements of the game caused the most injuries to forwards; being tackled caused most injuries to the backs. Prizes for the most dangerous positions on the field are reserved for hookers and the outside centre, who were shown to be at the greatest risk of injury.

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Losers Beware

The above research provides useful information about the incidence of injury in top class domestic rugby. But what happens during major international events? Do we see similar patterns and are the underlying contributory factors the same? Just over two years ago a team from the Australian Rugby Union and the School of Safety Science at the University of New South Wales, Australia, examined injury patterns during the 2003 Rugby World Cup (‘Rugby World Cup 2003 injury surveillance project’, British Journal of Sports Medicine 2005; 39:812-817).

As with the English study the team physicians recorded all injuries and this information was then submitted to the tournament medical officer. This study defined an injury as ‘any injury or medical condition related to a game event that caused a player to leave the field during a game and/or to miss a subsequent game’.

During the tournament 189 injuries were recorded over 48 matches. The overall incidence was 97.9 injuries per 1,000 player-hours. As seen in the English domestic competition, player position had an impact on the incidence of injury, although this time the open side flanker, inside centre and number 8 were the most frequently injured players.

Of particular interest is the fact that the tournament pool (elimination stage) matches yielded a higher injury rate than non-pool matches and the 12 non-finalist teams sustained significantly higher injury rates than the eight finalist teams. The non-finalist teams also recorded a higher rate of recurrent injuries. One possible explanation is that the pro rugby playing field is not level: smaller teams are likely to have a smaller pool of talented players, lack of adequate physical preparation,less appropriate injury prevention and management strategies, and a combination of these factors may well result in their players being at greater risk of injury.

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Beware of tackles

We can’t have a round-up of research into rugby related injuries without looking at the incidence of injuries in rugby league. Rugby league has similar rules and movement patterns to rugby union; however, it does not have line outs, has 13 players per team instead of 15, and involves the immediate play of the ball after every tackle. Just like rugby union, the league games are intense, with a high number of physical collisions throughout a match, making musculoskeletal injuries commonplace.

At the end of 2005 Tim Gabbett from the Athlete and Coach Support Services at the Queensland Academy of Sport, Australia, investigated whether playing position influenced the site, nature and cause of injuries to rugby league players (‘Influence of playing position on the nature and cause of rugby league injuries’, Journal of Strength and Conditioning Research 2005; 19(4):749- 755). The two studies above have highlighted how playing position can predispose players to injury in rugby union.

Is the same true for league players?

During two consecutive seasons (2000 and 2001) the researchers studied 156 semi-professional rugby league players: 77 in the first season, 79 in the second (39 players competed in both seasons). A single recorder collected injury data from 137 matches. In this study an injury was defined as ‘any pain or disability suffered by a player during a match that resulted in the player missing a subsequent match’.

Gabbett found the overall incidence to be 68 injuries per 1,000 player-hours, but that the rate was significantly higher among forwards than backs. Although the overall incidence of injuries was lower than that seen in the two rugby union studies above, there are clear similarities in the mechanism of injury. All three studies found that the tackle (either tackling or being tackled) was the highest-risk injury mechanism.

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The bottom line

All three studies clearly show that rugby is an extremely demanding sport that carries a relatively high injury risk. If you play rugby, irrespective of your chosen code, chances are you are going to pick up an injury during the course of a season. Working with a rugby player presents a significant challenge for medical and support personnel.