Sports Medicine

, Volume 43, Issue 10, pp 1043–1055 | Cite as

A Meta-Analysis of Injuries in Senior Men’s Professional Rugby Union

  • Sean Williams
  • Grant Trewartha
  • Simon Kemp
  • Keith Stokes
Systematic Review

Abstract

Background

Rugby Union has one of the highest reported incidences of match injuries amongst all professional team sports. The majority of research within this field has focused on elite male cohorts; in this study we present the first meta-analytic review of these data.

Objective

The aim of this study was to summarise the incidence and severity of injuries in senior men’s professional Rugby Union, and determine the overall effects of level of play, new versus recurrent injuries, playing position, type of injuries, location of injuries, severity of injuries, period of match, and injury incident.

Methods

Electronic databases were searched using keywords ‘Rugby Union’ and ‘inj*’. Fifteen papers addressing injuries in senior men’s professional Rugby Union (from 1995 through September 2012) were included in the review. A maximum of ten of these papers provided incidence data that could be modelled via a Poisson mixed-effects generalised linear model, while up to nine studies provided severity data that could be modelled via a general linear mixed model. Magnitude based inferences were used to assess differences between factors. A descriptive analysis was provided for studies that could not be included in the pooled analysis due to incongruent injury definitions.

Results

The overall incidence of injuries in senior men’s professional Rugby Union matches was 81 per 1,000 player hours (95 % CI 63–105), and 3 per 1,000 player hours (95 % CI 2–4) during training. Estimated mean severity for match injuries was 20 days (95 % CI 14–27), and 22 days (95 % CI 19–24) for training injuries. A higher level of play was associated with a greater incidence of injuries in matches, with no clear difference in severity. New injuries occurred substantially more often than recurrent injuries, while the severity of recurrent injuries was, on average, 10 days (95 % CI 4–17) greater than new injuries. Trivial differences were found in injury incidence and severity between forwards and backs. Muscle/tendon and joint (non-bone)/ligament injuries were the two most prevalent injury groups, whereas fractures and bone stress injuries had the highest average severity. The lower limb was the body region with the highest injury incidence, while upper limb injuries were most severe. The third quarter (40–60 min) of matches had the highest injury rate, and injuries most commonly occurred as a result of being tackled.

Conclusions

This meta-analysis confirms match injury incidence rates in professional Rugby Union can be considered high in comparison with other team sports, but similar to other collision sports. In order to markedly reduce overall injury burden, efforts should target lower-limb injury prevention strategies and technique during contact, as these may render the largest effect.

Notes

Acknowledgments

We thank Reidar Lystad from Macquarie University, Australia, for providing statistical advice.

Funding

Funding for this review was provided by the Rugby Football Union and University of Bath.

Conflict of interest

Simon Kemp was an author on some of the original studies reviewed, but was not involved in the assessment of study quality in the present meta-analysis.

References

  1. 1.
    Chadwick S, Semens A, Schwarz EC, et al. Economic impact report on global rugby. Part III: Strategic and emerging markets. 2010; http://www.irb.com/mm/document/newsmedia/mediazone/02/04/22/88/2042288_pdf.pdf (Accessed 31 Aug 2012).
  2. 2.
    Roberts SP, Trewartha G, Higgitt RJ, et al. The physical demands of elite English rugby union. J Sports Sci. 2008;26(8):825–33.CrossRefPubMedGoogle Scholar
  3. 3.
    Macqueen AE, Dexter WW. Injury trends and prevention in rugby union football. Curr Sports Med Rep. 2010;9(3):139–43.CrossRefPubMedGoogle Scholar
  4. 4.
    Brooks JHM, Kemp SPT. Recent trends in rugby union injuries. Clin Sports Med. 2008;27(1):51–73.CrossRefPubMedGoogle Scholar
  5. 5.
    Lorentzon R, Wedren H, Pietila T, et al. Injuries in international ice hockey—a prospective, comparative-study of injury incidence and injury types in international and Swedish elite ice hockey. Am J Sports Med. 1988;16(4):389–91.CrossRefPubMedGoogle Scholar
  6. 6.
    Phillips LH, Standen PJ, Batt ME. Effects of seasonal change in rugby league on the incidence of injury. Br J Sports Med. 1998;32(2):144–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Meyers MC, Barnhill BS. Incidence, causes, and severity of high school football injuries on FieldTurf versus natural grass—a 5-year prospective study. Am J Sports Med. 2004;32(7):1626–38.CrossRefPubMedGoogle Scholar
  8. 8.
    Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, seasons 1997–2000. Br J Sports Med. 2002;36(1):39–44.CrossRefPubMedGoogle Scholar
  9. 9.
    Fuller CW, Molloy MG, Bagate C, et al. Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. Br J Sports Med. 2007;41(5):328–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Blettner M, Sauerbrei W, Schlehofer B, et al. Traditional reviews, meta-analyses and pooled analyses in epidemiology. Int J Epidemiol. 1999;28(1):1–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Checkoway H. Data pooling in occupational studies. J Occup Environ Med. 1991;33(12):1257–60.Google Scholar
  12. 12.
    Van Mechelen W, Hlobil H, Kemper HCG. Incidence, severity, etiology and prevention of sports injuries—a review of concepts. Sports Med. 1992;14(2):82–99.CrossRefPubMedGoogle Scholar
  13. 13.
    Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology—a proposal for reporting. J Am Med Assoc. 2000;283(15):2008–12.CrossRefGoogle Scholar
  14. 14.
    Von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med. 2007;45(4):247–51.CrossRefGoogle Scholar
  15. 15.
    Olmos M, Antelo M, Vazquez H, et al. Systematic review and meta-analysis of observational studies on the prevalence of fractures in coeliac disease. Dig Liver Dis. 2008;40(1):46–53.CrossRefPubMedGoogle Scholar
  16. 16.
    International Rugby Board. Men’s Next Senior National Represntative Team. 2012; http://www.irb.com/mm/Document/LawsRegs/Regulations/02/06/29/68/nsrt.pdf (Accessed 10 Oct 2012).
  17. 17.
    Lystad RP, Pollard H, Graham PL. Epidemiology of injuries in competition taekwondo: a meta-analysis of observational studies. J Sci Med Sport. 2009;12(6):614–21.CrossRefPubMedGoogle Scholar
  18. 18.
    Hopkins WG. A spreadsheet for combining outcomes from several subject groups. Sportscience. 2006;10:51–3.Google Scholar
  19. 19.
    Hopkins WG. Linear models and effect magnitudes for research, clinical and practical applications. Sportscience. 2010;14:49–57.Google Scholar
  20. 20.
    Hopkins WG. A spreadsheet for deriving a confidence interval, mechanistic inference and clinical inference from a p value. Sportscience. 2007;11:16–20.Google Scholar
  21. 21.
    Batterham AM, Hopkins WG. Making meaningful inferences about magnitudes. Int J Sports Physiol Perform. 2006;1(1):50–7.PubMedGoogle Scholar
  22. 22.
    Brooks JHM, Fuller CW, Kemp SPT, et al. A prospective study of injuries and training amongst the England 2003 Rugby World Cup squad. Br J Sports Med. 2005;39(5):288–93.CrossRefPubMedGoogle Scholar
  23. 23.
    Brooks JHM, Fuller CW, Kemp SPT, et al. Epidemiology of injuries in English professional rugby union: part 1 match injuries. Br J Sports Med. 2005;39(10):757–66.CrossRefPubMedGoogle Scholar
  24. 24.
    Brooks JHM, Fuller CW, Kemp SPT, et al. Epidemiology of injuries in English professional rugby union: part 2 training Injuries. Br J Sports Med. 2005;39(10):767–75.CrossRefPubMedGoogle Scholar
  25. 25.
    Fuller CW, Clarke L, Molloy MG. Risk of injury associated with rugby union played on artificial turf. J Sports Sci. 2010;28(5):563–70.CrossRefPubMedGoogle Scholar
  26. 26.
    Fuller CW, Laborde F, Leather RJ, et al. International Rugby Board Rugby World Cup 2007 injury surveillance study. Br J Sports Med. 2008;42(6):452–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Fuller CW, Raftery M, Readhead C, et al. Impact of the International Rugby Board’s experimental law variations on the incidence and nature of match injuries in southern hemisphere professional rugby union. S Afr Med J. 2009;99(4):232–7.PubMedGoogle Scholar
  28. 28.
    Fuller CW, Sheerin K, Targett S. Rugby World Cup 2011: International Rugby Board injury surveillance study. Br J Sports Med. 2012 (in press).Google Scholar
  29. 29.
    Garraway WM, Lee AJ, Hutton SJ, et al. Impact of professionalism on injuries in rugby union. Br J Sports Med. 2000;34(5):348–51.CrossRefPubMedGoogle Scholar
  30. 30.
    Kemp SPT, Brooks JHM, Fuller CW, et al. England Rugby Premiership Injury and Training Audit: 2010–2011 Season Report. 2011.Google Scholar
  31. 31.
    Takemura M, Okayama A, Takazawa Y, et al. Injury profile in the highest-level rugby union competition in Japan. In: 7th World congress on science and football (WCSF), 2011. Nagoya University, Japan; 2011.Google Scholar
  32. 32.
    Bathgate A, Best JP, Craig G, et al. A prospective study of injuries to elite Australian rugby union players. Br J Sports Med. 2002;36(4):265–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Best JP, Mcintosh AS, Savage TN. Rugby World Cup 2003 injury surveillance project. Br J Sports Med. 2005;39(11):812–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Holtzhausen LJ, Schwellnus MP, Jakoet I, et al. The incidence and nature of injuries in South African rugby players in the rugby Super 12 competition. S Afr Med J. 2006;96(12):1260–5.PubMedGoogle Scholar
  35. 35.
    Jakoet I, Noakes TD. A high rate of injury during the 1995 Rugby World Cup. S Afr Med J. 1998;88(1):45–7.PubMedGoogle Scholar
  36. 36.
    Targett SGR. Injuries in professional rugby union. Clin J Sport Med. 1998;8(4):280–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Gabbett TJ. Influence of playing position on the site, nature, and cause of rugby league injuries. J Strength Cond Res. 2005;19(4):749–55.PubMedGoogle Scholar
  38. 38.
    Ekstrand J. Epidemiology of football injuries. Sci Sports. 2008;23(2):73–7.CrossRefGoogle Scholar
  39. 39.
    Feeley BT, Kennelly S, Barnes RP, et al. Epidemiology of National Football League training camp injuries from 1998 to 2007. Am J Sports Med. 2008;36(8):1597–603.CrossRefPubMedGoogle Scholar
  40. 40.
    Bird YN, Waller AE, Marshall SW, et al. The New Zealand rugby injury and performance project: V. Epidemiology of a season of rugby injury. Br J Sports Med. 1998;32(4):319–25.CrossRefPubMedGoogle Scholar
  41. 41.
    Roberts SP, Stokes KA, Trewartha G, et al. RFU Community Rugby Injury Surveillance Project: 2011–2012 Season Report; 2012.Google Scholar
  42. 42.
    Taylor AE, Fuller CW, Molloy MG. Injury surveillance during the 2010 IRB Women’s Rugby World Cup. Br J Sports Med. 2011;45(15):1243–5.CrossRefPubMedGoogle Scholar
  43. 43.
    Palmer-Green DS, Stokes KA, Fuller CW, et al. Match injuries in English youth academy and schools rugby union—an epidemiological study. Am J Sports Med. 2013;41:749–55.CrossRefPubMedGoogle Scholar
  44. 44.
    Quarrie KL, Hopkins WG, Anthony MJ, et al. Positional demands of international rugby union: Evaluation of player actions and movements. J Sci Med Sport. 2013;16:353–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Creighton DW, Shrier I, Shultz R, et al. Return-to-play in sport: a decision-based model. Clin J Sport Med. 2010;20(5):379–85.CrossRefPubMedGoogle Scholar
  46. 46.
    Fuller CW, Bahr R, Dick RW, et al. A framework for recording recurrences, reinjuries, and exacerbations in injury surveillance. Clin J Sport Med. 2007;17(3):197–200.CrossRefPubMedGoogle Scholar
  47. 47.
    Hamilton GM, Meeuwisse WH, Emery CA, et al. Subsequent injury definition, classification, and consequence. Clin J Sport Med. 2011;21(6):508–14.CrossRefPubMedGoogle Scholar
  48. 48.
    Finch, CF, Cook, J. Categorising sports injuries in epidemiological studies: the subsequent injury categorisation (SIC) model to address multiple, recurrent and exacerbation of injuries. Br J Sports Med. 2013.Google Scholar
  49. 49.
    Quarrie KL, Hopkins WG. Changes in player characteristics and match activities in Bledisloe Cup rugby union from 1972 to 2004. J Sports Sci. 2007;25(8):895–903.CrossRefPubMedGoogle Scholar
  50. 50.
    Brooks JHM, Kemp SPT. Injury-prevention priorities according to playing position in professional rugby union players. Br J Sports Med. 2011;45(10):765–75.CrossRefPubMedGoogle Scholar
  51. 51.
    Cahill N, Lamb K, Worsfold P, et al. The movement characteristics of English Premiership rugby union players. J Sports Sci. 2013;31:229–37.CrossRefPubMedGoogle Scholar
  52. 52.
    Hughes DC, Fricker PA. A prospective survey of injuries to first-grade rugby union players. Clin J Sport Med. 1994;4:249–56.CrossRefGoogle Scholar
  53. 53.
    Gabbett TJ. Influence of fatigue on tackling technique in rugby league players. J Strength Cond Res. 2008;22(2):625–32.CrossRefPubMedGoogle Scholar
  54. 54.
    Brooks JHM, Fuller CW. The influence of methodological issues on the results and conclusions from epidemiological studies of sports injuries—illustrative examples. Sports Med. 2006;36(6):459–72.CrossRefPubMedGoogle Scholar
  55. 55.
    Fuller CW, Brooks JHM, Cancea RJ, et al. Contact events in rugby union and their propensity to cause injury. Br J Sports Med. 2007;41(12):862–7.CrossRefPubMedGoogle Scholar
  56. 56.
    Fuller CW, Taylor AE, Brooks JHM, et al. Changes in the stature, body mass and age of English professional rugby players: a 10-year review. J Sports Sci. 2013;31:795–802.CrossRefPubMedGoogle Scholar
  57. 57.
    Gianotti SM, Quarrie KL, Hume PK. Evaluation of RugbySmart: a rugby union community injury prevention programme. J Sci Med Sport. 2009;12(3):371–5.CrossRefPubMedGoogle Scholar
  58. 58.
    Brooks JH, Fuller CW, Kemp SP, et al. Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med. 2006;34(8):1297–306.CrossRefPubMedGoogle Scholar
  59. 59.
    Sanderson S, Tatt LD, Higgins JPT. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol. 2007;36(3):666–76.CrossRefPubMedGoogle Scholar
  60. 60.
    Steffen K, Emery CA, Romiti M, et al. High adherence to a neuromuscular injury prevention programme (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomised trial. Br J Sports Med. 2013.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Sean Williams
    • 1
  • Grant Trewartha
    • 1
  • Simon Kemp
    • 2
  • Keith Stokes
    • 1
  1. 1.Applied Biomechanics Suite 1.308, Sport and Exercise Science Research Group, Department for HealthUniversity of BathBathUK
  2. 2.Rugby Football UnionTwickenhamUK

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