Sports Medicine

, Volume 47, Issue 2, pp 197–205 | Cite as

Semi-Professional Rugby League Players have Higher Concussion Risk than Professional or Amateur Participants: A Pooled Analysis

  • Doug KingEmail author
  • Patria Hume
  • Conor Gissane
  • Trevor Clark
Review Article


A combined estimate of injuries within a specific sport through pooled analysis provides more precise evidence and meaningful information about the sport, whilst controlling for between-study variation due to individual sub-cohort characteristics. The objective of this analysis was to review all published rugby league studies reporting injuries from match and training participation and report the pooled data estimates for rugby league concussion injury epidemiology. A systematic literature analysis of concussion in rugby league was performed on published studies from January 1990 to October 2015. Data were extracted and pooled from 25 studies that reported the number and incidence of concussions in rugby league match and training activities. Amateur rugby league players had the highest incidence of concussive injuries in match activities (19.1 per 1000 match hours) while semi-professional players had the highest incidence of concussive injuries in training activities (3.1 per 1000 training hours). This pooled analysis showed that, during match participation activities, amateur rugby league participants had a higher reported concussion injury rate than professional and semi-professional participants. Semi-professional participants had nearly a threefold greater concussion injury risk than amateur rugby league participants during match participation. They also had nearly a 600-fold greater concussion injury risk than professional rugby league participants during training participation.


Pool Analysis Training Activity Injury Incidence Participation Level Rugby League 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this article.

Conflicts of interest

Doug King, Patria Hume, Conor Gissane and Trevor Clark declare that they have no conflicts of interest relevant to the content of this review.

Supplementary material

40279_2016_576_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 22 kb)


  1. 1.
    Seward H, Orchard J, Hazard H, et al. Football injuries in Australia at the elite level. Med J Aust. 1993;159(5):298–301.PubMedGoogle Scholar
  2. 2.
    Gabbett T. Incidence of injury in junior and senior rugby league players. Sports Med. 2004;34(12):849–59.CrossRefPubMedGoogle Scholar
  3. 3.
    King D, Hume P, Milburn P, et al. Match and training injuries in rugby league: a review of published studies. Sports Med. 2010;40(2):163–78.CrossRefPubMedGoogle Scholar
  4. 4.
    Raftery M, Parker R, Stacey E, et al. Incidence of injury in junior rugby league in the Penrith and district junior rugby league area: a report submitted to the NSW sporting injuries committee and Australian rugby league. Westmead: Children’s Hospital Institute of Sports Medicine, Research and Development office, The New Children’s Hospital; 1999.Google Scholar
  5. 5.
    Gabbett T. Incidence of injury in semi professional rugby league players. Br J Sports Med. 2003;37(1):36–44.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Hodgson Phillips L, Standen P, Batt M. Effects of seasonal change in rugby league on the incidence of injury. Br J Sports Med. 1998;32(2):144–8.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Gabbett T. Influence of training and match intensity on injuries in rugby league. J Sports Sci. 2004;22(5):409–17.CrossRefPubMedGoogle Scholar
  8. 8.
    King D, Gabbett T, Gissane C, et al. Epidemiological studies of injuries in rugby league: suggestions for definitions, data collection and reporting methods. J Sci Med Sport. 2009;12(1):12–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Gissane C, Jennings D, Kerr K, et al. A pooled data analysis of injury incidence in rugby league football. Sports Med. 2002;32(3):211–6.CrossRefPubMedGoogle Scholar
  10. 10.
    King D, Gissane C, Clark T, et al. The incidence of match and training injuries in rugby league: a pooled analysis of published studies. Int J Sport Sci Coach. 2014;9(2):417–31.CrossRefGoogle Scholar
  11. 11.
    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
  12. 12.
    Checkoway H. Data pooling in occupational studies. J Occup Med. 1991;33(12):1257–60.PubMedGoogle Scholar
  13. 13.
    Gissane C, Hodgson L, Jennings D. Time-loss injuries versus non–time-loss injuries in the first team rugby league football: a pooled data analysis. Clin J Sport Med. 2012;22(5):414–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Gardner A, Iverson G, Levi C, et al. A systematic review of concussion in rugby league. Br J Sports Med. 2015;49(8):495–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Friedenreich C. Methods for pooled analyses of epidemiologic studies. Epidemiology. 1993;4(4):295–302.CrossRefPubMedGoogle Scholar
  16. 16.
    Giacco D, McCabe R, Kallert T, et al. Friends and symptom dimensions in patients with psychosis: a pooled analysis. PLoS One. 2012;7(11):e50119.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Stroup D, Berlin J, Morton S, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. J Am Med Assoc. 2000;283(15):2008–12.CrossRefGoogle Scholar
  18. 18.
    Loosemore M, Knowles C, Whyte G. Amateur boxing and risk of chronic traumatic brain injury: systematic review of observational studies. BMJ. 2007;335(7624):809–12.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Twellaar M, Verstappen F, Huson A. Is prevention of sports injuries a realistic goal? A four-year prospective investigation of sports injuries among physical education students. Am J Sports Med. 1996;24(4):528–34.CrossRefPubMedGoogle Scholar
  20. 20.
    Lythe M, Norton R. Rugby league injuries in New Zealand. NZ J Sports Med. 1992;20:6–7.Google Scholar
  21. 21.
    Hoskins W, Pollard H, Hough K, et al. Injury in rugby league. J Sci Med Sport. 2006;9(1–2):46–56.CrossRefPubMedGoogle Scholar
  22. 22.
    Stephenson S, Gissane C, Jennings D. Injury in rugby league: a four year prospective survey. Br J Sports Med. 1996;30(4):331–4.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Gissane C, Jennings D, Kerr K, et al. Injury rates in rugby league football: impact of change in playing season. Am J Sports Med. 2003;31(6):954–8.PubMedGoogle Scholar
  24. 24.
    Gissane C, Jennings D, White J, et al. Injury in summer rugby league football: the experiences of one club. Br J Sports Med. 1998;32(2):149–52.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Gibbs N. Injuries in professional rugby league. A three-year prospective study of the South Sydney professional rugby league football club. Am J Sports Med. 1993;21(5):696–700.CrossRefPubMedGoogle Scholar
  26. 26.
    King D, Hume P, Clark T. Nature of tackles that result in injury in professional rugby league. Res Sports Med. 2012;20(2):87–105.Google Scholar
  27. 27.
    Gardner AJ, Iverson GL, Quinn TN, et al. A preliminary video analysis of concussion in the National Rugby League. Brain Inj. 2015;29(10):1182–5.CrossRefGoogle Scholar
  28. 28.
    Gabbett T, Domrow N. Risk factors for injury in subelite rugby league players. Am J Sports Med. 2005;33(3):428–34.CrossRefPubMedGoogle Scholar
  29. 29.
    Gabbett T. 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
  30. 30.
    King D, Gabbett T. Injuries in the New Zealand semi-professional rugby league competition. NZ J Sports Med. 2009;36(1):6–15.Google Scholar
  31. 31.
    King D, Gabbett T. Injuries in a national women’s rugby league tournament: an initial investigation. NZ J Sports Med. 2007;34(2):18–22.Google Scholar
  32. 32.
    King D, Gabbett T. Amateur rugby league match injuries in New Zealand. NZ J Sports Med. 2009;36(1):16–21.Google Scholar
  33. 33.
    King D, Gissane C. Injuries in amateur rugby league matches in New Zealand: a comparison between a division one and a division two premier grade teams. Clin J Sports Med. 2009;19(4):277–81.CrossRefGoogle Scholar
  34. 34.
    King D, Clark T, Gissane C. Use of a rapid visual screening tool for the assessment of concussion in amateur rugby league: a pilot study. J Neurol Sci. 2012;320(1–2):16–21.CrossRefPubMedGoogle Scholar
  35. 35.
    King D, Clark T. Injuries in amateur representative rugby league over three years. NZ J Sports Med. 2012;39(2):48–51.Google Scholar
  36. 36.
    King D, Gissane C, Hume P, et al. The King-Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand. J Neurol Sci. 2015;351(1–2):58–64.CrossRefPubMedGoogle Scholar
  37. 37.
    Gabbett T. Incidence of injury in junior rugby league players over four competitive seasons. J Sci Med Sport. 2008;11(3):323–8.CrossRefPubMedGoogle Scholar
  38. 38.
    King D. Incidence of injuries in the 2005 New Zealand national junior rugby league competition. NZ J Sports Med. 2006;34(1):21–7.Google Scholar
  39. 39.
    Gabbett T. Reductions in pre-season training loads reduce training injury rates in rugby league players. Br J Sports Med. 2004;38(6):743–9.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Gabbett T, Domrow N. Relationships between training load, injury, and fitness in sub-elite collision sport athletes. J Sports Sci. 2007;25(13):1507–19.CrossRefPubMedGoogle Scholar
  41. 41.
    King D, Gabbett T. Training injuries in New Zealand amateur rugby league players. J Sci Med Sport. 2008;11(6):562–5.CrossRefPubMedGoogle Scholar
  42. 42.
    Clark T, King D. Incidence of training injuries in a New Zealand amateur rugby league team over three consecutive years. Unpublished data. 2012.Google Scholar
  43. 43.
    Orr R, Cheng HL. Incidence and characteristics of injuries in elite Australian junior rugby league players. J Sci Med Sport. 2015;. doi: 10.1016/j.jsams.2015.03.007.PubMedGoogle Scholar
  44. 44.
    King D, Gabbett T, Dreyer C, et al. Incidence of injuries in the New Zealand national rugby league sevens tournament. J Sci Med Sport. 2006;9(1–2):110–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Orchard J, Hoskins W. Rugby league injuries at state of origin level. Sport Health. 2007;27(2):19–24.Google Scholar
  46. 46.
    Estell J, Shenstone B, Barnsley L. Frequency of Injuries in different age-groups in an elite rugby league club. Aust J Sci Med Sport. 1995;27(4):95–7.PubMedGoogle Scholar
  47. 47.
    Gabbett T. Incidence, site, and nature of injuries in amateur rugby league over three consecutive seasons. Br J Sports Med. 2000;34(2):98–103.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Gabbett T. Incidence of injury in amateur rugby league sevens. Br J Sports Med. 2002;36(1):23–7.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Gabbett T. Training injuries in rugby league: an evaluation of skill-based conditioning games. J Strength Cond Res. 2002;16(2):236–41.PubMedGoogle Scholar
  50. 50.
    Gabbett T. Influence of injuries on team playing performance in rugby league. J Sci Med Sport. 2004;7(3):340–6.CrossRefPubMedGoogle Scholar
  51. 51.
    Gabbett T, Godbolt R. Training injuries in professional rugby league. J Strength Cond Res. 2010;24(7):1948–53.CrossRefPubMedGoogle Scholar
  52. 52.
    Hodgson L, Standen P, Batt M. An analysis of injury rates after seasonal change in rugby league. Clin J Sports Med. 2006;16(4):305–10.CrossRefGoogle Scholar
  53. 53.
    Killen N, Gabbett T, Jenkins D. Training loads and incidence of injury during the preseason in professional rugby league players. J Strength Cond Res. 2010;24(8):2079–84.CrossRefPubMedGoogle Scholar
  54. 54.
    Gabbett TJ. The development and application of an injury prediction model for noncontact, soft-tissue injuries in elite collision sport athletes. J Strength Cond Res. 2010;24(10):2593–603.CrossRefPubMedGoogle Scholar
  55. 55.
    Kirkwood G, Parekh N, Ofori-Asenso R, et al. Concussion in youth rugby union and rugby league: a systematic review. Br J Sports Med. 2015;49(8):506–10.CrossRefPubMedGoogle Scholar
  56. 56.
    Gissane C, Jennings D, Standing P. Incidence of injury in rugby league football. Physio. 1993;79:305–10.CrossRefGoogle Scholar
  57. 57.
    Elwood M. Critical apprasial of epidemiological studies and clinical trials. 3rd ed. New York: Oxford University Press Inc.; 2007.CrossRefGoogle Scholar
  58. 58.
    Dompier T, Powell J, Barron M, et al. Time-loss and non-time-loss injuries in youth football players. J Athl Train. 2007;42(3):395–402.PubMedPubMedCentralGoogle Scholar
  59. 59.
    King D, Brughelli M, Hume P, et al. Assessment, management and knowledge of sport-related concussion: systematic review. Sports Med. 2014;44(4):449–71.CrossRefPubMedGoogle Scholar
  60. 60.
    Orchard J. Concussion: how do we reconcile risk-averse policies with risk-taking sports? In: Khan K, editor. BJSM Group Blogs; 2012.

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Doug King
    • 1
    • 4
    Email author
  • Patria Hume
    • 1
  • Conor Gissane
    • 2
  • Trevor Clark
    • 3
  1. 1.Faculty of Health and Environmental Sciences, Sports Performance Research Institute New Zealand, School of Sport and RecreationAuckland University of TechnologyAucklandNew Zealand
  2. 2.School of Sport, Health and Applied ScienceSt Mary’s UniversityTwickenhamUK
  3. 3.Faculty of Human PerformanceAustralian College of Physical EducationSydneyAustralia
  4. 4.Emergency DepartmentHutt Valley District Health BoardLower HuttNew Zealand

Personalised recommendations