Original research
A prospective epidemiological study of injuries to New Zealand premier club rugby union players

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Abstract

Objectives

The purpose of this study was to document and analyse injuries sustained in premier grade rugby union over a competitive season and investigate the seasonal trend of injury incidence.

Design

A prospective epidemiological cohort study of injury.

Setting

Field-based collection of match-play injury data.

Participants

Two-hundred and seventy-one players from eight premier grade rugby union teams.

Main outcome measures

Injury incidence as a function of exposure and match round including descriptive statistical analysis of injury characteristics.

Results

Injury incidence during the season was 52 injuries per 1000 player-match hours (95% CI: 42–65). Poisson regression demonstrated a significant decrease in injury rate by 2% for each successive round throughout the season (p < 0.04). Most injuries were sustained during the tackle resulting in soft tissue injuries to the lower limb.

Conclusions

The results of this study demonstrate an early season bias of injuries. The majority of injuries were classified as ‘slight’ with players returning to training or play within two days. The tackle was the phase of play which produced the most injuries consistent with previous research. Compared to analogous data collected 10 years previously, injury incidence of a similar cohort was considerably reduced.

Introduction

Sport participation as a form of exercise is considered essential for promoting physical activity and health, and is advocated as a preventative measure for many illnesses (Finch, Owen, & Price, 2001). While encouraging participation in sport or physical activity is considered important, increased participation also increases the incidence of sports-related injury (Waller, Feehan, Marshall, & Chalmers, 1994). With injury or disability reported as a barrier to participation (Finch et al., 2001), it is vital to conduct regular epidemiological studies in order to assess causal links between risk factors and injuries, and to inform decisions on therapeutic and preventive interventions (Brooks, Fuller, Kemp, & Reddin, 2006). The first step in identifying issues of public health concern, including sports and recreational injuries, is the gathering of incidence statistics (Marshall & Guskiewicz, 2003).

Rugby union is one of the most popular and prominent football sports in the world with almost 200 countries affiliated with the International Rugby Board (Kemp, Hudson, Brooks, & Fuller, 2008). Rugby union has one of the highest levels of injuries of all team sports (Nicholl, Coleman, & Williams, 1995), and contributes the largest number of injuries of any sport in New Zealand that result in compensation claims, accident and emergency visits, and hospitalisation (ACC., 2002, Dixon, 1993, Hume and Marshall, 1994).

While recent studies have focused on professional, elite and international rugby (Bathgate et al., 2002, Best et al., 2005, Brooks et al., 2005, Doyle and George, 2004, McManus and Cross, 2004, Quarrie and Hopkins, 2008, Targett, 1998) only 0.2% of players in New Zealand are professional (Gianotti, Hume, Hopkins, Harawira, & Truman, 2008). The ease and convenience of sampling elite players since the start of professionalism in rugby might lead to a bias in injury reporting. Studying the impact of rugby injuries at a professional level may therefore not demonstrate a true representation of the social and economic impact that rugby has on society. The majority of rugby is played at the amateur level and the incidence of injury, although suggested to be lower, likely represents the highest financial and social cost to society. Amateur play is also targeted for public health initiatives, including injury prevention strategies, as all players progress through this environment.

A continuing criticism of epidemiological studies is the change in definitions. Previous epidemiological rugby injury research is difficult to compare primarily because of different definitions of injury, severity, player exposure time and other methodological considerations (Fuller et al., 2007). To resolve these issues, a consensus statement has been established by the Rugby Injury Consensus Group (RICG) which provides operational definitions and methodologies for future studies of injuries in rugby union (Fuller et al., 2007). While a consensus is important to establish standardisation of definitional issues, it does not necessarily allow comparisons to past studies, particularly seminal studies in rugby union (Bird et al., 1998, Gerrard et al., 1994, Waller et al., 1994).

The Rugby Injury and Performance Project (RIPP) was a large prospective cohort study conducted in Dunedin, New Zealand in 1992 and published in a series of papers (Bird et al., 1998, Gerrard et al., 1994, Waller et al., 1994). The project was designed to identify risk and protective factors for rugby injury (Waller et al., 1994). As a result of these studies, rugby injury prevention programs have been developed to address the high level of associated injury (Chalmers, Simpson, & Depree, 2004). In order to ascertain these programs' effectiveness it is important that independent reviews of injury incidence are conducted on a regular basis.

The purpose of this study was to document and analyse injuries sustained in premier grade rugby union over a competitive season and investigate the seasonal trend of injury incidence. A secondary aim was to conduct a 10-year follow up of components of the RIPP study describing the incidence, severity, mechanism and aetiology of rugby injuries in Dunedin, New Zealand.

Section snippets

Methods

The study was designed as a prospective cohort observational study of match injuries sustained by participants in premier (A-grade) club rugby competition in Dunedin, New Zealand. Premier club rugby is the highest level of non-representative, non-professional rugby union in New Zealand, and participants in the study were drawn from a base population of registered players who played one or more games during the 2002 season. Ten teams were involved in a round-robin competition with 99 games

Results

Data collection commenced with the first round of the Dunedin premier rugby competition. Initially ten teams were involved in the study however due to lack of compliance with data collection two teams were later excluded. Injury surveillance data were therefore completed for 96 of the 99 matches during the season. From the remaining eight teams there were a total of 271 players who played one or more games during the season.

One-hundred and six players (Age 21.8 ± 2.8 years; Height 181.5 ± 6.3 cm;

Discussion

van Mechelen described four steps in a “sequence of prevention” model as it relates to athletic injuries; 1) Establishing the extent of the sports injury problem, 2) Establishing the aetiology and mechanism, 3) Introducing preventive measures, and 4) Assessing the effectiveness of these preventive measures by repeating step 1 (van Mechelen, Hlobil, & Kemper, 1992).

The primary aim of this study was describe the incidence, severity, mechanism and aetiology of rugby injuries sustained during

Conclusion

The current study was designed to compare injuries in a similar cohort of rugby competition over a decade, which included many years of targeted rugby injury prevention programs. Rugby injuries were shown to be substantially lower compared to 10 years previously, with the current study showing an overall injury incidence of 52 injuries/1000 player-match hours. In this cohort of amateur players, mainly minor injuries associated with tackling were found, with an early season bias. The current

Conflict of Interest

None

Ethical Approval

Ethics approval was granted by the University of Otago Ethics Committee.

Acknowledgements

The authors gratefully recognise R. Marks, M. Påsche, and C. Thompson for their assistance with data collection and preliminary analysis. The authors also acknowledge David Jackson for assisting with manuscript preparation.

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