England Professional Rugby Injury
Surveillance Project
2013-2014 Season Report February 2015
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
ThE ovERall RISk of maTch and TRaInIng InjuRy In ThE PREmIERShIP REmaInEd STablE duRIng ThE 2013-14 SEaSon
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
• TheEnglandProfessionalRugbyInjurySurveillanceProject(PRISP)hasreportedoninjuryrisksince2002,isthemostcomprehensiveinjurydatasetinProfessionalRugby Union and provides objective analysis of trends in injuryriskintheEnglishprofessionalgame.
• In2013-14theProjectteamsuccessfullyintegratedexistingsurveillanceprocesseswiththeRugbySquadplayerelectronicmedicalrecord,creatinggreateropportunitiesforinjuryandillnessanalysis.
Thekeyfindingsfromthe2013-14seasonwere:
• Theoverallrisk(incidenceanddaysabsence)ofmatchandtraininginjuryinthePremiershipremainedstableduringthe2013-14seasonandwasagainwithinthe“expectedrange”ofseasonbyseasonvariationseensincethestudybeganin2002.
• Theincidenceoftraininginjury,althoughfallingwithintheexpectedlimitsofvariation,wasoneofthehighestseenduringthestudyperiod.Thereshouldbecontinuedfocusoninjurypreventioneffortsinthispotentiallymorecontrollableenvironment.
• Concussionwas,forthethirdconsecutiveseason,themostcommonlyreportedPremiershipmatchinjury(10.5/1000player-hours)constituting12.5%ofallmatchinjuries.Improvingconcussionawarenessamongstplayers,coaches,refereesandmedicalstaffandthestandardisationofconcussionmanagementhasbeenthemajormedicalfocusoftheEnglishprofessionalgamesince2012andislikelytohavecontributedsignificantlytothiscontinuedriseinconcussionreporting.
• Therewasacontinueddecreaseintheincidenceofrecurrentinjuries,continuingthetrendseensince2007-8andaconsequenceofthecontinueddeliveryofeffective
rehabilitationofinjuriesbyclubmedicalandconditioningteams.Matchhamstringinjuriesreducedby50%totheirlowest level since 2002 again suggesting increasingly effectiveinjurypreventionapproachesacrosstheleague forthiscommoninjury.
• Theincidenceoftimelossinjuryinmatchesplayedonartificialturf(AllianzPark)inprofessionalrugbywascomparedwiththoseplayedonnaturalturfforthefirsttime.Theinjuryriskonartificialturfwassimilartothatonnaturalturf.However,continuedsurveillanceisrequiredbeforeinferencesregardingdifferencesintheriskofspecificinjuriescanbemade.Skinabrasionsweresubstantiallymorecommononartificialturfthannaturalgrass,althoughthemajorityofthesewereminorandonlytworesultedinanyreportedtime-loss.
• Theincidenceofmatchinjuriesassociatedwithscrumsunderthenewengagementsequence(crouch,bind,set)introducedin2013-14(3.9/1,000hrs)wassimilartothemeanincidenceforthestudyperiodandfellwithintheexpectedlimitsofvariation.
• Theincidenceofinjuryresultingfromnon-accidentalcollisions(whereatacklerillegallyimpedesorattemptstostoptheballcarrierwithouttheappropriateuseofhisarms)was5.5/1000hours.Thisconstitutesasignificantproportionofallmatchinjuriesandwasthehighestincidencereportedsince2009-10.Theconsistencywithwhichtheseillegaltacklesarepenalisedbyrefereeswarrantsfurtherinvestigation
• Timelostasaresultofillnessandretirementsasaresult ofinjuryandillnessarereportedforthefirsttime.
Executive summary
4
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
contents
5
AuthoredbytheEnglandProfessionalRugbyInjurySurveillanceProjectSteeringGroup
ChairedbyDrSimonKemp(ChiefMedicalOfficerRFU)andcomprisingDrJohnBrooks(InjuryRiskAnalystandExHarlequinsandEnglandSaxons),MatthewCross(PhDStudentandInjurySurveillanceProjectResearchAssistant,UniversityofBath),PhilMorrow(PerformanceDirector,SaracensRFC), SeanWilliams(PhDStudent,UniversityofBath),DrTimAnstiss(RPAMedicalAdvisor),DrAndySmith(ConsultantinEmergencyMedicine,MidYorkshireNHSTrustandPremiershipRugbyClinicalGovernanceAdvisor),AileenTaylor(Physiotherapist),DrGrantTrewartha(SeniorLecturer,UniversityofBath), DrJulianWiddowson(SportsPhysician,BathRFC)andDrKeithStokes(InjurySurveillanceProjectPrincipalInvestigator,UniversityofBath)
ThecontentofthereportisbasedondatacollectedandanalysedbyMatthewCross(UniversityofBath)
Theauthorswouldliketoacknowledgewithconsiderablegratitude,theworkofthedoctors,physiotherapistsandstrengthandconditioningstafffromthePremiershipclubsandEnglandteamswhohaverecordedinjuryandtraininginformationthroughouttheproject
467891011141516
181920212425262728
ExecutiveSummary
Background
Definitions
Keyfindings Matchinjuryincidenceandseverity
Traininginjuryincidenceandseverity
Time-lossillness
Injuriesleadingtoretirement MatchInjuryevent
Concussion
Artificalsurface
Traininginjuryevent
Trainingvolume Injury diagnosis
Mostcommonmatchinjuries
Highestriskmatchinjuries
Highestrisktraininginjuries
Mostcommontraininginjuries
MatchinjuriesEngland Senior side
Currentpublications
RFUinjurysurveillanceprojectmethods
Traininginjuries
SupplementarydataSupplementarydatacontents
Injury recurrence
Scruminjuriesandscrumengagementtrial
Hamstringinjuries
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
IntroductionTheRugbyFootballUnion(RFU)andPremierRugbyLtd(PRL)firstcommissionedaninjurysurveillancestudyacrossthePremiershipandEnglandteamsin2002thatremainsdrivenanddirectedtowardstheimprovementofplayerwelfareineliterugby.ThisreportpresentsPremiership-widekeyfindingsfromthe2013-14seasoncomparingthemlongitudinallywiththeresultsfrom10previousseasons.TheEnglandProfessionalRugbyInjurySurveillanceProject(PRISP)ispivotalinbothprovidingthebaselinedataneededtoassesstrendsininjuryandinguidingfurtherinvestigationintoinjuriesthatarecommon,severeorincreasinginincidence.
ThemethodsforPRISPcanbefoundtowardstheendofthisreport.Supportingtablesandfiguresareincludedinthesupplementarydatafilealongsidethisreport,thecontentsofthisfilearesummarisedattheendofthisreport.
Developments2013-14The2013-14seasonwasthefirsttimethatanelectronicdatacollectionmethodwasusedforPRISP.InjurydetailswerecapturedthroughRugbySquad(awholeleagueelectronicplayermedicalrecordsystemdevelopedbytheSportsOffice).ThePRISPprocesseswereintegratedwiththeplayermedicalrecordwithaconsequentreductioninthetimedemandonclubmedicalstaffandincreasedanalysisopportunities.Becauseoftherecognisedseasontoseasonvariabilityinthenumberofinjuriesreported,itisdifficult,withoutusingbothmethodssimultaneously,todefinitivelydeterminewhetherchangingthedatacollectionmethodusedwillleadtochangesin injuryreportingbehaviours.Nevertheless,whencomparingthe2013-14seasonwiththe2012-13season,therewasnocleardifferencebetweenthetwosystemsofdatacapturewhenconsideringthemeannumberofinjuriesreportedperclub(Table1).FeedbackregardingthenewPRISPprocessesfromclubmedicalstaffhasbeenpositiveanddatacollectionthroughRugbySquadwillcontinuein2014-15.
Table1:Meannumberofinjuriesperclubcomparingtheperiods2002-13(paperreporting)and2013-14(onlinereporting).
Illness ThenewelectronicdatacollectionmethodthroughRugbySquadallowedtheprojecttobegintosurveyillnessesforthefirsttimein2013-14.Thesedataaresummarisedbrieflyinthisreport.Itisplannedthatwewillcontinuetointegrateandbuildupontheinitialworkinthisimportantareaofplayerwelfare.
Recovery following concussion Inlinewithadesiretounderstandmoreaboutrecoveryafterconcussion,the2013-14seasonsawthecontinuationofaspecificconcussionauditacrossall12Premiershipclubs.Thiswasintroducedtoimproveourunderstandingofthetimecourseofresolutionofconcussioninprofessionalrugbyunionandincludesanauditofreturntoplaypractices.Whilethedetailedstudyresultswillbereleasedseparatelytothisreport,asummaryofconcussionincidenceandriskfor2013-14isincludedinthisreport.
Trainingandmatchload Inapilotstudyalignedwiththeinjurysurveillanceproject,individualtrainingandmatchintensityandloadwascapturedfromplayersatfourPremiershipclubsduringthe2013-14season.Theaimofthisstudyistoinvestigatetherelationshipbetweentrainingintensityandloadandinjuryrisk,anareathathasnotyetbeenexploredbyPRISP.Thefindingsfromthisstudywillbepublishedinnextseason’sreport.
ScrumEngagement 2013-14sawthetriallawamendmentofthe“crouch,bind,set”scrumengagementsequence.Itislikelythatfurtherglobalanalysiswillbeprovidedinthenearfuture,howeverthisreporthighlightstheincidenceoftime-lossinjuriesattributedtothescrumintheEnglishPremiershipsince2002andincludingthe2013-14season.
Looking Forward to 2014-15 ArtificialTurfFrom2014-15,twoEnglishPremiershipteamswillplaytheirhomefixturesonanartificialplayingsurface,anditisexpectedthattheuseofsuchsurfacesbyteamsacrossalllevelsofthegamewillincreaseinthefuture.Ourunderstandingoftheinfluencethatthenewgenerationartificialturfhasuponinjuryriskandperceptionsofmusclesorenessisstilldeveloping.Toaddressthis,astudywascommissionedbytheRFU,PRLandtheRugbyPlayersAssociation.Thisreportgivesashortsummaryoftheresultsfrom2013-14butthestudywillcontinuein2014-15.
background
6
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
7
Non-timelossinjury TheuseofRugbySquadmakesitpossibleforPRISPtoanalysenon-timelossinjuries(injuriesforwhichtheplayerreceivestreatmentbutthatdonotcausemorethan24hoursofabsencefromtrainingormatchplay).Theseinjurieshaveasignificantimpactonplayerwelfareandarelikelytoberiskfactorsforsubsequentinjury.Nextseason’sreportwillinclude,forthefirst-timeanoverviewofnon-timelossinjuriesfromthe2014-15season.
Definitions Injury Aninjurywasdefinedas‘anyinjurythatpreventsaplayerfromtakingafullpartinalltrainingactivitiestypicallyplannedforthatdayand/ormatchplayformorethan24hoursfrommidnightattheendofthedaytheinjurywassustained’. Forexample,ifaplayerwasinjuredduringamatchonSaturdayandhewasabletotakeafullpartintrainingonMonday,theincidentwouldnotbeclassedasaninjury.Iftheplayer’strainingwasrestrictedonMondayduetotheinjuryreceivedonSaturday,theincidentwouldbeclassedasaninjuryandreported.
Injury severity Injuryseveritywasmeasuredastime(days)lostfromcompetitionandpracticeanddefinedasthenumberofdaysfromthedateoftheinjurytothedatethattheplayerwasdeemedtohaveregainedfullfitnessnotincludingthedayofinjuryorthedayofreturn.Aplayerwasdeemedtohaveregainedfullfitnesswhenhewas‘abletotakeapartintrainingactivities(typicallyplannedforthatday)andwasavailableformatchselection.’
Recurrent injury Aninjuryofthesametypeandatthesamesiteasanindexinjuryandwhichoccursafteraplayer’sreturntofullparticipationfromtheindexinjury.
Injury incidence and days absence ThelikelihoodofsustaininganinjuryduringmatchplayortrainingisreportedastheInjuryincidence.TheInjuryincidenceisthenumberofinjuriesexpressedper1,000player-hoursofmatchexposure(ortrainingexposure).Equallyimportanttotheplayerand/orhisteamishowlongplayersareabsent.Thisisknownasinjuryseverityandismeasuredindaysabsence.
Illness Anyillness(classifiedusingtheOrchardsportsinjuryclassificationsystem–OSICS10.1)forwhichtheplayersoughtconsultationathisclubthatpreventedtheplayerfromparticipatingintrainingormatchplayforaperiodgreaterthan24hrsaftertheonsetofsymptoms.
Statisticalsignificance Aresultisconsideredtobestatisticallysignificantiftheprobabilitythatithasarisenbychanceislessthan5%or1in20.Inthisreportstatisticalanalysishasbeenperformedforthematchandtraininginjuryincidenceanddaysabsence.SPCchartinghasbeenusedtoshowtheexpectedlimitsofthesystemwithupperandlowerlimitssetat+/-2standarddeviationsfromthemean.
NB:Theverticallineoneachfiguredenotesthechangeindatacollectionmethods(movetoelectroniccapture)priortothe2013-14season.
TImE loST aS a RESulT of IllnESS and RETIREmEnTS aS a RESulT of InjuRy and IllnESS aRE REPoRTEd foR ThE fIRST TImE2002-13 2013-14
Mean injuries per club (match) 57 62
Mean injuries per club (training) 27 35
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
Match injury incidence and severity SummaryofmatchinjuryriskMatchinjuryriskremainswithintheexpectedlimitsofnaturalseason-to-seasonvariationbasedonthedatasince2002(ForabreakdownofincidenceandseveritybyseasonseetableS1).
Likelihoodorincidenceofinjury739matchinjuriesthatledtotimelostfromtrainingand/ormatchplaywerereportedinthe2013-14seasoncomparedwithameanof676injuriesduringtheperiod2002-13. Thematchinjuryincidencein2013-14was91/1000hours.Thisissimilartothemeanincidenceof87/1000hourssince2002.408teammatcheswereincludedintheanalysisduring2013-14equatingtoanaverageof62matchinjuriesperclubfortheseasonand1.8injuriesperclubpermatch.Thisisaround13injuriesperclubmorefortheseasonthanin2012-13.
Severityofinjuriesanddaysabsencefromplayingandtrainingasaresultofmatchinjuries Theaverageseverityof26daysforaninjurybeforereturntoavailabilityformatchselectionalsofallswithinexpectednaturalvariationbasedondatasince2002.
Asaconsequenceoftheincreaseinnumberandseverityofinjuries,thetotalnumberofdaysabsenceasaresultofmatchinjuriesfor2013-14washigherthanin2012-13andthemeanacrossthestudyperiod.Theaveragedaysabsenceperclubpermatchduetoinjuriesin2013-14was45.
key findings
8
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
9
Training injury and incidence and severity SummaryoftheTraininginjuryrisk414traininginjuries(rugbyskillsandstrengthandconditioningcombined)thatledtotimelostfromtrainingand/ormatchplaywerereportedinthe2013-14season. Thisequatedtoanincidencerateof2.9/1000playerhoursoraround 35 injuries per club per season (a season by season breakdowncanbeseenintableS3).
Theincidenceofinjuryfromtrainingfellwithintheexpectedlimitsofnaturalseason-to-seasonvariationbasedonthedatasince2002,althoughitisoneofthehighestseenduringthestudyperiod.Theseverityoftraininginjuries(25days)alsoreturnedwithinexpectednaturalvariationafterfallingoutsideoftheselimitsforthefirsttimein2012-13.Itshouldbenotedthattheseverityoftheseinjuriesremainshighwhencomparedtoearlierseasons.Ingeneralitisthemoresevereinjuriesthatcontributetothehighseverityin2013-14,withtheincidenceofinjuriesinthe22-28and29-84dayseveritycategoriesthehighestseensincethestudybegan(tableS4).
Daysabsence/1000hrsremainedwithintheexpectednaturalseason-to-seasonvariation,butwashigherthaninanyotheryearapartfrom2012-13duetotheincidenceandseverityoftraininginjuriesbeingrelativelyhighin2013-14.
2002-03
2003-04
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
0
20
40
60
80
100
120
Inci
denc
e/10
00hr
s
Incidence Mean Lower limit-2SD Upper limit-2SD
Mean: 872013-14: 91
2013-14
2002-03
2003-04
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
0
5
10
15
20
25
30
Seve
rity
(day
s ab
senc
e)
Severity Mean Lower limit-2SD Upper limit-2SD
Mean: 22
2013-14: 26
2013-14
2002-03
2003-04
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
0
500
1000
1500
2000
2500
3000
Day
s ab
scen
ce/1
000h
rs
Days abscence Mean Lower limit-2SD Upper limit-2SD
Mean: 1872
2013-14: 2247
2013-14
2002-03
2003-04
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
0
0.5
1
1.5
2
2.5
3
Inci
denc
e/10
00hr
s
Incidence Mean Lower limit-2SD Upper limit-2SD
Mean: 2.5
2013-14: 2.9
3.5
2013-14
2002-03
2003-04
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
0
5
10
15
20
25
30
Seve
rity
(day
s)
Severity Mean Lower limit-2SD Upper limit-2SD
Mean: 21
2013-14: 25
35
2013-14
2002-03
2003-04
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
0
10
20
30
40
50
60
Day
s ab
scen
ce/1
000h
rs
Days abscence Mean Lower limit-2SD Upper limit-2SD
Mean: 53
2013-14: 7470
80
90
2013-14
Figure1a:Incidenceratesofmatchinjuriesoverthestudyperiodwithmean±2xstandarddeviationshown.Verticallinedenoteschangeindatacollectionmethodstoelectroniccapture..Note - For anormaldistribution,95%ofalldatashouldfallbetween(Mean-2xstandarddeviation)and(Mean+2xstandarddeviation).
Figure1b:Severityofmatchinjuriesoverthestudyperiodwithmean±2xstandarddeviationshown.Verticallinedenoteschangeindatacollectionmethodstoelectroniccapture.
Figure1c:Daysabsence/1000hrsfrommatchinjuriesoverthestudyperiodwithmean±2xstandarddeviationshown.Verticallinedenoteschangeindatacollectionmethodstoelectroniccapture.
Figure2a:Incidenceratesoftraininginjuriesoverthestudyperiodwithmean±2xstandarddeviationshown.Verticallinedenoteschangeindatacollectionmethodstoelectroniccapture.
Figure2b:Severityoftraininginjuriesoverthestudyperiodwithmean±2xstandarddeviationshown.Verticallinedenoteschangeindatacollectionmethodstoelectroniccapture
Figure2c:Daysabsence/1000hrsfortraininginjuriesoverthestudyperiodwithmean±2xstandarddeviationshown.Verticallinedenoteschangeindatacollectionmethodstoelectronic capture
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
Time-loss illness Incidenceandseverityoftime-lossillnessAtotalof112time-lossillnesseswerereportedthroughRugbySquadin90playersduring2013-14.Thismeantthatofthe585playersthatconsentedtothestudy,15%reportedanillnesstotheirclubdoctorduringtheseason.Theincidenceofreportedillnessfor2013-14was191/1000athletes.ThisislikelytobeanunderestimateofthetotalnumberofillnessesasillnessesinplayerspresentingtogeneralpractitionerswhodonotuseRugbySquadwillnothavebeencaptured.
Themeanseverityoftime-lossillnessin2013-14was8(95%CI:6-10)daysabsence.Seventypercentofillnessesledto7daysorlessabsencefromtrainingandmatchplay.
Mostcommontime-lossillnessesThetop5illnessesbyoccurrencewere;Upperrespiratorytractinfection(excludingtonsillitis)(20cases),diarrhoea(19cases),gastroenteritis(15cases),tonsillitis(7cases)andotherear,noseandthroatillness(excludingtonsillitis)(5cases).Respiratoryillnesscombinedaccountedfor29cases,26%ofallillnesses,thisproportionissimilartothatfoundinpreviousstudiesinotherteamsports.
Boththeproportionofplayersthatreportedanillnessandtheincidenceofillnesswashigherthanthatseenatthe2012LondonOlympicsbutlessthanthatobservedinSuper14RugbyUniontournamentin2010(incidencecouldnotbedirectlycomparedbecauseofthedifferenceinillnessincidencedefinition).Thenatureoftheillnessesreportedwassimilartothesepreviousstudies.Additionalseasonsofdatacollectionarerequiredinordertopresentthesedatainfurtherdetailandtoallowthemonitoringandcomparisonofillnessincidenceandseverityacrossseasons.
Injury recurrenceSummaryofrecurrentinjuryrisk Recurrentinjuryriskformatchandtrainingin2013-14remainswithintheexpectedlimitsofnaturalseason-to-seasonvariationbasedonthedatasince2002(althoughseason2002-03fallsoutsideofwhatisexpected).Thedecreaseinreportedrecurrentinjuriessince2007-08thatwasmentionedinlastseason’sreportcontinues.The2013-14incidencerateforrecurrentmatchinjuries(4.3/1000playerhours)wasbelowthemeanincidenceof9.2/1000playerhoursfortheperiod2002-13.
Themostcommonlyreportedrecurrentmatchinjuriesforseason2014-15werehamstringmuscleinjury(3injuries)and
anklesyndesmosisinjury(3injuries).Theseinjurytypesaresimilartothosereportedinseason2012-13.MoredetailofthemostcommonrecurrentmatchinjuriescanbeseenintableS6.
NB:Concussionwasnotincludedintheanalysisofrecurrentinjuryassubsequentconcussionsareconsideredtoberepeatinjuriesratherthanarecurrenceofanindexinjury.
Workdefiningpracticaltoolstohelpmedicalteamsandcoachesevaluatewhenaplayerisappropriatelyrehabilitatedfromcommonandhighriskinjuriesshouldcontinue.
10
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
11
Injuries leading to retirement TheinjurysurveillancesteeringgroupwouldliketothanktheRugbyPlayersAssociation(RPA)foritsassistancewiththedataonplayerswhoretiredasaresultofinjuryorillness.
Previouslythisreporthasonlypresentedthenumberofplayerswhoretiredwithanunresolved(i.e.open)time-lossinjurysustainedintheseasonbeingstudied,ratherthanthetotalnumberofplayersretiringduringtheseasonasaresultofinjuryorillness.
Duringthe2013-14season,23playersretiredthroughinjuryand2asaresultofillness.Theinjuriesthatledtoretirementwerethefollowingbodylocations:
Head&neck-7Upperlimb-3Thoracicandlumbarspine-2Lowerlimb-11Theaverageageoftheplayerswas31
Match injury eventTheprofileofinjurycausationleadingtomatchtime-lossinjuryremainsverysimilarwhencomparedtotheperiod2002-13.Thetackleremainsthemostcommonmatcheventassociatedwithinjury.Themostcommoninjuriesasaresultofthetacklein2013-14were(inorder):
Ball CarrierConcussionMCLInjuryQuadricepshaematomaInferiorTibiofibularsyndesmosisInjury
TacklerConcussionQuadricepshaematomaCervicalstinger/burnerAcromioclavicularjointsprain
Whilstthesefindingsremainlargelysimilartothepastthreeseasons,forthefirsttimeconcussionhasbecomethemostcommonmatchinjuryforboththeballcarrierandthetackler.Injuriescausedbyplayercollisions(accidentalandnon-accidentalcombined)weresignificantlyhigherin2013-14thanfortheperiod2002-13.Theincidenceinjuryresultingfromnon-accidentalcollisions(whereatacklerimpedes/stopsballcarrier
withouttheuseofhisarms)was5.5/1000hourswhichconstitutesasignificantproportionofallmatchinjuriesandthehighestincidencereportedsince2009-10whencollisionswerefirstdividedintoaccidentalandnon-accidentalcollisions(Figure6).
Therearerecognisedlimitationstothenon-videobasedanalysis of injury events used in PRISP but non-accidental collisionsareillegalunderthelawsofthegameandconsistentpenalisationbytherefereeislikelytobeaneffectivecontrolmeasure.Furtherevaluationofthisareaiswarranted.
Injuriesassociatedwithrunningweresignificantlylowerin2013-14than2002-13(Figure5).
Whilstitisnotpossibletodrawanystrongconclusionsyetonwhythesechangesmayhaveoccurred,itisimportanttomonitortheseeventsinseason2014-15.
Mean: 9.2
2013-14: 4.3
2002-03
2003-04
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
0
2
4
6
8
10
12
Inci
denc
e/10
00hr
s
Incidence Mean Lower limit-2SD Upper limit-2SD
14
16
18
20
2013-14
RecurrentMatchInjuriesFigure3a:Incidenceratesofrecurrentmatchinjuriesoverthestudyperiodwithmean±2xstandarddeviationshown.Verticallinedenoteschangeindatacollectionmethodstoelectronic capture
RecurrentTrainingInjuriesFigure3b:Incidence rates of recurrent training injuries over thestudyperiodwithmean±2xstandarddeviationshown
Tackled
Tackling
Collision
Ruck
0
5
10
15
20
Inci
denc
e/10
00hr
s
2002-13 2013-14
25
Maul
Scrum
Lineout
Other contact
Other non-contact
Running
Not know
n
2009-100
1
2
3
4
5
6
Inci
denc
e/10
00hr
s
Non-accidental collisions
7
8
2010-11 2011-12 2012-13 2013-14
Figure5:Incidenceratesofmatchinjuriesbyinjuryevent.Errorbarsshow95%CI’s
Figure6:Incidenceofnon-accidentalmatchcollisionsbyseason.Errorbarsshow95%CI’s
2002-03
2003-04
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
0
0.1
0.2
0.3
0.4
0.5
0.6
Inci
denc
e/10
00hr
s
Severity Mean Lower limit-2SD Upper limit-2SD
Mean: 0.26
2013-14: 0.1
0.7
2013-14
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
ConcussionDuring2013-14therewere86reportedmatchconcussions(62Premiership,12EuropeanCompetition&12Nationalcupcompetition)and8trainingconcussions.13%ofplayersincludedinthestudysustained1ormorematchconcussionswith10playerssustaining2separateconcussiveeventswithintheseason.Noplayersustainedmorethan2reportedconcussionsduring2013-14.
Theincidenceofreportedconcussions(10.5/1000hours)duringmatchesisconsiderablyhigherthanhasbeenreportedinpreviousseasonsandisoutsideoftheexpectednaturalvariationbasedonthedatafromallseasonscombined.Duringthe2013-14season91%ofreportedconcussionsoccurredinmatchplayand9%intraining;theseproportionsareidenticaltothoseobservedinseason2012-13.Eighty-sevenpercentofplayerswentthroughtheseasonwithoutreportingaconcussion(90%inseason2012-13).
Thegroupbelievesthatthissignificantincreaseinreportedconcussionincidenceismostlikelytoreflectincreasedawarenessandbehaviouralchangeamongstplayers,medicalstaff,coachesandrefereesasaresultofRFU,PRL,RPAandWorldRugbyeducationinitiativesandmediaexposure. Anumberofpreviouslypublishedstudieshavesuggestedthatconcussionhashistoricallybeenunder-reportedinrugbyunionanditremainstobeseenwhethertheconcussionincidencereportedfor2013-14yetrepresentsa“true”reflectionofconcussionriskorwhetherunder-reportingis
stillanissue.Itisnotpossibletoseparateimprovementinreportingpracticefromthepossibilityofaninherentincreaseintheriskofconcussioninrecentyears,butgiventherateofchangeinincidenceitseemslikelythatthebiggestchangeisinreportingratherthan“true”risk.
Themeanseverityofreportedmatchconcussionsin2013-14was11days.Itshouldbenotedthattheguidelinesforreturntoplayafterconcussionchangedforthe2011-12season.Before2011-12theminimumrecommendedstand-downtimewas21days(unlessclearedbyaneurologicalspecialist).From2011-12onwards,playersprogressedthroughagraduatedreturntoplayprotocoldependentontheirindividualisedrecoverywithaminimumreturntoplaytimeof6days.In2013-14aroundathirdofplayerswithareportedconcussiondidnotreportanysymptomsorshowanysignsofcognitiveimpairmentafterthedayofinjuryorduringthegraduatedreturntoplayperiodandwerethereforeabletoreturntoplayin6days.
14
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
15
Scrum injuries and scrum engagement trialDuringthe2013-14seasonatriallawamendmentwasintroducedforthescrumengagement(“crouch,bind,set”).Currently,onlyoneseason’sworthofinjurydataexistsforthislawamendmentandtherefore,thedatamustbeinterpretedwithcaution.
Theincidenceofmatchinjuriesassociatedwithscrumsunderthenewengagementsequencein2013-14was3.9/1000hours.Thisfigurewassimilartothemeanincidenceforthestudyperiodandfellwithintheexpectedlimitsofvariation(Figure9).Thenewscrumengagementprocesshasbeenshowninpreviouslypublishedresearchtoreducetheimpactforceatengagementbyapproximately20%,thushopefullyleadingtoareductioninchronicinjuriescausedbyscrummaging.Furtherlongitudinalresearchisrequiredtoascertainthefullimpactofthislawvariation.Theinjurysurveillanceresearchgroupwillcontinuetomonitorinjuriesinthisaspectofthegameinfutureseasons.
Artificial surfaceTime-lossinjuries(from39.5matches)andabrasions(from27matches)werecomparedbetweenmatchesplayedonartificialturfandnaturalgrass.Theincidencevaluesformatchinjuriesoneachsurfacewere;naturalgrass:73/1000hours90%CI59-90andartificialturf:66/1000hours90%CI:52-83.Thus,injuryriskonartificialturfwasnotdifferenttothatonnaturalturfhowevercontinuedsurveillanceisrequiredbeforeinferencesregardingriskofspecificinjuriescanbemade.Abrasionsweresubstantiallymorecommononartificialturf(119/1000hours90%CI96-148)thannaturalgrass(15/1000hours90%CI9-26),althoughthemajorityofthesewereminorandonlytworesultedinanyreportedtime-loss.
Musclesorenesswasreportedoverthefourdaysfollowingamatchplayedoneachsurfaceby95visitingplayers(i.e.,playerswhonormallyplayonnaturalgrasssurfaces).Musclesorenesswasconsistentlyhigheroverthefourdaysfollowingamatchonartificialturfincomparisonwithnaturalgrass,althoughthemagnitudeofthiseffectwassmall.
AfullanalysisofthisareahasbeenacceptedforpublicationintheScandinavianJournalofMedicineandScienceinSport.
2002-03
2003-04
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
0
2
4
6
8
10
12
Inci
denc
e/10
00hr
s
Incidence Mean Lower limit-2SD Upper limit-2SD
Mean: 5.2
2013-14: 10.5
2013-14
2002-03
2003-04
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
0
1
2
3
4
5
6
Inci
denc
e /1
000h
rs
Severity Mean Lower limit-2SD Upper limit-2SD
Mean: 4.3
2013-14: 3.9
7
2013-14
Figure7:Incidenceper1000playerhoursofreportedmatchconcussionsbyseasonwithmean±2standarddeviations.Verticallinedenoteschangeindatacollectionmethodstoelectronic capture
Figure9:Incidenceper1000playerhoursofmatchinjuriesassociatedwiththescrumwithmean±2standarddeviations
2002-03
2003-04
2005-06
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
0
5
10
15
20
25
Seve
rity
(day
s ab
senc
e)
Severity Mean Lower limit-2SD Upper limit-2SD
2013-14: 11
2013-14
Figure8:Severity(daysabsence)ofreportedmatchconcussionsbyseasonwithmean±2standarddeviations.Verticallinedenoteschangeindatacollectionmethodstoelectronic capture
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
Training injury eventWhencomparedtotheperiod2002-13therewasnosignificantchangeintheincidenceratesforanytrainingmodality(abreakdownofincidencebyseveritygrouping canbeseenintableS4).
In2013-14,duringconditioningnonweightstrainingsessions,mostinjurieswereasaresultofrunningrelatedactivities(56%).Duringrugbyskillcontactsessions,mostinjuries(24%)resultedfromrunningrelatedactivities,withthetacklebeingthesecondmostcommoncauseofinjury(13%).
Hamstring injuries Hamstringinjuriesremainthemostcommonandhighestrisktraininginjuryacrossthestudyperiod.Hamstringinjuryincidenceinmatcheshoweverreducedbyaround50%in2013-14fromthepreviousthreeseasons,whichmightreflectafocussedinjuryreductioneffortinclubs.Therewasnochangeintheincidenceofhamstringtraininginjuriesin2013-14whencomparedto2002-13(0.40/1000hoursforboth2013-14and2002-13).AseasonbyseasonbreakdowncanbeseenintableS10.
Training volume Trainingvolumeforrugbyskillspracticespecificallywasalsosimilartothatseenintheperiod2002-13(3.3vs.3.7hours/week)whiletrainingvolumeforstrengthandconditioningin
2013-14wasidenticalto2002-13(2.7hours/week).Asimilarproportionoftimespentincontactandnon-contacttrainingmeansthatanychangeintraininginjuryincidenceisunlikelytoberelatedtoachangeintypeoftraining.Aseason-by-seasonbreakdowncanbeseenintableS9.
Theriskofinjuryduringtrainingisafunctionofthecontent/activity,thevolumeandtheintensity.Itishopedthatthetrainingloadpilotstudythatisinprogresswillgiveadditionalinsightintotheroleoftrainingintensityandloadoninjuryrisk.
Injury diagnosis Summaryofthemostcommonandhighestrisk matchinjuriesForthethirdconsecutiveseason,concussionwasthemostcommonmatchinjury(12.5%ofallmatchinjuries)withtheincidenceofthisinjurycontinuingtoincrease.Thisriseinincidenceislikelyduetoacombinationofincreasededucationandawarenessfromnationalandinternationalgoverningbodyinitiatives.
The2013-14seasonsawtheincidenceofmatch-relatedhamstringmuscleinjuriesreduceby50%,totheirlowestlevelsince2002.Thisisareductionofaround25injuriesovertheseason.Whileitwascommentedearlierthattheprofileofhamstringinjuriesintraininghasremainedsimilar,itisimportantthatwecontinuetomonitorhamstringmuscleinjuriesinmatchestoseeiftheincidenceremainsloweracrossmultipleseasons.
Matchinjuryriskexpressedasdaysabsenceper1000playerhoursdecreasedforanumberofinjuriesin2013-14.Thisreductioninriskhasresultedinmedialcollateralligament(MCL)injuriestothekneebecomingthehighestriskmatchinjuryin2013-14eventhoughtheriskofMCLinjuryisactuallylessthanseenin2012-13whenitwasranked2nd.90%ofMCLinjuriesoccurredincontactandconsequentlyarelikelytobedifficulttoprevent.Concussion,forthefirsttimeduringthestudyperiodappearedinthetop5highestrisk(daysabsence)matchinjuries.Thisisduetothehighincidenceofconcussionwhencomparedtoallotherinjuriesratherthanseverity.
Overalltherehasbeenverylittlechangeinthehighest riskmatchinjuriesoverthestudyperiod,withtheexceptionofconcussion.
16
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
17
Rugby skills
- contact
Rugby skills
- non-contact
Conditioning
weights
Conditioning
non-weights
0
1
2
3
4
5
6
Inci
denc
e/10
00hr
s
2002-12 2013-14
7
8
9
Figure10:Incidenceratesoftraininginjuriesbysessiontype.Errorbarsshow95%CI’s
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
Most common match injuries
18
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
19
Highest risk match injuries
Figure11a.Rankingofthetop5mostcommonmatchinjurieseachseasonfor2010-14withtheassociated incidencerates(injuries/1000hours)
Concussion
Thigh haematoma
MCL
Ankle lateral ligament
Hamstring muscle
2013-14
Thigh haematoma
Hamstring muscle
AC joint
Concussion
Calf muscle
2010-11
Concussion
Hamstring muscle
Thigh haematoma
Calf muscle
MCL
2011-12
Concussion
Hamstring muscle
Syndesmosis
MCL
Thigh haematoma
2012-13
MCL
ACL
Concussion
Hamstring muscle
Ankle syndesmosis
2013-14
ACL
Ankle syndesmosis
MCL
Tib/fib fracture
AC joint
2010-11
ACL
MCL
Hamstring muscle
Shoulder dislocation
PCL/LCL
2011-12
Ankle syndesmosis
MCL
Hamstring muscle
ACL
Clavicle fracture2012-13
Figure11b.Rankingofthetop5highestriskmatchinjurieseachseason2010-14withtheassociated daysabsence/1000hours
10.5
4.2
3.7
2.9
2.5
5.4
4.6
4.8
3.9
3.7
5.1
5.0
4.9
4.8
4.0
6.7
4.9
3.8
3.6
3.3
130
116
105
104
96
184
131
108
97
92
186
148
119
108
92
145
141
130
108
95
Summaryofthemostcommonandhighestrisk training injuriesTheprofileofthemostcommontraininginjuriesisverysimilartothatseensince2002.Theonlychangein2013-14istheincreaseinincidence/rankofhipflexor/quadricepsmuscleinjuryandadecreasedrateofadductormuscleinjuries.Hamstringmuscleinjuries(57injuries)remained
themostcommontraininginjurythroughoutthestudy.Hamstringmuscle,calfmuscleandlumbardisc/nerverootinjuriesarethehighestrisktraininginjuriesthroughoutthestudyperiod.Shoulderdislocationsintrainingenteredthehighestriskinjuriesforthefirsttimein2013-14.
20 21
Most common training injuries Highest risk training injuries
Figure12a.Rankingofthetop5mostcommontraininginjurieseachseason2010-14withassociatedincidencerates
Hamstring muscle
Calf muscle
Hip flexor/quad muscle
Ankle lateral ligament
Abductor muscle
2013-14
Hamstring muscle
Calf muscle
Hip flexor/quad muscle
Abductor muscle
Ankle lateral ligament
2010-11
Hamstring muscle
Calf muscle
Hip flexor/quad muscle
Abductor muscle
Ankle lateral ligament
2011-12
Hamstring muscle
Calf muscle
Abductor muscle
Ankle lateral ligament
Hip flexor/quad muscle
2012-13
Hamstring muscle
Calf muscle
Lumber disc/nerve root
Ankle lateral ligament
Shoulder dislocation
2013-14
Hamstring muscle
ACL
Calf muscle
Ankle lateral ligament
Knee cartilage
2010-11
Hamstring muscle
Lumber disc/nerve root
Calf muscle
Ankle lateral ligament
Tib/fib fracture2011-12
Hamstring muscle
ACL
Lumber disc/nerve root
Calf muscle
Lumber soft tissue
2012-13
Figure12b.Rankingofthetop5highestrisktraininginjurieseachseason2010-14withassociateddaysabsence/1000hours
0.40
0.22
0.18
0.13
0.09
0.45
0.30
0.15
0.14
0.11
0.42
0.24
0.11
0.10
0.09
0.39
0.29
0.18
0.10
0.09
8.2
4.5
3.9
2.4
1.9
6.9
6.8
3.8
3.7
3.1
7.3
6.5
3.4
2.1
2.1
9.5
6.3
5.3
4.9
4.5
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
20
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
21
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
EnglandmatchandtraininginjuryriskNostatisticallysignificantchangeininjuryrisk(matchortraining)wasseenfor2013-14whencomparedwithpreviousseasonsforplayersonEnglandSeniorsquadduty.
Theaverageseverityofmatchinjuriesdecreasedforthesecondseason.Traininginjuryseverityalsodecreasedforthoseinjuriesattributedtorugbyskillssessionsbutseverityincreasedforinjuriessustainedinstrengthandconditioningbasedsessions.Thesechangeswerenotstatisticallysignificant.
Note:therelativelysmallnumberofseniorEnglandtrainingsessionsinthestudymakesthedifferencesseeninthisgroupmuchmorelikelytohavearisen“bychance”ratherthantobetheresultofa“true”difference,reflectedinthewide95%confidenceintervalsandthelackofstatisticalsignificanceintheresults
England Senior side
24
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
25
Rugby skills Strength and conditioning
Injuries / 1000 hrs (95% CI)
Average severity, days
Days absence / 1000 hrs (95% CI)
Injuries / 1000 hrs (95% CI)
Average severity, days
Days absence / 1000 hrs (95% CI)
2002-03 4.5(2.6-8.0) 15 69(60-80) 4.0(1.0-15.9) 4 16(8-32)
2003-04 7.6(5.3-11.0) 12 89(80-99) 6.3(3.8-10.3) 13 79(68-90)
2005-06 0.6(0.1-4.0) 4 2(1-6) - - -
2006-07 9.8(5.9-16.3) 15 149(131-169) - - -
2007-08 7.3(4.5-10.1) 9 74(46-103) 2.5(0.5-4.6) 12 34(7-61)
2008-09 6.5(3.0-10.0) 20 135(62-209) 12.1(4.2-20.0) 18 233(81-385)
2009-10 5.3(3.4-8.3) 8 46(30-73) 4.0(2.0-8.6) 6 26(12-55)
2010-11 1.7(0.8-3.5) 7 12(5.7-26) 4.4(1.8-10.5) 5 22(9.1-52.5)
2011-12 3.2(1.4-5.1) 22 70(31-110) 2.8(0.4-5.3) 18 51(6-95)
2012-13 3.7(1.6-9.0) 20 58(24-139) 1.1(0.2-7.8) 9 10(1-71)
2013-14 7.9(4.7-13.3) 11 87(52-147) 3.9(1.3-12.1) 14 57(18-177)
TraininginjuriesTable4:Englandtraininginjuryincidence,averageseverity&daysabsencesince2002-03
MatchInjuriesTable3:Englandmatchinjuryincidence,averageseverity&daysabsencesince2002-03
Total number of injuries
Injuries / 1000 hrs (95% CI)
Injuries per match
Average severity, days
Days absence / 1000 hrs (95% CI)
Days absence per match
2002-03 53 221(169-289) 4.4 19 4264 (4010-4533) 85
2003-04 83 207(167-256) 4.1 11 2371(2225-2527) 47
2005-06 30 136(95-195) 2.7 10 1391(1243-1556) 28
2006-07 30 136(95-195) 2.7 28 3836(3586-4104) 77
2007-08 55 162(119-205) 3.2 24 3876(2852-4901) 78
2008-09 23 96(57-135) 1.9 8 813(480-1145) 16
2009-10 23 88(52-125) 1.8 19 1712(1012-2411) 34
2010-11 14 78(37-119) 1.5 23 1789(852-2726) 36
2011-12 16 62(31-92) 1.2 29 1754(894-2613) 35
2012-13 31 111(78-158) 2.2 24 2618(1841-3722) 52
2013-14 19 86(55-135) 1.7 20 1509(963-2366) 34
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
Writteninformedconsentwasobtainedfrom585registeredPremiershipsquadplayersforthe2013-14season.Noplayersformallyrefusedconsent.Atotalof408gameswereincludedintheanalysesforthe2013-2014season.
InjuriessustainedintrainingandinallmatchesintheAvivaPremiership,LVCupandEuropeanCompetitions(HeinekenandAmlinCup)wereincluded.
InjuriessustainedwhileplayersrepresentedEnglandwerereportedandanalysedseparately.
Matchandtraininginjurydata,andtrainingexposure data,wereprovidedbyall12Premiershipclubsin2013-2014. Acompletesetofdatawerecollectedfromall12premiershipclubsandtheEnglandseniorside.
MedicalpersonnelateachPremiershipclubandtheEnglandseniorteamreportedthedetailsofinjuriesandillnessessustainedbyaplayerattheirclub/teamthatwereincludedinthestudygrouptogetherwiththedetailsoftheassociated
injuryeventusinganonlinemedicalrecordkeepingsystem.Strengthandconditioningstaffrecordedthesquad’sweeklytrainingschedulesandexposureonapasswordprotectedonlinesystem.Teammatchdayswerealsorecordedbystrengthandconditioningstaff.
Injuryandillnessdiagnoseswererecordedusingthe OrchardSportsInjuryClassificationSystem(OSICS)version10.1.Thissportsspecificinjuryclassificationsystemallowsdetailed diagnoses to be reported and injuries to be grouped bybodypartandinjurypathology.
ThedefinitionsanddatacollectionmethodsutilisedinthisstudyarealignedwiththeIRBConsensusstatementoninjurydefinitionsanddatacollectionproceduresforstudiesofinjuriesinrugbyunion.
Rfu injury surveillance project methods
26
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
27
Furtherdetailedinformationoninjuryriskinthiscohortofplayerscanbeobtainedfromthefollowingpeerreviewedpublicationsthathavebeenproducedaspartofthesurveillanceproject
PublicationsCWFuller,AETaylor,&MRaftery.Epidemiologyofconcussioninmen’seliteRugby-7s(SevensWorldSeries)andRugby-15s(RugbyWorldCup,JuniorWorldChampionshipandRugbyTrophy,PacificNationsCupandEnglishPremiership).BritishJournalofSportsMedicine2014;10.1136/bjsports-2013-093381
AETaylor,SPTKemp,GTrewartha&KAStokes.ScruminjuryriskinEnglishprofessionalrugbyunion.BritishJournalofSportsMedicine2014;48(13)1066-1068.
SWilliams,GTrewartha,SPTKemp&KAStokes.Ameta-analysisofinjuriesinseniormen’sprofessionalrugbyunion.SportsMedicine2013;43(10)1043-1055.
CWFuller,AETaylorJHMBrooks&SPTKempChangesinthestature,bodymassandageofEnglishprofessionalrugbyplayers: A10-yearreview,JournalofSportsSciences2012DOI:10.1080/02640414.2012.753156
SCCheng,ZKSivardeen,WAWallace,DBuchanan,DHulse,KJFairbairn,SPKemp&JHBrooks.Shoulderinstabilityinprofessionalrugbyplayers-thesignificanceofshoulderlaxity.ClinicalJournalofSportsMedicine2012Sep;22(5):397-402
CJPearce,JHMBrooks,SPKemp&JDCalder.TheepidemiologyoffootinjuriesinprofessionalrugbyunionplayersFoot&AnkleSurgery.2011Sep;17(3):113-8.Epub2010Mar5.
JHMBrooks&SPTKempInjurypreventionprioritiesaccordingtoplayingpositioninprofessionalrugbyunionplayers.BritishJournalofSportsMedicine2011Aug;45(10):765-75.Epub2010May19
RASankey,JHMBrooks,SPTKemp&FSHaddadTheepidemiologyofankleinjuriesinprofessionalrugbyunionplayers.AmericanJournalofSportsMedicineDec2008;36:2415-2424
CWFuller,TAshton,JHMBrooks,RJCancea,JHall,&SPTKempInjuryrisksassociatedwithtacklinginrugbyunion.BritishJournal ofSportsMedicine2010;44(3):159-167
JHMBrooks,CWFuller,SPTKemp&DBReddinAnassessmentoftrainingvolumeinprofessionalrugbyunionanditsimpactontheincidence,severityandnatureofmatchandtraininginjuries.JournalofSportsSciences200826:8,863-873
SPTKemp,ZHudson,JHMBrooks&CWFuller.Theepidemiology ofheadinjuriesinEnglishprofessionalrugbyunion.ClinicalJournalofSportsMedicine2008;18:227-234
CWFuller,JHMBrooks,RJCancea,JHall,&SPTKempContacteventsinrugbyunionandtheirpropensitytocauseinjury.BritishJournalofSportsMedicine,Dec2007;41:862-867
JHeadey,JHMBrooks&SPTKemp.TheepidemiologyofshoulderinjuriesinEnglishprofessionalrugbyunion.AmericanJournalofSportsMedicine,Sep2007;35:1537-1543
RJDallana,JHMBrooks,SPTKemp&AWWilliams. TheepidemiologyofkneeinjuriesinEnglishprofessionalrugbyunion.AmericanJournalofSportsMedicine,May2007;35:818–830
CWFuller,JHMBrooks&SPTKemp.Spinalinjuriesinprofessionalrugbyunion:aprospectivecohortstudy.ClinicalJournalofSportMedicine,2007;17(1):10-16
JHMBrooks,CWFuller,SPTKemp&DBReddin.Incidence,riskandpreventionofhamstringmuscleinjuriesinprofessionalrugbyunion.AmericanJournalofSportsMedicine,2006;34:1297-1307
JHMBrooks,CWFuller,SPTKemp&DBReddin.Epidemiology ofinjuriesinEnglishprofessionalrugbyunion:part1matchinjuries.BritishJournalofSportsMedicine,Oct2005;39:757-766
JHMBrooks,CWFuller,SPTKemp&DBReddin.Epidemiology ofinjuriesinEnglishprofessionalrugbyunion:part2traininginjuries.BritishJournalofSportsMedicine,Oct2005;39:767–775.
JHMBrooks,CWFuller,SPTKemp&DBReddinAprospectivestudyofinjuriesandtrainingamongsttheEngland2003RugbyWorldCupsquadBritishJournalofSportsMedicine,May2005;39:288–293
Abstracts/PresentationsJHMBrooks,CWFuller,SPTKemp&DBReddin.TheIncidence,SeverityandNatureofInjuriesCausedbyTacklinginProfessionalRugbyUnionCompetition.Presented(poster)atTheAmericanCollegeofSportsMedicineAnnualMeeting,1stJune2006.Publishedin:MedicineandScienceinSportsandExercise2006:38(5)S351-352.
JHMBrooks,CWFuller,SPTKemp.TheIncidence,SeverityandNatureofGroinInjuriesinProfessionalRugbyUnion.Presented atTheAmericanCollegeofSportsMedicineAnnualMeeting, 1stJune2006.Publishedin:MedicineandScienceinSportsandExercise2006:38(5)S351.
JHMBrooks,CWFuller,SPTKemp&DBReddin.Theincidence,severityandnatureofinjuriescausedbybeingtackledinprofessionalrugbyunion.Presented(oral)atTheFacultyofSportsandExerciseMedicine,RoyalCollegeofPhysiciansIreland(RCPI)andRoyalCollegeofSurgeons,Ireland(RCSI)AnnualScientificMeeting,Dublin,5thSeptember2005
JHMBrooks,CWFuller,SPTKemp.Theincidence,severity,andnatureofscrummaginginjuriesinprofessionalrugbyunion.Presented(poster)at1stWorldCongressofSportsInjuryPrevention,Oslo,Norway23rd-25thJune2005.Publishedin:BrJSportsMed39:377.
current publications
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
• TableS1–Matchinjuryincidence,severityanddaysabsence since 2002-3
• TableS2–Matchinjuryseveritysince2002-03
• TableS3–Traininginjuryincidence,severityanddaysabsence since 2002-3
• TableS4–Traininginjuryincidenceinseverityclassificationssince2002-03
• RecurrentInjuries–FurtherDetail
• TableS5–Newvs.recurrentmatchinjuryincidence,average severity and days absence
• TableS6–Thefourmostcommonmatchinjuryrecurrences during 2013-14
• TableS7–Newvs.recurrenttraininginjuryincidence,average severity and days absence
• Timeofmatchinjury-Summary
• Timeinseason-Summary
• FigureS8.Incidenceratesofmatchinjuriesbymonthoftheseason.
• TableS9-Averageplayertraininghoursperweek
• TableS10–Hamstringtraininginjuries,incidenceanddaysabsenceper1000hrs2002-2014
Supplementary data contents
28
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
29
Supplementary data
TableS1:Matchinjuryincidence,averageseverityanddaysabsencesince2002-3
Season Total number of match injuries
Injuries / 1000 hrs (95% CI)
Injuries per club per match
Average severity, days (95%CI)
Days absence / 1000 hrs (95% CI)
Days absence per club per match
2002-03 748 100(92-107) 2.0 16(15-17) 1556(1444-1667) 31
2003-04 653 88(82-95) 1.8 20(19-22) 1773(1637-1909) 35
2005-06 482 75(68-82) 1.5 21(19-23) 1591(1449-1733) 32
2006-07 755 90(84-97) 1.8 21(20-23) 1879(1745-2013) 38
2007-08 660 83(77-89) 1.7 19(18-21) 1613(1490-1736) 32
2008-09 769 100(93-107) 2.0 23(21-25) 2285(2123-2446) 46
2009-10 636 80(73-86) 1.6 22(20-24) 1722(1588-1856) 34
2010-11 746 93(86-99) 1.9 21(20-23) 1917(1779-2054) 38
2011 -12 655 82(76-88) 1.6 27(25-29) 2222(2052-2392) 44
2012-13 588 73(67-79) 1.5 25(23-27) 1784(1645-1936) 35
2013-14 739 91(85-98) 1.8 26(24-28) 2247(2091-2415) 46
TableS2:Matchinjuryseveritysince2002-03
Season Incidence /1000 hrs
2 - 3 days
4 – 7days
8 - 21 days
22 - 28 days
29- 84 days
> 84 days
All
2002-03 24 33 26 4 9 3 100
2003-04 19 26 23 3 14 4 88
2005-06 10 19 24 5 13 3 75
2006-07 17 30 22 6 11 5 90
2007-08 15 24 26 4 10 4 83
2008-09 18 30 26 5 14 6 100
2009-10 15 21 25 4 10 4 80
2010-11 17 27 27 5 11 5 93
2011-12 13 21 22 6 13 7 82
2012-13 6 20 24 6 13 4 73
2013-14 8 30 27 6 14 6 91
TableS3:Traininginjuryincidence,averageseverityanddaysabsencesince2002-3
Total number of training injuries
Rugby skills Strength and conditioning
Season Injuries / 1000 hrs (95% CI
Average severity, days
Days absence / 1000 hrs (95% CI)
Injuries / 1000 hrs (95% CI
Average severity, days
Days absence / 1000 hrs (95% CI)
2002-03 159 3.3(2.7-4.0) 28 93(90-97) 2.3(1.7-3.0) 13 29(27-31)
2003-04 217 1.7(1.4-2.0) 26 44 (42-45) 1.3(1.1-1.6) 17 23 (22-24)
2005-06 203 2.2(1.9-2.6) 22 49(47-51) 1.5(1.2-1.9) 16 24 (22-25)
2006-07 209 2.1(1.7-2.5) 18 37(35-38) 1.6(1.3-2.0) 16 25(24-27)
2007-08 318 3.2(2.7-3.7) 19 60(51-68) 2.7(2.2-3.1) 15 44 (36-52)
2008-09 258 2.5(2.1-2.9) 26 63(53-73) 2.4(2.0-2.9) 17 41(34-49)
2009-10 298 2.8(2.4-3.2) 21 59(50-67) 2.1(1.7-2.4) 18 37(30-43)
2010-11 340 3.1(2.7-3.5) 25 76(66-87) 2.6(2.1-3.0) 17 41(34-48)
2011-12 323 2.7(2.4-3.1) 26 68(59-78) 2.2(1.8-2.6) 18 39(32-46)
2012-13 335 3.2(2.9-3.6) 33 106(93-121) 2.0(1.7-2.4) 24 49(41-60)
2013-14 414 3.1(2.7-3.5) 27 84(75-95) 2.1(1.7-2.4) 20 40(34-47)
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
30
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
31
Incidence / 1000 hrs
2 - 3 days
4 – 7days
8 - 21 days
22 - 28 days
29- 84 days
> 84 days
All
2002-03 0.64 0.49 1.11 0.18 0.42 0.18 3.0
2003-04 0.21 0.40 0.52 0.11 0.30 0.08 1.6
2005-06 0.46 0.58 0.60 0.10 0.35 0.10 2.2
2006-07 0.57 0.42 0.51 0.10 0.20 0.07 1.9
2007-08 0.50 0.76 0.94 0.14 0.38 0.07 2.8
2008-09 0.43 0.57 0.77 0.17 0.31 0.10 2.4
2009-10 0.33 0.76 0.70 0.19 0.34 0.07 2.4
2010-11 0.48 0.76 0.91 0.21 0.32 0.13 2.8
2011-12 0.25 0.62 0.82 0.15 0.30 0.14 2.3
2012-13 0.35 0.55 0.79 0.19 0.49 0.21 2.6
2013-14 0.32 0.62 1.00 0.25 0.52 0.18 2.9
TableS4:Traininginjuryincidenceinseverityclassificationssince2002-03
Recurrent InjuriesOfrecurrentinjuriesin2013-14,50%occurredwithinonemonthofreturntoplay,32%within1-6months,0%greaterthanayearand18%werenotspecified.Overall,theseproportionsaresimilartothosereportedinpreviousseasonswithinparticular,asimilarproportionofreportedrecurrentinjuriesoccurringwithinonemonthofreturntoplaywhencomparedtopreviousseasons(61%intheperiod2008-2012,52%inseason2012-13).
Between2007-08and2010-11therewasadecreaseintheincidenceofrecurrenttraininginjuries.Since2010-2011theincidencehasremainedthesame,athemethatcontinuesinseason2013-14.Theincidenceofrecurrenttraininginjuriesin2013-14(0.1/1000playerhours)wasbelowthatobservedduringtheperiod2002-13(0.26).Inadditiontheseverityofnewvs.recurrenttraininginjuriescanbeseenintableS7.
New injuries Recurrent injuries
Injuries / 1000 hrs
Average severity, day
Days absence / 1000 hrs
Injuries / 1000 hrs
Average severity, days
Days absence / 1000 hrs
2002-03 79 14 1084 19 23 438
2003-04 72 18 1333 13 33 435
2005-06 67 20 1372 10 29 279
2006-07 76 21 1574 8 33 261
2007-08 74 19 1444 9 20 169
2008-09 85 21 1800 14 34 485
2009-10 72 21 1515 8 29 207
2010-11 87 21 1776 6 25 141
2011-12 77 27 2106 5 23 116
2012-13 68 25 1659 5 26 125
2013-14 87 25 2157 4 25 90
TableS5:Newvs.recurrentmatchinjuryincidence,averageseverityanddaysabsence
Diagnosis Number of injuries Average Severity
Hamstring muscle injury 3 30
Ankle syndesmosis injury 3 3
Grade 1 MCL injury 2 21
Lumbar facet joint pain/stiffness 2 13
TableS6:Thefivemostcommonmatchinjuryrecurrencesduring2012-13
New injuries Recurrent injuries
Injuries / 1000 hrs
Average severity, day
Days absence / 1000 hrs
Injuries / 1000 hrs
Average severity, days
Days absence / 1000 hrs
2002-03 2.5 21 54 0.5 34 16
2003-04 1.3 21 27 0.3 36 12
2005-06 1.8 19 35 0.4 21 8
2006-07 1.7 17 30 0.2 15 3
2007-08 2.3 17 39 0.5 23 11
2008-09 2.0 21 41 0.4 27 11
2009-10 2.2 20 44 0.2 21 4
2010-11 2.7 20 53 0.1 58 8
2011-12 2.2 22 49 0.1 46 4
2012-13 2.6 29 69 0.1 33 4
2013-14 2.8 25 70 0.1 25 4
TableS7:Newvs.recurrenttraininginjuryincidence,averageseverityanddaysabsence
TimeofInjuryTheprofileforthetimingofinjurieswithinamatchremainedsimilartotheperiod2002-13.Thepercentageofinjuriesforwhichnoprecisetimeofinjurywasknownwasfarlowerthanthatreportedinpreviousseasons.In2013-14lessthan1%ofmatchinjurieshadanunknowntimeofevent.Thenumberofmatchinjuriesthanwereassociatedwithanunknowninjuryeventin2013-14remainssimilartopreviousseasonsat14%.
TimeinSeasonTherehasbeennosignificantchangeoverthestudyperiodinthetimeduringtheseasonwheninjuriesoccur.Forthesecondsuccessiveseason,2013-14sawasignificantdifferenceintheincidenceofinjuriesreportedinNovember.InjuriesweresustainedthroughouttheseasonwithapeakininjuryincidenceseeninMarch.
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
32
Training Hrs per week
Year Rugby Skills Strength & Conditioning
Total
2002-03 3.9 2.5 6.4
2003-04 5.0 3.7 8.7
2005-06 4.3 3.1 7.4
2006-07 4.1 3.1 7.2
2007-08 3.0 2.7 5.7
2008-09 3.2 2.6 5.8
2009-10 3.2 2.9 6.1
2010-11 3.1 2.8 5.9
2011-12 3.6 2.8 6.4
2012-13 3.1 2.7 5.9
2013-14 3.3 2.9 6.2
TableS9:Averageplayertraininghoursperweek TableS10:Hamstringtraininginjuries,incidenceanddaysabsenceper1000hrs2002-2014
Year Incidence/1000hrs Days Absence/1000hrs
2002-03 0.45 6.4
2003-04 0.21 4.2
2004-05 0.36 4.6
2006-07 0.32 5.1
2007-08 0.59 9.5
2008-09 0.36 5.0
2009-10 0.38 6.1
2010-11 0.45 6.9
2011-12 0.42 7.3
2012-13 0.39 9.5
2013-14 0.40 10.7
TableS8:Incidenceratesofmatchinjuriesbymonthoftheseason.Errorbarsshow95%CI’s.
August
Septem
ber
October
Novem
ber
0
20
40
60
80
100
120
Inci
denc
e/10
00hr
s
2002-12 2013-14
130
140
Decem
ber
January
February
March
April
May
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
34
England Professional Rugby Injury Surveillance Project 2013-2014 Season Report
35
notesnotes
RugbyFootballUnion,RugbyHouse,TwickenhamStadium,200WhittonRoad,TwickenhamTW27BA
Tel:08712222120Fax:02088929816rfu.com
RugbyFootballUnion.TheRFURoseandthewords‘EnglandRugby’areofficialregisteredtrademarksoftheRugbyFootballUnion.