England Professional Rugby Injury Surveillance Project · England Professional Rugby Injury...

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

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contents

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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

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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


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

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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


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

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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

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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

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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

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0.5

1

1.5

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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

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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

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50

60

Day

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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


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.

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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

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2012-13

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RecurrentMatchInjuriesFigure3a:Incidenceratesofrecurrentmatchinjuriesoverthestudyperiodwithmean±2xstandarddeviationshown.Verticallinedenoteschangeindatacollectionmethodstoelectronic capture

RecurrentTrainingInjuriesFigure3b:Incidence rates of recurrent training injuries over thestudyperiodwithmean±2xstandarddeviationshown

Tackled

Tackling

Collision

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2002-13 2013-14

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Running

Not know

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2009-100

1

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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

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Mean: 0.26

2013-14: 0.1

0.7

2013-14


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.

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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

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2

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6

8

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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


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)


2013-14: 11

2013-14

Figure8:Severity(daysabsence)ofreportedmatchconcussionsbyseasonwithmean±2standarddeviations.Verticallinedenoteschangeindatacollectionmethodstoelectronic capture


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


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


Most common match injuries

18


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


Abductor muscle

2013-14

Hamstring muscle

Calf muscle


Abductor muscle


2010-11

Hamstring muscle

Calf muscle


Abductor muscle


2011-12

Hamstring muscle

Calf muscle

Abductor muscle



2012-13

Hamstring muscle

Calf muscle

Lumber disc/nerve root


Shoulder dislocation

2013-14

Hamstring muscle

ACL

Calf muscle


Knee cartilage

2010-11

Hamstring muscle


Calf muscle


Tib/fib fracture2011-12

Hamstring muscle

ACL


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


20


21


EnglandmatchandtraininginjuryriskNostatisticallysignificantchangeininjuryrisk(matchortraining)wasseenfor2013-14whencomparedwithpreviousseasonsforplayersonEnglandSeniorsquadduty.

Theaverageseverityofmatchinjuriesdecreasedforthesecondseason.Traininginjuryseverityalsodecreasedforthoseinjuriesattributedtorugbyskillssessionsbutseverityincreasedforinjuriessustainedinstrengthandconditioningbasedsessions.Thesechangeswerenotstatisticallysignificant.

Note:therelativelysmallnumberofseniorEnglandtrainingsessionsinthestudymakesthedifferencesseeninthisgroupmuchmorelikelytohavearisen“bychance”ratherthantobetheresultofa“true”difference,reflectedinthewide95%confidenceintervalsandthelackofstatisticalsignificanceintheresults

England Senior side

24


25

Rugby skills Strength and conditioning

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 per match



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


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


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


• 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


29

Supplementary data

TableS1:Matchinjuryincidence,averageseverityanddaysabsencesince2002-3

Season Total number of match injuries


Injuries per club per match

Average severity, days (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



Injuries / 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)


30


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



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


Injuries / 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.


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


34


35

notesnotes

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