Injuries associated with elite participation in women’s rugby over

a competitive season: an initial investigation

Clare Doylea,1, Keith Georgeb,*

aDepartment of Exercise and Sport Science, Manchester Metropolitan University, Hassall Road, Alsager, Cheshire ST7 2HL, UKbResearch Institute for Sport and Exercise Science, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK

Received 2 August 2002; accepted 3 November 2003

Abstract

Objectives. The purpose of this study was to document and analyse injuries sustained over a competitive season by an elite squad of female

rugby players.

Design. A prospective cohort observational study of an international squad of female rugby players over a competitive season.

Setting. Field-based data collection.

Participants. Thirty-five players in the England Women’s rugby squad 2001–2002. All players provided written informed consent for the

collection of personal and injury data relevant for this study.

Method. All information relating to injuries sustained was compiled by the medical team using a standard reporting (questionnaire) format.

Basic health and personal details (age, height, weight, position played, number of years playing rugby, previous injuries, menstrual cycle

information) were collected at the beginning of the season and fitness trainers provided game and training time exposure data.

Results. A total of 27 injuries were recorded in 18 players. Only one player sustained three injuries. The most frequent injury by category

was as follows: player position (prop, n ¼ 9), severity (severe, n ¼ 12), phase of play (tackling, n ¼ 8), site (knee, n ¼ 6), diagnosis (medial

collateral ligament or ankle sprain, n ¼ 4), and month (January, n ¼ 7). Incidence rates per 1000 athletic exposures and 1000 playing hours

were 7.2 and 3.6, respectively. Variables that were either significantly different between injured and non-injured players (t-tests) or

associated with injury by chi-squared analysis were age (injured were older), body mass (injured were heavier), and player position (more

forwards were injured).

Conclusions. These descriptive data provide the first insight into the injuries associated with elite level performance of a women’s

international rugby team and provide a springboard for future research.

q 2003 Elsevier Ltd. All rights reserved.

Keywords: Injury; Rugby player; Cohort observational study; Epidemiology

1. Introduction

Rugby is a contact sport which can place adverse

stresses on the body, thereby increasing the risk of injury

(Garraway et al., 2000; Lee et al., 2001). There have been

many studies examining the incidence, type, risk factors and

severity of injury in men’s rugby (Bottini et al., 2000;

Chalmers, 1994; Garraway et al., 2000; McManus, 2000;

Quarrie et al., 2001; Sharp et al., 2001; Van Mechelen et al.,

1992), but there is a paucity of data on the women’s game,

particularly at the elite level (Carson et al., 1999; Gerrard

et al., 1994; Havkins, 1986; Lewis and George, 1996). This

lack of data is despite the fact that women’s rugby is one of

the fastest growing team sports with 30% growth in the last

year in New Zealand and an increase from 12 teams in 1983

to over 400 clubs with over 7000 players registered in

England in 2002 (International Rugby Board, 2002).

The literature on comparative data between male and

female rugby indicates a lower injury rate (approximately

50%) for female players (Carson et al., 1999; Gerrard et al.,

1994; Havkins, 1986; Lewis and George, 1996). It has been

proposed that the size and speed of male players plus the

aggressive approach shown by them to rugby could account

for the increased injury rates in male players (Carson et al.,

Physical Therapy in Sport 5 (2004) 44–50

www.elsevier.com/locate/yptsp

1466-853X/$ - see front matter q 2003 Elsevier Ltd. All rights reserved.

doi:10.1016/j.ptsp.2003.11.001

1 Former Senior Lecturer in Sport Rehabilitation at St Mary’s College,

Waldegrave Road, Twickenham, Middlesex TW1 4SX, UK.

* Corresponding author. Tel.: þ44-151-231-4353; fax: þ44-151-231-

4088.

E-mail address: k.george@livjm.ac.uk (K. George).

1999). However, the attitude of female players towards

aggression, injury, and physical danger has been shown to

be very similar to male players (Young and White, 1995). In

specific areas of injury research, other studies have

suggested a similar or higher rate of injury for female

rugby players, particularly in relation to certain anatomical

regions such as the knee (Arendt and Dick, 1995; Gwinn

et al., 2000). The explanations for these findings are likely to

be multi-factorial including reproductive hormonal effects

(Arendt and Dick, 1995; Hutchinson and Ireland, 1995;

Myklebust et al., 1998).

To add to the current database on descriptive injury

statistics in female rugby players this study uniquely

followed an elite (international) squad throughout a

complete season. This study examined a range of factors

related to injury including the nature, incidence, and

severity, as well as associating injury with a range of

factors such as age, size, stature, playing experience,

playing position, and menstrual cycle phase/oral contra-

ceptive use.

2. Method

2.1. Participants

This investigation was a prospective cohort observa-

tional study of the injuries sustained by members of the

England women’s rugby squad over the 2001/2002 season.

The squad was followed during training and competitive

matches from September 2001 through to the end of the Six

Nations championships in April 2002. The squad consisted

of 35 players who gave their written and verbal consent for

the collection of personal and injury data relevant for this

study. Thirty-five players consisting of 20 forwards and 15

backs played an average of 19.2 games (range 10–22) over

the 2001/2002 season. Their ages ranged from 21 to 37

years with a mean age of 29 ^ 4 years.

2.2. Data collection

The squad physiotherapist collected background per-

sonal information at the beginning of the season that

included age, height, body mass, years playing rugby,

number of England caps, and menstrual cycle history.

Specifically, players were asked to document current and

previous use of oral contraceptives, current and previous

menstrual cycle history, as well as the age at menarche

(onset of menses). Those players not taking oral contra-

ceptives were asked to document the average length of their

menstrual cycle, where a cycle of between 26 and 30 days

was determined to be normal (Karageanes et al., 2000) and

to keep a regular record of menstruation and oral contra-

ceptive pill usage throughout the season to aid in the

reporting of the day of the menstrual cycle the injury

occurred.

Injuries sustained throughout the season (club training

and matches, England training, matches, and other fitness

related activity) were reported to and assessed by the squad

medical team and an injury report form was completed for

each injury. Injury data were collected in this study using

the injury report form designed by McManus (2000). This

form was designed specifically for rugby and to enable

researchers to use a similar method of data collection and

thereby minimise the level of variation within epidemiolo-

gical studies. The injury data collection instrument was

found to be valid and reliable (McManus, 2000). This form

was used to collect information pertinent to player position,

timing of the injury, severity, phase of play, site, diagnosis,

month of occurrence, weather, and whether the mechanism

of injury was intrinsic (defined as being related to internal or

personal factors) or extrinsic (defined as relating to external

and/or environmental causes) (Orchard et al., 2001). An

additional question was included on the timing of the

reported injury in relation to the player’s menstrual cycle.

Time missed from training and games was also collated

during the season by the England medical team. To optimise

the accuracy of injury reporting the subjects were contacted

at regular intervals (face-to-face, at training sessions,

matches, phone calls, or e-mail). The injury report form

was completed as soon as possible after the injury was

sustained to increase the accuracy of the data obtained.

A contentious area within epidemiological research is the

definition of terms. Injury has been classified in many

different ways in previous research (McManus, 2000; Van

Mechelen et al., 1992). This study adopted a definition for

injury previously used by Carson et al. (1999), that is, any

event which prevented the player from partaking in normal

physical activity (training or playing in a match) for greater

than 24 h and/or required the attention of a doctor (including

dental, nerve, eye, laceration injuries and concussion).

Likewise, the definition of injury severity has been the

subject of some debate within epidemiological literature.

McManus (2000) identified four levels of injury severity,

those being: minor, the player was able to return to the game

or training in which the injury occurred; mild, the player

missed 1 week; moderate, the player missed 2 weeks; and

severe, the player missed more than 2 weeks. This definition

of severity was adopted in this study to maintain consistency

of data obtained from the injury report form designed by the

same author (McManus, 2000).

The coach, medical team, and fitness trainers of the squad

supplied data relating to the exposure time for rugby and

non-rugby related fitness training for the squad during the

season. These data were collated with game time and

exposure as well as club game and training information to

determine injury incidence data. The injury incidence rate

was expressed as injuries per 1000 athletic exposures and

per 1000 player-hours. This form of measurement is

commonly used within injury studies and was used by

Carson et al. (1999) in their study of female rugby players in

Canada. Carson et al. (1999) defined an athletic exposure

C. Doyle, K. George / Physical Therapy in Sport 5 (2004) 44–50 45

as participation in one rugby practice or game and this was

applied to the current study. Data on non-rugby related

training exposures and hours were also included in this

study, which to the authors’ knowledge has not been applied

in previous research on injury in women’s rugby. The non-

rugby related training sessions were designed by the

England fitness trainers and consisted of a yearly phasic

cycle of training involving endurance, strength, power, and

speed work, as well as rest periods. Player-hours were

calculated on the number of hours of participation in rugby

practice/training, non-rugby related practice/training, and

games.

2.3. Data analysis

Baseline data were analysed using descriptive statistics

and frequency tables. Independent t-tests were used to

assess the differences between the baseline subject data such

as age, height, weight, number of years playing rugby,

England caps, age at onset of menses (dependent variables),

and injury (independent variable). Pearson’s chi-square

analysis was used to analyse the association between injury

(independent variable) and dependent variables contained in

the injury data questionnaire (e.g. player position, menstrual

cycle/oral contraceptive information). The critical alpha

level adopted was 0.05. The statistical software package

used was Statistica (Statsoft, Tulsa, OK).

3. Results

There were a total of 27 injuries sustained by 18 players

in the 2001/2002 season. The descriptive breakdown of

these injuries is displayed in Table 1. It is clear that more

injuries were sustained by forwards despite the similar

numbers of forwards and backs on the pitch. Of the 18

players injured during the season, eight (44%) sustained

more than one injury, all of which were forwards, and one

subject (a prop) sustained three injuries. Injuries were more

frequent in match play than in training. Most injuries were

either mild or severe, two injuries were as a result of illegal

play, and 20 of the injuries sustained were extrinsic and

seven intrinsic in nature. With respect to phase of play no

injuries occurred in lineouts, mauls, or kicking. It is clear

from Table 1 that the lower limb accounted for a majority of

injuries (67%), and all of the injuries reported by the backs

involved the lower limb. Of the injuries to forward players,

11 were to the lower limb, five to the upper limb, three to the

spine, and one each to the head and face. The diagnosis of

injury varied and whilst medial collateral ligament (MCL)

and lateral ankle ligament sprains were most common, a

number of injuries including sacroiliac joint sprain, wrist

sprain, laceration to the face, and plantar fascitis occurred

only once. Injuries were sustained in every month of the

season with the exception of April when there was only one

match involving the England squad. A month-by-monthTab

le1

Des

crip

tive

bre

akdow

no

fin

jury

dat

afr

equen

cyb

yca

tegory

(%of

tota

lw

her

ere

levan

t)

Pla

yer

po

siti

on

Pro

pH

oo

ker

Sec

on

dro

wB

ack

row

Hal

f-b

ack

Cen

tre

FB

-win

g

9(3

3)

3(1

1)

4(1

5)

5(1

8)

3(1

1)

2(7

)1

(4)

Ph

ase

of

pla

yT

ack

lin

gR

uck

ing

Ru

nn

ing

Un

kn

ow

nS

cru

mC

oll

isio

ns

85

43

22

Occ

asio

no

fin

jury

Mat

ch—

1st

hal

fM

atch

—2n

dh

alf

Ru

gb

ytr

ain

ing

No

n-r

ug

by

trai

nin

g

8(3

0)

10

(37

)6

(22

)3

(11

)

Sev

erit

yM

ino

rM

ild

Mo

der

ate

Sev

ere

3(1

1)

10

(37

)2

(7)

12

(44

)

Sit

eK

nee

An

kle

LL

egU

Leg

Sh

ou

lder

Nec

kF

oot

Pel

vis

Th

um

bW

rist

Fac

e

6(2

2)

5(1

8)

3(1

1)

3(1

1)

3(1

1)

2(7

)1

(4)

1(4

)1

(4)

1(4

)1

(4)

Dia

gno

sis

MC

Lsp

rain

An

kle

spra

inC

alf

stra

inA

Csp

rain

QU

AD

stra

inO

ther

s

4(1

5)

4(1

5)

3(1

1)

3(1

1)

2(7

)1

1(4

1)

Month

Sep

tem

ber

Oct

ober

Novem

ber

Dec

ember

Januar

yF

ebru

ary

Mar

chA

pri

l

3(1

1)

4(1

5)

4(1

5)

5(1

8)

7(2

6)

2(7

)2

(7)

0(0

)

FB

,fu

llb

ack

;L

Leg

,lo

wer

leg

;U

Leg

,u

pp

erle

g;

QU

AD

,q

uad

rice

ps.

C. Doyle, K. George / Physical Therapy in Sport 5 (2004) 44–5046

breakdown of injury frequency is shown in Table 1.

Weather was described as being a contributory factor in

10 injuries: half cited cold weather as a factor, three cited

wet weather, and two cited heat. Terrain was reported to be a

factor in 12 injuries with soft and muddy conditions being

cited in six injuries and hard ground cited in two injuries.

Table 2 demonstrates injury rates in exposures and

player-hours for games, rugby training, and other non-rugby

related fitness training. During the season there were 7440

player-hours and 3604 athletic exposures (rugby training

and games only). The resulting injury rate was 3.6 per 1000

player-hours and 7.2 per 1000 athletic exposures. If non-

rugby related training hours and exposures are included

(5388 h and 4490 exposures) the injury rate was reduced to

2.1 per 1000 player-hours and 3.3 per 1000 athletic

exposures.

In an attempt to determine pre-disposing factors for

injury, independent t-tests compared characteristics of those

who were injured and non-injured. Table 3 demonstrates

that the injured subjects were significantly older and heavier

than the non-injured subjects. Other baseline data were not

significantly different between groups.

Pearson’s chi-squared analysis results indicate that only

player position (forward/back) was significantly associated

with injury (see Table 4). Data for injury occurrence during

specific menstrual cycle phases was equivocal with eight

injuries reported in the first half (follicular phase), 10

injuries reported in the second half (luteal phase) of

the menstrual cycle, and for nine injuries, participants

could not recall in which part of the cycle their injury

occurred. The injury pattern in those subjects who were oral

contraceptive users, menstrual cycle of regular length and

menstrual cycle of irregular length, was consistent with the

overall squad injury breakdown.

4. Discussion

Playing position (forward) was significantly associated

with the highest frequency of injury and this study found

that prop forward was the most commonly injured playing

position, sustaining a third of all injuries recorded. Whilst

the playing unit corresponds to previous research (Bottini

et al., 2000; Garraway et al., 2000; Havkins, 1986; Lewis

and George, 1996), the individual position has varied

somewhat (No. 8, Roy, 1974; hooker, Clark et al., 1990;

fullback, O’Brien, 1992; flanker, Stokes et al., 1994; Bottini

et al., 2000). The explanation for the current findings is

likely to be related to a number of factors but body mass was

highlighted in Table 3 as being greater in the injured

players. This also will impact upon player position

designation. Greater injury frequency in the forwards is

also likely to be a consequence of the greater number of

contact situations these players are exposed to, and this is

borne out by the phase of play data. Indeed front row

forwards face a high level of collision and contact in scrums

Table 2

Relative injury risk in rugby games, rugby training and non-rugby related

training

Athletic exposures ðnÞ (including rugby training and games) 3604

Player-hours (including rugby training and games) 7440

Injury rate per 1000 athletic exposures (including

rugby training and games)

7.2

Injury rate per 1000 playing-hours (including rugby

training and games)

3.6

Non-rugby related training exposures ðnÞ 4490

Non-rugby related training hours 5388

Injury rate per 1000 non-rugby related exposures 0.7

Injury rate per 1000 non-rugby related player-hours 0.6

Athletic exposures ðnÞ (including rugby training,

games and non-rugby related training)

8243

Player-hours (including rugby training, games and

non-rugby related training)

12,828

Injury rate per 1000 athletic exposures (including rugby

training, games and non-rugby related training)

3.3

Injury rate per 1000 player-hours (including rugby training,

games and non-rugby related training)

2.1

Table 3

Comparison of injured and non-injured players for baseline data (mean ^

SD)

Variable Non-injured

subjects

Injured

subjects

t-value P-value

Age (years) 28.1 ^ 3.2 30.2 ^ 3.2 22.16 0.03*

Height (cm) 170.0 ^ 6.4 172.8 ^ 7.0 21.33 0.19

Body mass (kg) 72.9 ^ 7.3 77.6 ^ 7.8 22.03 0.04*

Years playing rugby 8.6 ^ 3.4 10.7 ^ 3.5 21.96 0.05

England caps ðnÞ 14 ^ 13 17 ^ 17 20.53 0.59

Age at menarche (years) 13.0 ^ 1.1 13.4 ^ 1.4 21.12 0.27

*Significantly different.

Table 4

Pearson’s chi-squared analysis on factors associated with injury

Variable N Chi-square P-value

Position 4.38 0.03*

Injuries in forwards 21

Injuries in backs 6

Menstrual cycle phase 8.24 0.14

Injuries in follicular phase 8

Injuries in luteal phase 10

For abnormal menstrual cycle length 0.08 0.98

Injury 5

No injury 4

For normal menstrual cycle length 0.07 0.78

Injury 8

No injury 8

For current OCP users 0.29 0.59

Injury 5

No injury 5

OCP, oral contraceptive. *Significantly associated.

C. Doyle, K. George / Physical Therapy in Sport 5 (2004) 44–50 47

and rucks, which may lead to higher numbers of injury. It is

interesting to note that tackling, with the highest frequency

of injuries in this study, has also been cited as the most

common cause of injury by other authors (Garraway et al.,

2000; Quarrie et al., 2001).

The majority of injuries occurred during match play

(67%) with rugby training being responsible for 22% of

injuries. This is in agreement with previous studies where

injury frequency was compared between match play and

practice (rugby training 19% vs. games 81%—Lewis and

George, 1996; rugby training 17% vs. games 83%—Bottini

et al., 2000; rugby training 11% vs. games 89%—Carson

et al., 1999). The high level of injury during match play

could be due to the intensity of the activity as compared to

training scenarios. It is interesting to note that none of the

above studies considered injuries as a result of non-rugby

related training/fitness activities (which accounted for 11%

of injuries in the present study). Most injuries were

sustained in the second half of games. This supports the

findings of other authors, where muscle fatigue and slower

reaction times were given as possible reasons to account for

this difference (Bottini et al., 2000; Lewis and George,

1996). The findings of the present study do differ with the

Lewis and George (1996) study where almost double the

number of injuries was recorded in the second half of games

as compared to the first. This could be due to fitness level

differences between the two different female subject

populations as players in the earlier study were primarily

club-level players.

The most frequent level of severity of injury was

‘severe’. Due to differing definitions of severity of injury,

comparisons with previous studies are difficult. As more

studies are published using the injury report form further

comparisons can be made (McManus, 2000). The high

number of injuries that were reported as severe and

stopped the player from training/playing for 2 weeks or

more could be due to the high level of contact between

the players and the medical staff whose treatment and

advice may have led to time taken from training/playing

to reduce the risk of injury aggravation.

The knee joint was the site where most injuries occurred.

This concurs with the findings of other authors (Garraway

et al., 2000; Lewis and George, 1996; O’Brien, 1992). The

ankle was the second most involved site. The nature of

rugby, involving cutting, pivoting, and twisting movements

into contact situations, places the lower limb at particular

risk of injury. Therefore, it was not unexpected that the

greater proportion of injury involved the lower limb.

However, interestingly there were no anterior cruciate

ligament ruptures reported during the study. This may be

due in part to the relatively small sample size. Further long-

term study of this group may provide more data on which to

analyse the incidence of specific injuries.

Most injuries were sustained in the months of December

and January (the mid part of the season). This is in contrast

to some other studies that implicated the beginning of the

season and after the mid-season break as the most common

times for injury to occur (Garraway et al., 2000; Lewis and

George, 1996). Due to the women’s world cup taking place

at the end of 2001/2002 season, the club league season was

compressed to occur between September and January. After

this point, no England players were released to their clubs to

play, therefore, they participated in significantly fewer

games in the second half of the season. This may account for

the sudden reduction of injuries from February onwards.

The low frequency of injury at the start of season could be

due to effective pre-season training involving power,

strength, and proprioceptive agility work. Further investi-

gation and longitudinal studies into this area would be

recommended to give a greater insight into injury incidence

and pre-season preparation. Weather and terrain were only

sporadically cited as factors involved in injuries and this

concurs with the results reported by Engstrom et al. (1991).

The injury incidence rate in this study of 3.6 per 1000

player-hours and 7.2 per 1000 athletic exposures compares

favourably to previous studies on women’s sport. Carson

et al. (1999), in a study of female regional/national rugby

players in Canada, reported an incidence of 7.1 injuries per

1000 player-hours and 12 per 1000 athletic exposures.

Engstrom et al. (1991) reported 8.6 injuries per 1000 athletic

exposures in women’s soccer. The findings of the current

study compared favourably to male rugby injury incidence

rates. For example, Garraway and Macleod (1995) reported

13.9 injuries per 1000 player-hours, which represents three

times the rate of the present study. Current and previous data

in women’s rugby could imply a reduced risk of injury as

compared to the male equivalent (Carson et al., 1999).

Further studies on elite female rugby populations would be

needed to examine this difference in greater depth. The

explanation for the reduced injury incidence in women

rugby players could be the greater size and higher speed of

collision/contact between male players (Carson et al., 1999;

Havkins, 1986).

Data from Tables 3 and 4 suggest that menstrual cycle

phase, and the use of oral contraceptive pills had no

significant effect on incidence of injury in the players

studied. This may be somewhat surprising given that Heitz

et al. (1999) suggested that high levels of the menstrual

cycle hormones (oestrogen and progesterone) were linked to

an increase in laxity of ligamentous tissues. This could

imply that at certain times within the menstrual cycle when

these hormones are at their highest levels there may be a

greater risk of injury in the female athlete. However, various

studies into this area have implicated different parts of the

menstrual cycle as being most injurious. For example,

Wojtys et al. (1998) indicated a higher level of injury in the

ovulatory phase while Slauterbeck and Hardy (2001)

reported that most injuries occurred around menses.

Another author reported no significant risk of injury in

any single phase of the menstrual cycle, and thus, would

seemingly support the current findings (Lebrun, 1994). The

impact of menstrual cycle phase was hindered by a high

C. Doyle, K. George / Physical Therapy in Sport 5 (2004) 44–5048

number of individuals who were unsure at what point in

their cycle their injury occurred. Indeed, due to design and

practical limitations involved within this study it was very

difficult to precisely assess the phase of the menstrual cycle

at which each injury occurred. Closer scrutiny of cycle

phase would be beneficial in future research, although this

may be logistically difficult as a number of subjects reported

problems in keeping an accurate note of their menstrual

cycles.

Menstrual cycle irregularity was not associated with

greater injury risk in this study. This is in contrast to another

study that reported a significant increase in risk with absent

or irregular menses in athletes performing vigorous exercise

(Lloyd et al., 1986). However, similar problems with recall

and accuracy of this data may have been present in the

current study. The use of the oral contraceptive pill has also

been claimed to be associated with a lower injury risk

possibly due to the stabilisation of hormonal levels having

a protective effect against injury (Moller-Nielsen

and Hammar, 1989). Despite this, the use of oral contra-

ceptive pills was not associated with a reduced risk of injury

in this study.

Whilst the data from the current study provides a unique

insight into injury patterns in elite women rugby players

some limitations are derived from the analysis of such

cohorts. The sample size studied ðn ¼ 35Þ is small and

restricts the generalisability of these findings to other

populations. The homogeneous nature of training and

playing patterns within this small sample size may also be

a factor that limits generalisability and comparability.

However, to apply the current study design and procedures

to on-going research will assist in creating a larger (and

possibly broader) database on which future comparisons can

be made between other female rugby populations. Specific

issues may be developed in future research such as a more

sophisticated analysis of menstrual cycle and oral contra-

ceptive pill effects on injury, and the impact of individual

physical fitness on injury.

The incidence of injury within this elite women’s rugby

squad is considerably less than that recorded with men’s

rugby, but is comparable with other female team sports. The

pattern of injury in terms of site, position played, and other

factors are remarkably similar to that found in the published

data on men’s rugby. The factors found to be significantly

related to injury were age, weight, and position played.

These findings, however, may not be generalised to other

female rugby populations. Phase and regularity of the

menstrual cycle and the use of oral contraceptives were not

found to be significantly associated in injury within

women’s rugby.

Acknowledgements

The authors would like to thank several people for their

help in conducting this study including the England

Women’s Rugby medical team for their help in the collation

of injury data and the fitness trainers of the squad for their

assistance with training data information. The authors

would like to acknowledge the partial funding provided

for this research by the Rugby Football Union for Women

and the London Clinic. The authors’ gratitude is also

directed to the players for their patient participation in the

study and colleagues at St Mary’s College, Twickenham for

their kind help and support.

References

Arendt, E., Dick, R., 1995. Knee injury patterns among men and women in

collegiate basketball and soccer. NCAA data and review of the

literature. American Journal of Sports Medicine 23, 694–701.

Bottini, E., Poggi, E.J.T., Luzuriaga, F., Secin, F.P., 2000. Incidence and

nature of the most common rugby injuries sustained in Argentina

(1991–1997). British Journal of Sports Medicine 34, 94–97.

Carson, J.D., Roberts, M.A., White, A.L., 1999. The epidemiology of

women’s rugby injuries. Clinical Journal of Sport Medicine 9, 75–78.

Chalmers, D.J., 1994. New Zealand’s injury prevention research unit:

reducing sport and recreational injury. British Journal of Sports

Medicine 28, 221–222.

Clark, D.R., Roux, C., Noakes, T.D., 1990. A prospective study of the

incidence and nature of injuries to adult rugby players. South African

Medical Journal 77, 559–562.

Engstrom, B., Johansson, C., Tornkvist, H., 1991. Soccer injuries among

elite female players. American Journal of Sports Medicine 19,

372–375.

Garraway, M., Macleod, D., 1995. Epidemiology of rugby football injuries.

Lancet 345, 1485–1487.

Garraway, W.M., Lee, A.J., Hutton, S.J., Russell, E.B., Macleod, D.A.D.,

2000. Impact of professionalism on injuries in rugby union. British

Journal of Sports Medicine 34, 348–351.

Gerrard, D.F., Waller, A.E., Bird, Y.N., 1994. The New Zealand rugby

injury and performance project. 2. Previous injury experience of a rugby

playing cohort. British Journal of Sports Medicine 28, 229–233.

Gwinn, D.E., Wilckens, J.H., McDevitt, E.R., Ross, G., Kao, T., 2000. The

relative incidence of anterior cruciate ligament injury in men and

women at the United States naval academy. American Journal of Sports

Medicine 28, 98–102.

Havkins, S.B., 1986. Head, neck, face and shoulder injuries in female and

male rugby players. Physician and Sportsmedicine 14, 111–118.

Heitz, N.A., Eisenman, P.A., Beck, C.L., Walker, J.A., 1999. Hormonal

changes throughout the menstrual cycle and increased anterior ligament

laxity in females. Journal of Athletic Training 34, 144–149.

Hutchinson, M.R., Ireland, M.L., 1995. Knee injuries in female athletes.

Sports Medicine 19, 288–302.

International Rugby Board, 2002. irb.com/intouch/member_unions/union-

s_england.cfm.

Karageanes, S.J., Blackburn, K., Vangelos, A., 2000. The association of the

menstrual cycle with the laxity of the anterior cruciate ligament in

adolescent female athletes. Clinical Journal of Sport Medicine 10,

162–168.

Lebrun, C.M., 1994. The effect of the phase of the menstrual cycle and the

birth control pill on athletic performance. Clinics in Sports Medicine

13, 419–441.

Lee, A.J., Garraway, W.M., Arneil, D.W., 2001. Influence of preseason

training, fitness, and existing injury on subsequent rugby injury. British

Journal of Sports Medicine 35, 412–417.

Lewis, E.R., George, K.P., 1996. An investigation of injuries in women,

men and youths playing rugby union football at the same club. Sports

Exercise and Injury 2, 186–191.

C. Doyle, K. George / Physical Therapy in Sport 5 (2004) 44–50 49

Lloyd, T., Triantafyllou, S.J., Baker, E.R., Houts, P.S., Whiteside, J.A.,

Kalenak, A., Stumpf, P.G., 1986. Women athletes with menstrual

irregularity have increased musculoskeletal injuries. Medicine and

Science in Sports and Exercise 18, 374–379.

McManus, A., 2000. Validation of an instrument for injury data collection

in rugby union. British Journal of Sports Medicine 34, 342–347.

Moller-Nielsen, J., Hammar, M., 1989. Women’s soccer injuries in relation

to the menstrual cycle and oral contraceptive use. Medicine and Science

in Sports and Exercise 21, 126–129.

Myklebust, G., Maehlum, S., Holm, I., Bahr, R., 1998. A prospective cohort

study of anterior cruciate ligament injuries in elite Norwegian team

handball. Scandinavian Journal of Medicine and Science in Sports 8,

149–153.

O’Brien, C., 1992. Retrospective survey of rugby injuries in the Leinster

province of Ireland: 1987–1989. British Journal of Sports Medicine 26,

243–244.

Orchard, J., Seward, H., McGivern, J., Hood, S., 2001. Intrinsic and

extrinsic risk factors for anterior cruciate ligament injury in Australian

footballers. American Journal of Sports Medicine 29, 196–200.

Quarrie, K.L., Alsop, J.C., Waller, A.E., Bird, Y.N., Marshall, S.W.,

Chalmers, D.J., 2001. The New Zealand rugby injury and performance

project. 6. A prospective cohort study of risk factors for injury in rugby

union football. British Journal of Sports Medicine 35, 157–166.

Roy, S.P., 1974. The nature and frequency of rugby injuries: a pilot study of

300 injuries at Stellenbosch. South African Medical Journal 48,

2321–2327.

Sharp, J.C.M., Murray, G.D., Macleod, D.A.D., 2001. A unique insight into

the incidence of rugby injuries using referee replacement reports.

British Journal of Sports Medicine 35, 34–37.

Slauterbeck, J.R., Hardy, D.M., 2001. Sex hormones and knee ligament

injuries in female athletes. The American Journal of the Medical

Sciences 322, 196–199.

Stokes, M.A., Mc Keever, J.A., McQuillan, R.F., 1994. A season of football

injuries. Irish Journal of Medical Science 163, 290–293.

Van Mechelen, W., Hlobil, H., Kemper, H.C.G., 1992. Incidence, severity,

aetiology and prevention of sports injuries. Sports Medicine 14, 82–99.

Wojtys, E.M., Huston, L.J., Lindenfeld, T.N., Hewett, T.E., Greenfield, M.,

1998. Association between the menstrual cycle and anterior cruciate

ligament injuries in female athletes. American Journal of Sports

Medicine 26, 614–619.

Young, K., White, P., 1995. Sport, physical danger, and injury: the

experience of elite women athletes. Journal of Sport and Social Issues

19, 45–61.

C. Doyle, K. George / Physical Therapy in Sport 5 (2004) 44–5050