<--Back Injuries Types of Injuries The New Zealand Rugby Injury and Performance Project: V. Epidemiology of a season of rugby injury. Bird YN, Waller AE, Marshall SW, Alsop JC, Chalmers DJ, Gerrard DF Department of Preventive and Social Medicine, Medical School, University of Otago, Dunedin, New Zealand. OBJECTIVE: To describe the incidence, nature, and circumstances of injury experienced by a cohort of rugby union players during a full competitive club season. METHODS: A prospective cohort study followed up 356 male and female rugby players throughout the 1993 competitive club season. Players were interviewed by telephone each week to obtain information on the amount of rugby played and the injury experienced. RESULTS: Detailed information was collected for 4403 player-games and 8653 player-practices. A total of 671 injury events were reported, of which 569 were rugby related. The injury rate for games was higher than that for practices (rate ratio 8.3). At 10.9 injuries per 100 player-games, males had a higher rate of injury than females at 6.1 injuries per 100 player-games (p<0.001). Injury rates varied by position, with male locks (13.0 injuries per 100 player-games) and female inside backs (12.3 injuries per 100 player-games) having the highest rate in their respective sexes. The lower limb was the body region most often injured in games (42.5%) and practices (58.4%). Sprains/strains were the most common type of injury in games (46.7%) and practices (76.1%). In games the tackle was the phase of play in which the most injuries occurred (40%), followed by rucks (17%) and mauls (12%). Thirteen per cent of game injury events were the result of foul play. CONCLUSIONS: Rugby injury was common among the study subjects and varied according to grade and gender. Identifying the causes of injuries in the tackle, lower limb injuries, and dealing with the issue of foul play are priority areas for the prevention of rugby injury. Injuries in professional Rugby Union. Targett SG Capital Sports Medicine, University of Otago, Wellington, New Zealand. OBJECTIVE: To document injury rates in professional rugby players in the Rugby Super 12 competition and to act as a pilot study for future studies of rugby injuries. DESIGN: Prospective longitudinal study encompassing the 1997 Super 12 rugby season. SETTING: A New Zealand Super 12 rugby squad. PATIENTS AND PARTICIPANTS: 25 professional rugby players (replacement players were used for unavailable players, so although 30 different players were used during the season, there were only 25 in the squad at any one time). OUTCOME MEASURES: An "injury" was defined as something that prevented a player from taking part in two training sessions, from playing the next week, or something requiring special medical treatment (suturing or special investigations). An injury was "significant" if it prevented the player from being able to play one week after sustaining it (that is, if it made the player miss the next match). RESULTS: The overall injury rate was 120/1000 player hours. The rate of significant injuries was 45/1000 player hours. Those playing the position of "forward" had a higher overall injury rate than other players, but there was no difference in significant injury rate between the forwards and the backs. Injuries that caused players to miss game time occurred almost exclusively during the pre-season program or in the final third of the season. The majority of injuries were musculo-tendinous sprains or strains. The phase of play responsible for the majority of injuries was the tackle. The most frequently injured body part was the head and face. No catastrophic injuries occurred during the study period. CONCLUSIONS: Injury rates increase with increasing grade of rugby, injury rates in the Super 12 competition being higher than in first grade rugby. There is very little quality data on rugby injuries, and the few studies available use different methods of data collection and injury definition. There is a pressing need for the collection of accurate ongoing epidemiological data on injuries in rugby. Incidence of sporting injury in New Zealand youths aged 6-15 years. Pringle RG, McNair P, Stanley S Department of Leisure Studies, University of Waikato, Hamilton, New Zealand. OBJECTIVE: To document the incidence of injury in 6-15 year olds playing rugby union, rugby league, and netball, and to identify the common mechanisms, sites, severity, and time of injury. METHODS: Cross sectional data were collected by trained observers who watched 258 games of rugby union, netball, and rugby league over a four week period. The condition of the injured participants was monitored until recovery. RESULTS: In total, 5174 players were observed and an injury rate of 18 per 1000 player hours was calculated. Of all observed injuries, 29% required some form of medical treatment. A significant difference (p<0.05) in the distribution of injury over the four quarters of the games was recorded, most occurring in the first three quarters. In total, 81% of the injuries were classified as contact injuries, and these mainly occurred through direct contact with the opposition. Of all observed injuries, 27% were recurrent. CONCLUSIONS: The incidence of injury in rugby union, netball, and rugby league is low for children aged between 6 and 15 years relative to adult rates. Incidence, site, and nature of injuries in amateur rugby league over three consecutive seasons. Gabbett TJ School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Griffith University Gold Coast, Queensland, Australia. t.gabbett@mailbox.gu.edu.au OBJECTIVES: To report the incidence, site, and nature of injuries in amateur rugby league over three consecutive seasons. METHODS: Six hundred players registered with an amateur rugby league organisation were studied over three consecutive seasons. All injuries sustained during the amateur rugby league matches were recorded. Information recorded included the date and time of injury, name of injured player, anatomical site and nature of injury, and position of the player. RESULTS: The incidence of injury was 160.6 per 1000 player-position game hours, with forwards having a significantly higher incidence of injury than backs (182.3 per 1000 v 142.0 per 1000, chi2 = 14.60, df = 1, p<0.001). Over 25% of the total injuries (40.6 per 1000) sustained during the three year period were to the head and neck, while injuries to the face (21.3 per 1000, 13.3%), abdomen and thorax (21.3 per 1000, 13.3%), and knee (17.8 per 1000, 11.1%) were less common (chi2 = 21.83, df = 8, p<0.01). Muscular injuries (haematomas and strains) were the most common type of injury (45.7 per 1000, 28.5%, chi2 = 17.98, df = 7, p<0.05). Significantly more injuries occurred in the latter stages of the season (chi2 = 22.94, df = 1, p<0.001), with most injuries (70.8%, chi2 = 162.29, df = 1, p<0.001) sustained in the second half of matches. CONCLUSIONS: The results show that muscular injuries and injuries to the head and neck are the most commonly sustained injuries in amateur rugby league. Furthermore, injuries are more often sustained in the latter stages of the season and during the second half of matches. These findings suggest that fatigue or accumulative microtrauma, or both, may contribute to injuries in amateur rugby league players. Prevention Factors influencing tackle injuries in rugby union football. Garraway WM, Lee AJ, Macleod DA, Telfer JW, Deary IJ, Murray GD Alvie Epidemiology Associates, Aviemore, Inverness-shire, Scotland. OBJECTIVES: To assess the influence of selected aspects of lifestyle, personality, and other player related factors on injuries in the tackle. To describe the detailed circumstances in which these tackles occurred. METHODS: A prospective case-control study was undertaken in which the tackling and tackled players ("the cases") involved in a tackle injury were each matched with "control" players who held the same respective playing positions in the opposing teams. A total of 964 rugby matches involving 71 senior clubs drawn from all districts of the Scottish Rugby Union (SRU) were observed by nominated linkmen who administered self report questionnaires to the players identified as cases and controls. Information on lifestyle habits, match preparation, training, and coaching experience was obtained. A validated battery of psychological tests assessed players' trait anger and responses to anger and hostility. The circumstances of the tackles in which injury occurred were recorded by experienced SRU coaching staff in interviews with involved players after the match. RESULTS: A total of 71 tackle injury episodes with correct matching of cases and controls were studied. The following player related factors did not contribute significantly to tackle injuries: alcohol consumption before the match, feeling "below par" through minor illness, the extent of match preparation, previous coaching, or practicing tackling. Injured and non-injured players in the tackle did not differ in their disposition toward, or expression of, anger or hostility. Some 85% of tackling players who were injured were three quarters, and 52% of injuries occurred when the tackle came in behind the tackled player or within his peripheral vision. Either the tackling or tackled player was sprinting or running in all of these injury episodes. One third of injuries occurred in differential speed tackles--that is, when one player was traveling much faster than the other at impact. The player with the lower momentum was injured in 80% of these cases. Forceful or crunching tackles resulting in injury mostly occurred head on or within the tackled player's side vision. CONCLUSIONS: Attention should be focused on high speed tackles going in behind the tackled player's line of vision. Comparative information on the circumstances of the vast majority of tackles in which no injury occurs is required before any changes are considered to reduce injuries in the tackle. Occurrence of Cervical Spine Injuries During the Rugby Scrum M.J. Wetzler, MD, T. Akapata, BS, W. Laughlin, BS, A. S. Levy, MD The incidence of cervical spine injuries in each phases of rugby is well documented in the literature from other Rugby playing nations other than the US. A retrospective study was undertaken to document and analyze the occurrence of cervical spinal injuries in the rugby scrum in the United States from 1970 to 1995. The data was accumulated from reports collected by one of the authors (TA), as well as from information collected by the American Orthopedic Rugby Football Foundation (AORFA). Initially, the scrum was a tool to restart play after a dead ball or minor infraction. As rugby became more and more competitive the scrum became a powerful offensive as well as defensive tool. It is formed when the 8 forwards bind together in a pyramid formation. The scrum is made up of three integral rows of players. The front row consist of three players. A hooker who is supported and flanked by two props. The props are the foundation of the scrum and form two structural columns with their opponents to support the hooker and the rest of the scrum. Thirty-five injuries occurred during the scrum from 1970 to 1995. Twenty-two (63%) injuries occurred when the two opposing scrum came together (engagement) and 13 (37%) occurred when the scrum collapsed. In regards to position, hookers were responsible for 28 (80%) of the injuries, prop for 6 (17%) and a second row for one (3%) of the injuries. Twenty (60%) hookers were hurt during engagement and 8 (23%) when the scrum collapses. Two (6%) props were hurt during collapse and 4 (11%) during engagement. One second row (3%) was injured when a scrum collapsed. Significantly more injuries happen during engagement than collapse and hooker were injured significantly more than props. This study demonstrates the occurrence of cervical spine injuries in the scrum in the US. front row and prop require significant practice and skill to dissipate the forces generate at engagement of the scrum as well as during a sustain scrum. In addition, to prevent collapse the front rows must maintain a stable base as the scrums drive against each other to gain an advantage. In review of college programs and many senior clubs, coaching as well as facilities to practice scrummaging are limited. Only 50% of the colleges programs reviewed had either a coach or facilities to practice scrummaging. Effectiveness of external ankle support. Bracing and taping in rugby union. Hume PA, Gerrard DF Department of Sport and Exercise Science, University of Auckland, New Zealand. p.hume@auckland.ac.nz Ankle inversion sprain is common in rugby. This review outlines research evidence relating to the effects of external ankle support by means of bracing and taping, on the incidence of ankle injuries, how performance is affected by support, how support may act at the joint (with respect to end range of motion, strength, resistive torque, muscle activation patterns and proprioception) to prevent injury, and how exercise changes the effectiveness of support. In addition, the implications of the laws of rugby for the use of external support are discussed. Prospective epidemiological studies have shown a decrease in the incidence of ankle injury with external ankle support use. The effectiveness of external ankle support was dependent upon the material properties and application method of the tape or brace, and on the athlete's status of ankle stability or previous injury. Experimental studies have indicated that the degree of ankle inversion restriction provided, and the degree of loss of restriction after exercise, were dependent upon the external support tested. External ankle support has been reported to have no effect on performance, or to have an adverse effect on performance in a variety of movement tasks. No prophylactic external ankle support has been shown to improve performance. If an external support is to provide mechanical support to a ligament it should exceed the strength of the ligament, which for the anterior fibular ligament is a force limit of between 6 and 56 kg. Tape can provide only limited mechanical support of the ankle joint complex, but it may have proprioceptive effects. Taping may work as a psychological reminder, so that the athlete consciously moderates lower limb-loading behaviour. There is equivocal evidence of the effect of brace use on ground reaction force excursions, balance ability and ankle strength. It is concluded that while there have been many investigations of the effects of tape and some forms of brace on ankle range of motion with and without exercise, there is equivocal evidence regarding the mechanism by which an external support acts. It is recommended that future research address the effects of external ankle support during dynamic exercise and that brace manufacturers utilize the information in the development of future brace designs to help reduce the risk of ankle inversion sprain injury. As external support can decrease the incidence of ankle inversion sprain the International Rugby Board should consider the use of ankle braces in rugby, allowing for stiff lateral components of the brace. Padding in Rugby Union Gerrard DF School of Physical Education, University of Otago, Dunedin, New Zealand. In any contact sport where impact and collision are an accepted feature, the use of various forms of external padding has become more common. Rugby union players experience a combination of characteristic extrinsic forces through the acts of tackling and scrummaging. The laws which are part of the international regulation of rugby union only permit the wearing of certain, clearly delineated forms of padding. Only then is such padding permitted on medical recommendation, provided that this padding is attached to the body or sewn into the jersey. This article discusses the padding of the shoulders, shins and thighs of rugby union players and highlights the need to address these issues with respect to the increasing number of women who are now playing this sport, particularly in the Southern hemisphere. There is little evidence to show that shoulder pads decrease the incidence of severe shoulder injuries. However, well-fitting shoulder pads constructed of materials that effectively disperse the force of impact appear to reduce the effect of direct contact and reduce the potential for soft tissue damage. Shin guards that are made of light, soft, compliant materials are effective in reducing impact to the shin and thereby reduce the risk of bruising injuries which are common to the pretibial region. Similarly, thigh pads are considered to be able to modify the effects of direct contact forces to the anterior thigh where deep contusional injuries with the potential for myositis ossificans are well reported. Informed advice for women rugby players regarding the use of specific padding is unavailable at present. Current information is anecdotal and not confirmed by statistical studies or well-conducted research. In these circumstances, women rugby players should observe the same recommendations that apply to their male counterparts.