Severity and Significance: Injuries and Illnesses in a professional rugby club Jack Nash, Fourth Year Medical Student, University of Manchester

Dr David Jones, Head of Medicine Sale Sharks, Lead Physician EIS Northwest

Introduction

Levels of injury in rugby union have increased dramatically since the game became professional in the mid ‘90s[2]. Recent figures suggest that at a premiership club, 23% of the playing staff are unavailable for selection at any given time [3]. High profile examples show that injury prevention and reduction can be the difference between winning and losing. Analysis of injury data is extremely useful in predicting future injuries and when they may occur. Auditing the injuries and illnesses sustained in a 12 month period at Sale Sharks RFC (SSRFC) has enabled the tailoring of training and technique. The findings of this audit will help shape injury prevention programmes at the club.Method

A retrospective cohort study was carried out using the SSRFC 1st team squad in the 2011-2012 season. All of the injuries and illnesses that occurred in this time were included in the study. The definition of an injury or illness used was: any physical complaint that prevented a player from playing or training for 24 hours after the incident began [3].

The initial data was collected from: player consultations, input from the backroom staff and activity information listed on RugbySquad (a rugby performance management system).

The medical team were interviewed at the end of the season to clarify data. EPAS (the RFU auditing system) was searched to

access the notes of the players to add additional information to the end of season interviews.

A refined injury database was compiled from the above data. The injury data formed the basis of multidisciplinary team meetings

which were held to discuss the complex cases and their subsequent management.

Results

There was 153 incidents which ruled a player out of selection for a day or longer. 2287 days were missed, with a mean injury duration of 14.9 days. 70% (107) of all cases were injuries caused in contact situations, 20% (31) were injuries caused in non contact situations and 10% (15) of the cases were caused by illness. Each player, on average missed 57.2 days in the season (SD 26.5).

Conclusions

• This audit contributes to the already known facts about the role of contact in rugby union injuries.

• Severe injuries, proportionally account for a considerable number of total days missed.

• Relatively high incidence of medical illness in this audit suggests it is a cause of absence which should not be underestimated in elite sport.

• SSRFC medical team perform remarkably well in comparison to other premiership clubs, with almost half as many days missed compared to the league wide average [3].

• Prehabilitation, isokinetic analysis and injury prevention exercises are possible reasons for this at Sale Sharks RFC.

Fig.2 Mechanism of injuries

Impact injuries (collisions and the tackle area) account for 63.9% of all injuries sustained.

Data Collection Process

The most common injury site for Forwards was the shoulder, with a mean injury length of 43.5 days. For Backs, the knee was the most common injury site, with a mean of 20.3 days missed.

(1)Jackson P. Medics say early return could risk Jonny’s career. http://www.dailymail.co.uk/sport/rugbyunion/article-480193/Medics-say-early-return-risk-Jonnys-career.html (accessed 18 September).(2)Garraway W, Lee A, Hutton S. Impact of professionalism on injuries in rugby union. British Journal of Sports Medicine 2000. Volume 35. 348-351. (3)Brooks JH, Fuller CW, Kemp SPT. Epidemiology of injuries in English professional rugby union: part 1 match injuries. British Journal of Sports Medicine 2005. Volume 39. 757-766.

Fig.3 Injury site and mean days missed - Nowhere is spared in rugby union!

An absence greater than 28 days was deemed significant. Of the injuries and illnesses, 15% (23) were considered to be significant and 85% (130) were deemed non-significant. Despite this low number of significant injuries, the severity of these was such that they accounted for a large proportion of total days missed (38.2%). The ever increasing size and speed of the modern player suggest this trend is likely to continue. The above data emphasises the importance of medical care in rugby union.

Fig.4a Percentage of significant vs. non-significant injuries

Fig.1 - A sign of the times? [1]

Fig.4b Percentage of days missed by injury significance