Identifying risk factors for severe injuries in rugby players

Abstract

The game of rugby is physically demanding with many physical collisions and tackles leading to musculoskeletal injuries. The players require not only a wide range of individual skills but also well-developed fitness qualities. The role of physical fitness however, in the prevention of injury is not well understood. Due to the high incidence of severe injuries and the consequences, it is critical to identify risk factors to develop adequate injury prevention strategies. Therefore, the purpose of this study was to determine the influence of physical fitness parameters on the risk of severe injuries in rugby players in different levels of play and in different formats. Two prospective studies were conducted in this study. In season 2014-15, a study was conducted to amateur athletes on rugby-7s teams which included 104 university rugby players (90M : 14F) aged 20.6 ± 1.9 years (mean ± SD). For season 2015-16, another study was conducted on 135 rugby-15s players which included 74 semi-professional players (47M: 27F) and 61 amateur players (44M: 17F) aged 24.1 ± 4.00 years. Players underwent pre-season assessments of power, strength, speed, agility, endurance, stability and flexibility. Throughout the season, rugby-related injury and exposure data were collected. Potential predictor variables were analyzed using Cox regression model to identify risk factors associated with severe injuries (time loss > 28 days). The findings of the study revealed that the incidence of severe injuries for the match in amateur rugby-7s players was 22.2/1000 player hours and in rugby-15s was 14.7 and 12.8/1000 player hours for amateur and semi-professional players respectively. For amateur rugby 7-s players, female gender (adjusted hazard ratio [HR] = 8.35; 95% confidence intervals [CI] = 2.01-34.8), slower (adjusted HR = 3.51; 95% CI = 1.17-10.5) and less agile (adjusted HR = 2.22; 95% CI =1.26-3.92) players as well as players with hip flexors tightness (adjusted HR = 1.12; 95% CI = 1.00-1.25) were at significantly greater risk of sustaining severe injuries. For amateur rugby-15s players, those with greater body weight (adjusted HR = 6.84; 95% CI = 1.8-26.3) and poorer balance ability (adjusted HR = 4.38; 95% CI = 1.1-17.9) were at significantly higher risk of severe injuries. There was no significant predictor for severe injuries in semi-professional players. These findings highlight the importance of pre-season screening for amateur players to identify athletes who are at higher risk of injury; that may have implications towards injury prevention. The development of gender-specific injury prevention measures that emphasize speed and agility for rugby-7s players and balance training for rugby-15s players may be important to reduce the risk of severe injuries.