Rugby World Cup 2019 injury surveillance study.

Background: Full contact team sports, such as rugby union, have high incidences of injury. Injury surveillance studies underpin player welfare programmes in rugby union. Objective: To determine the incidence, severity, nature and causes of injuries sustained during the Rugby World Cup 2019. Methods: A prospective, whole population study following the definitions and procedures recommended in the consensus statement for epidemiologic studies in rugby union. Output measures included players' age (years), stature (cm), body mass (kg), playing position, and group-level incidence (injuries/1000 player-hours), severity (days-absence), injury burden (days absence/1000 player-hours), location (%), type (%) and inciting event (%) of injuries. Results: Overall incidences of injury were 79.4 match injuries/1000 player-match-hours (95% CI: 67.4 to 93.6) and 1.5 training injuries/1000 player-training-hours (95% CI: 1.0 to 2.3). The overall mean severity of injury was 28.9 (95% CI: 20.0 to 37.8) days absence during matches and 14.8 (95% CI: 4.1 to 25.5) days absence during training. The most common locations and types of match injuries were head/face (22.4%), posterior thigh (12.6%), ligament sprain (21.7%) and muscle strain (20.3%); the ankle (24.0%), posterior thigh (16.0%), muscle strain (44.0%) and ligament sprain (16.0%) were the most common locations and types of injuries during training. Tackling (28.7%), collisions (16.9%) and running (16.9%) were responsible for most match injuries and non-contact (36.0%) and contact (32.0%) rugby skills activities for training injuries. Conclusion: The incidence, severity, nature and inciting events associated with match and training injuries at Rugby World Cup 2019 were similar to those reported for Rugby World Cups 2007, 2011 and 2015.

Modeling the impact of players' workload on the injury-burden of English Premier League football clubs.

The loss of players through injury is known to affect team performance in many sports; it is important, therefore, for professional teams to be able to quantify the likely injury-burden that will be encountered throughout a season. A kinetic model, based on the rates at which match and training injuries are sustained and resolved, a team's squad size and the 2017/2018 season fixture schedule for teams competing in the English Premier League, is used to produce daily forecasts of injury-burden experienced by a typical team. The incidences and median severities of match (incidence: 26.9 injuries/1000 player-match hours, 95% CI: 21.5-33.7; severity: 17.5 days, 95% CI: 13.0-28.0) and training (incidence: 4.3 injuries/1000 player-training hours, 95% CI: 3.4-5.5; severity: 14.0 days, 95% CI: 11.0-22.0) injuries were determined using data collected from four English Premier League football clubs during the 2016/2017 season. Time-to-recovery curves for the match and training injuries sustained in the Premier League closely matched the time-to-recovery curves predicted by the kinetic model used in this study. The kinetic model predicted higher match and lower training injury burdens and a higher overall injury burden for successful teams competing in both national and European club competitions compared to teams competing only in national competitions. The model also showed that, in terms of injury-burden, there were no benefits in adopting a 4-week mid-season break during the season: reducing the number of clubs competing in the Premier League would, however, reduce the overall injury burden during a season.

Comparison of injuries sustained on artificial turf and grass by male and female elite football players.

The objective of this study was to compare incidences and patterns of injury for female and male elite teams when playing football on artificial turf and grass. Twenty teams (15 male, 5 female) playing home matches on third-generation artificial turf were followed prospectively; their injury risk when playing on artificial turf pitches was compared with the risk when playing on grass. Individual exposure, injuries (time loss) and injury severity were recorded by the team medical staff. In total, 2105 injuries were recorded during 246,000 h of exposure to football. Seventy-one percent of the injuries were traumatic and 29% overuse injuries. There were no significant differences in the nature of overuse injuries recorded on artificial turf and grass for either men or women. The incidence (injuries/1000 player-hours) of acute (traumatic) injuries did not differ significantly between artificial turf and grass, for men (match 22.4 v 21.7; RR 1.0 (95% CI 0.9-1.2); training 3.5 v 3.5; RR 1.0 (0.8-1.2)) or women [match 14.9 v 12.5; RR 1.2 (0.8-1.8); training 2.9 v 2.8; RR 1.0 (0.6-1.7)]. During matches, men were less likely to sustain a quadriceps strain (P=0.031) and more likely to sustain an ankle sprain (P=0.040) on artificial turf.

Consensus statement on epidemiological studies of medical conditions in tennis, April 2009.

BACKGROUND: The reported incidence, severity and nature of injuries sustained in tennis vary considerably between studies. While some of these variations can be explained by differences in sample populations and conditions, the main reasons are related to differences in definitions and methodologies employed in the studies. OBJECTIVE: This statement aims to review existing consensus statements for injury surveillance in other sports in order to establish definitions, methods and reporting procedures that are applicable to the specific requirements of tennis. DESIGN: The International Tennis Federation facilitated a meeting of 11 experts from seven countries representing a range of tennis stakeholders. Using a mixed methods consensus approach, key issues related to definitions, methodology and implementation were discussed and voted on by the group during a structured 1-day meeting. Following this meeting, two members of the group collaborated to produce a draft statement, based on the group discussions and voting outcomes. Three revisions were prepared and circulated for comment before the final consensus statement was produced. RESULTS: A definition of medical conditions (injuries and illnesses) that should be recorded in tennis epidemiological studies and criteria for recording the severity and nature of these conditions are proposed. Suggestions are made for recording players' baseline information together with recommendations on how medical conditions sustained during match play and training should be reported. CONCLUSIONS: The definitions and methodology proposed for recording injuries and illnesses sustained during tennis activities will lead to more consistent and comparable data being collected. The surveillance procedures presented here may also be applicable to other racket sports.

An empirical approach for defining acceptable levels of risk: a case study in team sports.

OBJECTIVES: To determine acceptable levels of risk in sport and to compare these with values used in occupational settings. DESIGN: Cross-sectional, questionnaire-based study. SETTINGS: Seven soccer and 11 rugby union teams. SUBJECTS: 140 male athletes and 108 male and 100 female spectators associated with soccer and rugby union teams. MAIN OUTCOMES: Views on acceptable frequencies with which athletes sustain acute injuries of various levels of severity. RESULTS: The responses of athletes and spectators were similar, although spectators consistently indicated a higher acceptable frequency of injury than athletes. There were no significant differences in responses as a function of respondents' gender and age. The results confirmed an inverse relationship between the acceptable frequency of occurrence and the severity of injury, although the relationships identified by the risk-averse and risk-taking minorities within the sample population were widely different. CONCLUSION: The mean frequency-severity risk relationship identified by athletes and spectators in soccer and rugby was similar to the relationship routinely used for risk assessments in industry and commerce.

International Rugby Board Rugby World Cup 2007 injury surveillance study.

OBJECTIVE: to determine the incidence, nature and causes of injuries sustained during the International Rugby Board (IRB) Rugby World Cup 2007. DESIGN: Pospective, whole-population survey. POPULATION: 626 international rugby players representing 20 teams competing at the IRB Rugby World Cup 2007 in France. METHODS: The survey followed the international consensus procedures for studies of injuries in rugby union; the main outcome measures were incidence of match and training injuries (number of injuries/1000 player hours), severity (days absence), location, type and cause of injury. RESULTS: the incidence of injuries was 83.9/1000 player-match hours (forwards 84.0; backs 83.7) and 3.5/1000 player-training hours (forwards 3.5; backs 3.6). The average severity of injuries was 14.7 days (forwards 14.0; backs 15.5) during matches and 17.8 (forwards 15.9; backs 19.8) during training. Lower limb muscle and ligament injuries were the main injuries during both matches and training. Most injuries were sustained in the tackle during matches and in full-contact skills activities during training. CONCLUSIONS: This study shows the application of the methodology described in the international consensus statement on injury surveillance studies in rugby union and provides benchmark values for the incidence, severity, nature and causes of match and training injuries sustained during the IRB Rugby World Cup.

Tackle mechanisms and match characteristics in women's elite football tournaments.

BACKGROUND: Several tools have been used for assessing risk situations and for gathering tackle information from international football matches for men but not for women. PURPOSE: To analyse activities in women's football and to identify the characteristics and risk potentials of tackles. STUDY DESIGN: Retrospective video analysis. METHOD: Video recordings of 24 representative matches from six women's top-level tournaments were analysed for tackle parameters and their risk potential. RESULTS: 3531 tackles were recorded. Tackles in which the tackling player came from the side and stayed on her feet accounted for nearly half of all challenges for the ball in which body contact occurred. 2.7% of all tackles were classified as risk situations, with sliding-in tackles from behind and the side having the highest risk potential. Match referees sanctioned sliding-in tackles more often than other tackles (20% v 17%, respectively). Tackle parameters did not change in the duration of a match; however, there was an increase in the number of injury risk situations and foul plays towards the end of each half. CONCLUSIONS: Match properties provide valuable information for a better understanding of injury situations in football. Staying on feet and jumping vertically tackle actions leading to injury were sanctioned significantly more times by the referee than those not leading to injury (p<0.001), but no such difference was seen for sliding-in tackles (previously reported to have the highest injury potential in women's football). Therefore, either the laws of the game are not adequate or match referees in women's football are not able to distinguish between sliding-in tackles leading to and those not leading to injury.

Causation of injuries in female football players in top-level tournaments.

BACKGROUND: Analyses of tackle parameters in injury situations have provided valuable information regarding men's football. However, there are no similar data for women's football. OBJECTIVE: To categorise the tackle mechanisms leading to injury in elite women's football. STUDY DESIGN: Retrospective video analysis of injury situations. METHODS: Events associated with all reported injuries during six women's top-level tournaments were analysed on video recordings for tackle parameters. RESULTS: More than half of all injuries were due to tackles from the side (52%, 103/200), whereas tackles from behind were much less commonly involved in injury situations (11%, 21/200). One-footed (65%, 130/200) and upper body (21%, 42/200) tackle actions were most common. Sliding-in tackles leading to injury were the least likely to be sanctioned by match referees. Tackling players (45%, 90/200) were almost as likely to be injured as the tackled player (55%). CONCLUSION: The present study found differences between injury mechanisms in women's football and previously published data on men's football. Further research, especially using video analysis, is needed for a better understanding of risk situations in football.

Preparticipation medical evaluation in professional sport in the UK: theory or practice?

OBJECTIVE: To determine the level of pre-employment, pre-season, and post-injury medical evaluation of players undertaken within UK professional team sports. DESIGN: A postal, whole population survey. SETTING: Elite professional sports teams in England. POPULATION: Six groups comprising the following clubs: professional football (Premiership, 15 of 20; Championship, 22 of 24), rugby union (Premiership, 9 of 12; Division 1, 11 of 14), rugby league (Super League, 6 of 11) and cricket (County, 12 of 18). MAIN OUTCOME MEASURES: Number (percentage) of clubs recording players' medical history and undertaking medical examinations of players' cardiovascular, respiratory, neurological, and musculoskeletal systems at pre-employment, pre-season and post-injury. RESULTS: The overall response to the survey was 74%, with a range from 55% to 92% among groups. Almost 90% of football (Premiership and Championship) and rugby union (Premiership) clubs took a pre-employment history of players' general health, cardiovascular, respiratory, neurological, and musculoskeletal systems, but fewer than 50% of cricket and rugby union (Division 1) clubs recorded a history. The majority of football (Premiership and Championship) and rugby union (Premiership) clubs implemented both cardiovascular and musculoskeletal examinations of players before employment. Fewer than 25% of clubs in any of the groups implemented neurological examinations of players at pre-employment, although 100% of rugby union (Premiership) and rugby league clubs implemented neurological testing during pre-season. CONCLUSIONS: None of the sports implemented best practice guidelines for the preparticipation evaluation of players at all stages of their employment. Departures from best practice guidelines and differences in practices between clubs within the same sport leave club physicians vulnerable if their players sustain injuries or ill health conditions that could have been identified and avoided through the implementation of a preparticipation examination.

Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union.

Wide variations in the definitions and methodologies used for studies of injuries in rugby union have created inconsistencies in reported data and made interstudy comparisons of results difficult. The International Rugby Board established a Rugby Injury Consensus Group (RICG) to agree on appropriate definitions and methodologies to standardize the recording of injuries and reporting of studies in rugby union. The RICG reviewed the consensus definitions and methodologies previously published for football (soccer) at a meeting in Dublin to assess their suitability for and application to rugby union. Following this meeting, iterative draft statements were prepared and circulated to members of the RICG for comment; a follow-up meeting was arranged in Dublin at which time all definitions and procedures were finalized. At this stage, all authors confirmed their agreement with the consensus statement. The agreed-on document was presented to and approved by the International Rugby Board Council. Agreement was reached on definitions for injury, recurrent injury, nonfatal catastrophic injury, and training and match exposures together with criteria for classifying injuries in terms of severity, location, type, diagnosis, and causation. The definitions and methodology presented in this consensus statement for rugby union are similar to those proposed for football. Adoption of the proposals presented in this consensus statement should ensure that more consistent and comparable results will be obtained from studies of injuries within rugby union.

Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries.

Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football injuries; this has made inter-study comparisons difficult. An Injury Consensus Group was established under the auspices of FIFA Medical Assessment and Research Centre. Using a nominal group consensus model approach, a working document that identified the key issues related to definitions, methodology and implementation was discussed by members of the group during a 2-day meeting. Following this meeting, iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis and causation are proposed. Proforma for recording players' baseline information, injuries and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented. The definitions and methodology proposed in the consensus statement will ensure that consistent and comparable results will be obtained from studies of football injuries.

Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries.

Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries, making interstudy comparisons difficult. Therefore an Injury Consensus Group was established under the auspices of Fédération Internationale de Football Association Medical Assessment and Research Centre. A nominal group consensus model approach was used. A working document on definitions, methodology, and implementation was discussed by the group. Iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity, and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players' baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented.

Quantifying the functional rehabilitation of injured football players.

OBJECTIVE: To determine whether quantified, auditable records of functional rehabilitation can be generated using subjective assessments of players' performance in fitness tests routinely used in professional football. METHOD: Ten sequential test elements grouped into three phases (fitness, ball and match skills, match pace football) were used to monitor players' functional recovery from injury. Physiotherapists subjectively assessed players' performance in each test element using a six point subjective rating scale. Satisfactory performance in each element of the assessment programme added 10% to the injured player's recovery score. Daily recovery scores for injured players were recorded against the time spent in functional rehabilitation. RESULTS: Rehabilitation data for 118 injuries sustained by 55 players over two seasons were recorded. The average time in functional rehabilitation depended on the time spent in pre-functional rehabilitation and the nature and location of injury. Benchmark functional rehabilitation curves (y = mln(x) + c) were developed for thigh (n = 15) and lower leg (n = 8) muscle strains and knee (n = 7) and ankle (n = 9) ligament sprains (R(2) = 0.95-0.98). CONCLUSIONS: A structured, quantified rehabilitation programme based on routine fitness and skills exercises and a graded subjective assessment of performance provides an auditable record of a player's functional recovery from a range of lower limb injuries and a transparent exit point from rehabilitation. The proposed method provides a permanent record of the functional rehabilitation of players' injuries and evidence based data to support management's return to play decisions.

Epidemiology of injuries in English professional rugby union: part 2 training Injuries.

OBJECTIVES: To undertake a detailed epidemiological study of training injuries sustained by professional rugby union players in order to define their incidence, nature, severity, and causes. METHODS: A two season prospective design was used to study training injuries associated with 502 rugby union players at 11 English Premiership clubs. Team clinicians reported all training injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury. Training exposures for individual players were recorded on a weekly basis. Loss of time from training and match play was used as the definition of an injury. RESULTS: The overall incidence of injury was 2.0 per 1000 player-hours, and each injury resulted on average in 24 days lost time. Recurrences, which accounted for 19% of injuries, were more severe (35 days) than new injuries (21 days). Twenty two per cent of all training occurred during the preseason but 34% of all injuries were sustained in this period. Hamstring, calf, hip flexor/quadriceps, and adductor muscle injuries were the most common for backs, whereas hamstring, lateral ankle ligament, and lumbar disc/nerve root injuries predominated for forwards. Lumbar disc/nerve root, shoulder dislocation/instability, and hamstring muscle injuries for forwards and hamstring muscle and anterior cruciate ligament injuries for backs caused the greatest number of days absence. Running was the predominant cause of injury for both forwards and backs, although the overall incidence and severity of injuries sustained during skills training were significantly greater than those sustained during conditioning training. CONCLUSIONS: On average, a club will have 5% of their players unavailable for selection as a consequence of training injuries.

Epidemiology of injuries in English professional rugby union: part 1 match injuries.

OBJECTIVES: To undertake a detailed, large scale epidemiological study of match injuries sustained by professional rugby union players in order to define their incidence, nature, severity, and causes. METHODS: A two season prospective design was used to study match injuries associated with 546 rugby union players at 12 English Premiership clubs. Team clinicians reported all match injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury. Match exposures for individual players were recorded on a weekly basis. Loss of time from training and match play was used as the definition of an injury. RESULTS: The overall incidence of injury was 91 injuries/1000 player-hours, and each injury resulted on average in 18 days lost time. Recurrences, which accounted for 18% of injuries, were significantly more severe (27 days) than new injuries (16 days). Thigh haematomas were the most common injury for forwards and backs, but anterior cruciate ligament injuries for forwards and hamstring injuries for backs caused the greatest number of days absence. Contact mechanisms accounted for 72% of injuries, but foul play was only implicated in 6% of injuries. The ruck and maul elements of the game caused most injuries to forwards, and being tackled caused most injuries to backs. The hooker and outside centre were the playing positions at greatest risk of injury. CONCLUSIONS: On average, a club will have 18% of their players unavailable for selection as a consequence of match injuries.

A six year prospective study of the incidence and causes of head and neck injuries in international football.

OBJECTIVE: To identify those risk factors that have the greatest impact on the incidence of head and neck injuries in international football. METHOD: A case-control study of players sustaining head and neck injuries during 20 FIFA tournaments (men and women) from 1998 to 2004. Video recordings of incidents were used to identify a range of parameters associated with the incidents. Team physicians provided medical reports describing the nature of each injury. chi2 tests (p< or =0.01) and 95% confidence intervals were used to assess differences in distribution and incidence of injury, respectively. RESULTS: In total, 248 head and neck injuries were recorded of which 163 were identified and analysed on video sequences. The commonest injuries were contusions (53%), lacerations (20%), and concussions (11%). The incidence of all head and neck injuries was 12.5/1000 player hours (men 12.8, women 11.5) and 3.7 for lost-time injuries (men 3.5, women 4.1). The commonest causes of injury involved aerial challenges (55%) and the use of the upper extremity (33%) or head (30%). The unfair use of the upper extremity was significantly more likely to cause an injury than any other player action. Only one injury (a neck muscle strain) occurred as a result of heading the ball throughout the 20 tournaments equivalent to 0.05 injuries/1000 player hours. CONCLUSIONS: Players' actions most likely to cause a head or neck injury were the use of the upper extremity or the head but in the majority of cases these challenges were deemed to be fair and within the laws of the game.

A prospective study of injuries and training amongst the England 2003 Rugby World Cup squad.

OBJECTIVES: To assess the aetiology, incidence, severity, and causes of injuries to England rugby union players during preparation for and participation in the 2003 Rugby World Cup. METHOD: A 63 week prospective design was employed to study the training practices and injuries of England rugby players. The team physician reported all training and match injuries and provided details of the location, diagnosis, severity, and mechanism of each injury. The team fitness coach reported details of the number and duration of training sessions and the time dedicated to rugby and conditioning training. Players' stature, body mass, and skinfolds were measured at the beginning and end of the study period. RESULTS: The overall incidence of injury was 17 injuries/1000 h of exposure (match: 218 injuries/1000 h; training: 6.1 injuries/1000 h). The major locations of injuries were the lower (60%) and upper (17%) limbs and the most common diagnoses were muscle and tendon (50%) and joint (non-bone) and ligament (41%) injuries. The highest incidences of match injuries occurred whilst being tackled (50 injuries/1000 h) and in a ruck or maul (35 injuries/1000 h), whilst the greatest incidences of training injuries occurred during endurance running (24 injuries/1000 h) and contact activities (20 injuries/1000 h). Players' average body mass increased and skinfold measurement decreased significantly over the study period. CONCLUSIONS: The incidence of match injuries at international level was found to be higher than previously reported. The tackle, ruck, and maul elements of match play and the endurance running and contact elements of training presented the highest risk of injury for all players.

An assessment of player error as an injury causation factor in international football.

OBJECTIVE: To quantify the frequency of injury in football as a function of tackle parameters. METHOD: Video recordings of 123 international matches in three Federation Internationale de Football Association tournaments were used to analyze tackle parameters, and team physicians provided reports of postmatch medical attention to players. RESULTS: A total of 8572 tackles were assessed, of which 3464 (40.4%) were fouls. There were 299 incidents of on-pitch medical attention, of which 131 (44%) resulted from foul tackles, and 200 postmatch team physicians' reports, of which 96 (48%) resulted from foul tackles. The cases of on-pitch medical attention resulted in 76 (25%) postmatch physicians' reports, but 124 (62%) of the postmatch physicians' reports were not associated with on-pitch medical attention. Tackled players received 74% of the postmatch medical reports. Tackle types with the greatest probability of requiring medical attention were from the side in terms of tackle direction, jumping vertically in terms of tackle mode, and a clash of heads in terms of tackle action. CONCLUSION: Human error on the part of players during the process of tackling and inadequacies in the laws of football and/or their application by match referees were equally responsible for the high levels of injury observed.