Rugby injury surveillance and prevention programmes: are they effective?

Since rugby union became a professional sport in 1995 its popularity has increased such that the Six Nations Championship in 2014 had a higher average attendance per game than either the UEFA Euro Cup 2012 or the FIFA World Cup 2014. 2 3 Rugby (both union and league) is the third most popular team contact sport worldwide. Rugby union is played in around 120 countries and rugby league in around 40. 6 England has the largest number of rugby union players in the world—over two million, which is almost 40% of the world total. The high rates of injury in rugby union and rugby league for professional and amateur players, including children, are well established and a cause for medical concern. Around 12% of child and adolescent rugby players sustain an injury severe enough to require at least seven days’ absence from playing in a season.Ameta-analysis of rugby injuries among adult rugby union players found an overall incidence of injury of 81 per 1000 player hours, three times that of child and adolescent players (26.7 per 1000 player hours). So adult players can expect to be injured once every 9.3 matches on average, assuming that each match is 80 minutes long. Recent high profile cases have exposed the mismanagement of concussion on the rugby field, sometimes with fatal consequences. 16 The risk of concussion and reduced cognitive and motor function in later life is also high in other collision sports including American football and ice hockey. 18 19 In the United States a settlement of at least $1bn (£680m; €940m) has been granted preliminary approval by the judge in a case against the National Football League brought by former players over failure to inform them of the risks of concussion. Multiple autopsy findings reveal chronic traumatic encephalopathy in the brains of former professional wrestlers and players of American football, ice hockey, and rugby. 21 22 The aim of this paper is to establish whether rule changes and injury prevention strategies around the world have been successful in reducing injury rates in rugby. Collecting data