England Rugby Injury & Training Audit 2008-09 - Key Findings
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769 match injuries at Guinness Premiership clubs were reported - an average of two injuries per club per match.
Likelihood of sustaining a match injury increased by 20% in 2008-09 compared with 2007-08, but was the same level as the 2002-3 season. This equates to an extra 0.3 injuries per club per match or 119 extra injuries compared with 2007-8.
Average numbers of days absence as a result of each match injury increased to 23 days in 2008-9 compared with 19 in 2007-8.
Consequently, the total number of days absence as a result of match injury increased by 42% to 2285 days/1000hrs in 2008-9 compared with 1613 days absence/1,000 hrs in 2007-8 - the highest level reported since the study began in 2002-3.
Significant rise in the number of days lost as a result of match knee anterior cruciate ligament (ACL) injuries (117 to 232 days lost/1,000 hrs), match knee medial collateral ligament (MCL) injuries (88 to 154 days lost/1,000 hrs) and match hamstring injuries (74 to 138 days lost/1,000 hrs).
258 training injuries at Guinness Premiership clubs reported - an average of 22 training injuries per club per season.
The likelihood of sustaining an injury during both rugby skills and strength and conditioning training was reduced in 2008-09 by 19% compared with 2007-08.
The total day's absence from playing and training as a result of a training injury sustained during rugby skills and strength and conditioning remained similar to 2007-08 .
England Senior side
Note: The study includes data from the Elite squad training camp, Autumn Internationals, Six Nations and Argentina summer tour. However the relatively small number of senior England training sessions in the study makes the differences seen in this group much more likely to have arisen by chance rather than to be the result of a true difference.
In a match situation there were a total of 23 injuries in the senior England side compared to 55 in 2007/8 but given the smaller numbers involved there is no statistical change in risk year on year.
The likelihood, the average severity of injury and the total days absence as a result of injury sustained whilst playing for the England Senior side all reduced significantly in 2008-09 compared to 2007-08 and was the lowest since the study began in 2002-3.
Compared to 2007-08, there was a reduction from 7.3/1,000 hrs to 6.5/1,000 hrs in the incidence of rugby skill training injuries for the England Senior side but an increase in strength and conditioning incidence from 2.5/1,000 hrs to 12.1/1,000 hrs.
Largely as a result of two severe injuries which skewed the numbers, the average severity and total day's absence for both England Senior rugby skills training injuries and strength and conditioning injuries increased.
Actions resulting from the 2008-9 audit
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Injury audit data collection will be integrated with the enhanced electronic player medical record keeping system (EPAS Medical), whose use will be mandatory for all elite players, for the season 2011-12. This will allow both more comprehensive and injury specific data capture and will also allow illnesses also to be reported. This enhanced system of data collection will be piloted during the 2010-11 season prior to implementation for 2011-12.
Integration of the injury audit with a structured video analysis of the structure of the elite game and game injury events is needed to provide a better understanding of the relationship between changes in the frequency and nature of contact events, the overall shape of the game and injury risk.
Risk evaluation, treatment and prevention
A multidisciplinary working group will be created representative of all stakeholders across all rugby disciplines within the Elite Game (to include players, elite coaches, medical staff, S&C, referees, discipline, law makers and administrators) in England to accept, consider and evaluate research and injury data and risk, consider injury risk mitigation approaches and to monitor and make proposals to the Professional Game Board on the shape of the elite game.
A multidisciplinary working group will be tasked to:
- minimise the nature of match injury risk by systematic review and analysis of existing laws. This will involve working closely with the existing Laws Group to scope any proposals to potentially amend the laws of the game from a safety perspective
- Review how best to optimise players' skills and techniques from a safety perspective by refining coaching practices whilst maximising performance
- Optimise the extent players are exposed to the risk of injury to plan appropriate training and playing commitments and ensure adequate recovery
- Use injury audit data and evidence from projects to minimise injury risk by ensuring that the laws of the game are consistently applied. This will involve close liaison with the IRB
Integrated conditioning and medical programmes will be designed to protect players from injury. Priority will be given to developing prevention, treatment and rehabilitation strategies for the highest risk match injuries - shoulder dislocation and instability, ACL injury, MCL injury, hamstring muscle injury, knee meniscal cartilage/articular cartilage injury.
Undertake a structured analysis using video footage to assess the injury mechanism of match Knee Anterior Cruciate Ligament (ACL) injuries and Knee Medial Collateral Ligament injuries (MCL) injuries and in particular establish the extent to which these injuries are contact or non contact injuries. This will inform prevention initiatives.
Undertake a detailed analysis of current elite game medical and strength and conditioning staff practices regarding hamstring injury prevention, diagnosis, treatment and rehabilitation should now be undertaken.
Continue to improve diagnosis, treatment and rehabilitation processes to reduce days lost from the injuries that cause the longest absences.
Ensure appropriate resources to include facility and personnel resources to develop and deliver injury risk management on the ground at clubs.
Extending the use of Global Positioning System (GPS) technology already use by the RFU for fitness evaluation into the area of training and match workload and the prevention of injury.