2023-08-18 14:22:15
Rugby injury epidemiology
Rugby is a pivotal contact sport, as well as football, basketball, handball and combat sports. “It’s a ball sport, which can be likened to a collective combat sport and it’s above all a collision sport” summarizes Dr. Miniot. However, the main causes of injury in XV rugby are the impacts.
“At a high level, we have an estimate of collisions between players thanks to GPS placed in the back between the shoulder blades. Impacts can reach 20 G forces between the players, which is enormous” explains the sports doctor. For comparison, a shock of 35 G corresponds to the collision of a damaged car traveling at 65 km / h!
Many epidemiological surveys have been made on the incidence of rugby injuries.
Epidemiological studies show 2 things: the frequency and severity of injuries vary enormously depending on the level of play, the position in which one plays, and the sex of the player. Dr Miniot.
The risk of injury as a professional is thus 40 times higher than that of a child in rugby schooland scrum players (first, second and third line) are more at risk of injury than three-quarters.
Finally, and as one might expect, the frequency and severity of traumatic injuries in women’s rugby practice are significantly lower than those in men’s practice. This can be explained by the fact that the women’s game is much more focused on running in the intervals and on the game of avoidance than on direct confrontation.
The seriousness of an injury is assessed, among other things, by the duration of the player’s unavailability. “A wound like operated shoulder dislocation leads 4 to 5 months player downtimewhich makes her a serious injury” underlines the doctor.
In professional rugby for men, there are 200 weeks off per yeareither 5 weeks per player on average.
The most common rugby injuries
In professional rugby, the incidence of injuries ranges from 30 to 91, or even 120, per 1,000 match hours according to epidemiological studies. The lower limb is the site most frequently affected in matches (30 to 55% of injuries), followed head and cervical spine (14 to 30%), then of the upper limb (15 to 20 %) and finally of the trunk (10 to 14%) (1).
Contacts (tackles) and scrums are responsible for 90% of injuries.
Knee and cruciate ligament injuries
The knee is particularly exposed to rugby, and is therefore the seat of many injuries.
Knee injuries are varied and range from meniscal lesions, to ligament lesions, to fractures, or even to a combination of the 3.
The rupture of the anterior cruciate ligament is frequent, and is an obsession of the players because it must always be operated on at a high level, and it leads to an unavailability of 9 months on average but which can go up to 2 years. Dr Miniot.
Rupture of the cruciate ligament can be isolated, or associated with other lesions : sprain or rupture of the lateral ligaments, meniscal lesions, sprain or rupture of the posterior cruciate ligaments or fracture of the tibial plateaus.
Knee injuries can also be less serious, like a simple sprain of the internal lateral ligament, leading to 3 weeks to 3 months of unavailability “only”.
Cervical injuries
THE cervical spine injuries in rugby are frequent and dreaded. They mainly take place during scrums (entry into scrum, open scrum or fall in scrum) and tackles,
It is generally contusion, benign sprains or osteoarthritic degeneration due to repeated traumatisms which can go as far as cervicarthrotic myelopathy.
“Severe sprains with spinal cord involvement are fortunately rare. They can cause transient tetraplegia, and exceptionally permanent tetraplegia. On average, there are one to two spinal cord injuries per year at most,” says Dr Miniot.
But these figures have dropped considerably over the past decade thanks to an adaptation of the rules by the French rugby federation in order to reduce the number of accidents.
The main change is to the distance before melee players enter, which was previously approximate, but quite high. From 2007, in order to reduce the distance between the first two lines, players are obliged to touch the shoulder of their vis-à-vis before entering the scrum. Recently, melee entry is done by placing oneself, which prohibits the violent “head to head” entries of the past. The players are obliged to push in the axis and keep their trunk parallel to the ground in order to limit the risk of collapses.
Shoulder injuries
THE shoulder injuries account for 9 to 11% of rugby player injuries et 65% of upper limb lesions.
The two most common are:
- Acromioclavicular sprain : which occurs during a direct impact on the shoulder or an indirect trauma with a fall on the arm in extension. “There are 4 stages of different severity: the first two can be treated medically, and the second two requiring surgical treatment” indicates the sports doctor,
- shoulder dislocation : which is a real problem for the professional player, because it must be operated almost systematically, without which the recurrence occurs in more than 2/3 of the cases. The injury involves 4 to 5 months of unavailability in competition.
Shoulder dislocations are 5 times greater in rugby players than in the general population.
The rugby player is also subject tocollarbone fracturegenerally resulting from a fall on the shoulder.
Head and face injuries
And rugby, the face is not protectedand is therefore very exposed to shocks and injuries.
We see everything: facial wounds, openings in the superciliary arch, dental lesions (dislocation, enucleation, fractures, etc.), jaw dislocations, corneal damage, orbital floor fractures, etc. .Dr Miniot.
These are essentially the same injuries that can be found following a fight or a car accident.
Ankle and foot injuries
During peaks of speed or sudden changes of direction, or in the event of a tackle, the ankles can be affected. The most common lesions are then:
– THE fractures of the external or internal malleolusor bi-malleolar fractures,
– THE sprainscaused by forced inversion of the foot,
– THE lesions of the tibiofibular syndesmosisnamely the lower joint between the tibia and the fibula.
Depending on the degree of seriousness, these injuries may require surgery and result in more or less significant unavailability of the player.
Fractures and ruptures of the Achilles tendon are rarer in rugby.
Concussion: potentially very serious
Concussion is a scary word in the world of rugby, because it can lead to more or less debilitating and serious neurological sequelae.
Relatively common in the professional environment, a 2018 epidemiological study thus evaluated its incidence at one concussion per team every three games.
To limit recurrences and serious sequelae, a strict protocol has been put in place : when first concussion, the player is arrested for 3 weeks. If he is a victim of a second concussion in the same year, the judgment is brought to 3 monthsand in case of 3rd concussion, a year off is imposed.
Prevention: How not to get injured in rugby?
Effective injury prevention requires:
- Upstream, a search for contraindications to the practice of this sport and in particular congenital or acquired anomalies of the cervical spine,
- Before each practice: a warm-up rigorously carried out.
- Regular maintenance of muscle massespecially in the traps and upper back to help keep the joints in their place.
- Wearing padded head protection (helmet) and the shoulders, and of course a mouth guard,
Certain varied exercise protocols exist at the top level – particularly studied in football and rugby – are supposed to reduce the incidence of injuries. “Unfortunately, these protocols do not make it possible to observe a reduction in the incidence of cruciate ligament injuries, ankle sprains and muscle lesions” indicates Dr. Miniot.
In the case of rugby even more than in other sporting practices, respect for the rules and for others is essential to avoid accidents.
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Which sport has the most injuries?
The most dangerous sport in competition is hockey, with an increased risk of injury during matches at 136/1,000 hours of practice.
Then, the sports most responsible for serious injuries and the most deadly are: mountaineering, scuba diving, horse riding and motor sports, in particular motocross.
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