Content uploaded by John H M Brooks
Author content
All content in this area was uploaded by John H M Brooks on Jun 05, 2014
Content may be subject to copyright.
Original article
Brooks JHM, Kemp SP T. Br J Sports Med (2010). doi:10.1136/bjsm.2009.066985 1 of 11
Rugby Football Union,
Twickenha m, U K
Correspondence to
Dr J H M Brooks, Rugby
Football Union, Rugby House,
Rugby Road, Twickenham TW1
1DS, UK ;
johnbrooks@rfu.com
Accepted 24 November 2009
Injury-prevention priorities according to playing
position in professional rugby union players
J H M Brooks, S P T Kemp
ABSTRACT
Objective To examine the match injury profi le of
professional rugby union players by individual playing
position.
Design 4-season prospective cohor t design.
Setting 14 English Premiership clubs.
Participants 899 professional players.
Main outcome measure Incidence of match injury
(recorded as the number of injuries/1000 player-hours
of match exposure), severity of injury (recorded as the
number of days of absence) and days of absence due to
injury per 1000 player-hours of match exposure.
Assessment of risk factors Injury diagnosis and
individual playing position during a match.
Results 2484 injuries were reported. While there
were no signifi cant dif ferences in the total days of
absence as a result of injury between different positions
in the forwards and the backs, there were a number
of signifi cant differences in injury profi le for players in
individual playing positions. Although three common
body locations caused a high proportion of days of
absence due to match injury for forwards (shoulder,
knee, ankle/heel) and backs (shoulder, hamstring,
knee), there were signifi cant differences in injury profi le
between individual positions.
Conclusions The results clearly demonstrate the
need for individual position-specifi c injury-prevention
programmes in rugby union. When devising such
programmes, a player’s previous injury history should
also be taken into account.
INTRODUCTION
The incidence of injury in professional rugby
union is high in comparison with many other
sports;1 furthermore, the total absence from
playing and training due to these injuries is also
high.1 Reducing this injury burden should be a
central focus for rugby union medical, coach-
ing and conditioning teams; however, time and
training constraints2 typically limit the scope of
injur y-prevention interventions. To counter this,
it is important to focus on injury-prevention pro-
grammes that are most likely to have the great-
est impact on reducing the injuries that cause the
most days of absence .3 4
Playing position is an easily identifi able, albeit
non-modifi able, risk factor that can be used to
shape injury-prevention programmes based on
differences in injury profi le by position. Casual
observations as far back as the early 20th cen-
tury highlighted positional differences in injury
profi les.5 These were confi rmed in subsequent
publications,6–8 although there was no statistical
analysis of the results, and the number of injuries
reported in t hese studie s was relatively smal l. Law
modifi cations and the introduction of profession-
alism have signifi cantly changed the nature of
the modern game of rugby union,9 making these
studies less applicable. More recently, studies of
injuries to individual body parts in professional
rugby union have suggested some positional dif-
ferences in injury risk.10–15 However, to optimise
statistical power, these studies have commonly
grouped positions together, such as the front-row
forwards, even though it is recognised that indi-
vidual positions within these positional groups
have subtly different playing roles, are likely to
experience different loads and forces through dif-
ferent parts of their bodies during a match and, as
a result, may exhibit different injury profi les. A n
example of a variation in load is the difference in
the loads absorbed and transmitted by each of the
front-row positions during a scrum.16
Investigation of the injury profi le of players in
individual positions has not been undertaken in
any detail. The purpose of the current study was
to present match injury profi le data as a function
of days of absence and playing position compared
with other forwards or backs.
METHODS
Participants
The study has been described in detail previous-
ly.17 In summary, 899 players (488 forwards and
411 backs) from 14 English Premiership clubs took
part. Players were included or excluded from the
st udy when they bec ame or c eased to be member s
of the club’s fi rst team squad. The average team
squad size was 39 players. Written informed con-
sent was obtained from each subject.
Injury defi nition
The injury defi nition used in the study was: ‘any
injury that prevents a player from taking a full
part in all training and match play activities typ-
ically planned for that day for a period of greater
than 24 h from midnight at the end of the day the
injur y was sustained.’ Injury severity was defi ned
by the number of days of absence before a player
returned to full fi tness; full fi tness was defi ned as
‘able to take a full part in training activities (typi-
cally planned for that day) and available for match
selection.’ Absences due to illness and non-sport-
related medical conditions were not included in
the study. The injury defi nitions and data-collec-
tion methods utilised in this study are compliant
with the institutional review board consensus
statement on injury defi nitions and data collec-
tion procedures for studies of injuries in rugby
union.18
bjsports66985.indd 1bjsports66985.indd 1 5/10/2010 11:31:57 AM5/10/2010 11:31:57 AM
BJSM Online First, published on May 19, 2010 as 10.1136/bjsm.2009.066985
Copyright Article author (or their employer) 2010. Produced by BMJ Publishing Group Ltd under licence.
group.bmj.com on May 15, 2011 - Published by bjsm.bmj.comDownloaded from
Original article
Brooks JHM, Kemp SP T. Br J Sports Med (2010). doi:10.1136/bjsm.2009.0669852 of 11
(loose-head props: 2952; hookers: 3689; tight-head props:
3254; second-rows: 5916; blind-side fl ankers: 2652; open-side
fl ankers: 3471; number-8s: 3335) and 21 345 days of absence
to backs (scrum-halves: 3117; fl y-halves: 3017; centres: 6558;
wingers: 5963; full-backs: 2690). In total there were 30 267
h of match exposure reported (forwards: 16 103 h; backs:
14 164 h). There were no signifi cant differences in total days
of absence/1000 player-hours due to injury between players
in different positions within the forwards (fi gure 1) and the
backs (fi gure 2).
Loose-head prop’s injury profi le
Absence due to neck injuries was higher for loose-head props
(161 days of absence/1000 player-hours) (p=0.13) because of a
signifi cant ly higher absenc e f rom cer vical disc/ner ve root inju-
ries (fi gure 3). The majority of these injuries were sustained
during tackling (57%) and scrummaging (29%). There was
also a signifi cantly higher absence due to shoulder rotator cuff
injuries (scrummaging: 66% (75% of these to the right shoul-
der)) and a signifi cantly higher absence due to chest injuries
(p=0.03) due to a signifi cantly higher absence due to rib frac-
tures and contusions and pneumothoraces.
Hooker’s injury profi le
Absence due to shoulder injuries was signifi cantly higher for
hookers (p=0.01) because of a signifi cantly greater absence
from rotator cuff injuries (fi gure 4) (tackling: 57%). Absence
due to neck injuries was higher (p= 0.24) because of a signifi -
cantly greater absence due to cervical disc/nerve root injuries.
The majority of these were sustained during tackling (38%),
collisions (25%) and scrummaging (19%).
Tight-head prop’s injury profi le
Absence due to lumbar spine injuries (p<0.001) because of a
signifi cantly greater absence from lumbar disc/nerve root
and soft tissue injuries and absence due to lower leg injuries
(p<0.001) because of a signifi cantly greater absence due to calf
muscle injuries were both signifi cantly higher for tight-head
props (fi gure 5). Calf-muscle injuries were predominately sus-
tained during scrummaging (54%) and running (33%), lumbar
Data collection
Medical personnel at each club reported all match injur y epi-
sodes on a weekly basis. They also completed a standard injur y
report form for each injury which detailed the injury diagnosis
using a modifi ed Orc hard Sports I njur y Clas sifi cation System19
and associated injury information including injury event and
playing position at the time of injury. Individual player match
exposure data were recorded every week for each player; this
identifi ed the position played and the total time on the fi eld in
competitive matches.
Data analysis
Seven forward playing positions (loose-head prop, hooker,
tight-head prop, second-rows (2), blind-side fl anker, open-side
fl anker and number-8) and fi ve back positions (scrum-half, fl y-
half, centres (2), wingers (2) and full-back) were used for analy-
sis purposes. Results for each playing position were compared
with data for the remaining forwards or backs. The incidence
of match injury was recorded as the number of injuries/1000
player-hours of match exposure, the average severity of injury
was recorded as the number of days of absence, and the days of
absence due to injur y were recorded as the t otal number of days
of absence/1000 player-hours of match exposure. Differences
in the days of absence due to match injuries between groups
were considered signifi cant if the 95% CI of the days of
absence risk ratios for the groups did not include the value of
1.0, and the p value (Z test for the comparison of rates) was less
than 0.05.20 Injury locations causing more than 150 days of
absence/1000 player-hours were classifi ed as injury-prevention
priorities because, in total, they were responsible for 50% or
more of the total days of absence due to match injuries (for-
wards: 50%; backs: 54%).
RESULTS
Number of injuries and days of absence
A total of 1307 injuries to forwards (loose-head props: 157;
hookers: 192; tight-head props: 189; second-rows: 306; blind-
side fl ankers: 150; open-side fl ankers: 153; number-8s: 160)
and 1177 injuries to backs (scrum-halves: 143; fl y-halves: 198;
centres: 356; wingers: 320; full-backs: 160) were reported.
These injuries caused 25 269 days of absence to forwards
0
01
02
03
051001050
(
1000 hours
)ecnedicnI
Average severity (days)
rekooH reknalfedis-nepO 8-rebmuN porpdaeh-thgiT porpdaeh-esooL wordnoceS reknalfedis-dnilB sdrawrofllA
9651
)50.0=p(2531
)11.0=p(9441
)94.0=p(0941
)98.0=p(5851
)43.0=p(3861
)51.0=p(9471
)50.0=p(2971
/1000 hourssbasyaD
)sdrawrofrehtootecnereffid(
Figure 1 Incidence, average severit y and days of absence due to injury for forwards. Bubble size: days of absence/1000 player-hours.
bjsports66985.indd 2bjsports66985.indd 2 5/10/2010 11:31:57 AM5/10/2010 11:31:57 AM
group.bmj.com on May 15, 2011 - Published by bjsm.bmj.comDownloaded from
Original article
Brooks JHM, Kemp SP T. Br J Sports Med (2010). doi:10.1136/bjsm.2009.066985 3 of 11
disc/nerve root injuries and lumbar soft tissue injuries during
scrummaging (67% and 57% respectively).
Second-row’s injury profi le
Absence due to ank le/heel injuries (p=0.14) was higher in sec-
ond-row forwards because of a signifi cantly greater absence
due to ankle lateral ligament injuries (fi gure 6 ). A higher pro-
portion of these injuries were sustained in t he lineout (21%)
compared with other forwards.
Blind-side fl anker’s injury profi le
Absence due to thigh injuries was signifi cantly higher in
blind-side fl ankers (p=0.04) because of a greater absence due
to hamstring muscle injuries (predominately sustained during
running: 86%) (fi gure 7).
Open-side fl anker’s injury profi le
Absence due to neck injuries (p=0.01) was signifi cantly
higher for open-side fl ankers (sustained predominately in
the tackle: 63%) because of a signifi cantly greater absence
due to cervical facet joint injuries (fi gure 8). Absence due to
shoulder injuries (p=0.11) because of a signifi cantly greater
absence due to acromio-clavicular joint injuries and absence
due to ankle/heel injuries (p=0.06) because of a signifi cantly
greater absence due to ankle joint capsule sprains/jars were
also higher.
Number-8’s injury profi le
Absence due to arm and hand injuries was signifi cantly higher
in number-8s (p<0.001) because of a sign ifi cantly greater
absence due to biceps muscle injuries and wrist /hand fractures
(fi gure 9). Absence due to knee injuries (p=0.16) because of a
signifi cantly greater absence due to patella tendon injuries was
also higher.
Scrum-half’s injury profi le
Absence due to lumbar spine injuries was sign ifi cantly
higher in scrum-halves (p<0.001) because of a signifi cantly
greater absence from lumbar disc/nerve root and soft tissue
(including muscle strain) injuries (fi gure 10). Absence due to
0
01
02
03
051001050
1000/hours)(ecnedicnI
Average severity (days)
sertneC flah-murcS flah-ylF sregniW kcab-lluF skcabllA
7051
)90.0=p(0331
)26.0=p(2741
)67.0=p(7741
)28.0=p(4351
)70.0=p(4361
/1000 hours (difference tosbasyaD )skcabrehto
Figure 2 Incidence, average severit y and days of absence due to injury for backs. Bubble size: days of absence/1000 player-hours.
0 100 200 300 400 500
Head
Neck
Should er
Arm and hand
Ches t
Abdomen and thoracic spine
Lumb ar s pin e
Groin/ hip/ buttock
Thigh
Knee
Lowe r leg
Ankle/ heel
Foot
Days absence (1000/hours)
Loose-head prop All oth er forward s
*
*
0.182.05 (0.72 to 5.83)49Inferior tib-fib syndesmosis
0.930.96 (0.40 to 2.30)69Achilles tendon
0.931.10 (0.15 to 8.04)65
Knee meniscal/ articula r
cartilage
0.870.85 (0.10 to 7.02)92Knee ACL
0.0516.98 (1.06 to 271)25Pneumothorax
0.013.51 (1.35 to 9.15)50Rib fracture/ contusion
0.210.40 (0.09 to 1.69)55
Shoulder dislocation/
instability
0.0043.76 (1.52 to 9.31)128Should er rotator cuff
0.190.53 (0.21 to 1.37)14Cervical facet joint
0.032.33 (1.07 to 5.09)196Cervical d isc/ nerve root
p (Z-test)
Risk ratio to other forwards (95%
CI)
Days absence/
1000 hours
Injury diagnosis
The two injuries causing the greatest absence in locati ons with >150 days absence/1000 player-hours or in locations
where absence due to in jury was significantly greater than other forwards
Figure 3 Days of absence injury profi le for loose-head props. *Signifi cantly different from other forwards (p<0.05). ACL, anterior cruciate
ligament.
bjsports66985.indd 3bjsports66985.indd 3 5/10/2010 11:31:58 AM5/10/2010 11:31:58 AM
group.bmj.com on May 15, 2011 - Published by bjsm.bmj.comDownloaded from
Original article
Brooks JHM, Kemp SP T. Br J Sports Med (2010). doi:10.1136/bjsm.2009.0669854 of 11
0 100 200 300 400 500
Head
Neck
Shoulder
Arm and hand
Chest
Abdomen and thoracic spine
Lumb ar s pi ne
Groin/ hip/ buttock
Thigh
Knee
Lowe r le g
Ankle/ heel
Foot
Days abs en ce (1000/h ours)
Second-row All oth er forwards
*
*
*
0.0022.43 (1.39 to 4.24)62
Ankle lateral ligament
0.861.09 (0.43 to 2.73)76
Achilles tendon injury
0.770.91 (0.48 to 1.72)79Knee MCL
0.372.10 (0.41 to 10.85)176Knee ACL
p (Z-test)
Risk ratio to other forwards
(95% CI)
Days
absence/
1000 hours
Injury diagnosis
The two injuries causing the greatest absence in locations with >150 days absence/1000
player-hours or in locations where absence due to injury was significantly greater than
other forwards
Figure 6 Days of absence injury profi le for second-rows. *Signifi cantly different from other forwards (p<0.05). ACL, anterior cruciate ligament;
MCL, medial collateral ligament.
0 100 200 300 400 500
Head
Neck
Shoulder
Arm and hand
Ches t
Abdomen and thoracic spine
Lumb ar s pin e
Groin/ hip/ buttock
Thigh
Knee
Lowe r le g
Ankle/ heel
Foot
Days absence (1000/hours)
Tight-head prop All ot her forward s
*
*
*
*
*
0.921.08 (0.25 to 4.58)76
Achilles tendon
0.001254 (15.92 to 406)91
Ankle instability
0.050.31 (0.10 to 1.00)6
Calf/ shin haematoma
<0.0015.85 (3.64 to 9.40)297
Calf muscle
0.520.73 (0.28 to 1.89)45
Knee meniscal/ articular
cartilage
0.880.85 (0.10 to 7.03)93Knee ACL
<0.00111.08 (4.13 to 29.75)33
Lumbar soft tissue
0.042.86 (1.06 to 7.02)56
Lumbar disc/ nerve root
0.331.57 (0.63 to 3.88)67Shoulder rotator cuff
0.371.93 (0.46 to 8.16)221
Shoulder dislocation/
instability
p (Z-test)
Risk ratio to other forwards
(95% CI)
Days absence/
1000 hours
Injury diagnosis
The two injuries causing the greatest absence in locations with >150 days absence/1000 player -hours or
in locations where absence due to injury was significantly greater than other forwards
Figure 5 Days of absence injury profi le for tight-head props. *Signifi cantly different from other forwards (p<0.05). ACL, anterior cruciate
ligament.
0 100 200 300 400 500
Head
Neck
Shoulder
Arm and hand
Ches t
Abdomen and thoracic spine
Lumb ar s pin e
Groin/ hip/ buttock
Thigh
Knee
Lowe r le g
Ankle/ heel
Foot
Days abs enc e (1000/h ours)
Hooker A ll othe r forwards
*
*
0.080.40 (014 to 1.10)15
Ankle lat eral ligament
0.211.87 (0.70 to 4.99)120
Achilles tendon
0.092.25 (0.89 to 5.72)34
Calf/ shin haemat oma
0.151.50 (0.87 to 2.50)116
Calf muscle
0.831.25 (0.15 to 10.41)130Knee ACL
0.013.08 (1.26 to 7.50)146
Knee meniscal/ articular
cartilage
0.0033.75 (1.59 to 8.87)127Shoulder rotator cuff
0.981.01 (0.38 to 2.67)129Shoulder dislocation/ instability
0.230.53 (0.19 to 1.50)14Cervical facet joint
0.021.99 (1.14 to 3.49)173Cervical disc/ nerve root
p (Z-test)Risk ratio to other forwards (95% CI)
Days absence/
1000 hours
Injury diagnosis
The two injuries causing the greatest absence in locations with >150 days absence/1000 player- hours or in locations
where absence due to injury was significantly greater than other forwards
Figure 4 Days of absence injury profi le for hookers. *Signifi cantly different from other forwards (p<0.05). ACL, anterior cruciate ligament.
bjsports66985.indd 4bjsports66985.indd 4 5/10/2010 11:31:59 AM5/10/2010 11:31:59 AM
group.bmj.com on May 15, 2011 - Published by bjsm.bmj.comDownloaded from
Original article
Brooks JHM, Kemp SP T. Br J Sports Med (2010). doi:10.1136/bjsm.2009.066985 5 of 11
0 100 200 300 400 500
Head
Neck
Shoulder
Arm and hand
Ches t
Abdomen and thoracic spine
Lumb ar s pin e
Groin/ hip/ buttock
Thigh
Knee
Lowe r le g
Ankle/ heel
Foot
Days abs enc e (1000/h ours)
Open-side flanker A ll other fo rwards
*
*
*
<0.00113.25 (3.65 to 48.14)75
Ankle joint sprain/ jar
0.701.49 (0.20 to 10.98)100
Achilles tendon
0.940.93 (0.11 to 7.70)100Knee ACL
0.141.82 (0.82 to 4.05)140Knee MCL
0.0013.89 (1.80 to 8.40)136Acromioclavicular joint
0.701.23 (0.43 to 3.56)153
Shoulder dislocation/
instability
0.450.80 (0.45 to 1.82)81Cervical disc/ nerve root
<0.0018.53 (3.76 to 19.37)106Cervical facet joint
p (Z-test)
Risk ratio to other forwards
(95% CI)
Days absence/
1000 hours
Injury diagnosis
The two injuries causing the greatest absence in locations with >150 days absence/1000 player-hours or
in locations where absence due to injury was significantly greater than other forwards
Figure 8 Days of absence injury profi le for open-side fl ankers. *Signifi cantly dif ferent from other forwards (p<0.05). ACL, anterior cruciate
ligament; MCL, medial collateral ligament.
0 100 200 300 400 500
Head
Neck
Shoulder
Arm and hand
Ches t
Abdomen and thoracic spine
Lumb ar s pin e
Groin/ hip/ buttock
Thigh
Knee
Lowe r le g
Ankle/ heel
Foot
Days absence (1000/hours)
Blind-side flanker All oth er forward s
*
*
*
*
0.472.13 (0.27 to 16.65)59
Patella tendon
0.067.32 (0.94 to 56.69)68
Knee haematoma
0.631.18 (0.61 to 2.26)35Th igh haematoma
0.092.03 (0.90 to 4.55)99Ha mstring muscle
0.240.50 (0.15 to 1.61)136Acromioclavicular joint
0.092.05 (0.90 to 4.68)232
Shoulder dislocation/
instability
p (Z-test)
Risk ratio to other forwards
(95% CI)
Days
absence/
1000 hours
Injury diagnosis
The two injuries causing the greatest absence in locations with >150 days absence/1000 player-
hours or in locations where absence due to injury was significantly greater than other forwards
Figure 7 Days of absence injury profi le for blind-side fl ankers. *Signifi cantly dif ferent from other forwards (p<0.05).
shoulder injuries was signifi cantly higher in scrum-halves
(0.04) because of a signifi cantly greater absence from acro-
mioclavicular joint injuries. Absence due to thigh injuries
(p<0.001) was signifi cantly lower in scrum-halves due to a
signifi cantly lower absence due to hamstring muscle injuries
(p=0.001).
Fly-half injuries
Absence due to thigh injuries (p=0.01) because of signifi cantly
greater absence due to hamstring muscle injuries and absence
due to arm and hand injuries (p=0.001) because of a signifi -
cantly greater absence due to elbow joint injuries were both
signifi cantly higher in fl y-halves (fi gure 11).
Centre’s injury profi le
Absence due to head injuries (p<0.001) (tackling: 44%; being
tackled: 39%) because of a signifi cantly greater absence due
to concussion, absence due to neck injuries (p=0.005) (being
tackled: 46%; tackling: 42%) because of a signifi cantly greater
absence due to cervical disc/ner ve root injuries, absence due
to shoulder injuries (p=0.01) (tackling 68%; being tackled:
18%) because of a greater absence due to shoulder dislocation/
instability and absence due to lower leg injuries (p=0.001)
because of a greater absence due to tibia/fi bula fractures were
all signifi cantly higher in centres (fi gure 12).
Winger’s injury profi le
Absence due t o thigh i njuries (p =0.001) was sig nifi cantly higher
in wingers because of a signifi cantly greater absence due to
thigh haematomas (fi gure 13). Absence due to head (p<0.001)
and shoulder (p=0.02) injuries was signifi cantly lower.
Full-back injuries
Absence due to groin /hip/buttock injuries was signifi cantly
higher in full-backs (p<0.001) because of a greater absence due
to groin nerve entrapment injuries (fi gure 14). Absence due to
chest injuries was signifi cantly higher in full-backs (p=0.03)
due to a greater absence from costochondral/sternal injuries
and rib fractures/contusions.
Injury-prevention priorities for players by playing position
The injury-prevention priorities for players by playing posi-
tion are summarised in table 1.
bjsports66985.indd 5bjsports66985.indd 5 5/10/2010 11:32:00 AM5/10/2010 11:32:00 AM
group.bmj.com on May 15, 2011 - Published by bjsm.bmj.comDownloaded from
Original article
Brooks JHM, Kemp SP T. Br J Sports Med (2010). doi:10.1136/bjsm.2009.0669856 of 11
0 100 200 300 400 500
Head
Neck
Shoulder
Arm and hand
Ches t
Abdomen and thoracic spine
Lumb ar s pin e
Groin/ hip/ buttock
Thigh
Knee
Lowe r le g
Ankle/ heel
Foot
Days absence (1000/hours)
Number-8 All other forwards
*
*
*
*
*
0.480.57 (0.12 to 2.66)9
Foot/ toe joint sprain
0.035.49 (1.19 to 25.41)149
Foot fracture
0.015.89 (1.56 to 22.19)115Patella tendon
0.201.69 (0.76 to 3.76)132Knee MCL
0.015.77 (1.56 to 21.32)82Wrist/hand fracture
0.0123.55 (2.13 to 260)93Biceps muscle injury
0.471.37 (0.58 to 3.26)62Acromioclavicular joint
0.390.59 (0.18 to 1.96)79
Shoulder dislocation/
instability
p (Z-test)
Risk ratio to other forwards (95%
CI)
Days absence/
1000 hours
Injury diagnosis
The two injuries causing the greatest absence in locations with >150 days absence/1000 player -hours or in
locations where absence due to injury was sig nificantly greater than other forwar ds
Figure 9 Days of absence injury profi le for number-8s. *Signifi cantly different from other forwards (p<0.05). MCL, medial collateral ligament.
0.731.22 (0.40 to 3.73)28
Inferior tib-fib syndesmosis
0.081.96 (0.92 to 4.19)96
Ankle lateral ligament
0.352.35 (0.39 to 14.05)108Knee ACL
0.142.23 (0.77 to 6.50)133
Knee meniscal/ articula r
cartilage
0.351.60 (0.60 to 4.25)17
Lumbar soft tissue
0.025.97 (1.27 to 28.11)69
Lumbar disc/ nerve root
0.032.32 (1.09 to 4.96)90Acromioclavicular joint
0.202.08 (0.68 to 6.38)187
Shoulder dislocation/
instability
p (Z-test)
Risk ratio to other forwards (95%
CI)
Days absence/
1000 hours
Injury diagnosis
The two injuries causing the greatest absence in locations with >150 days absence/1000 player-hours or in
locations where absence due to injury was significantly greater than other backs
0 100 200 300 400 500
Head
Neck
Shoulder
Arm and hand
Chest
Abdomen and thoracic spine
Lumbar spine
Groin/ hip/ buttock
Thigh
Knee
Lower leg
Ankle/ heel
Foot
Days absence (1000/hours)
Scrum-half All other backs
*
*
*
*
Figure 10 Days of absence injury profi le for scrum-halves. *Signifi cantly different from other backs (p<0.05). ACL, anterior cruciate ligament.
0.540.72 (0.26 to 2.02)78Kn ee MCL
0.082.19 (0.92 to 5.26)132
Knee menis cal/ articular
cartilage
0.560.86 (0.52 to 1.42)63Thigh haematoma
0.051.65 (1.01 to 2.70)241Hamstring musc le
0.710.75 (0.17 to 3.36)36Wrist/ hand fracture
<0.00143.14 (9.66 to 193)39Elbow joint injury
p (Z-test)
Risk ratio to other forwards (95%
CI)
Days absence/
1000 hours
Injury diagnosis
The two injuries causing the greatest absence in locati ons with >150 days absence/1000 player-hours or in
locations where absence due to injury was significantly greater than other backs
0 100 200 300 400 500
Head
Neck
Shoulder
Arm and hand
Chest
Abdomen and thoracic spine
Lumbar spine
Groin/ hip/ buttock
Thigh
Knee
Lower leg
Ankle/ heel
Foot
Days absence (1000/hours)
Fly-half All other backs
*
*
*
*
*
0 100 200 400 500
Head
Neck
Shoulder
Arm and hand
Chest
Abdomen and thoracic spine
Lumbar spine
Groin/ hip/ buttock
Thigh
Knee
Lower leg
Ankle/ heel
Foot
Fly-half All other backs
*
*
*
*
*
Figure 11 Days of absence injury profi le for fl y-halves. *Signifi cantly different from other backs (p<0.05). MCL, medial collateral ligament.
DISCUSSION
Absence due to match injuries was not signifi cantly higher in
any of th e individua l playing pos itions with in the for wards and
backs in the current study. This is consistent with other large
rugby union epidemiological studies where few differences
have also been reported in injury incidence between posi-
tions.17 21 22 Nevertheless, players in every position still missed
a signifi cant number of days of absence due to match injuries
(forwards: 1569 days of absence/1000 player-hours equivalent
to 33 days of absence per match due to forwards injuries; backs
bjsports66985.indd 6bjsports66985.indd 6 5/10/2010 11:32:01 AM5/10/2010 11:32:01 AM
group.bmj.com on May 15, 2011 - Published by bjsm.bmj.comDownloaded from
Original article
Brooks JHM, Kemp SP T. Br J Sports Med (2010). doi:10.1136/bjsm.2009.066985 7 of 11
0 100 200 300 400 500
Head
Neck
Shoulder
Arm and hand
Ches t
Abdomen and thoracic spine
Lumb ar s pin e
Groin/ hip/ buttock
Thigh
Knee
Lowe r le g
Ankle/ heel
Foot
Days absence (1000/hours)
Cent res All other backs
*
*
*
*
*
*
0.940.98 (0.53 to 1.82)46
Calf muscle
0.113.74 (0.76 to 18.54)108
Tibia/fibula fracture
0.00110.81 (2.80 to 41.80)78Knee PC L/ LCL
0.801.08 (0.57-2.05)110Knee MCL
0.020.64 (0.43 to 0.94)51Thi gh haematoma
0.601.12 (0.72 to 1.74)173Hamst ring muscle
0.211.76 (0.73 to 4.24)63Shoulder rotator cuff
0.102.24 (0.87 to 5.81)172
Shoulder dislocation/
instability
––
25
Spinal cord injury
0.013.09 (1.36 to 6.99)65
Cervical disc/ nerve root
0.182.60 (0.65 to 10.39)19
Head/ facial fracture
<0.0012.54 (1.56 to 4.12)105
Concussion
p (Z-test)
Risk ratio to other forwards (95%
CI)
Days absence/
1000 hours
Injury diagnosis
The two injuries causing the greatest absence in locations with >150 days absence/1000 player-hours or in
locations where absence due to injury was significantly greater than other backs
Figure 12 Days of absence injury profi le for centres. *Signifi cantly dif ferent from other backs (p<0.05). LCL, lateral collateral ligament; MCL,
medial collateral ligament; PCL, posterior cruciate ligament.
0.311.67 (0.62 to 4.51)33
Inferior tib-fib syndesmosis
0.160.61 (0.30 to 1.23)38
Ankle lateral ligament
0.490.72 (0.29 to 1.81)55
Knee meniscal/ articular
cartilage
0.171.57 (0.82 to 3.01)140Knee MC L
<0.0012.82 (1.88 to 4.22)133Thigh haematoma
0.890.97 (0.67 to 1.42)157Hamstring muscle
0.0024.45 (1.75 to 11.29)28Should er haematoma
0.132.16 (0.79 to 5.90)70Shoulder rotator cuff
p (Z-test)
Risk ratio to other forwards (95%
CI)
Days absence/
1000 hours
Injury diagnosis
The two injuries causing the greatest absence in locations with >150 days absence/1000 player-hour s or in
locations where absence due to injury was significantly greater than other backs
0 100 200 300 400 500
Head
Neck
Shoulder
Arm and hand
Chest
Abdomen and thoracic spine
Lumbar spine
Groin/ hip/ buttock
Thigh
Knee
Lower leg
Ankle/ heel
Foot
Days absence (1000/hours)
Wingers All other backs
*
*
*
Figure 13 Days of absence injury profi le for wingers. *Signifi cantly different from other backs (p<0.05). MCL, medial collateral ligament.
1507 days of absence/1000 player-hours equivalent to 28 days
of absence per match due to backs injuries). There is a clear
need to design and implement injury-prevention programmes
for all players to reduce this injury burden.
Three main body locations (the shoulder, knee and ankle/
heel) for forwards and three main body locations (the shoul-
der, hamstring and knee) for backs caused more than 150
days of absence/1000 player-hours; this constituted more
than half of all days of absence due to match injuries. As a
result, injury-prevention strategies for injuries to these four
body regions should be prioritised. Studies implementing
injur y-prevention interventions in other non-collision sports
have been successful at reducing the incidence of injury to all
of these lower-limb locations (hamstrings, knees and ankles)
by utilising exercises designed to improve parameters such as
propriception, core stability and muscle strength.23–30 While
the need for more research into the effectiveness of injury-
prevention interventions in collision sports is recognised, it
is likely that interventional approaches used in other sports
would be transferrable to the rugby union population. Fewer
studies have attempted to prevent shoulder injuries by using
controlled injury-prevention interventions, although reducing
shoulder capsular tightness31 and eccentric resistance train-
ing32 have been highlighted.
bjsports66985.indd 7bjsports66985.indd 7 5/10/2010 11:32:02 AM5/10/2010 11:32:02 AM
group.bmj.com on May 15, 2011 - Published by bjsm.bmj.comDownloaded from
Original article
Brooks JHM, Kemp SP T. Br J Sports Med (2010). doi:10.1136/bjsm.2009.0669858 of 11
by the greater use of the neck extensors during scrummaging
for loose-head props and hookers. Development of the cervi-
cal musculature may be of benefi t in preventing cervical inju-
ries in these players,38 although the detail of the intervention
needs more investigation.
Shoulder rotator cuff injuries also caused signifi cantly more
absence in loose-head props and hookers. A large propor-
tion of these injuries to loose-heads were due to scrummag-
ing (66%), although the majority of these were to their right
shoulder (75%), which is bound to the hooker rather than the
opposition. None of the rotator cuff injuries to hookers were
sustained during scrummaging. Factors that might result in
these players being more predisposed to rotator cuff injuries14
include rotator cuff weakness,39 fatigue-induced propriception
and skill defi cits40 41 and suboptimal glenhumeral alignment.42
The high impact forces and loads experienced during scrum-
maging16 37 and the repetitive demands placed on hookers from
throwing the ball into the lineout in matches and training may
also increase the risk of injury to these players.
Despite the lack of differences in total absence due to injur y
for each playing position and the identifi cation of three prin-
cipal body regions for injury-prevention programmes for the
majority of forwards and backs, signifi cant differences in
injury profi le between players in different playing positions
were reported. These can be used to focus further on injury-
prevention programmes.
Loose-head props and hookers both exhibited similar
injury profi les. Cervical injuries, in particular cervical disc/
nerve root injuries, caused signifi cantly greater absence com-
pared with other forwards. It has long been established that
the risk of sustaining a cervical injury is higher in front-row
forwards, in particular during scrummaging;8 11 33– 36 how-
ever, in the current study, tackling was the most common
cause of cervical disc/nerve root injuries for these players.
Nevertheless, the greater impact forces on scrum engagement
and the loads transmitted and absorbed by front-row for-
wards during scrummaging16 37 may have predisposed these
players to cervical injuries. This may have been exacerbated
0.112.58 (0.81 to 8.21)52
Patella tendon
0.412.50 (0.28 to 22.34)113
Knee ACL
0.040.61 (0.38 to 0.99)46Th igh haematoma
0.981.01 (0.58 to 1.73)161Hamstring muscle
0.271.64 (0.68 to 3.95)41
Adductor mu scle
0.001120 (7.51 to 1918)49
Groin nerve entrapment
0.191.93 (0.72 to 5.17)36Rib fracture/ contusion
0.072.27 (0.94 to 5.48)51Costochondral/ sternal injury
0.551.38 (0.48 to 3.95)60Acromi oclavicular joint
0.671.31 (0.38 to 4.54)130
Shoulder dislocation/
instability
p (Z-test)
Risk ratio to other forwards (95%
CI)
Days absence/
1000 hours
Injury diagnosis
The two injuries causing the greatest abse nce in locations with >150 days abse nce/1000 player-hours or in
locations where absence due to injury was sign ificantly greater than other backs
Days absence (1000/hours)
Full-back All other bac ks
*
*
*
*
0 100 200 300 400 500
Head
Neck
Shoulder
Arm and hand
Chest
Abdomen and thoracic spine
Lumbar spine
Groin/ hip/ buttock
Thigh
Knee
Lower leg
Ankle/ heel
Foot
Full-back All other bac ks
*
*
Figure 14 Days of absence injury profi le for full-backs. *Signifi cantly dif ferent from other backs (p<0.05).
Table 1 Injur y locations of highest injury risk for players in each playing position
Playing position Head Neck Shoulder
Arm and
hand Chest
Abdomen and
thoracic spine
Lumbar
spine
Groin/hip/
buttock Thigh Knee Lower leg Ankle/heel Foot
Loose-head prop – √√ –√––––√–√–
Hooker – √√ ––– –– –√√ √ –
Tight-head prop – – √––– √––√√ √ –
Second row – – – – – – – – – √–√–
Blind-side fl anker – – √––– –– √√–– –
Open-side fl anker – √√ ––– –– –√–√–
Number-8 – – √√–– – – –√–– √
Average forward – – √––– –– –√–√–
Scrum-half – – √––– √––√–√–
Fly-half – – – √–– – – √√–– –
Centres √√√ ––– –– √√√ ––
Wingers – – √––– –– √√–√–
Full-back – – √–√––√√√–– –
Average back – – √– – – – – √ √ – – –
Injur y locations that caused >150 days of abse nce/1000 player-hours or were signi fi cantly g reater than t he aver age for ward or back ar e liste d as injur y-prevention priorities (√).
bjsports66985.indd 8bjsports66985.indd 8 5/10/2010 11:32:03 AM5/10/2010 11:32:03 AM
group.bmj.com on May 15, 2011 - Published by bjsm.bmj.comDownloaded from
Original article
Brooks JHM, Kemp SP T. Br J Sports Med (2010). doi:10.1136/bjsm.2009.066985 9 of 11
is advocated as a possible injury-prevention strategy.44 45
However, the repeated lumbar fl exion and rotation may have
positively conditioned the hamstrings of these players by
increasing hamstring fl exibility53–55 and eccentric strength10 2 4
resulting in the signifi cantly lower absence due to hamstring
muscle injuries observed.
Fly-halves had a signifi cantly greater absence due to thigh
injuries, specifi cally hamstring muscle injuries, compared
with other backs. A high incidence of hamstring muscle inju-
ries in sports that involve a lot of kicking has been previously
reported58 –60 and the frequency wit h which fl y-halves kick the
ball during a match compared with other positions may pre-
dispose them to an increased risk of hamstring muscle injury,
although this has yet to be confi rmed. Greater absence due to
arm and hand injuries was largely as a consequence of injuries
for which injury-prevention strategies are less well validated,
namely elbow joint injuries, while the signifi cantly lower
absence from shoulder injuries may be due to fl y-halves mak-
ing fewer tackles in a match compared with other backs.57
The observation that absence due to head injuries, in partic-
ular concussions, was signifi cantly higher in centres compared
with other backs has been reported previously.13 Absence due
to neck and shoulder injuries was also signifi cantly higher in
centres compared with other backs, and the most common
injur y event was tackling (42–68%). High speed going into
the tackle, high impact force and contact with the tackler’s
head and neck have all been identifi ed previously as signifi -
cant risk factors for tacklers.57 61 Centres tend to make more
tackles in a match than other backs57 and have been signif-
icantly more prone to injur y when tackling than players in
other positions.61
While absence due to thigh injuries was high for the major-
ity of backs, it was signifi cantly higher for wingers compared
with other backs. One might expect that this greater absence
would be due to hamstring muscle injuries because of the
greater number of sprints performed in a match by outside
backs52 and as a consequence of the faster run ning speed of
these players. While absence due to hamstring muscle injuries
was high in wingers, it was the absence due to thigh haemato-
mas that was most signifi cant.
The signifi cant differences in the injury profi le of the full-
backs, namely greater absence due to groin/hip/buttock inju-
ries and chest injuries, were largely as a consequence of injur ies
for which injury-prevention strategies are less well validated,
namely groin nerve entrapment injuries, costochondral /sternal
injuries and rib fractures/contusions.
We believe that this study demonstrates the need for injury-
prevention programmes for all players and that playing posi-
tion should be considered as an independent risk factor for
injur y and consequently as a driver for individualised injury-
prevention programmes. While signifi cant absence due to
injur y to three body regions was relatively consistent for all
positions within the forwards (shoulder, knee and ankle/heel)
and the backs (shoulder, hamstring and knee), signifi cant dif-
ferences in the injury profi le between positions demonstrate
the need for injury-prevention programmes to be position-
specifi c. Such programmes should also be player-specifi c and
recognise the importance of focusing on a player’s previous
injur y history because of the signifi cantly greater absence
due to recurrent injuries compared with new injuries.17 In the
future, our understanding of differences in the injury profi le
between different positions could be further en hanced by a
greater understanding of the position-specifi c demands of the
game and the mechanism of injury.
Tight-head props exh ibited a different i njury profi le from the
other front-row positions. Lower leg and lumbar spine injuries
caused signifi cantly more absence compared with other for-
wards due to a signifi cantly greater absence from calf muscle
strains, lumbar disc/nerve root and lumbar sof t tissue injuries;
trends that have been identifi ed previously.11 43 The majority
of all of these injuries were sustained during scrummaging
(54–6 7%). It has been shown that greater loads are transmit-
ted by tight-head props during scrummaging than by all other
forwards.16 The inability of the lumbar spine and calf muscu-
lature of tight-head props to adapt to these high loads there-
fore needs addressing. Improving scrummaging technique
to ensure the lumbar spine is maintained in a strong neutral
position by improving neuromuscular control44 and specifi c
strength training for the lumbar and calf regions are plausi-
ble interventions.45 46 The association between lumbar spine
pathology and calf muscle symptoms or strains should also not
be overlooked.47
Absence due to lateral ank le ligament injuries was signifi -
cantly higher in second-rows, and a higher proportion of these
injuries were sustained in the lineout (21%) compared with
other forwards. This is similar to previous fi ndings15 where
inversion ankle injuries on landing from a lineout lift was felt
to be a signifi cant risk factor. Landing from a jump is a com-
mon cause of ankle injuries in other sports such as soccer48
and volleyball.49 Injury-prevention interventions that have
focussed on adopting the correct lower-limb alignment when
landing have been successful at reducing the incidence of ankle
injuries in other sports.23 27 30
Blind-side fl ankers had more absence due to thigh injuries
than other for wards, in particular due to hamstring muscle
injuries. The majority of these injuries were sustained during
running (86%), typically during sprinting or runn ing at high
speed.28 50 The back-row perform between 1.4 and 2 times as
many sprints in a match compared with other forwards.51 5 2
Eccentric strengthening of the hamstrings,10 24 improving
hamstring fl exibility53–55 and sports-specifi c conditioning28
have all been successful at reducing the incidence of hamstring
injuries.
Absence due to neck injuries, in particular cervical facet
joint injuries, was signifi cantly higher in open-side fl ankers.
The tackle is the most common cause of absence due to injur y
largely because it is the most frequent contact event.56 Open
side fl ankers make more tackles than players in other posi-
tions during a match,57 and the majority of open-side neck
injuries were sustained in the tackle (63%). Open-side fl ankers
may benefi t from gains in cer vical musculature strength38 to
improve their ability to adapt to high impact forces on their
neck, as well as improvements in tackling technique previ-
ously advocated.17
The signifi cant differences in the injury profi le of the
number-8, namely greater absence due to arm and hand inju-
ries and foot injuries, were largely as a consequence of injuries
for which injury-prevention strategies are less well validated,
namely wrist, hand and foot fractures and biceps muscle
injuries.
While absence due to shoulder and knee injuries was high
in scrum-halves, as with other backs, absence due to lumbar
spine injuries, more specifi cally lumbar disc/nerve root inju-
ries, caused signifi cantly more days of absence for scrum
halves t han for other backs. The repeated lumbar fl exion and
rotation necessary to pass the ball off the ground might pre-
dispose these players to lumbar injury. Optimising global and
local muscular control of this combined lumbar movements
bjsports66985.indd 9bjsports66985.indd 9 5/10/2010 11:32:03 AM5/10/2010 11:32:03 AM
group.bmj.com on May 15, 2011 - Published by bjsm.bmj.comDownloaded from
Original article
Brooks JHM, Kemp SP T. Br J Sports Med (2010). doi:10.1136/bjsm.2009.06698510 of 11
11. Fuller CW, Brooks JH, Kemp SP. Spinal injuries in professional r ugby union: a
prospective cohort study. Clin J Sport Med 2007;17:10–16.
12. Dallalana RJ, Brooks JH, Kemp SP, et al. The epidemiology of knee injuries in
English p rofes sional r ugby union. Am J Sports Med 2007;35:818–30.
13. Kemp SP, Hudson Z, Brooks JH, et al. The epide miology of head injuri es in English
professional rugby union. Clin J Sport Med 2008;18:227–34.
14. Headey J, Brooks JH, Kemp SP. The epidemiology of shoulder injuries in English
professional rugby union. Am J Sports Med 2007;35:1537–4 3.
15. Sankey RA, Brooks JH, Kemp SP, et al. The epidemiolog y of ankle injuries in
professional rugby union players. Am J Sports Med 2008;36:2415–24.
16. Milburn PD. The kinetics of rugby union scrummaging. J Sports Sci
199 0;8:47–6 0.
17. Brooks JH, Fuller CW, Kemp SP, et al. Epidemiology of injuries in English
professional rugby union: par t 1 match injurie s. Br J Spor ts Med 2005;39:757–66.
18. Fuller CW, Molloy MG, Bagate C, et al. Consensus statemen t on injury defi nitions
and data collec tion procedures for studies of i njuries in rugby union. Br J Sports
Med 2007;41:328–31.
19. Orchar d J. Orchar d Sports Injur y Classifi cation Sy stem (OSICS). http://www.
injuryupdate.com.au/research/OSICS8.pdf. (accessed Jul 2006).
20. Kirkwood BR, Sterne JAC. Essential medical statistics. Ox ford: Blackwell
Science, 2003:158–64 and 240–3.
21. Bird YN, Waller AE, Marshall SW, et al. The New Zealand Rugby Injury and
Perf ormance Project: V. Epidemiology of a season of rugby injury. Br J Sports Med
1998;32:319–25.
22. Quarrie KL, Alsop JC, Waller AE , et al. The New Ze aland rugby injury and
perf orman ce proje ct. VI. A prospective cohort study o f risk factors f or injur y in
rugby union football. B r J Sports Med 2001;35:157–66 .
23. Bahr R, Bahr IA. Incidence of acute volleyball injuries: a prospecti ve cohort
study o f injur y mechanisms and risk factors. Scand J Med Sci Sports
1997;7:166 –71.
24. Askling C, Karlsson J, Thorstensson A. Hamstrin g injur y occur rence in elite
soccer players after preseason strength training with eccentric over load. Scand J
Med Sci Sports 2003;13:244 –50.
25. Myklebust G, Engebr etsen L , Braekken IH, et al. Pre vention of anterior cr uciate
ligament injur ies in female team handball players: a prospecti ve intervention
study over thre e seasons. Clin J Sport Med 2003;13:71–8 .
26. Verhagen E, van der Bee k A, Twisk J, et al. The e ffe ct of a pro prioceptive
balanc e board training progr am for the prevention of ankle spr ains: a prospect ive
controlled trial. Am J Sports Med 2004;32:1385 –9 3.
27. Olsen OE, My klebust G, Engebretsen L, et al. Exercises to prevent lower limb
injuries in youth spor ts: cluster rand omised controlled trial. BMJ 2005;330:449.
28. Verrall GM, Slavotine k JP, Barnes PG. The ef fect of spor ts specifi c training on
reducing the incidence o f hamstring injuries in professional Austr alian Rules
football players. Br J Sports Med 2005;39:363–8.
29. Mandelbaum BR, Silv ers HJ, Watanabe DS, et al. Effective ness of a
neuromuscular and propriocep tive training program in preventing anterior
cruciate ligament injuries in female athletes: 2-year follo w-up. Am J Sport s Med
2005;33:1003–10.
30. Soligard T, Myklebust G, S teffen K, et al. Comprehensive war m-up programme
to prevent injur ies in young female footballer s: cluster randomised controlled trial.
BMJ 2008;337:a2469.
31. Burkhart SS, Morgan CD, Kibler WB. T he disabled throwing shoulder: spect rum
of path ology P art III: The SICK scapula, scapular dyskinesis, the kinetic ch ain and
rehabilitation. Arthroscopy 2003;19:641–61.
32. Jonsson P, Wahlström P, Ohberg L, et al. Ecce ntric training in chro nic painful
impingement syndrom e of the shoulder : results of a pilo t study. Knee Surg Sports
Trau mato l Ar thro sc 2006;14:76–81.
33. Nathan M, Goedeke R, No akes TD. T he incidence and nature of rugby
injuries experienced at one school dur ing the 1982 r ugby season. S Afr Med J
198 3;64:132–7.
34. Roux CE, Goedeke R, Visser GR, et al. The epidemiology o f schoolboy rugby
injuries. S Afr Med J 1987;71:307–13.
35. Sparks JP. Rugby footb all injuries, 1980 –1983. Br J Spor ts Med 1985 ;19:71–5.
36. Quarrie KL, Cantu RC, Chalmers DJ. Rugby union i njuries to the cervic al spine
and spinal cord. Spor ts Med 2002;32:633–53.
37. Quarrie KL, Wilson BD. Force production in t he rugby union scrum. J Sports Sci
2000;18:237–46.
38. Peek K, Gatherer D. The rehabilitation of a prof ession al rugby union player
follow ing a C7/ T1 posterior microdiscectomy. Phys Ther Spor t 2005;6:195– 200.
39. Chen SK, Simonian PT, Wick iewicz TL, et al. Radiographic evaluation of
glenohumeral kinematics: a muscle fatigue mo del. J Shoulder Elbow Surg
1999;8:49–52.
40. Warner JJ, Lephart S, Fu F H. Role of proprioception in pat hoetiology of shoulder
instability. Clin Orthop Relat Res 1996; 35 –9.
41. Davey PR, Thorpe RD, W illiams C. Fatigue decreases skilled tennis per formance.
J Sport s Sci 2002;20:311–18.
42. Hayes K, Callanan M, Walto n J, et al. Shoulder instability : management an d
rehabilitation. J Orthop Sport s Phys Ther 2002;32:497–5 09.
Acknowledgements The authors thank C Fuller (Centre for Sports Medicine,
University of Nottingham) for his key role in initiating and suppor ting the project
(England Rugby Injury and Training Audit). The authors thank the doctors,
physiotherapists, and fi tness, strength and conditioning staff from the following
clubs and teams who have recorded injury and training infor mation throughout the
project: Bath Rugby, Bristol Rugby, Gloucester RFC, England, Leeds Tykes, Leicester
Tigers, London Irish, London Wasps, Harlequins, Newcastle Falcons, Northampton
Saints, Rotherham, Sale Sharks, Saracens and Worcester Warriors. The authors
also thank the Rugby Football Union for their fi nancial support and R Vickers (Rugby
Football Union) and T Clear y (Rugby Football Union) for their help in collecting and
processing the data.
Funding Rugby Football Union.
Competing interests None.
Provenance and peer review Not commissioned; exter nally peer reviewed.
Detail has been removed from this case description or these case descriptions to
ensure anonymity. The editors and reviewers have seen the detailed information
available and are satisfi ed that the information backs up the case the authors are
making.
REFERENCES
1. Brooks JH, Kemp SP. Recent trends in rugby union injuries. Clin Spor ts Med
2008;27:51–73, vii–viii.
2. Brooks JH, Fuller CW, Kemp SP, et al. An assessment of t raining volume in
professional rugby union and its impac t on the incidence, severity and nature o f
match and training injuries. J Sports Sci 2008;26:863–73.
3. Fuller C, Drawer S. The app lication of risk management in sport. Sports Med
2004;34:349–56.
4. Brooks JH, Fuller CW. The infl uence of met hodological issues on the resul ts and
conclusions from epidemiological studies of sport s injuries: illus trative examples.
Sports Med 2006;36:459 –72.
5. O’Connell TC. Rugby footb all injuries and their prevention; a review of 60 0 cases.
J Ir Med Assoc 195 4;34:20–6.
6. Myers PT. Injuries presen ting from rugby union football. Med J Aust 198 0;2:17–20.
7. Dalley DR, Laing DR, Rowberry JM, et al. Rugby i njuries: an epidemiological
survey, Christchurch 1980. NZ J Sports Med 1982;10:5–17.
8. Sugerman S. Injuries in an Austr alian schools rugby unio n season. Aust J Sports
Med Ex Sci 19 83;15:5 –14.
9. Quarrie KL, Hopkins WG. Changes in player characteristics and ma tch activities
in Bledisloe Cup r ugby union from 1972 to 2004. J Sports Sci 2007;25:895–90 3.
10. Brooks JH, Fuller CW, Kemp SP, et al. Incidence, risk and preven tion of
hamstring muscle injuries in professional rugby unio n. Am J Spor ts Med
2006;34:1297–306.
What is already known about this topic
▶ Trends in the profi le of injuries sustained in rugby
union matches between different positions have
been reported in the literature on several occasions.
However, the injury profi le has typically only been
reported for grouped playing positions, such as
front-row forwards or midfi eld backs, rather than for
individual playing positions.
What this study adds
▶ This study demonstrates that there are individual
position-specifi c differences in match injury profi le
that in conjunction with a player’s past injury history
can be used to design more targeted injury-prevention
programmes in rugby union.
bjsports66985.indd 10bjsports66985.indd 10 5/10/2010 11:32:03 AM5/10/2010 11:32:03 AM
group.bmj.com on May 15, 2011 - Published by bjsm.bmj.comDownloaded from
Original article
Brooks JHM, Kemp SP T. Br J Sports Med (2010). doi:10.1136/bjsm.2009.066985 11 of 11
53. Cross KM, Worrell T W. Eff ects of a static stretching pr ogram on the incidence of
lower ex tremity musculotendinous strains. J Athl Train 1999;34:11–14.
54. Witvrouw E, Danneels L, Asselman P, et al. Muscle fl exibility as a risk factor for
developing muscle injur ies in male professional soccer players. A prospective
study. Am J Sports Med 2003;31:41–6.
55. Dadebo B, Whi te J, George KP. A survey o f fl exibilit y training protocols and
hamstring strains in profes sional f ootball clubs in England. Br J Spor ts Med
2004;38:388–94.
56. Fuller CW, Brooks JH, Cancea RJ, et al. Conta ct events in rugby union and their
propensity to c ause injury. Br J Sports Me d 2007;41:862–7; discussion 8 67.
57. Quarrie KL, Hopkins WG. Tackle injuries in professional Rugby Union. Am J
Sports Med 2008;36:1705–16.
58. Seward H, Orchard J, Hazard H, et al. Football injuries in Aus trali a at the élite
level. Med J Aust 1993; 159:298–301.
59. Orchard J, Sew ard H. Epidemiology of injuries in the Aus tralian Football Le ague,
seasons 1997–2000. Br J Spor ts Med 2002;36:39– 44.
60. Woods C, Hawkins RD, Maltby S, et al.; Football A ssocia tion Medical Research
Progr amme. The Football Association Medical Rese arch Pr ogramme: an audit of
injuries in professional football —analysis of hamstr ing injuries. Br J Sports Med
2004;38:36–41.
61. Fuller CW, Ashton T, Brooks JHM, et al. Injury risks associ ated wi th tack ling in
rugby union. Br J Sports Med 2010;44:159– 67.
43. Brooks JHM, Fuller CW, Kem p SPT. The incidence, sever ity an d nature of
scrummaging injuries in professional rugby union. Br J Sports M ed 2005;39:377.
44. Zazulak B, Cholewicki J, Reeves NP. Neuromuscular control of t runk stabili ty:
clinical implications for sports injury prevention. J Am Acad Orthop Surg
2008;16:497– 505 .
45. Hodges PW, Richardson CA. Inef fi cient muscular st abilization o f the lumbar
spine associated with low back pain. A motor control evalu ation of transversus
abdominis. Spine 1996 ;21:2640–50.
46. Durall CJ, Manske RC. Avoiding lumbar spine injury during resistan ce training.
Strength Cond J 2005;27:64–72.
47. Orchard JW, Farhart P, Leopold C. Lumbar spine region pathology and
hamstring and c alf injuries in athletes: is there a connection? Br J Sports Med
2004;38:502–4; discussion 502– 4.
48. Woods C, Haw kins R, Hulse M, et al. The Football Association Medical Research
Progr amme: an audit of injuries in professional football: an analysis of ankle
sprains. Br J Sports Med 2003;37:233– 8.
49. Reeser JC, Verhagen E, Briner WW, et al. Strategies for the prevention of volleyb all
related injuries. Br J Sports Med 2006;40:594– 600; discussion 599 –600.
50. Orchard J. Biomechanics of muscl e strain injur y. NZ J Sports Med 2002;30:90– 6.
51. Duthie G, Pyne D, Hooper S. Time motion analysis of 20 01 and 2002 super 12
rugby. J Sports Sci 2005;23:523–30.
52. E aton C, George K. Position speci fi c rehabilitation for rugby union players. Part I:
empirical movement an alysis d ata. Phys Ther Spor t 2006;7:22–9.
bjsports66985.indd 11bjsports66985.indd 11 5/10/2010 11:32:03 AM5/10/2010 11:32:03 AM
group.bmj.com on May 15, 2011 - Published by bjsm.bmj.comDownloaded from
doi: 10.1136/bjsm.2009.066985
published online May 19, 2010Br J Sports Med
J H M Brooks and S P T Kemp
players unionplaying position in professional rugby
Injury-prevention priorities according to
http://bjsm.bmj.com/content/early/2010/05/12/bjsm.2009.066985.full.html
Updated information and services can be found at:
These include:
References http://bjsm.bmj.com/content/early/2010/05/12/bjsm.2009.066985.full.html#ref-list-1
This article cites 58 articles, 25 of which can be accessed free at:
P<P Published online May 19, 2010 in advance of the print journal.
service
Email alerting the box at the top right corner of the online article.
Receive free email alerts when new articles cite this article. Sign up in
Notes
publication.
Advance online articles must include the digital object identifier (DOIs) and date of initial
publication priority; they are indexed by PubMed from initial publication. Citations to
available prior to final publication). Advance online articles are citable and establish
not yet appeared in the paper journal (edited, typeset versions may be posted when
Advance online articles have been peer reviewed and accepted for publication but have
http://group.bmj.com/group/rights-licensing/permissions
To request permissions go to:
http://journals.bmj.com/cgi/reprintform
To order reprints go to:
http://group.bmj.com/subscribe/
To subscribe to BMJ go to:
group.bmj.com on May 15, 2011 - Published by bjsm.bmj.comDownloaded from
