Colin W Fuller’s research while affiliated with WWF United Kingdom and other places

This study aimed to describe anthropometry and incidence, nature and causes of match injuries in women’s international rugby sevens and to compare these with results reported previously for men’s international rugby sevens. The study comprised an 8-season, prospective study of World Rugby’s women’s Sevens World Series. Over the eight seasons, the overall incidence of injury was 105.6 (95% CI: 96.0 to 116.3) injuries/1000 player-match-hours with a mean injury severity of 53.4 (95% CI: 46.9 to 59.9) days-absence. There were no statistically significant trends for backs or forwards in the incidence (backs: p = 0.470; forwards: p = 0.242) or mean severity (backs: p = 0.098; forwards: p = 0.544) of injuries sustained over the 8-season period. Head/face (20.8%), knee (19.7%), ankle (11.3%) and shoulder/clavicle (8.4%) were the most common injury locations while ligament sprain (31.7%), concussion (15.6%), haematoma/bruise (11.5%) and fracture (11.5%) were the most common types of injury sustained. Being-tackled (35.4%), tackling (26.3%), collisions (13.8%) and rucks (8.8%) were the match events responsible for most injuries. The study indicates that injury burden in women’s international rugby sevens (5,640 days-absence/1000 player-match-hours; 95% CI: 5,123 to 6,209) is similar to that reported previously for men’s international rugby sevens (5,263 days-absence/1000 player-match-hours; 95% CI: 5,000 to 5,540).

Purpose Whilst kicking in Rugby Union can be influential to match outcome, the epidemiology of kicking injuries remains unknown. This study therefore aimed to investigate the epidemiology of injuries attributed to kicking in professional rugby, including playing position‐specific effects and differences in kicking volumes and kick types. Methods Fifteen seasons of injury surveillance data and two seasons of match kicking characteristics from professional rugby players were analysed. Incidence, propensity and severity of kicking‐related injuries were calculated together with the locations and types of these injuries. Position‐related differences in match kicking types and volumes were also established. Results Seventy‐seven match and 55 training acute‐onset kicking injuries were identified. The match‐kicking injury incidence for backs was 1.4/1000 player‐match‐hours. Across all playing positions, the propensity for match kicking injury was 0.57 injuries/1000 kicks. Fly‐halves sustained the greatest proportion of match kicking injuries (47%) and performed the greatest proportion of match kicks (46%); an average propensity for match kicking injury (0.58/1000 kicks). Scrum‐halves executed 27% of match‐related kicks but had a very low propensity for match kicking injury (0.17/1000 kicks). All other positional groups executed a small proportion of match‐related kicks but a high propensity for match kicking injury. Ninety‐two per cent of match kicking injuries occurred in the pelvis or lower limb, with the majority sustained by the kicking limb. 21% of all match kicking injuries were associated with the rectus femoris muscle. Conclusion Match‐kicking profiles and kicking injuries sustained are position‐dependent, which provides valuable insight for developing player‐specific conditioning and rehabilitation protocols.

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.

The aim of this study was to describe the incidence, nature and causes of match injuries in men’s international rugby sevens and to compare these to values for international rugby fifteens. The study comprised a 10-season, whole population, prospective study of the Sevens World Series. Over the ten seasons, the overall incidence of injury was 122.4 (95% CI = 116.3 to 128.9) injuries/1000 player-match-hours and the mean severity of injury was 43.0 (95% CI = 40.3 to 45.7) days-absence. There was an increasing trend in the incidence of injury over the ten-season period (slope = 5.3 injuries/1000 player-hours/season, R² = 0.68, p = 0.003) but no trend in the mean severity of injury (slope = 0.02 days/season, R² < 0.01, p = 0.971). Head/face (15.7%), knee (15.6%), ankle (15.4%) and shoulder/clavicle (11.9%) were the most common injury locations and ligament sprain (30.5%), muscle strain (16.4%), concussion (12.6%) and haematoma/bruise (10.6%) the most common types of injury sustained. Being-tackled (33.1%), tackling (23.4%), running (16.1%) and collisions (12.4%) were the most common events leading to injury. These results indicate that the burden of injury in international rugby sevens is two to three times higher than that reported for international rugby fifteens.

Rugby union is a popular team sport that demands high levels of physical fitness and skill. The study aim was to examine trends in training volume and its impact on injury incidence, severity and burden over an 11-season period in English professional rugby. Data were recorded from 2007/08 through 2017/18, capturing 1,501,606 h of training exposure and 3,782 training injuries. Players completed, on average, 6 h 48 minutes of weekly training (95% CI: 6 h 30 mins to 7 h 6 mins): this value remained stable over the 11 seasons. The mean incidence of training-related injuries was 2.6/1000 player-hours (95% CI: 2.4 to 2.8) with a mean severity rising from 17 days in 2007/08 to 37 days in 2017/18 (Change/season = 1.773, P <0.01). Rate of change in severity was dependent on training type, with conditioning (non-gym-based) responsible for the greatest increase (2.4 days/injury/season). As a result of increasing severity, injury burden rose from 51 days absence/1000 player-hours in 2007/08 to 106 days’ absence/1000 player-hours in 2017/18. Despite the low incidence of injury in training compared to match-play, training accounted for 34% of all injuries. Future assessments of training intensity may lead to a greater understanding of the rise in injury severity.

Objectives: The vast majority of rugby union ('rugby') participants are community-based players; however, the majority of injury surveillance studies reported relate to the elite, professional game. A potential reason for this dearth of studies could be the perceived difficulty of using the consensus statement for injury recording at the community level. The aim of this study was to identify areas where the consensus statement could be adapted for easier and more appropriate implementation within the community setting. Design: Round-table discussion. Methods: All community-based injury surveillance issues were discussed during a 2-day facilitated round-table meeting, by an 11-person working group consisting of researchers currently active in rugby-related injury surveillance, sports medicine and sports science issues. The outcomes from the meeting were summarised in a draft guidance document that was then subjected to an extensive iterative review prior to producing methodological recommendations. Results: Each aspect of the rugby-specific consensus statement was reviewed to determine whether it was feasible to implement the standards required in the context of non-elite rugby and the resources available within in a community setting. Final recommendations are presented within a community-based injury report form. Conclusions: It is recommended that whenever possible the rugby-specific consensus statement for injury surveillance studies be used: this paper presents an adapted report form that can be used to record injury surveillance information in community rugby if suitable medical support is not available.

Introduction The aim of this study was to develop a quick and simple screening procedure for evaluating the return on investment provided by injury prevention programmes in professional football. Injury prevention in sport has usually been considered in isolation of other management responsibilities, and interventions are published irrespective of whether their impact is worthwhile and irrespective of the return on players’ time investment in the programme. This approach is naive from a business perspective and is not an approach normally adopted by commercial organisations. Methods In professional football, the overwhelming cost associated with implementing an injury prevention programme is the players’ time commitment, and the major benefit is the players’ increased availability, achieved through the reduction in the number of injuries. A comparison of these time-based costs and benefits provides the basis for the evaluation process presented. Results Applying the evaluation process to a number of published injury prevention programmes recommended for football demonstrates that they are unlikely to provide an adequate return on investment. Conclusions Researchers should focus on developing injury prevention programmes that provide an adequate return on players’ time investment, otherwise there is no incentive for clubs to implement the programmes. Reporting that an injury prevention programme produces a statistically significant reduction in the incidence of injury, for example, is insufficient information. Injury prevention programmes should focus on ‘at risk’ players to increase the return on investment, and researchers should evaluate and report on the utility of prevention programmes within the intended sports setting.

The aim of this review was to provide insights into and a critical assessment of injury burden, risk matrices and risk contours in the context of team sports. Injury burden is the product of injury incidence and mean severity, and is normally reported as days’ absence/1000 player-hours. An important feature of injury burden is that equal values can reflect quite different numerical combinations of injury incidence and severity. The timeframe over which injury burden affects a team depends on the incidence and severity values of the injuries sustained. Injury burden is evaluated through the use of risk matrices and risk contours. The main benefits of using risk matrices, and the reasons for their widespread acceptance, are the minimal data inputs required, the ease of understanding the visual data presentation, the transparent nature of the evaluation criteria and the simplicity with which the conclusions can be communicated to stakeholders. Injury burden is most often used for the identification of injuries that cause the greatest loss of time for players, ranking the importance of injury risk factors and prioritising injury prevention plans. Although risk matrices are commonly used for evaluating risks during the risk assessment process, there is little evidence to demonstrate that they improve decision-making, as they have a number of limitations, including potential inconsistencies and discrepancies when evaluating and ranking risks. These limitations suggest that physicians, physiotherapists and sports scientists should only use injury burden, risk matrices and risk contours when they fully understand their strengths and weaknesses.

Background Choosing an appropriate definition for injury in injury surveillance studies is essential to ensure a balance among reporting reliability, providing an accurate representation of injury risk, and describing the nature of the clinical demand. Purpose To provide guidance on the choice of injury definition for injury surveillance studies by comparing within- and between-team variability in injury incidence with >24-hour and >7-day time-loss injury definitions in a large multiteam injury surveillance study. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods Injury data were reported for 2248 professional rugby union players from 15 Premiership Rugby clubs over 12 seasons. Within-team percentage coefficient of variation and mean between-team standard deviation (expressed as a percentage coefficient of variation) in injury incidence rates (injuries per 1000 player match hours) were calculated. For both variables, a comparison was made between >24-hour and >7-day injury incidence rates in terms of the magnitude of the observed effects. Results The overall mean incidence across the population with a >24-hour time-loss injury definition was approximately double the reported incidence with the >7-day definition. There was a 10% higher between-team variation in match injury incidence rates with the >24-hour time-loss definition versus the >7-day definition. Conclusion There was a likely higher degree of between-team variation in match injury incidence rates with a >24-hour time-loss definition than with a >7-day definition of injury. However, in professional sports settings, it is likely that the benefits of using a more inclusive definition of injury (improved understanding of clinical demand and the appropriate and accurate reporting of injury risk) outweigh the small increase in variation in reporting consistency.

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 2017/18 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 to 33.7; severity: 17.5 days, 95% CI: 13.0 to 28.0) and training (incidence: 4.3 injuries/1000 player-training-hours, 95% CI: 3.4 to 5.5; severity: 14.0 days, 95% CI: 11.0 to 22.0) injuries were determined using data collected from four English Premier League football clubs during the 2016/17 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.