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Editor,—Garraway et al1 are to be congratulated on their meticulous investigation of the incidence of rugby injuries.
Rugby has a very high incidence of injuries. Garraway et al state: “An injury episode occurred in a professional team for every 59 minutes of competitive play”—that is, one serious injury among 30 professional players every 59 minutes. Of greater concern is the fact that Garraway et al reported two neck dislocations, one of which resulted in permanent neurological damage, in this recent paper compared with nil in the earlier one.2
The question of rugby injuries is an emotive one and I have been concerned, over the years, with the incidence of severe injuries causing tetraplegia. The fact that professional players are suffering a greater number of injuries was apparent from my own researches in 19843 on 67 patients with tetraplegia whom I treated. I followed this up in 19924 and 19945 and found that there was a direct correlation between the standard of play, the fitness of the player, and the number of injuries. My findings suggested that greater skill does not provide protection, as six of the players injured were first class players and there are only about 2000 such players in England compared with a total of 400 000 players at all standards. The large number of injuries sustained on tours supports the view that the stronger and fitter the player, the greater the likelihood of an injury occurring.
The analogy with vehicle accidents is striking, whereby the forces involved and the speed of deceleration are the major factors in determining the severity of the injury. This is confirmed in the first class game where the players run faster and are bigger and heavier and impact with greater force.
Schneider6 made a separate study of this among American players. He found that 141 serious injuries occurred among 780 000 high school football players, 34 among 70 000 university footballers, and 14 among 4500 professional players, whereas, in Sandlot football, an unskilled form of the game (where players do not wear protective clothing!), 26 injuries occurred among 1 645 000 players. He concluded that unskilled players do not play as hard as highly skilled or professional athletes and that the greater degree of force and skill exaggerates the likelihood of injury.
Garraway et al1 say “where valid comparisons can be made, it appears that professional rugby union produces higher injury rates than professional rugby league.” This is not in accord with my earlier findings. It has been suggested that rugby league is a much safer game as the ruck and maul have been abolished. However, the incidence of injury is four players out of 26 000 with broken necks for rugby league versus five players out of 500 000 for rugby union, which does not support this claim.
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