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Editor,—We were concerned to read about the alarming increase in injury in Scottish rugby union football.1 In their article, Garraway et al report the results of a 1997–1998 survey of senior Scottish club players, which, when compared with the findings of a 1993–1994 survey, indicate a substantial increase in the incidence of injury. The authors attribute this increase to factors associated with the advent of professionalism in rugby union football.
Garraway et al consider a number of possible explanations for their findings and then conclude that “the factor that is most likely to have contributed to the increased burden of injuries in competitive play and requires the most urgent attention is the almost universal adoption of protective equipment in rugby union between the 1993–1994 and 1997–1998 seasons.” The questions this raised for us was: did the researchers question players about protective equipment in the two surveys and if so did they find an increase in the wearing of such equipment?
Later in the article, Garraway et al assert that “players at the professional level have turned to the use of this equipment during competitive matches in the expectation that it will minimise the consequences of bodily impact and may even give them a psychological edge when using their increasing physical presence to tackle opponents” and that “amateur players are already following their example.” These assertions raise further questions for us: were the participants in the surveys questioned about their motives for wearing padded equipment and/or their beliefs regarding its effects on their risk of being injured? How is the risk of injury modified for players who enter contact situations confidently compared with players who approach contact more tentatively? Are confident players more or less likely to use correct technique in contact situations?
Two recent reviews have concluded that little is known of the psychological effects (advantageous or otherwise) of wearing protective equipment in rugby.2,3 The most common reasons for wearing protective equipment given by participants in a New Zealand study were: to prevent injury (57%), because of previous injury (53%), and because of medical advice (21%).4 Australian schoolboy rugby players also cited safety as the primary reason for using headgear and reported that they played more confidently when wearing headgear.5
On the basis of their conclusions regarding the impact of padded equipment on the incidence of injury, Garraway et al recommend that the International Rugby Board “place a moratorium on the further development of protective equipment until it has been established that it is not contributing to the substantial increase in player morbidity associated with the introduction of professional rugby union.” In their abstract, they go further by recommending that the moratorium should be placed on the “use of protective equipment in competitive matches”.
There is at present little evidence to suggest that padded equipment modifies the risk of injury in rugby. We have no argument with the need to find explanations for the disturbing increase in injury reported by Garraway et al. What concerns us is that their recommendations have been made in the absence of supporting evidence, and that in making such recommendations attention is diverted from other explanations for the observed increase in injuries, such as law changes that affect the way in which rugby is played. Investigation of the effects of padded equipment on injury risk, through well designed research, is required before recommendations about its use can be made. Placing a moratorium on the use of protective equipment may make it difficult to undertake such research!
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