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  1. Sean Williams1,
  2. Grant Trewartha1,
  3. Simon Kemp2,
  4. John Brooks3,
  5. Colin Fuller4,
  6. Aileen Taylor5,
  7. Matt Cross2,
  8. Gavin Shaddick6,
  9. Keith Stokes1
  1. 1Department for Health, University of Bath, Bath, United Kingdom
  2. 2Rugby Football Union, Twickenham, United Kingdom
  3. 3The Population Health Research Institute, St. George's University of London, London, United Kingdom
  4. 4Colin Fuller Consultancy, Sutton Bonington, United Kingdom
  5. 5Karabati Limited, Nottingham, United Kingdom
  6. 6Department of Mathematical Sciences, University of Bath, Bath, United Kingdom


    Background Player welfare concerns have been raised by a number of professional Rugby Union stakeholders regarding the match exposure demands faced by players.

    Objective To investigate the influence that acute and chronic match exposures have upon injury risk.

    Design A seven-season (2006/7–2012/13) prospective cohort design was used to record time-loss injuries (>24 h) and match exposure.

    Setting English Premiership Professional Rugby Union.

    Participants 1253 professional players.

    Assessment of Risk Factors A player's 12-month match exposure (number of matches a player was involved in for ≥20 mins in the preceding 12 months) and month match exposure (number of full-game equivalent matches in preceding 30 days) were assessed as ‘chronic’ and ‘acute’ risk factors, respectively.

    Main Outcome Measurements A nested-frailty model was applied to calculate adjusted hazard ratios (HR) for the assessed risk factors. Thresholds for beneficial and harmful effects were 0.90 and 1.11, respectively.

    Results 12-month match exposure was associated with injury in a non-linear fashion, with players who had been involved in less than ≈15 or greater than ≈35 matches (for ≥20 mins) over the preceding 12-month period being more susceptible to injury. Monthly match exposure was linearly associated with injury (HR: 1.14 per 2-SD increase, 90% CI: 1.08–1.20; likely harmful), although this effect was substantially attenuated for players in the upper quartile for 12-month match exposure (>28 matches).

    Conclusions A player's accumulated and recent match exposure substantially influences their current injury risk. Careful attention should be paid to planning the workload and monitoring the responses of players involved in: 1) a high number of matches in the previous year; 2) a low number of matches in the previous year; 3) a low-moderate number of matches in the previous year but have played intensively in the recent past. These findings could inform match workload planning in professional Rugby Union.

    • Injury

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