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Trends in match injury risk in professional male rugby union: a 16-season review of 10 851 match injuries in the English Premiership (2002–2019): the Professional Rugby Injury Surveillance Project
  1. Stephen W West1,
  2. Lindsay Starling1,
  3. Simon Kemp2,
  4. Sean Williams1,
  5. Matthew Cross3,
  6. Aileen Taylor4,
  7. John H M Brooks5,
  8. Keith A Stokes1,2
  1. 1 Department for Health, University of Bath, Bath, UK
  2. 2 Medical Services, Rugby Football Union, London, UK
  3. 3 Premiership Rugby, London, UK
  4. 4 Chartered Physiotherapist, Nairobi, Kenya
  5. 5 Connect Health, Merton, UK
  1. Correspondence to Professor Keith A Stokes, Department for Health, University of Bath, Bath BA2 7AY, UK; k.stokes{at}


Objectives The Professional Rugby Injury Surveillance Project is the largest and longest running rugby union injury surveillance project globally and focuses on the highest level of rugby in England.

Methods We examined match injuries in professional men’s rugby over the period 2002/2003 to 2018/2019 and described trends in injuries over this time.

Results Over the period 2002/2003–2018/2019, 10 851 injuries occurred in 1 24 952 hours of match play, equating to a mean of 57 injuries per club per season and one injury per team per match. The mean incidence, severity (days absence) and burden (days absence/1000 hours) of injury were 87/1000 hours (95% CI 82 to 92), 25 days (95% CI 22 to 28) and 2178 days/1000 hours (95% CI 1872 to 2484), respectively. The tackle accounted for 43% injuries with running the second most common activity during injury (12%). The most common injury location was the head/face with an incidence of 11.3/1000 hours, while the location with the highest overall burden was the knee (11.1 days/1000 hours). Long-term trends demonstrated stable injury incidence and proportion of injured players, but an increase in the mean and median severity of injuries. Concussion incidence, severity and burden increased from the 2009/2010 season onwards and from 2011 to 2019 concussion was the most common injury.

Conclusion The rise in overall injury severity and concussion incidence are the most significant findings from this work and demonstrate the need for continued efforts to reduce concussion risk as well as a greater understanding of changes in injury severity over time.

  • rugby
  • injury
  • epidemiology
  • prevention

Data availability statement

All publicly available data are included in the article or uploaded as online supplemental information.

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Data availability statement

All publicly available data are included in the article or uploaded as online supplemental information.

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  • Correction notice This article has been corrected since it published Online First. Typographical errors within the title have been corrected.

  • Contributors Each of the authors was involved in the original conception of the paper, data collection process, analysis of results and interpretation of findings. SWW and LS drafted the original manuscript and all other authors provided significant feedback and comments in refining the final manuscript.

  • Funding This project was funded by the Rugby Football Union and Premier Rugby.

  • Competing interests SK and KAS are employed by the Rugby Football Union. MC is employed by Premier Rugby.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research; however, the project steering group includes a range of stakeholders and practitioners.

  • Provenance and peer review Not commissioned; externally peer reviewed.