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248 U.S. rugby-7s players injury incidence, severity and burden effects by positions and levels of play
  1. Victor Lopez1,2,3,4,
  2. Shen-Ying Richard Ma1,2,5,
  3. Meryle G Weinstein1,6,
  4. Patria Hume2,
  5. Robert C Cantu7,8,9,10,11,
  6. Christian Victoria1,12,
  7. Sophie C Queler1,
  8. Khalil JA Webb1,13,
  9. Answorth A Allen1,2,14,15,16
  1. 1Rugby Research and Injury Prevention Group, affiliate of Hospital for Special Surgery, New York, USA
  2. 2Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
  3. 3USA Rugby Empire and New England Geographic Union Rugby Football Unions, New York/Boston, USA
  4. 4Northeast Rugby Academy, USA Rugby Development Program and USOC-Community Olympic Development Program, New York/Boston, USA
  5. 5University of Missouri, Missouri Orthopaedic Institute and Thompson Laboratory for Regenerative Orthopaedics, Columbia, USA
  6. 6New York University, Steinhardt School of Culture, Education and Human Development, New York, USA
  7. 7Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, USA
  8. 8Department of Neurosurgery and Sports Medicine, Emerson Hospital, Concord, USA
  9. 9Neurologic Sports Injury Center, Brigham and Women’s Hospital, Boston, USA
  10. 10Concussion Legacy Foundation, Waltham, USA
  11. 11World Rugby, Independent Concussion Group, Dublin, Ireland
  12. 12New York University, College of Global Public Health, Urban Epidemiology Lab, New York, USA
  13. 13University of Arizona, Tucson, USA
  14. 14Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, USA
  15. 15National Basketball Association, New York Knickerbockers, New York, USA
  16. 16USA Basketball, Colorado Springs, USA


Background There are limited injury data for Rugby-7s, and even less data analysed by participation level or days return-to-sport after injury.

Objective To describe injury incidence, severity, and injury burden for three levels of Rugby-7s competition.

Design Prospective descriptive epidemiology study.

Setting U.S. Rugby-7s tournaments/series and championships (n=57; 2010–2014) over 72 tournament days; L1 elite, L2 sub elite, and L3 under-19/college/senior games (exposure=14,591 player-hours).

Participants 24,538 U.S. players (men=17,770; women=6,768; age 13–54 years).

Assessment of Risk Factors Intrinsic and extrinsic risk in match injuries.

Main measurement outcome Incidence (per/1000 player-hour (ph)) and mechanism of injury were captured using Rugby Injury Survey & Evaluation (RISE) report methodology. Time-loss injuries, injury severity (days=d) from training/competition (including post tournament) were documented, and injury burden were calculated.

Results Injury incidence (n=491) was not significantly different between levels (L3:30.74/1000ph, CI:27.26–34.54; L2:36.24/1000ph, CI:30.84–42.31; L1:41.78/1000ph, CI:30.8–55.39). Mean injury burden was significantly lower for L3 than L1 and L2 (L3-vs-L2, P<0.001; L3 vs L1, P<0.001). Greater risk of lower limb injuries was noted in L3-vs-L1 (RR:0.59, CI:0.38–0.95, P=0.024). The cohort sustained high head/neck injury rates (22.6%; 13.3/1000ph). Backs had more injuries among levels than forwards (L1 backs 51.8/1000ph, forwards 26.4/1000ph, P=0.034; L2 backs 37.7/1000ph, forwards 29.6/1000ph, P=0.152; L3, backs 32.76/1000ph, forwards 24.8/1000ph, P=0.029; total cohort backs 35.74/1000ph, forwards 26.39/1000ph, RR:1.35; CI:1.12–1.65, P=0.002). Average days absent post injury=44.0d (37.8–50.1d) in 68.4% with follow-up data. A significant difference (P=0.018) in mean severity days absent from sport was between the L3 (57.1d) and L2 (27.9d) forwards.

Conclusions Competition level and playing position had significant effects on injury burden and nature of injury. The L1 and L2 had higher injury burden than the lower L3. The L1-vs-L3 cohort had a high proportion of head/neck injury risk compared with other injury locations. Backs sustained greater injury incidence rates among all three levels as compared to forwards.

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