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Abstract
Objective To assess and evaluate injuries sustained during the 2010 Women's Rugby World Cup.
Design Prospective, cohort.
Participants 285 women rugby players.
Results Incidence of match injury was 35.5/1000 player-hours; mean severity was 55.0 days and median severity 9 days. Only one training injury was reported. Knee-ligament injuries were the most common (15%) and resulted in most days lost (43%). The tackle was the cause of most injuries.
Conclusions The risk of injury in international rugby is significantly lower for women than for men. Further research is required to assess knee-ligament injuries in women's rugby.
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Introduction
An injury surveillance study was undertaken at the Women's Rugby World Cup (WRWC) in 2006,1 but there were limitations to this study, such as implementation occurred before publication of the consensus statement for epidemiological studies in rugby union,2 injury severity data were not reported, there were some discrepancies in the results reported (eg, incidence of injury) and some analyses combined match and training injuries. The aim of this study was to obtain detailed information about women's international rugby using the International Rugby Board consensus procedures2 and compare the results with those for the 2006 WRWC.1
Method
This was a prospective, cohort study of the 2010 WRWC. Definitions and procedures were compliant with the consensus statement for epidemiological studies in rugby.2 A detailed study manual covering the aims of the study, definitions and procedures was sent to the lead medical staff for each country before the start of the tournament.
At the beginning of the tournament, player's baseline information and informed consent were obtained. Match exposure was collected on the basis of 15 players/team exposed for 80 min/match; training exposure was collected on a daily basis. Team doctors recorded injury details; where injuries persisted for more than 2 months, team doctors provided estimated return-to-play/training dates based on the diagnosis and prognosis of the player's rehabilitation at that time.
Baseline data are summarised as means (SD), incidence of injury as injuries/1000 player-hours (95% CI) and severity as mean (days; 95% CI), median (days; 95% CI) and grouped according to consensus severity categories.2 Differences between groups were assessed using t tests for anthropometric data and z tests for incidences and proportions; significance was considered for tests where p<0.05.
Results
Of the 12 countries at the 2010 WRWC, 11 took part with each team playing five games (1100 player-match-hours: forwards, 587; backs, 513). The age, stature and body mass of players (forwards, 153; backs, 132) included in the study are shown in table 1.
Baseline data for participating players
One training injury and 5375 player-training-hours were recorded: no further analysis of this injury was undertaken. Thirty-nine time-loss match injuries (forwards, 18; backs, 21) were recorded; incidences of injury as a function of playing position and grouped severity are presented in table 2.
Incidence of injuries as a function of severity grouping and playing position
A total of 2144 days were lost from training/competition as a result of injury (forwards, 491; backs, 1653). The mean severity of injury for all players was 55.0 days (24.1–85.9): forwards, 27.3 (3.2–51.4); backs, 78.7 (26.6–130.8). The median severity of injury for all players was 9 days (5–22): forwards, 5.5 (2–18); backs, 9 (5–81). There were no significant differences in the incidence or severity of injuries sustained by forwards and backs. Tables 3 and 4 summarise the locations and types of injury: the knee (28%), head/face (23%) and ankle (13%) were the most commonly injured sites.
Distribution of injuries for playing position, location, type and nature of onset
Distribution of injuries (n=39) as a function of location and type
Overall, knee-ligament (15%), ankle-ligament (13%) and concussion (10%) were the most common pathologies reported. Knee-ligament injuries resulted in the most days lost (43%). The knee (38%) was the most common injury location for backs and was responsible for 68% of their total days lost; head/face (28%) was the most common location for forwards, but knee injuries resulted in the most days lost (42%). There were three anterior cruciate ligament (ACL) ruptures during the tournament resulting in the loss of 836 days. Table 5 summaries the risk factors associated with match injuries.
Distribution of injury as a function of associated risk factors
Discussion
The cohort in this study was similar to that in the 2006 WRWC1; as reported in previous studies for men3 4 and women,1 forwards were significantly older, taller and heavier than backs. There were no significant differences in the incidence of injuries sustained by forwards and backs in this study or compared with the 2006 WRWC.1 The overall incidence of injury for women was, however, significantly lower than that reported for men (2007 RWC: 83.9, p≤0.0013; 2008/2010 Junior World Championship/Junior World Rugby Trophy (JWC/JWT): 57.2, p=0.0074). Injury severity data were not provided for the 2006 WRWC1 and therefore comparison was not possible. The mean and median severities of injury during the 2010 WRWC were higher than those reported for men at the 2007 RWC3 and 2008/2010 JWC/JWT,4 but the difference was only significant when compared with the mean severity at the 2007 RWC. The knee was the most commonly injured structure (n=11), the location of the most severe injuries, and the cause of most days absence. Although knee-ligament injuries resulted in the most days lost at the men's 2007 RWC (14% of all days lost),3 the proportion of these injuries was significantly (p≤0.001) less than that at the 2010 WRWC. There was a slightly higher proportion of concussions and a lower proportion of fractures at the 2010 WRWC compared with the 2006 WRWC,1 but neither difference was significant (p=0.447 and p=0.653, respectively). Similar to previous studies of men's and women's international rugby,1 3 4 the tackle caused most injuries. At the 2010 WRWC, backs sustained most injuries being tackled and forwards in the ruck. The injury causation data reported for the 2006 WRWC did not differentiate between forwards and backs; however, ‘being tackled’ was the most common cause of injury (66%).1
This study has some limitations. Because of the severity of some of the injuries sustained, estimated return-to-play dates were reported for injuries over 2 months; however, this limitation did not affect the results in terms of grouped injury severity categories.
In summary, the results from this study are generally similar to those reported for the 2006 WRWC, and taken together, these results confirm that the incidence of injury in women's international rugby is less than half of that experienced in the men's game. Because of the known higher risk of ACL injuries for women,5 6 further research is required to confirm whether this type of injury is a significant issue for women's rugby.
Acknowledgments
The authors would like to acknowledge the contribution made by the IRB tournament managers for facilitating and supporting the implementation of this study. The authors would also like to acknowledge the support of the medical teams working with each of the participating teams.
Footnotes
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Funding The study was funded by the International Rugby Board, Dublin, Ireland.
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Competing interests None.
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Ethical approval The study was approved by University of Nottingham, Medical School Ethics Committee.
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Provenance and peer review Not commissioned; externally peer reviewed.