1. Comparative Injury Studies Michael Keating, MS, ATC, CSCS USA Rugby Medical Services

2. What does everyone want to know??? Is rugby safer than football??

4. Recent Literature Review 1.Injuries…HS Rugby Players 05-06 – Collins et al – 2008 (RIO Rugby study) 2.Collegiate Rugby Union Injuries – Kerr et al – 2008 3.Injuries in US HS Athletes – Darrow et al – 2009 4.Tackle Injuries in Pro Rugby – Quarrie & Hopkins – 2008

5. RIO Study 1.Online reporting of ~ 60 clubs during 2005- 2006 2.Online reporting mechanism 3.Looked at over 62,000 player exposures 4.Examined over 290 total injuries 5.75% of the reporting was completed by coach

6. Rio Study Injury rate per 1,000 player exposures 2005 Rugby Rio 2006 Rugby Rio HS Football Total6.64.74.4 Game15.915.012.1 Practice1.51.12.5

7. Rio Study Injury rate per 10,000 player exposures 2005 Rugby Rio 2006 Rugby Rio HS Football Concussion**8.68.24.6 Fracture8.88.24.9 Knee5.26.36.6

8. RIO Study 1.Fractures, Concussions and Ligament Sprains were the most common injuries – each comprised ~ 16% of all injuries 2.Almost 60% of all injuries occurred during the tackle, 75% involved contact with another player 3.Females had more ligament injuries as compared to males (20.8% > 14.9%) 4.More likely to suffer injury in game v. practice (10:1)

9. Collegiate Rugby Injuries - USA 1.Online reporting of ~ 70 clubs during 2005- 2006 2.Online reporting mechanism 3.Looked at almost 70,000 player exposures 4.Examined 850 total injuries 5.83% of the reporting was completed by coach

10. Collegiate Rugby Injury Study Injury rate per 1,000 player exposures RugbyFootball Game22.541.4* (35.9) Practice5.55.9

11. Collegiate Rugby Injury Study Injury rate per 1,000 player exposures RugbyFootball Concussion2.04.5 Fracture1.5+ Sprains3.5+

12. College Rugby Injury Study 1.Ligament Sprains, Muscle Strains and Concussions were the most common injuries 2.Almost 50% of all injuries occurred during the tackle, 75% involved contact with another player 3.More likely to suffer injury in game v. practice (4:1) 4.Possible lower injury rates as compared to other studies secondary to lower standard of play

13. Future Direction 1.Continue to utilize and fund research focusing on youth and college rugby 2.Higher participation of clubs 3.Reliable reporting from medical personnel 4.Equipment variations/improvements 5.Tackle, scrum, lineout, ruck and maul education 6.Anthropometric measures of players

15. Injury Prevention forRugby

16. Acute Injuries vs. Gradual Onset/Overuse

17. Overuse or Gradual Onset Used to be a prime concern and still is at Elite Level Identify underlying pathology and pathomechanics during screen

18. Proper Dynamic Warm-up Prescribe exercise specific to demands “Injury Prevention” programs?? Long Term Athletic Development Model Methods

19. Acute Injuries Previously little to no thought in this arena and now IS the FOCUS How do we approach this??

20. Acute Injuries Absolutely begins and ends with education and coaching!

21. Acute Injuries Techniques/skills – especially in contact Training Sessions – contact vs. limited contact LTAD

22. Optimal development of young players Influence of growth and maturity on early success Dangers of overspecialisation at an early age (physical and skills-related) Long-term consequences (skill-base, injury, burnout) Some evidence (Hartwig et al 2008) that high training volumes better tolerated than high competition volumes Overall lack of information – urgent need for longitudinal observational studies form 16 – 21 years

23. Anti-DopinginRugby

24. Key is early education that is both Consistent/Persistent &Relevant

25. Resources 1.USADA – www.usantidoping.org 2.IRB – new site – www.keeprugbyclean.com 3.WADA