How Much Rugby is Too Much? A Seven-Season Prospective Cohort Study of Match Exposure and Injury Risk in Professional Ru
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ORIGINAL RESEARCH ARTICLE
How Much Rugby is Too Much? A Seven-Season Prospective Cohort Study of Match Exposure and Injury Risk in Professional Rugby Union Players Sean Williams1 • Grant Trewartha1 • Simon P. T. Kemp2 • John H. M. Brooks3 Colin W. Fuller4 • Aileen E. Taylor5 • Matthew J. Cross1,2 • Gavin Shaddick6 • Keith A. Stokes1
•
Ó The Author(s) 2017. This article is an open access publication
Abstract Introduction Numerous studies have documented the incidence and nature of injuries in professional rugby union, but few have identified specific risk factors for injury in this population using appropriate statistical methods. In particular, little is known about the role of previous short-term or longer-term match exposures in current injury risk in this setting. Objectives Our objective was to investigate the influence that match exposure has upon injury risk in rugby union. Method We conducted a seven-season (2006/7–2012/13) prospective cohort study of time-loss injuries in 1253 English premiership professional players. Players’
This article is part of Topical Collection on Rugby Health.
Electronic supplementary material The online version of this article (doi:10.1007/s40279-017-0721-3) contains supplementary material, which is available to authorized users. & Sean Williams [email protected] 1
Department for Health, University of Bath, Bath BA2 7AY, UK
2
Rugby Football Union, Twickenham, UK
3
The Population Health Research Institute, St. George’s University of London, London, UK
4
Colin Fuller Consultancy, Sutton Bonington, UK
5
Karabati Limited, Nottingham, UK
6
Department of Mathematical Sciences, University of Bath, Bath, UK
12-month match exposure (number of matches a player was involved in for C20 min in the preceding 12 months) and 1-month match exposure (number of full-game equivalent [FGE] matches in preceding 30 days) were assessed as risk factors for injury using a nested frailty model and magnitude-based inferences. Results The 12-month match exposure was associated with injury risk in a non-linear fashion; players who had been involved in fewer than &15 or more than &35 matches over the preceding 12-month period were more susceptible to injury. Monthly match exposure was linearly associated with injury risk (hazard ratio [HR]: 1.14 per 2 standard deviation [3.2 FGE] increase, 90% confidence interval [CI] 1.08–1.20; likely harmful), although this effect was substantially attenuated for players in the upper quartile for 12-month match exposures ([28 matches). Conclusion A player’s accumulated (12-month) and recent (1-month) match exposure substantially influences their current injury risk. Careful attention should be paid to planning the workloads and monitoring the responses of players involved in: (1) a high ([&35) number of matches in the previous year, (2) a low (\&15) number of matches in the previous year, and (3) a low-moderate number of matches in previous year but who have played intensively in the recent past. These findings make a major contribution to evidence-based
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