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. 2017 Nov;47(11):2395-2402.
doi: 10.1007/s40279-017-0721-3.

How Much Rugby is Too Much? A Seven-Season Prospective Cohort Study of Match Exposure and Injury Risk in Professional Rugby Union Players

Sean Williams  1 , Grant Trewartha  2 , Simon P T Kemp  3 , John H M Brooks  4 , Colin W Fuller  5 , Aileen E Taylor  6 , Matthew J Cross  2   3 , Gavin Shaddick  7 , Keith A Stokes  2
Affiliations

How Much Rugby is Too Much? A Seven-Season Prospective Cohort Study of Match Exposure and Injury Risk in Professional Rugby Union Players

Sean Williams et al. Sports Med. 2017 Nov.

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' 12-month match exposure (number of matches a player was involved in for ≥20 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 policy decisions regarding match workload limits in professional rugby union.

Keywords: Frailty Model; Injury Risk; Rugby Union; Rugby Union Player; Shared Frailty Model.

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Conflict of interest statement

Conflicts of interest

Sean Williams received PhD scholarship funding from the Rugby Football Union to undertake this work. Keith Stokes and Grant Trewartha received grant funding from the Rugby Football Union and Premiership Rugby to support the running of this project. Simon Kemp is employed as the Chief Medical Officer for the Rugby Football Union. Matthew Cross is employed by the Rugby Football Union as a medical research officer. John Brooks, Colin Fuller, Gavin Shaddick, and Aileen Taylor have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Non-linear association between injury risk and 12-month match exposure, with 90% confidence intervals. Shaded area represents thresholds for benefit (hazard ratio: 0.90) and harm (hazard ratio: 1.10)
Fig. 2
Fig. 2
Linear association between injury risk and 1-month match exposure, with 90% confidence intervals. Shaded area represents thresholds for benefit (hazard ratio: 0.90) and harm (hazard ratio: 1.10)
See this image and copyright information in PMC

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