Injury trends in Irish schoolboy rugby union

Background: Rugby Union is one of the world’s most popular team sports. Schoolboy Rugby, in particular, has increased in popularity and competitiveness in recent times. Due to  the physical nature of the sport, identifying injury risk and developing an understanding of  injury trends in school players is paramount to player welfare and safety. 

Aim: To establish the incidence, nature, mechanism and severity of injuries occurring in schoolboy Rugby in Ireland with a view to identifying key injury trends to inform future  injury prevention strategies.

Methods: A systematic programme of research was undertaken. This comprised of four studies; 1) A systematic review and critical appraisal of existing literature, 2) A national  survey to evaluate the availability of qualified personnel and current injury monitoring practices across Rugby schools, 3) A two-year surveillance and investigation of injury trends  in schoolboy Rugby and 4) An in-depth investigation of shoulder injuries in schoolboy  Rugby.  

Results: (1) The findings of the systematic review highlight a high degree of variability in methodologies, definitions, participant age, level of play and type of injury data reported. In turn, this provided a challenge in attempting to evaluate and compare injury surveillance studies in school Rugby. In summary however, the literature incidence rate (IR) reported for school Rugby ranged from 23.7 to 129.8 per 1,000 player hours (h) for players aged 9-18 years of age. (2) The first finding of the national survey demonstrated that there is limited access for schools to medical personnel, and that substantial variations exist in terms of current injury surveillance and prevention practices. The inconsistency, and variability in  injury data reported for the school Rugby cohort justified the need for the modification of an established injury reporting system, IRISweb, and implementation into the school Rugby setting. (3) A two-year season analysis of 12 Senior Cup (16-19 years) school Rugby teams  reported an overall IR of 53.6 per 1,000h. Forwards sustained significantly more injuries than  backs (p <0.05) with IR’s of 65.4 per 1,000h and 40.5 per 1,000h reported respectively. Head  and shoulder injuries were significantly higher for forwards compared to backs (p<0.05). Concussions were the most common injury diagnoses for forwards while ankle sprains were the most common injury diagnoses for backs. (4) An investigation into shoulder injuries reported an IR of 12.2 per 1,000h overall accounting for 2,189 days absence across the two seasons. Shoulder dislocations (4.1 per 1,000h) were the most burdenous injury diagnoses overall and represented the most common type of shoulder injury. The tackler sustained three times more shoulder injuries than the ball carrier. 

Conclusion: This programme of research adds to the existing literature on injury surveillance  in school Rugby. The findings from this thesis demonstrate that specific injury trends exist for the school Rugby cohort with the identification of a significant (p<0.05) relationship  between playing position and injury incidence. It also highlights practical guidelines for conducting injury surveillance within a school setting. The injury trends identified serve to  inform the development of future injury reduction strategies to improve the welfare of school  Rugby players.