World Rugby Surveillance Studies Sevens World Series (Men) Summary of Results: 2008/09 to 2015/16 Colin Fuller and Aileen Taylor 1 September 2016
1 Introduction Rugby Sevens (Men) 2008-2016 World Rugby is committed to implementing surveillance studies at all major World Rugby Tournaments and to disseminate the results within the Rugby community. The aims of these studies are: to record and analyse injuries and illnesses sustained by male and female players at individual Tournaments, to identify changing patterns of injury, and to bring injury-related areas of concern to the attention of World Rugby s Chief Medical Officer. Previous surveillance studies in men s Rugby Sevens reported the incidence and nature of match and training injuries sustained during the men s Sevens World Series from 2008/09 to 2014/15. This report continues the on-going study of Rugby Sevens by reporting match and training injuries and illnesses sustained during the men s 2015/16 Sevens World Series. This review also combines the new data, from the men s 2015/16 Sevens World Series, with all data reported in previous Series in order to provide an updated review of the risks of injury and illness in elite men s Rugby Sevens. 2 Methods All studies were conducted in accordance with the definitions and protocols described in the World Rugby approved consensus statement on definitions and procedures for injury surveillance studies in Rugby (Fuller et al., 2007). The definition of injury was: Any injury sustained during a Sevens World Series Tournament match or training activity that prevents a player from taking a full part in all normal training activities and/or match play for more than one day following the day of injury. A recurrent injury was defined as: An injury (as defined above) of the same type and at the same site as an index injury and which occurs after a player s return to full participation from the index injury. Specific injuries were classified using OSICS 8 (Orchard, 1995). Injury location, type and cause together with the event leading to the injury were also recorded. The definition of an illness used in this study was: Any medical condition sustained while travelling to a Sevens World Series Tournament, while at a Tournament or while travelling home at the end of a Tournament that prevents a player from taking a full part in all training activities and/or match play for more than one day following the day of onset of the illness. Injuries and illnesses not related directly to rugby-related activities at a Sevens World Series Tournament were not included. Injury/illness severity was determined by the number of days a player was injured/ill: a player was deemed to be injured/ill until he could undertake full, normal training and be available for match selection, whether or not he was actually selected. Medical staff were required to make an informed clinical judgement about a player s fitness to train/play on those days when players were Dr C Fuller (1 September 2016) Page 2 of 18
not scheduled to train or play. Injured/ill players were followed up after each Tournament to obtain their return-to-play date: the return-to-play dates for players with injuries/illnesses that remained unresolved 90 days after the final Tournament were estimated on the basis of the player s medical staff s clinical judgement and prognosis. The complete lists of categories and sub-categories used for categorising injury locations and injury types are provided in the Rugby injury consensus publication (Fuller et al., 2007). Differences in players anthropometric data were assessed using unpaired t-tests; differences in the incidences, mean severity and proportions of injuries were assessed using z-tests and differences in median severity using a Mann-Whitney U test. Differences in injury numbers were assessed using the chi-squared test. Statistical significance was accepted at the p=0.05 level; it is recognised that this could identify some differences that occur by chance due to the number of statistical comparisons being made in the study. 3 Data collection At the beginning of each Sevens World Series, the team s medical staff explained to squad players the purpose of the epidemiological study. Each player s baseline anthropometric information was recorded on a Player Baseline Information Form (playing position [back, forward]; date of birth; body mass [Kg]; stature [cm]); players joining a country s squad at a later date were added to the list of players and the anthropometric data recorded at the time the player joined the squad. A member of the team s medical staff recorded every injury/illness sustained during a Sevens World Series on a Tournament Summary of Injuries and Illnesses Report Form, which was returned to the study co-ordinator at the end of the Tournament. A member of the team s medical staff also recorded information about each injury and illness on an Injury/Illness Report Form (date of injury/illness, date of return to play, location and type of injury/illness, cause of injury/illness, event leading to injury/illness). Injury/illness Report Forms were returned to the study co-ordinator when the final piece of information had been entered on the Form (normally the return-to-play date). 4 Results Results for previous Sevens World Series have been presented in earlier reports (Fuller and Taylor, 2015). In the 2015/16 Sevens World Series, the number of tournaments increased from 9 to 10. The tournaments (Dubai, South Africa, New Zealand, Australia, USA, Canada, Hong Kong, Singapore, France, England) took place over the period 4 December 2015 to 22 May 2016. This study recorded players anthropometric data and match and training injuries and illnesses sustained by the 15 core teams (Argentina, Australia, Canada, England, Fiji, France, Kenya, New Zealand, Portugal, Russia, Samoa, Scotland, South Africa, USA, Wales) taking part in all ten of the 2015/16 Sevens World Series tournaments. Dr C Fuller (1 September 2016) Page 3 of 18
4.1 Anthropometric data Table 1 summarises the numbers and anthropometric data for players categorised as backs, forwards and all players in the 2015/16 Sevens World Series together with values averaged over the period 2008/09 to 2015/16. Table 1: Players anthropometric data: 2015/2016 Sevens World Series. Measure Mean (Standard deviation, number of players) Backs Forwards ALL players 2015/16 Stature, cm 180.7 (6.5, 203) 187.9 (5.2, 137) 183.6 (7.0, 340) Body mass, Kg 87.9 (8.1, 203) 98.1 (7.4, 137) 92.0 (9.2, 340) Age, years 24.1 (3.5, 203) 24.5 (3.8, 137) 24.2 (3.6, 340) All Series (2008/09 2015/16) Stature, cm 180.5 (6.4, 1291) 187.2 (5.6, 860) 181.7 (6.9, 2160) Body mass, Kg 86.7 (7.6, 1295) 97.1 (6.8, 860) 90.8 (8.9, 2164) Age, years 23.1 (3.3, 1293) 24.2 (3.6, 861) 23.7 (3.5, 2163) For the 2015/16 Sevens World Series, there is no significant difference in the ages (p=0.317) of backs and forwards but forwards are significantly heavier (p<0.001) and taller (p<0.001) than backs. Averaged over the period 2008/09 to 2015/16 forwards are significantly older, taller and heavier than backs (p<0.001 for all parameters). Trends in players age, stature and body mass over the period 2008/09 to 2015/16 are shown in Figures 1 to 3, respectively. 25 Age, years 24 23 22 2008/09 2009/10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Seven Series Back Forward Fig 1. Trends in players age (years) Dr C Fuller (1 September 2016) Page 4 of 18
190 Stature, cm 185 180 175 2008/09 2009/10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Seven Series Back Forward Fig 2. Trends in players stature (cm) 100 Body mass, Kg 95 90 85 80 2008/09 2009/10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Seven Series Back Forward Fig 3. Trends in players body mass (Kg) Backs (p=0.040) and forwards (p=0.020) have been getting older in the period 2008/09 to 2015/16 but there has been no significant change in the stature (backs: p=0.193; forwards: p=0.858) or body mass (backs: 0.137; forwards: p=0.887) of players over this period. 4.2 Match injuries 4.2a Incidence of injury Table 2 summarises the numbers of match injuries, match exposures and incidences of match injuries for backs, forwards and all players during the 2015/16 Sevens World Series and the equivalent values over the period 2008/09 to 2015/16. Dr C Fuller (1 September 2016) Page 5 of 18
Table 2: Number, match exposure (player-hours) and incidence (injuries/1000 player-match-hours, 95% confidence interval) of match injuries: 2015/16 Sevens World Series. Measure Backs Forwards ALL players 2015/16 Injuries 84 69 153 Exposure 796.7 597.5 1394.2 Incidence 105.4 (85.1 130.6) 115.5 (91.2 146.2) 109.7 (93.7 128.6) All Series (2008/09 2015/16) Injuries 532 323 855 Exposure 4499.9 3374.9 7874.8 Incidence 118.2 (108.6 128.7) 95.7 (85.8 106.7) 108.6 (101.5 116.1) Although in 2015/16 the incidence of injuries sustained by backs was lower and the incidence for forwards was higher than those seen in previous years, neither were significantly different from the long-term averages (backs: p=0.327; forwards: p=0.156) Trends in the incidence of injury for backs and forwards over the period 2008/09 to 2015/16 are shown in Figure 4. While the incidence of injury sustained by forwards was higher than that for backs, the long-term trend remains for the incidence of injury for backs to be significantly greater (p<0.001) than that for forwards. 150 Injuries/1000 player-hours 125 100 75 50 25 0 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Seven Series Backs Forwards Figure 4. Trends in the incidence of injury 4.2b Severity of injury Table 3 summarises the mean and median severities of injuries sustained during the 2015/16 Sevens World Series for backs, forwards and all players and the equivalent Series average values observed over the period 2008/09 to 2015/16. Dr C Fuller (1 September 2016) Page 6 of 18
Table 3: Mean and median severities of match injuries: 2015/16 Sevens World Series. Measure Severity (95% Confidence interval), days Backs Forwards ALL players 2015/16 Mean 41.0 (32.1 49.9) 36.7 (22.3 51.1) 39.0 (29.3 47.1) Median 26 (21 40) 17 (14 24) 21 (17 26) All Series (2008/09 2015/16) Mean 46.1 (41.4 50.8) 40.9 (35.6 46.2) 44.2 (40.9 47.8) Median 28 (27 31) 24 (21 28) 27 (24 29) The median severity of injuries sustained by backs in 2015/16 was significantly higher than that for forwards (p=0.018) but the mean values were not significantly different (p=0.617). Similarly, over the long-term period (2008/09 to 2015/16), the median severity of injuries sustained by backs was significantly higher than the value for forwards (p=0.002) but there was no significant difference in the mean severity values (p=0.162). Trends in the mean and median injury severity values over the period 2008/09 to 2015/16 are shown in Figures 5 and 6. 60 Mean, days 40 20 0 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Sevens series Backs Forwards Fig 5. Trends in mean severity Dr C Fuller (1 September 2016) Page 7 of 18
60 Median, days 40 20 0 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Sevens Series Backs Forwards Fig 6. Trends in median severity The lower mean and median severities of injuries sustained by forwards in the last 5 years is the result of a downward trend in the proportions of severe injuries (>28 days) sustained by forwards compared to backs over this period (Figures 7 and 8). 60 Propor0on of injuries, % 40 20 0 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Sevens series Minimal (2-3 days) Mild (4-7 days) Moderate (8-28 days) Severe (>28 days) Fig 7. Trends in injury severity categories of backs Dr C Fuller (1 September 2016) Page 8 of 18
60 Propor0on of injuries, % 40 20 0 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Sevens series Minimal (2-3 days) Mild (4-7 days) Moderate (8-28 days) Severe (>28 days) Fig 8. Trends in injury severity categories of forwards 4.2c Location of injury Tables 4 summarises the main and sub-locations of injuries sustained during the 2015/16 Rugby Sevens Series for backs, forwards and all players. Table 4: Locations of match injuries sustained: 2015/16 Sevens World Series. % (95% Confidence interval) Location of injury Backs Forwards ALL players 2015/16 Head/neck 20.2 (11.6 28.8) 20.3 (10.8 29.8) 20.3 (13.9 26.6) Head/face 20.2 (11.6 28.8) 17.4 (8.4 26.3) 19.0 (12.7 25.2) Neck/cerv l spine 0.0 ( - ) 2.9 (0 6.9) 1.3 (0 3.1) Upper limbs 29.8 (20.0 39.5) 27.5 (17.0 38.1) 28.8 (21.6 35.9) Shoulder/clavicle 16.7 (8.7 24.6) 13.0 (5.1 21.0) 15.0 (9.4 20.7) Upper arm 1.2 (0 3.5) 0.0 ( - ) 0.7 (0 1.9) Elbow 1.2 (0 3.5) 1.4 (0 4.3) 1.3 (0 3.1) Forearm 3.6 (0 7.5) 1.4 (0 4.3) 2.6 (0.1 5.1) Wrist 1.2 (0 3.5) 1.4 (0 4.3) 1.3 (0 3.1) Hand/fingers 6.0 (0.9 11.0) 10.1 (3.0 17.3) 7.8 (3.6 12.1) Trunk 2.4 (0 5.6) 5.8 (0.3 11.3) 3.9 (0.8 7.0) Ribs/upper back 2.4 (0 5.6) 2.9 (0 6.9) 2.6 (0.1 5.1) Abdomen 0.0 ( - ) 1.4 (0 4.3) 0.7 (0 1.9) Low back 0.0 ( - ) 0.0 ( - ) 0.0 ( - ) Sacrum/pelvis 0.0 ( - ) 1.4 (0 4.3) 0.7 (0 1.9) Lower limbs 47.6 (36.9 58. 46.4 (34.6 58.1) 47.1 (39.1 55.0) Hip/groin 1.2 (0 3.5) 1.4 (0 4.3) 1.3 (0 3.1) Thigh, posterior 10.7 (4.1 17.3) 2.9 (0 6.9) 7.2 (3.1 11.3) Thigh, anterior 3.6 (0 7.5) 1.4 (0 4.3) 2.6 (0.1 5.1) Knee 7.1 (1.6 12.7) 13.0 (5.1 21.0) 9.8 (5.1 14.5) L-Leg/Achilles 2.4 (0 5.6) 13.0 (5.1 21.0) 7.2 (3.1 11.3) Ankle 19.0 (10.7 27.4) 14.5 (6.2 22.8) 17.0 (11.0 22.9) Foot/toe 3.6 (0 7.5) 0.0 ( - ) 2.0 (0 4.2) Dr C Fuller (1 September 2016) Page 9 of 18
The main and sub-locations of injuries, averaged over the period 2008/09 to 2015/16, are shown, as a function of playing position, in Table 5. Table 5: Locations of match injuries sustained: 2008/09 to 2015/16 Sevens World Series. Location of injury % (95% Confidence interval) Backs Forwards ALL players All Series (2008/09 2015/16) Head/neck 14.7 (11.7 17.7) 19.8 (15.5 24.2) 16.6 (14.1 19.1) Head/face 14.1 (11.2 17.1) 17.3 (13.2 21.5) 15.3 (12.9 17.8) Neck/cerv l spine 0.6 (0 1.2) 2.5 (0.8 4.2) 1.3 (0.5 2.0) Upper limbs 18.8 (15.5 22.2) 19.5 (15.2 23.8) 19.1 (16.5 21.7) Shoulder/clavicle 10.0 (7.4 12.5) 13.0 (9.3 16.7) 11.1 (9.0-13.2) Upper arm 0.8 (0 1.5) 0.0 ( - ) 0.5 (0 0.9) Elbow 0.9 (0.1 1.8) 0.3 (0 0.9) 0.7 (0.1 1.3) Forearm 0.9 (0.1 1.8) 0.6 (0 1.5) 0.8 (0.2 1.4) Wrist 0.6 (0 1.2) 1.2 (0 2.4) 0.8 (0.2 1.4) Hand/fingers 5.6 (3.7 7.6) 4.3 (2.1 6.6) 5.2 (3.7 6.6) Trunk 4.9 (3.1 6.7) 7.1 (4.3 9.9) 5.7 (4.2 7.3) Ribs/upper back 2.6 (1.3 4.0) 3.4 (1.4 5.4) 2.9 (1.8 4.1) Abdomen 0.6 (0 1.2) 0.6 (0 1.5) 0.6 (0.1 1.1) Low back 1.5 (0.5 2.5) 1.9 (0.4 3.3) 1.6 (0.8 2.5) Sacrum/pelvis 0.2 (0 0.6) 1.2 (0 2.4) 0.6 (0.1 1.1) Lower limbs 61.6 (57.4 65.7) 53.6 (48.1 59.0) 58.5 (55.2 61.9) Hip/groin 2.1 (0.9 3.3) 2.2 (0.6 3.8) 2.1 (1.1 3.1) Thigh, posterior 12.6 (9.8 15.4) 4.6 (2.3 6.9) 9.6 (7.6 11.6) Thigh, anterior 5.5 (3.5 7.4) 7.1 (4.3 9.9) 6.1 (4.5 7.7) Knee 15.8 (12.7 18.9) 17.3 (13.2 21.5) 16.4 (13.9 18.9) L-Leg/Achilles 5.6 (3.7 7.6) 7.1 (4.3 9.9) 6.2 (4.6 7.8) Ankle 16.4 (13.2 19.5) 12.1 (8.5 15.6) 14.8 (12.4 17.1) Foot/toe 3.6 (2.0 5.2) 3.1 (1.2 5.0) 3.4 (2.2 4.6) 4.2d Type of injury Table 6 details the types of injuries sustained at the 2015/16 Sevens World Series, as a function of playing position. Dr C Fuller (1 September 2016) Page 10 of 18
Table 6: Types of match injuries sustained: 2015/16 Sevens World Series. Type of injury % (95% Confidence interval) Backs Forwards ALL players 2015/16 Bone 13.1 (5.9 20.1) 4.3 (0 9.2) 9.2 (4.6 13.7) Fracture 11.9 (5.0 18.8) 4.3 (0 9.2) 8.5 (4.1 12.9) Other bone 1.2 (0 3.5) 0.0 ( - ) 0.7 (0 1.9) C/PNS 17.9 (9.7 26.0) 17.4 (8.4 26.3) 17.6 (11.6 23.7) Concussion 16.7 (8.7 24.6) 17.4 (8.4 26.3) 17.0 (11.0 22.9) Nerve 1.2 (0 3.5) 0.0 ( - ) 0.7 (0 1.9) Joint (non-bone)/lig t 41.7 (31.1 52.2) 40.6 (29.0 52.2) 41.2 (33.4 49.0) Dislocation/sublux n 4.8 (0.2 9.3) 13.0 (5.1 21.0) 8.5 (4.1 12.9) Lesion meniscus 2.4 (0 5.6) 1.4 (0 4.3) 2.0 (0 4.2) Sprain/ligament 34.5 (24.4 44.7) 26.1 (15.7 36.4) 30.7 (23.4 38.0) Muscle/tendon 22.6 (13.7 31.6) 29.0 (18.3 39.7) 25.5 (18.6 32.4) Haematoma/etc 6.0 (0.9 11.0) 13.0 (5.1 21.0) 9.2 (4.6 13.7) Muscle rupture/etc 14.3 (6.8 21.8) 8.7 (2.0 15.3) 11.8 (6.7 16.9) Tendon injury/etc 2.4 (0 5.6) 7.2 (1.1 13.4) 4.6 (1.3 7.9) Skin 1.2 (0 3.5) 5.8 (0.3 11.3) 3.3 (0.5 6.1) Abrasion 0.0 ( - ) 4.3 (0 9.2) 2.0 (0 4.2) Laceration 1.2 (0 3.5) 1.4 (0 4.3) 1.3 (0 3.1) Other types 3.6 (0 7.5) 2.9 (0 6.9) 3.3 (0.5 6.1) Dental 0.0 ( - ) 0.0 ( - ) 0.0 ( - ) Visceral 2.4 (0 5.6) 1.4 (0 4.3) 2.0 (0 4.2) Other 1.2 (0 3.5) 1.4 (0 4.3) 1.3 (0 3.1) C/PNS: Central and peripheral nervous systems Reported concussions continued to increase during the 2015/16 Series, Figure 9. 20 Concussion, % of all injuries 15 10 5 0 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Sevens Series Figure 9: Trend in concussion reporting Dr C Fuller (1 September 2016) Page 11 of 18
Table 7 summarises the types of injury, as a function of playing position, averaged over the period 2008/09 to 2015/16. Table 7: Types of match injuries sustained: 2008/09 to 2015/16 Sevens World Series. Type of injury % (95% Confidence interval) Backs Forwards ALL players All Series (2008/09 2015/16) Bone 8.7 (6.3 11.1) 8.7 (5.6 11.7) 8.7 (6.8 10.6) Fracture 8.1 (5.8 10.4) 8.0 (5.1 11.0) 8.1 (6.3 9.9) Other bone 0.6 (0 1.2) 0.6 (0 1.5) 0.6 (0.1 1.1) C/PNS 12.1 (9.3 14.8) 13.6 (9.9 17.4) 12.6 (10.4 14.9) Concussion 10.9 (8.3 13.6) 12.7 (9.1 16.3) 11.6 (9.4 13.7) Nerve 1.1 (0.2 2.0) 0.9 (0 2.0) 1.1 (0.4 1.7) Joint (non-bone)/lig t 43.1 (38.9 47.3) 44.9 (39.5 50.3) 43.8 (40.5 47.1) Dislocation/sublux n 5.5 (3.5 7.4) 7.1 (4.3 9.9) 6.1 (4.5 7.7) Lesion meniscus 5.6 (3.7 7.6) 5.6 (3.1 8.1) 5.6 (4.1 7.2) Sprain/ligament 32.0 (28.0 36.0) 32.2 (27.1 37.3) 32.1 (29.0 35.2) Muscle/tendon 33.0 (29.0 37.0) 28.2 (23.3 33.1) 31.1 (28.0 34.3) Haematoma/etc 10.2 (7.6 12.7) 11.8 (8.3 15.3) 10.8 (8.7 12.9) Muscle rupture/etc 19.2 (15.9 22.6) 12.1 (8.5 15.6) 16.5 (14.0 19.0) Tendon injury/etc 3.6 (2.0 5.2) 4.3 (2.1 6.6) 3.9 (2.6 5.2) Skin 1.7 (0.6 2.8) 2.8 (1.0 4.6) 2.1 (1.1 3.1) Abrasion 0.0 ( - ) 0.9 (0 2.0) 0.4 (0 0.7) Laceration 1.7 ( 0 2.8) 1.9 (0.4 3.3) 1.8 (0.9 2.6) Other types 1.5 (0.5 2.5) 1.9 (0.4 3.3) 1.6 (0.8 2.5) Dental 0.0 ( - ) 0.3 (0 0.9) 0.1 (0 0.3) Visceral 0.9 (0.1 1.8) 0.9 (0 2.0) 0.9 (0.3 1.6) Other 0.6 (0 1.2) 0.6 (0 1.5) 0.6 (0.1 1.1) 4.2e Most common and highest risk injuries Table 8 lists the five specific injuries resulting in the most injuries and Table 9 lists the five injuries resulting in the greatest injury burden (total days lost) for backs and forwards over the period 2008/09 to 2015/16. Table 8: Five most common injuries sustained by backs and forwards: Sevens World Series 2008/09 2015/16 (% of total number of injuries reported). Backs Forwards Injury % Injury % Hamstring muscle strain 12.6 Concussion 12.8 Concussion 11.1 Knee MCL sprain 5.9 Lateral ankle ligament sprain 6.3 Lateral ankle ligament sprain 5.3 Knee MCL sprain 6.1 Quadriceps haematoma 5.0 Inf r tib-fib syndesmosis injury 4.4 Hamstring muscle strain 4.0 Dr C Fuller (1 September 2016) Page 12 of 18
Table 9: Five injuries resulting in the greatest injury burden for backs and forwards: Sevens World Series 2008/09 2015/16 (% of total reported days lost). Backs Injury Injury burden, % Forwards Injury Injury burden, % Anterior cruciate ligament 12.2 Anterior cruciate ligament 11.0 Hamstring muscle strain 10.4 Shoulder dislocat n /instability 7.8 Knee MCL sprain 7.5 Tibia/fibula fractures 6.2 Shoulder dislocat n /instability 6.7 Knee MCL sprain 6.0 Inf r tib-fib syndesmosis injury 6.4 Concussion 5.8 4.2f Nature of onset of injury Table 10 summarises the nature of injury-onset (acute, gradual) at the 2015/16 Sevens World Series, as a function of playing position, and the equivalent values for the period 2008/09 to 2015/16. Table 10: Nature of the injury-onset of match injuries: 2014/15 Sevens World Series. % (95% Confidence interval) Nature of onset Backs Forwards ALL players 2015/16 Acute 95.2 (90.7 99.8) 94.2 (88.7 99.7) 94.8 (91.2 98.3) Gradual 4.8 (0.2 9.3) 5.8 (0.3 11.3) 5.2 (1.7 8.8) All Series (2008/09 2015/16) Acute 92.9 (90.7 95.1) 92.2 (89.3 95.2) 92.6 (90.9 94.4) Gradual 7.1 (4.9 9.3) 7.8 (4.8 10.7) 7.4 (5.6 9.1) Based on the all-series injury data, over 92% of injuries sustained are acute in nature. 4.2g Cause of onset of injury Table 11 summarises the cause of onset of injury (contact, non-contact) at the 2014/15 Sevens World Series, as a function of playing position, and the equivalent values for the period 2008/09 to 2015/16. Dr C Fuller (1 September 2016) Page 13 of 18
Table 11: Cause of onset of injury: 2015/16 Sevens World Series. Cause of onset % (95% Confidence interval) Backs Forwards ALL players 2015/16 Contact 81.5 (73.0 89.9) 89.6 (82.2 96.9) 85.1 (79.4 90.9) Non-contact 18.5 (10.1 27.0) 10.4 (3.1 17.8) 14.9 (9.1 20.6) All Series (2008/09 2015/16) Contact 74.7 (70.9 78.4) 87.9 (84.2 91.5) 79.7 (77.0 82.5) Non-contact 25.3 (21.6 29.1) 12.1 (8.5 15.8) 20.3 (17.5 23.0) Based on the all Series data, 80% of all injuries are the result of contact events; however, compared to forwards, a significantly (p<0.001) higher proportion of injuries sustained by backs are non-contact injuries. 4.2h Match events leading to injury Table 12 provides a summary of the match events leading to injury as a function of playing position. Because of the wide range of match events leading to injury, only the all-series (2008/09 2015/16) summary is presented. Table 12: Match events leading to injury: Sevens World Series 2008/09 2015/16. Cause of onset % (95% Confidence interval) Backs Forwards ALL players All Series (2008/09 2015/16) Collision 12.2 (9.3 15.0) 12.6 (9.0 16.3) 12.3 (10.1 14.6) Kicking 0.8 (0 1.5) 0.0 ( - ) 0.5 (0 1.0) Lineout 0.0 ( - ) 2.2 (0.6 3.8) 0.8 (0.2 1.5) Maul 0.4 (0 0.9) 0.3 (0 0.9) 0.4 (0 0.8) Ruck 6.1 (4.0 8.2) 12.0 (8.4 15.6) 8.3 (6.5 10.2) Running 22.5 (18.9 26.2) 9.5 (6.2 12.7) 17.5 (14.9 20.1) Scrum 0.0 ( - ) 1.6 (0.2 2.9) 0.6 (0.1 1.1) Tackled 33.1 (29.1 37.2) 30.9 (25.8 36.0) 32.3 (29.1 35.5) Tackling 21.4 (17.8 24.9) 25.9 (21.0 30.7) 23.1 (20.2 26.0) Other 3.5 (1.9 5.1) 5.0 (2.6 7.5) 4.1 (2.8 5.5) Being tackled (33.1%), running (22.5%) and tackling (21.4%) are the match events responsible for the most injuries to backs while being tackled (30.9%), tackling (25.9%) and collisions (12.6%) are the events responsible for most injuries sustained by forwards. Apart from position-specific activities such as lineouts and scrums, the higher proportion of running injuries sustained by backs is the only statistically significant difference (p<0.001) between backs and forwards. This higher proportion of running injuries reflects the higher proportion of non-contact injuries sustained by backs shown in Table 11. Dr C Fuller (1 September 2016) Page 14 of 18
The most common match events leading to concussion were tackling (backs: 39.7%; forwards: 43.9%), being tackled (backs: 34.5%; forwards: 19.5%) and collision (backs: 19.0%; forwards: 22.0%). 4.2i Time of injury Based on the all-series data (2008/09 2015/16), Table 13 provides a summary of the period in a match when injury events take place as a function of playing position. Table 13: Time during matches of injuries sustained in the period 2008/09 to 2015/16. Time of injury, min % (95% Confidence interval) Backs Forwards ALL players All Series (2008/09 2015/16) First half 37.9 (33.7 42.1) 39.8 (34.4 45.1) 38.6 (35.3 41.9) Second half 62.1 (57.9 66.3) 60.2 (54.9 65.6) 61.4 (58.1 64.7) There are significantly (p<0.001) more injuries sustained in the second half of games for both backs and forwards but there is no significant difference between the results for backs and forwards. A detailed analysis of the time that injuries are sustained during tournaments has been published separately (Fuller et al., 2016). 4.2j Removal of injured players from the pitch Based on the all-series injury data (2008/09 2015/16), 51.5% of players were removed from play immediately, 24.5% were removed later in the game and 23.9% remained on the pitch until the end of the game. For players with concussion, 71.4% of players were removed immediately, 11.2% were removed later in the game and 17.3% remained on the pitch until the end of the game. 4.3 Training injuries All 15 of the core teams provided training injury and exposure data during the 2015/16 Sevens World Series. A total of 14 training injuries (backs: 7; forwards: 7) were reported, of which 4 occurred during Pre-match-warm-up, 3 during Noncontact-rugby-skills and 7 during Contact-rugby-skills. Over the ten Tournaments, a total of 11,732 player-training-hours were reported (backs: 6,405; forwards: 5,326): the incidence of training injuries over the ten Tournaments was, therefore, 1.2 injuries/1000 player-training-hours (95% CI: 0.7 2.0). For backs, the incidence was 1.1 (95% CI: 0.5 2.3) and for forwards the incidence was 1.3 (95% CI: 0.6 2.8). There is no statistically significant difference in the incidences of training injuries between backs and forwards (p=0.634). The mean severity of training injuries for all players was 39.5 days and the median severity was 27 days. Because of the small number of training injuries sustained, further analysis of the 2015/16 training data is not justified. Dr C Fuller (1 September 2016) Page 15 of 18
The average incidence of training injuries over the three Series from 2013/14 to 2015/16 is 0.9 injuries/1000 player-training hours (backs: 0.9; forwards: 0.9). The mean severity of training injuries is 35.9 days (backs: 29.5; forwards: 43.5) and the median severity is 27 days (backs: 28.5; forwards: 27). Further analysis of the training data cannot be justified at this stage due to the small number of training injuries sustained in each Series. 4.4 Illnesses Sixteen cases of illness resulting in time-loss were reported during the ten 2015/16 Sevens World Series Tournaments: of these, ten were related to gastrointestinal infections, 5 to a variety of other infections and 1 to an existing medical condition. Thirteen of the illnesses were sustained while at a Tournament, two while travelling to a Tournament and one while travelling home from a Tournament. These results indicate a Series-wide time-loss illness period prevalence among the players of 4.7%. 5 Summary of key points 5.1 Match injuries Although forwards are heavier and taller than backs, the anthropometric measurements of both groups of players have remained essentially constant over the period 2008/09 to 2015/16. The ages of backs and forwards have been increasing over this period. Based on the all-series data, the incidence of injury for backs is significantly greater (p<0.001) than that for forwards. The median severity of injuries sustained by backs is significantly higher than that for forwards but there is no significant difference in the mean severities of injury. Although there was a reduction in the proportion of lower limb injuries sustained in the 2015/16 Series, over the long-term the lower limb remains the most injured body region for both backs (61.6%) and forwards (53.6%). The most common specific locations for backs are the ankle (16.4%), knee (15.8%) and head/face (14.1%); for forwards, the knee (17.3%), head/face (17.3%) and shoulder/clavicle (13.0%) were the most common injury locations. The most common types of injury are joint (non-bone)/ligament for both backs (43.1%) and forwards (44.9%). The most common types of injury sustained by backs are sprain/ligament (32.0%), muscle rupture/strain/etc (19.2%) and concussion (10.9%) injuries; for forwards, the most common types are also sprain/ligament (32.2%), concussion (12.7%) and muscle rupture/strain/etc (12.1%). Again, based on the all-series data, the majority of injuries sustained by backs (74.7%) and forwards (87.9%) are caused by contact events. Backs (25.3%) sustain a significantly (p<0.001) higher proportion of non-contact injuries than forwards (12.1%), which is reflected in the higher proportion of running injuries sustained by backs. Being tackled (backs: 33.1%; forwards: 30.9%) and tackling (backs: 21.4%; forwards: 25.9%) remain the most common causes of injury. Dr C Fuller (1 September 2016) Page 16 of 18
5.2 Training injuries and illnesses Although training injury and illness data have been collected for three Series, the numbers of cases remain small, which limits the generalisations that can be presented at this stage. Dr C Fuller (1 September 2016) Page 17 of 18
6. References Rugby Sevens (Men) 2008-2016 Fuller CW, Molloy MG, Bagate C, et al. Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. Br J Sports Med 2007;41;328-331. Fuller CW, Taylor A, Molloy MG. Epidemiological study of injuries in international rugby sevens. Clin J Sport Med 2010;20;179-184. Fuller CW, Taylor A. International Rugby Board Surveillance Studies: Sevens World Series (Men) Summary of Results: 2008/09 to 2014/15. International Rugby Board; Dublin 2014. Available at: http://playerwelfare.worldrugby.org Fuller CW, Taylor A. World Rugby Surveillance Studies: Sevens World Series (Women). Summary of Results: 2011/12 to 2014/15. World Rugby; Dublin. Available at: http://playerwelfare.worldrugby.org Orchard J. Orchard Sports Injury Classification System (OSICS). Sport Health 1995;11:39-41. Fuller CW, Taylor A, Raftery M. Should player fatigue be the focus of injury prevention strategies for international rugby sevens tournaments? Br J Sports Med 2016;50:682-7. 7. Acknowledgements The authors acknowledge the valuable support provided by team physicians and physiotherapists during the collection of the data analysed in this report. Unfortunately, the authors are not always aware of the specific people providing the data, as many medical teams change from Tournament to Tournament and Series to Series. The authors would therefore like to apologise if anyone who provided data for the studies is not included in the list of acknowledgements below: Argentina: Garcia Orsetti Gohzalo, Hugo Peralta, Juan Martin Zucchiatti, Marco Caldo Australia: Alan Davies, Andrew Cooke, Cameron Watson, John Mitchell, Jonathon Moses, Josh Bird, Katie Ryan, Tim McGrath Canada: Carla Brash, Danielle Mah, Isabel Grondin, Kim Oslund England: Brett Davison, Remi Mobed Fiji: Jennifer Khalik, Una Vunibaka, William Koong France: Bernard Zabotto, Laurent Tiffounet, Marc Julia, Nicolas Barizien, Philippe Coste-Garriguet, Philippe Turblin Japan: Atsushi Tasaki Kenya: George Odhiambu, Lamech Francis New Zealand: Katherine Rottier, Matt Wenham, Paul Cameron Portugal: Cesar Corte Goncalves, Jose Carlos Rodrigues Russia: Denis Hkramov Samoa: Akbar Bhamji, Avi Carroll, Dave Clarke, Karolina Unaisi Vunibaka, Mathew Siliga Amituanai, Prashant Jhala Scotland: Alastair Little, Dan Moore, Gemma Scott, Kerry Kirk, Scott McAllister South Africa: Hugh Everson Spain: Angel De Lanuza Torres, Guillermo Zurdo Gallo, Rafael Lazaro Fernandez USA: Brian Green, Kristen Douhan, Mike Keating, Nikki Blanchflower Wales: Ashley James, Ben Searle, Dan Jones, Gary Ahmed, Gruff Parsons Dr C Fuller (1 September 2016) Page 18 of 18