Download PDF
Int J Sports Med 2017; 38(10): 791-798
DOI: 10.1055/s-0043-114862
Orthopedics & Biomechanics
© Georg Thieme Verlag KG Stuttgart · New York

Subsequent Injuries and Early Recurrent Diagnoses in elite Rugby Union Players

Sean Williams
1   Department for Health, University of Bath, Bath, United Kingdom of Great Britain and Northern Ireland
,
Grant Trewartha
2   Health, Bath, University of Bath, United Kingdom of Great Britain and Northern Ireland
,
Simon Kemp
3   Rugby Football Union, United Kingdom of Great Britain and Northern Ireland, Twickenham, London
,
Matthew J. Cross
4   Medical department, Rugby Football Union, Twickenham, United Kingdom of Great Britain and Northern Ireland
,
John H. M. Brooks
5   The Population Health Research Institute, St. George’s University of London, London, United Kingdom of Great Britain and Northern Ireland
,
Colin W. Fuller
6   Colin Fuller Consultancy, Research, Sutton Bonington, United Kingdom of Great Britain and Northern Ireland
,
Aileen E. Taylor
7   Karabati Limited, Nottingham, United Kingdom of Great Britain and Northern Ireland
,
Keith A. Stokes
1   Department for Health, University of Bath, Bath, United Kingdom of Great Britain and Northern Ireland
› Author Affiliations
Further Information

Publication History



accepted after revision 02 June 2017

Publication Date:
31 July 2017 (online)

Also available at
    Permissions and Reprints

Abstract

An eight-season (2005/06–2012/13) prospective cohort design was used to record time-loss injuries in 15 English Premiership teams. Data pertaining to a total of 1 556 players and 9 597 injuries (8 180 subsequent) were included in the analysis. Injuries subsequent to an index injury were classified as (1) New: different site; (2) Local: same site (and different type); or (3) Recurrent: same site and type. The severity of subsequent injuries (days missed) was compared with their related index injury. The proportions of early (<2 months), late (2–12 months) and delayed (>12 months) subsequent injuries were compared across injury classifications and diagnosis groupings. The majority of subsequent injuries (70%) were classified as new injuries, with 14% local and 16% recurrent. A large proportion of recurrent subsequent injuries (42%) occurred within two months of return-to-play. Subsequent injuries were not more severe than their corresponding index injury (effect sizes <0.20). Specific local and recurrent subsequent injury diagnoses with the highest risk of occurring within two months of return-to-play were: ‘neck muscle strain’, ‘ankle joint capsule sprain’, and ‘cervical nerve root’ injuries. These findings may be used to drive targeted secondary prevention efforts, such as reconsideration of return-to-play protocols for neck muscle strain injuries.

Key words

secondary injury prevention - subsequent injury classification - recurrent injury - re-injury - return to play

Supplementary Material

 

  • References

  • 1 Anderson SJ. When to return to play after an ankle sprain. Physician Sports Med 2002; 30: 39-40
    PubMedSearch in Google Scholar
  • 2 Batterham AM, Hopkins WG. Making meaningful inferences about magnitudes. Int J Sports Physiol Perform 2006; 1: 50-57
    CrossrefPubMedSearch in Google Scholar
  • 3 Creighton DW, Shrier I, Shultz R, Meeuwisse WH, Matheson GO. Return-to-play in sport: A decision-based model. Clin J Sport Med 2010; 20: 379-385
    CrossrefPubMedSearch in Google Scholar
  • 4 Ekstrand J, Walden M, Hagglund M. A congested football calendar and the wellbeing of players: Correlation between match exposure of European footballers before the World Cup 2002 and their injuries and performances during that World Cup. Br J Sports Med 2004; 38: 493-497
    CrossrefPubMedSearch in Google Scholar
  • 5 Finch CF, Cook J. Categorising sports injuries in epidemiological studies: The subsequent injury categorisation (SIC) model to address multiple, recurrent and exacerbation of injuries. Br J Sports Med 2013; 48: 1276-1280
    PubMedSearch in Google Scholar
  • 6 Fuller CW, Molloy MG, Bagate C, Bahr R, Brooks JHM, Donson H, Kemp SPT, Mccrory P, Mcintosh AS, Meeuwisse WH, Quarrie KL, Raftery M, Wiley P. Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. Br J Sports Med 2007; 41: 328-331
    CrossrefPubMedSearch in Google Scholar
  • 7 Hägglund M, Walden M, Ekstrand J. Lower reinjury rate with a coach-controlled rehabilitation program in amateur male soccer: A randomized controlled trial. Am J Sports Med 2007; 35: 1433-1442
    CrossrefPubMedSearch in Google Scholar
  • 8 Hägglund M, Walden M, Ekstrand J. UEFA injury study - An injury audit of European Championships 2006 to 2008. Br J Sports Med 2009; 43: 483-489
    CrossrefPubMedSearch in Google Scholar
  • 9 Hägglund M, Waldén M, Ekstrand J. Injuries among male and female elite football players. Scand J Med Sci Sports 2009; 19: 819-827
    CrossrefPubMedSearch in Google Scholar
  • 10 Hamilton GM, Meeuwisse WH, Emery CA, Shrier I. Subsequent injury definition, classification, and consequence. Clin J Sport Med 2011; 21: 508-514
    CrossrefPubMedSearch in Google Scholar
  • 11 Harriss D, Atkinson G. Ethical standards in sport and exercise science research: 2016 update. Int J Sports Med 2015; 36: 1121-1124
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Hawkins RD, Fuller CW. A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med 1999; 33: 196-203
    CrossrefPubMedSearch in Google Scholar
  • 13 Hertel J. Functional instability following lateral ankle sprain. Sports Med 2000; 29: 361-371
    CrossrefPubMedSearch in Google Scholar
  • 14 Hopkins W, Marshall S, Batterham A, Hanin J. Progressive statistics for studies in sports medicine and exercise science. Med Sci Sports Exerc 2009; 41: 3-12
    CrossrefPubMedSearch in Google Scholar
  • 15 Hopkins WG. Linear models and effect magnitudes for research, clinical and practical applications. Sportscience 2010; 14: 49-57
    PubMedSearch in Google Scholar
  • 16 Junge A, Langevoort G, Pipe A, Peytavin A, Wong F, Mountjoy M, Beltrami G, Terrell R, Holzgraefe M, Charles R. Injuries in team sport tournaments during the 2004 Olympic Games. Am J Sports Med 2006; 34: 565-576
    CrossrefPubMedSearch in Google Scholar
  • 17 Kemp S, Brooks JH, Cross M, Morrow P, Williams S, Anstiss T, Smith A, Taylor A, Palmer C, Bryan R, Trewartha G, Stokes K. England Professional Rugby Injury Surveillance Project: 2014-15 Season Report. 2016;
    PubMed
  • 18 Mohammadi F. Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players. Am J Sports Med 2007; 35: 922-926
    CrossrefPubMedSearch in Google Scholar
  • 19 Myklebust G, Bohr R. Return to play guidelines after anterior cruciate ligament surgery. Br J Sports Med 2005; 39: 127-131
    CrossrefPubMedSearch in Google Scholar
  • 20 Orchard J. Orchard Sports Injury Classification System (OSICS). Sports Health 1993; 11: 39-41
    PubMedSearch in Google Scholar
  • 21 Orchard J, Best TM. The management of muscle strain injuries: An early return versus the risk of recurrence. Clin J Sport Med 2002; 12: 3-5
    CrossrefPubMedSearch in Google Scholar
  • 22 Pasila M, Kiviluoto O, Jaroma H, Sundholm A. Recovery from primary shoulder dislocation and its complications. Acta Orthop Scand 1980; 51: 257-262
    CrossrefPubMedSearch in Google Scholar
  • 23 Quarrie KL, Cantu RC, Chalmers DJ. Rugby union injuries to the cervical spine and spinal cord. Sports Med 2002; 32: 633-653
    CrossrefPubMedSearch in Google Scholar
  • 24 Rauh MJ, Macera CA, Ji M, Wiksten DL. Subsequent injury patterns in girls’ high school sports. J Athl Train 2007; 42: 486-494
    PubMedSearch in Google Scholar
  • 25 Sharpe SR, Knapik J, Jones B. Ankle braces effectively reduce recurrence of ankle sprains in female soccer players. J Athl Train 1997; 32: 21-24
    PubMedSearch in Google Scholar
  • 26 Shrier I, Steele RJ. Classification systems for reinjuries: A continuing challenge. Br J Sports Med 2013; 48: 1338-1339
    PubMedSearch in Google Scholar
  • 27 Sterne JA, Smith GD. Sifting the evidence—What’s wrong with significance tests?. Phys Ther 2001; 81: 1464-1469
    CrossrefPubMedSearch in Google Scholar
  • 28 Swenson DM, Yard EE, Fields SK, Comstock RD. Patterns of recurrent injuries among us high school athletes, 2005-2008. Am J Sports Med 2009; 37: 1586-1593
    CrossrefPubMedSearch in Google Scholar
  • 29 Trewartha G, Preatoni E, England ME, Stokes KA. Injury and biomechanical perspectives on the rugby scrum: A review of the literature. Br J Sports Med 2014; 49: 425-433
    PubMedSearch in Google Scholar
  • 30 Waldén M, Hägglund M, Ekstrand J. Injuries in Swedish elite football—A prospective study on injury definitions, risk for injury and injury pattern during 2001. Scand J Med Sci Sports 2005; 15: 118-125
    CrossrefPubMedSearch in Google Scholar
  • 31 Williams S, Trewartha G, Kemp S, Stokes K. A meta-analysis of injuries in senior men’s professional Rugby Union. Sports Med 2013; 43: 1043-1055
    CrossrefPubMedSearch in Google Scholar
  • 32 Williams S, Trewartha G, Kemp SPT, Brooks JHM, Fuller CW, Taylor AE, Cross MJ, Stokes KA. Time loss injuries compromise team success in Elite Rugby Union: A 7-year prospective study. Br J Sports Med 2015; 50: 651-656
    PubMedSearch in Google Scholar