Rugby World Cup injuries: That’s gotta hurt

Wallabies player Drew Mitchell is taken from the field after an injury during Rugby World Cup match between Australia and Russia. AAP Image/Dave Hunt

RUGBY WORLD CUP – The Cup has already taken its toll on many players – finalists New Zealand have lost star player, Dan Carter and Australia goes into its battle for third place against Wales four men down. The Conversation spoke to sport injuries prevention expert, Caroline Finch about what can be done to make rugby safer.

What are the most common injuries in rugby? What’s the rate of injury?

Rugby like most of our other football codes is a contact sport and even a collision sport.

Many of the injuries that occur in such sports are related to body contact, for example whilst tackling for the ball, even in scrum engagement, but also in players competing for a ball that’s moving around a field at a very fast pace.

That’s another aspect of this game, like other football codes too, rugby is a running game, and so the most common injuries are to the lower limbs (knee, thigh, ankle), because it’s about running and changing direction.

Some of the injuries that have been getting lots of media coverage have been things like concussion and mild-traumatic brain injuries and they do occur, as you would expect from a sport where there is collision, but only about 11% of injuries are related to concussion. The vast majority are to the lower limbs. Other body contact injuries occur to places like the shoulders.

In terms of the injury rates, it’s really hard to give a definitive overall answer to that, because it depends on the level of play.

The elite players, the ones we see in the Rugby World Cup now, are very finely tuned physical men and because they know their game inside out they’re not going to get injuries related to poor ball handling, lack of skills or a lack of fitness.

But when we’re talking more about community sports, particularly our weekend warriors or children then we’re going to get different injuries and those factors become relevant.

So even if the injury rates were the same, we’re talking about very different types of injuries and causes of those injuries depending on the level of game and the standards that the players are at.

Welsh player, Adam Jones walks off the field after sustaining a calf injury. AFP/William West

Do you think the current concussion rules we have in rugby are safe enough? Are they being followed?

The state of play at the moment is that the International Rugby Board has guidelines on concussion that require anyone who sustains a concussion must take a three week break from more training and from all games.

These should be mandatory for players in age-graded competitions, so for players under the age of 19, irrespective of what the level of play is.

Older players can return within three weeks but only if they’re declared symptom free and fit to play by a neurological specialist.

These guidelines will be enforced in the Rugby World Cup and you’d find that those guidelines will be followed to the tee. Because all the teams have their medical staff, they’ll have their specialists there, and if a player is concussed, then the team is not going to perform well if one of their key players is hindered by injury – so it’s not in their interest.

When we come to other levels of play though, the issue becomes a bit complicated as it’s up to different regions to adopt the guidelines.

In Australia, Australian Rugby Union recommends community players and coaches follow the guidelines.

But we’ve actually recently had a study published online in the British Journal of Sports Medicine where we looked at around 2,000 rugby union players from community clubs.

They were aged between around 15 and 48 years, some of them in school competitions, some of them in suburban competitions.

About 200 of those players received more than one concussion and we tried to find out how many knew about the advice.

The vast majority of players who got concussion weren’t even told that they need to sit out.

Even more worryingly, the small proportion of players who did get advice ignored it.

It’s not just rugby union that has this problem, we’re finding this internationally in all sports injuries prevention fields, that there is actually a mismatch between what formal safety policies and gudilines are and what actual practice is.

Butting heads in the game between France and Japan in the 2011 Rugby World Cup. EPA/Kim Ludbrook

Are helmets the answer? Is the current headgear safe?

This is again, a really topical issue, the guidelines that we’ve just talked about are a strategy to use once players have sustained injuries.

So, of course, we want to prevent those injuries in the first place. I have to say, too often people say the answer is to just put a helmet on them, that’s going to solve everything.

In rugby, we have a padded soft-shell helmet or a scrum cap that’s used. It’s has a soft covering and it’s padded to a certain thickness. The IRB has stipulations as to how thick that padding can be, it specifies both a minimum level but also a maximum.

We published a study that actually looked at whether or not headgear would work to prevent head injuries and concussion in the sport.

A lab-based study by Associate Profesor Andrew McIntosh at the University of New South Wales, who’s an injury biomechanist and specialist in designing and testing protective equipment, showed that [the current headgear] is not going to protect against concussion. It might prevent superficial grazes but it won’t prevent concussions.

So he then asked, what if we made headgear a bit thicker, would that prevent injuries?

And so the IRB funded this study, whereby we followed over 4,000 players over about 30,000 player hours.

Roughly a third of that group wore the IRB regulated helmets, another third wore the modified helmets and the other third were allowed to play with whatever they normally played with.

We did that in a randomised control trial (the gold standard for studying these sorts of preventative measures) and we found there was actually no reduction in head injury or concussion rates with protective helmets, at all.

We didn’t even find it with the players in the modified helmets which had thicker padding.

But we did see some trend towards there being less time away from the sport in that group, so the injuries were probably less severe.

So we’ve got no evidence really that soft-shell helmets help prevent concussion, although they may prevent against superficial injuries.

However, if players feel safer and want to wear helmets than we’re all for that. But we certainly wouldn’t be saying at this stage that this is a protective device that is going to prevent everything, therefore it should not be compulsory to wear one.

Are there ways of improving the safety culture of rugby?

I think we have seen a culture change in the sport in the last ten years even when regards to helmets.

It’s not uncommon to see players with soft-shell helmets now, where as it’s very uncommon in a sport like Australian Rules Football.

That culture hasn’t supported it, but Rugby has.

There’s also been other changes too where people have recognised, yes, the sport is a collision and contact sport so we don’t really need our juniors playing like our senior players.

So why don’t we develop modified rule versions of the game so that children get introduced to the skills of the game gradually. And when they’re physically, cognitively, and developmentally ready to tackle then we’ll allow that.

So I think there have already been big cultural shifts, and really positive in terms of making the game as safe as possible for children.

Bad injuries happen across the codes, including in rugby league. AAP/Patrick Hamilton

Is there anything that rugby could learn about injury prevention and safety from other codes, like rugby league and the AFL?

Certainly, one of things about Australian Football, particularly when we’re talking about the elite professional level of the game is that they’ve invested very significantly in infrastructure to support injury surveillance and monitoring of injuries in all elite games.

So every AFL team has a sport medicine doctor and other support staff, who provide injury data on a weekly basis to a central database.

So people don’t realise each individual club shares their injury information for the benefits of the whole game. Now that’s a real model for data collection for injury surveillance globally, and it’s one that could be used I think in rugby.

And the other thing we need to do, and it’s the same in Australian Football, is that we need to start to move those information systems down to lower levels of play because if we know exactly why injuries are occurring then we know how to better prevent them.

Without that information it’s very hard to say what injuries occur and why,and what could be done to prevent them, you just rely on anecdotal or newspapers reports.

This is the seventh part of our Rugby World Cup series. To read the other parts, follow these links:

- Part one: Rugby World Cup: All Blacks, New Zealand Maori and the politics of the pitch

- Part two: What will the Rugby World Cup be worth to New Zealand

- Part three: Art or science? Decision making in rugby

- Part four: Rugby World Cup: Are cheats prospering?

- Part five: Rugby World Cup: The Australian situation

- Part six: Selling the Rugby World Cup

- Part seven: Rugby World Cup injuries: That’s gotta hurt

- Part eight: Rugby World Cup a lottery amid refereeing chaos

- Part nine: All Blacks’ proud tradition of the haka insulted in Rugby World Cup