The Correlation Between Hypermobility Syndrome and the Incidence of Musculoskeletal Injuries in Male Club Rugby Players

Joseph Ryan Bautista, DO, Jeremy Hanson, DO, Clifford Stark, DO Primary Care Sports Medicine Fellowship Northwell Health at Plainview Hospital Introduction

■ Hypermobility is a risk factor for musculoskeletal injury ■ Numerous research has been conducted, primarily on Ehlers- Danlos Syndrome (EDS) patients, with little research done on non- EDS patients ■ The purpose of this study is to determine if any correlation exists between hypermobility and musculoskeletal injuries, with male club rugby players serving as the subjects of this study ■ Our hypothesis is that there is a positive correlation between the level of hypermobility and the incidence of musculoskeletal injuries sustained by male club rugby players Methods / Study Design ■ Northwell IRB exemption was obtained ■ Single center retrospective analysis ■ 55 male club rugby players were screened for hypermobility via Beighton scores at their pre-participation physical evaluations prior to the Fall 2019 season – Inclusion criteria: players active for at least 80% of games (N=50) – Exclusion criteria: players inactive for greater than 20% of games (Not as a result of MSK injury, N=5)

N = 55 total rugby players

Met Inclusion Excluded: Criteria: N = 5 N = 50 Figure 1: Number of players meeting inclusion / exclusion criteria

■ All in-season musculoskeletal injuries sustained were recorded by their training staff Figure 2: The Beighton Score scoring system Results ■ N = 50 ■ All male subjects ■ Mean age of 27.31 years old ■ Age range of 19-34 years old ■ Ethnic Backgrounds – 52% Caucasian – 24% African American – 16% Hispanic – 8% Asian / Pacific Islander ■ Sept. 2019 - Dec. 2019, 10 rugby games ■ 14 musculoskeletal injuries Table 1: Beighton score and corresponding ■ Incidence = 0.2800 number of players ■ Pearson correlation coefficient of 0.4515 Results (cont.)

Figure 3: Beighton scores and corresponding number of players with and without injuries Results (cont.)

Figure 4: Distribution of musculoskeletal injury sites Conclusions

■ Wide range of musculoskeletal injury sites seen, with the ankle being the most common ■ Data analysis yielded a Pearson correlation coefficient of 0.4515, indicating a positive correlation with moderate strength between the level of hypermobility and the incidence of musculoskeletal injuries in male club rugby players ■ The results supported our hypothesis that higher levels of hypermobility in male club rugby players, as measured by their pre-participation physical evaluation Beighton scores, increase the incidence and thus risk of musculoskeletal injuries Limitations

■ Small study size ■ All male subject group ■ Narrow age range ■ One sport ■ Unable to account for other potential confounding variables, i.e. different rugby equipment, different playing fields (grass / turf), underlying medical issues / injuries Significance of Findings / Future Directions ■ Hypermobility is a risk factor for musculoskeletal injuries and should be a consideration when evaluating patients, especially those with multiple or recurrent injuries

■ May lead to further research focused on the effects of hypermobility on musculoskeletal injuries in: – female athletes – athletes across broader age ranges – athletes of different sports ■ May also lead to research on hypermobility-related injury risk prevention via Hypermobility Syndrome-specific therapies and treatment protocols References

■ Wolf, J.; Cameron, K.; Owens, B. Impact of Joint Laxity and Hypermobility on the Musculoskeletal System. Journal of the American Academy of Orthopaedic Surgeons. (2011) 19: 463-471. ■ Smith R.; Damodaran, A.; Swaminathan S.; Campbell R.; Barnsley L. Hypermobility and sports injuries in junior netball players. British Journal of Sports Medicine (2005) 39: 628-631. ■ Razak H.; Ali N.; Howe T. Generalized ligamentous laxity may be a predisposing factor for musculoskeletal injuries. Journal of Science and Medicine in Sport. (2014) 17: 474-478. ■ Oddy C.; Johnson M.; Jones G. The effect of generalised joint hypermobility on rate, risk and frequency of injury in male university-level rugby league players: a prospective cohort study. BMJ Open Sport & Exercise Medicine. (2017) 2: 1-5. ■ Reuter, P.; Fichthorn K. Prevalence of generalized joint hypermobility, musculoskeletal injuries, and chronic musculoskeletal pain among American university students. Peer J. (2019) 7:e7625. ■ Russek, L.; Errico, D. Prevalence, injury rate and, symptom frequency in generalized joint laxity and joint hypermobility syndome in a 'healthy' college population. Clinical Rheumatology (2016) 35: 1029- 1039. ■ Beighton P.; Grahame R.; Bird H. Assessment of Hypermobility. Hypermobility of Joints (2012) 1: 11-26. Acknowledgements

■ We would like to thank the AOASM for giving us the opportunity to present our research ■ Special thanks to the Old Blue Rugby Football Club for their help with this project Any questions?