Gardner Et Al. a Systematic Review and Meta-Analysis of Concussion in Rugby Union

Electronic Supplementary Material Table S2. Studies Reporting on Concussion Incidence

Reference Concussion incidence (per Injury Definition Level of Play Number of teams and Ranking of concussion 1,000 playing/training seasons frequency among all other hours) injuries, and rates of overall injury.

Fuller et al. Rugby-7s: International consensus statement on Elite; August 2007 to July N/A (the injury focus in this (2014) (70) Overall: 8.3 injury surveillance studies for rugby. international 2013; study was on concussion Forwards: 7.4 only). Backs: 9.0 Concussion: “Any concussion Rugby-15s – English sustained by a player during a match Premiership (seasons: Rugby-15s: that prevented the player from taking 2007/2008 to Overall: 4.5 a full part in all training activities or 2010/2011), Rugby Forwards: 4.5 match play for more than one day World Cup (years: Backs: 4.5 following the day of injury, 2007, 2011), Pacific irrespective of whether match or Nations Cup (years: training sessions were actually 2012, 2013), Junior scheduled” World Championships (years: 2008, 2010- Cases that were coded as HN1 2013), Junior World (concussion) under the Orchard Rugby Trophy (years: Code. 2008, 2010-2013).

Rugby-7s – Sevens World Series (series: 2008/2009, 2010/2011 to 2012/2013).

RFU (2014) Match play: 6.7 Any injury that prevents a player Elite 12 teams in the Aviva 1st (65) from taking a full part in all training Premiership, over one activities typically planned for that season (2012-2013). day and/or match more than 24 hours from midnight at the end of the day the injury was sustained.

Fuller et al. Overall: 7.8 (4.7 to 13.0) ‘Any physical complaint sustained by Elite; All 20 competing Match Play: 4th (2013) (64) Forwards: 8.8 (4.6 to 16.9) a player during a RWC match or international teams at the RWC, =1st muscle rupture, tear, strain Backs: 6.7 (3.0 to 14.9) training session that prevented the or cramp: 19.8; A Systematic Review and Meta-Analysis of Concussion in Rugby Union Online Supplementary Material Andrew J. Gardner, PsyD, Grant L. Iverson, PhD, W. Huw Williams, PhD, Stephanie Baker, M.Sci, & Peter Stanwell, PhD Page 1 of 17 Gardner et al. A Systematic Review and Meta-Analysis of Concussion in Rugby Union

player form taking a full part in all New Zealand, 2011 =1st sprained ligament: 19.8; training activities or match play for 3rd Haematoma, contusion, or more than 1 day following the day of bruise: 16.1. the injury irrespective of whether Overall match play injury rate: match or training sessions were 89.1 actually scheduled’ Training: No concussions Overall training injury rate: 2.2

RFU (2013) Match play: 5.1 Any injury that prevents a player Elite 12 teams in the Aviva Match play: 1st (64) from taking a full part in all training Premiership, over one Training: 0.04 activities typically planned for that season (2011-2012). Training: 11th day and/or match more than 24 hours from midnight at the end of the day the injury was sustained.

RFU (2013) Match play: 4.7 Any injury that prevents a player Elite 12 teams in the Aviva Match play: 4th (64) from taking a full part in all training Premiership, over one Training: 0.07 activities typically planned for that season (2010-2011). Training: = 8th day and/or match more than 24 hours from midnight at the end of the day the injury was sustained.

RFU (2013) Match play: 3.9 Any injury that prevents a player Elite 12 teams in the Aviva Match play: 4th (64) from taking a full part in all training Premiership, over one activities typically planned for that season (2009-2010). day and/or match more than 24 hours from midnight at the end of the day the injury was sustained.

RFU (2013) Match play: 4.9 Any injury that prevents a player Elite 12 teams in the Aviva Match play: 4th (64) from taking a full part in all training Premiership, over one activities typically planned for that season (2008-2009). day and/or match more than 24 hours

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from midnight at the end of the day the injury was sustained.

RFU (2013) Match play: 4.6 Any injury that prevents a player Elite 12 teams in the Aviva Match play: 2nd (64) from taking a full part in all training Premiership, over one activities typically planned for that season (2007-2008). day and/or match more than 24 hours from midnight at the end of the day the injury was sustained.

RFU (2013) Match play: 3.3 Any injury that prevents a player Elite 12 teams in the Aviva Match play: = 5th (64) from taking a full part in all training Premiership, over one activities typically planned for that season (2003-2004). day and/or match more than 24 hours from midnight at the end of the day the injury was sustained.

RFU (2013) Match play: 5.6 Any injury that prevents a player Elite 12 teams in the Aviva Match play: 3rd (64) from taking a full part in all training Premiership, over one activities typically planned for that

day and/or match more than 24 hours season (2002-2003). from midnight at the end of the day the injury was sustained.

Roberts et al. Match play: An injury that occurred during a first Sub-elite, and Three seasons (season Match play overall: 5th (2013) (67) Overall: 1.2 team match resulting in an absence Community 1: 46 clubs, season 2: 1st knee ligament/joint: 2.4 from participating in match play for 67 clubs; season 3: 76 = 2nd ankle ligament/joint: 1.7 one week or more from the day of the clubs = 2nd Shoulder ligament/joint: injury. 1.7 4th: hamstring strain: 1.4

Fuller et al. Match play: An injury of the same type and at the Elite; 20 teams, 615 players Match Play: 3rd (2012) (71) Overall: 7.8 same site as an index injury and which international at the IRB Rugby 1st muscle rupture, tear, strain Forwards: 8.8 occurred after the player’s return to full World Cup, 2011 or cramp: 19.8; Backs: 6.7 participation from the index injury 2nd Haematoma, contusion, or Training: no concussions bruise: 16.1. were recorded Overall match play injury rate: 89.1 Training: No concussions Overall training injury rate: 2.2

Taylor et al. Match play: Definitions and procedures were Elite; 11 teams, 285 women Match Play: 3rd (2011) (79) Overall head/neck: 25.6 compliant with the consensus International at the 2010 Women’s 1st knee-ligament: 15% of Forwards: 33.3 statement for epidemiological studies Rugby World Cup. reported injuries 2nd Backs: 19.0 in rugby (Fuller et al. 2007); “any ankle ligament: 13% 3rd physical complaint, which was concussion:10% Overall central/peripheral caused by a transfer of energy that nervous system: 10.3 exceeded the body’s ability to Forwards 11.1 maintain its structure and/or Backs 9.5 functional integrity, that was sustained by a player during a rugby match or rugby training, irrespective of the need for medical attention or

time-loss from rugby activity”

Haseler et al. Match play: Injuries were defined according to the Amateur school 210 players, all male, Match play: (2010) (89) Concussion: 1.8 International Rugby Board consensus boys over nine months, 1636 1st knee: 4.9 Head and neck: 6.1 statement. player-hours 2nd shoulder: 4.9 3rd head: 4.3 4th concussion: 1.8 Overall injury rate: 24.0

Fuller and Match play: Definitions and procedures were Elite 35 teams, 941 players, Match play: equal 4th Molloy Overall head/neck: 12.1 compliant with the international 2008 and 2010 IRB U- 1st ankle ligament: n = 25 (2011) (99) Forwards: 12.5 consensus statement for 20 Junior World 2nd knee ligament: n = 14 Backs: 11.6 epidemiological studies in rugby Championships and 3rd shoulder ligament: n = 11 (Fuller et al., 2008). “Any physical Junior World Rugby 4th Anterior thigh hematoma: n Overall central/peripheral complaint sustained by a player Trophies, 166 team = 9 nervous system: 6.9 during a Rugby World Cup match or matches Overall Injury: 57.2 Forwards: 5.7 training session that prevented the Forwards: 55.3 Backs: 8.1 player from taking a full part in all Backs: 59.4 training activities or match play for Concussion was more than one day following the day responsible for 9 of the 10 of injury, irrespective of whether injuries (backs, 5 of 7; match or training session were forwards, actually scheduled” 4 of 5) reported to the central/peripheral nervous system

Fuller et al. Match play: Definitions and procedures were International, 2008/2009 Match play: (2010) (95) Concussion: 2.0 compliant with the international Elite International Rugby 1st Ankle ligament:18.4 consensus statement for Board Sevens World 2nd Knee ligament: 16.3 Overall head/neck: 4.9 epidemiological studies in rugby Series (8 tournaments) 3rd Hamstring muscle strain: Forwards: 7.3 (Fuller et al., 2007). “Any physical and Rugby World Cup 11.2 Backs: 3.3 complaint sustained by a player Sevens 2010, 290 Overall match play injury rate: during a Rugby Sevens match that

Overall central and prevented the player from taking a players, 12 countries 106.2 peripheral nervous system: full part in training and/or match play 4.9 for more than one day following the Forwards: 4.9 day of injury.” Backs: 5.0

Fuller et al. Match play: Definitions and procedures were Elite 2 seasons, six teams in Match injuries: (2010) (94) Total of 3 concussions: compliant with the international Hong Kong Division 1 Incidence of injuries on artificial: 1; grass: 2. consensus statement for and training injuries Artificial grass: 38.2 epidemiological studies in rugby. sustained by two teams Incidence of injuries on grass: (Fuller et al. 2007); “any physical in the English 26.9 complaint, which was caused by a Premiership. transfer of energy that exceeded the Total 282 players from Grass: head/neck: 25.0 body’s ability to maintain its Hong Kong; 169 Artificial: head/neck: 19.2 structure and/or functional integrity, players from England Grass: C/PNS: 10.7 that was sustained by a player during study of training Artificial: C/PNS: 1.9 a rugby match or rugby training, injuries. irrespective of the need for medical Training Injuries: attention or time-loss from rugby Grass head/neck: 4.6 activity” Artificial head/neck: 3.7 Grass C/PNS: 3.0 Artificial C/PNS: 0.0

McIntosh et Match play: Two operational injury definitions Amateur 2002 and 2003 season, Match play: al. (2010) (93) Concussion Game Injuries: were used: (1) game injury – any 82 teams in 2002 and Game Injuries: 6.9 injury requiring on-field treatment or 87 in 2003. 1st head, face & neck: 30% resulting in the player being removed Missed Game Injuries: from the field during a rugby game, 1st head, face & neck: 13% and (2) missed game injury – any injury occurring in a rugby game resulting in the player missing a game the next week.

Hollis et al. Match play: Concussion/mTBI was defined as a Amateur to sub- Followed between 1 N/A. The only injury

(2009) (90) Concussion: 7.97 traumatically induced physiological elite and 3 winter playing observation was concussion. Under 21 age group was disruption of brain function that seasons over a 3 year the highest: 10.54 involves at least one of the following: period from 2005- a period of loss of consciousness 30 2007; 3207 male minutes or less, any loss of memory nonprofessional rugby for events immediately before or after players; 26 the incident, or any alteration in nonprofessional rugby mental state such as feeling dazed or clubs and 8 schools confused. participated.

Schneiders et Match Play: 2.87 Injury definitions used in this study Sub-elite 271 players from 8 Match play: 4th al. (2009) (41) were retroactively modified in an premier grade rugby 1st haematoma/bruising: 21.3% 5.5% (n=9) of overall attempt to comply with the consensus union teams; one 2nd ligament tear & sprain: reported injuries were statement on reporting injuries in season 20.7% concussions. rugby union (Fuller at al., 2007). 3rd muscle strains & tears: “Any physical complaint sustained by 14.0% a player during a Rugby match that prevented the player from taking a Overall injury incidence: 52.2 full part in training and/or match play for more than one day following the day of injury.”

Fuller et al. Super 14 Definitions and procedures described Elite One season; 27 teams; Brain, spinal cord & PNS (not (2009) (98) Injury location: head/neck; in the manual were consistent with 813 players taking part just concussions) Injury type: Brain/spinal the consensus statement for injury in the 2008 Super 14 cord/PNS: 11.0 surveillance studies in rugby union and Vodacom Cup Super 14 Match play: 3rd (Fuller et al., 2007). “Any physical competitions. 1st joint (non-bone)/ligament Vodacom Cup complaint sustained by a player 39.7% Injury location: head/neck; during a Rugby match that prevented 2nd muscle/tendon 38.8% Injury type: Brain/spinal the player from taking a full part in rd cord/PNS: 13.5 training and/or match play for more Vodacom Cup Match Play: 3 st than one day following the day of 1 muscle/tendon: 40.5% nd injury.” 2 joint (non-bone)/ligament

Shuttleworth- Concussion Incidence Concussion was defined as any Amateur - elite School, university, club N/A. The only injury Edwards et al. (average % per season): alteration in neurological status and provincial level observation was concussion. (2008) (42) School age level: between occurring as a result of head-jarring rugby union players in 4% and 14% trauma with or without a loss of South Africa; 2002- Adult level: Between 3% consciousness. 2006; 1366 athletes and 23%

Kerr et al. Match play: Men: 2.16 An injury was defined as (1) Sub-elite 31 men’s and 38 Match play : Men 3rd (2008) (74) Match Play: Women: 1.58 occurring in an organised inter- women’s teams during 1st Sprain: 3.67 collegiate game or practice; (2) 2005-2006 season 2nd Strain: 2.16 Training: Men : 0.37 requiring medical attention during or Training: Women: 0.30 after the game or practice; and (3) Match play: Women 3rd resulting in any restriction of the 1st Sprain: 3.74 athlete’s participation for > 1 day(s) 2nd Strain: 2.85 beyond the day of injury, or in a dental injury. Overall injury rate men: 16.88 women: 17.05

Fuller et al. Match play: 2.6 Definitions and procedures used were Elite IRB Rugby World Cup Match play: 5th (2008) (75) Forwards: 2.0 compliant with the IRB approved 2007; 626 players; 20 1st Sprain/ ligament: 24.5 2nd Backs: 3.3 international consensus statement teams Muscle ruptures/tear/ strain: (Fuller et al., 2007). “Any physical 22.4 Training: 0.1 complaint sustained by a player 3rd haematoma /contusion: Forwards: 0.1 during a Rugby match that prevented 14.6 Backs: 0.0

the player from taking a full part in 4th Bone fractures: 6.3 training and/or match play for more All injury: 83.9 than one day following the day of injury.” Training: 4th 1st muscle rupture: 1.5 2nd sprain: 0.8 3rd lesion of meniscus: 0.6 All types of injury: 3.5

Schick et al. Match play: 0.33 “Any physical complaint, which was Elite All teams in the 2006 Match play: 6th (2008) (80) caused by a transfer of energy that Women’s Rugby 1st sprain/ligament: 1.42 exceeded the body’s ability to World Cup; 339 2nd muscle rupture: 1.08 maintain its structural and/or players 3rd haematoma: 0.67 functional integrity, that was 4th nerve injury: 0.50 sustained by a player during a rugby 5th fracture: 0.42 match or rugby training, irrespective of the need for medical attention or Match play overall injury: time loss from rugby activities.” 37.5 (Fuller et al., 2007). Training overall injury: 12.5

Kemp et al. Match play: 4.1 “any injury that prevents a player Elite 3 seasons; 13 English N/A. The only injuries (2008) (76) Forwards: 3.4 from taking a full part in all training Premiership teams; 757 observed were head injuries Backs: 4.8 and match play activities typically male players and concussion. planned for that day for a period of Training: 0.02 greater than 24 hours from midnight Forwards: 0.01 at the end of the day the injury was Backs: 0.02 sustained.

Holtzhausen Match play: 1.35 Prevented a player from playing or Elite Super 12 Rugby; 75 Overall injury rate match play: et al. (2006) Training: N/A (no squad training, or one that required South African players; 55.4 (72) concussion recorded). special medical treatment. one season. Overall injury rate training: 4.3

Best et al. Match play: 2.07 Injury defined as an event which Elite World Cup 2003; 8 Match play: 11th

(2005) (20) forced a player either to leave the finalist teams and 12 field or to miss a subsequent game or non-finalist teams both. Overall injuries: 97.9

Brooks et al. Match play: 4.4 “Any injury that prevents a player Elite Two seasons; 546 Match play: Equal 3rd (2005) (22) Forwards: 4.0 from taking a full part in all training rugby union players Backs: 4.9 and match play activities typically from 12 English 1st thigh haematoma: 8.0 planned for that day for a period of Premiership Clubs 2nd hamstring: 5.6 greater than 24 hours from midnight th at the end of the day the injury was Forwards: 4 st sustained” (Brooks, 2003). 1 haematoma (thigh): 7.4 2nd calf muscle injury: 5.7 3rd cervical nerve foot injury and ankle ligament: 4.5

Backs: 3rd 1st haematoma (thigh): 8.7 2nd hamstring muscle: 8.7

Overall injury incidence: 91.0

Brooks et al. Match play: 0.02 “Any injury that prevents a player Elite Two seasons; 502 Match play: Equal 18th (2005) (77) Forwards: 0.01 from taking a full part in all training players;11 English Backs: 0.02 and match play activities typically Premiership teams Forwards: 27th planned for that day for a period of 1st hamstring (thigh): 0.28 greater than 24 hours from midnight 2nd lateral ankle ligament and at the end of the day the injury was lumbar disc: 0.19 sustained” (Brooks, 2003). 3rd calf muscle: 0.17 Backs: 15th 1st hamstring (thigh): 0.32 2nd calf muscle: 0.18

3rd hip flexor (thigh): 0.17

Overall injury incidence: 2.0

Brooks et al. 0.36 (n = 3) “Any injury that prevents a player Elite 2003 Rugby World All injuries (match & (2005) (78) from taking a full part in all training Cup; 63 weeks; training): 15th and match play activities typically England rugby players: planned for that day for a period of 32 forwards and 31 1st hamstring: 1.67 greater than 24 hours from midnight backs 2nd calf muscle: 1.43 at the end of the day the injury was 3rd thigh haematoma: 1.19 sustained” (Brooks, 2003). Overall injury incidence: 17.0

Match play: 218.0 Training: 6.1

Comstock and Concussions 9.7% (n = 10) Defined as any injury sustained in the Sub-elite Self-administered Match play: 6th Fields (2005) of all injuries reported. most recent 3 month period while questionnaire to 258 1st strain/sprain: 43.7% (81) playing or practicing rugby for which players, 14 teams at a 2nd fracture: 18.5% the player obtained medical attention women’s rugby = 3rd tear: 17.5% or which prevented the player from tournament; based on = 3rd contusion: 17.5% playing rugby or doing normal work their most recent 3 5th laceration: 10.7% or school activities for at least seven months of play days. Injury rate: 1.4 injuries/100 total rugby exposure (matches and practices) Matches: 4.4 /100 matches Training: 0.2 /100 practices

Junge et al. 1.45 (n = 10) Any physical complaint caused by Schoolboys One season; ten teams Match play: = 7th (2004) (24) rugby during school training and 1st strain: 17.9 matches. The duration of absence due 2nd contusion: 10.6 to an injury was categorised 3rd sprain: 8.44 according to the severity grading of 4th fracture: 2.04 the National Injury Registration

System: up to one week, 8-21 days, 5th dislocation: 1.6 or more than 21 days. An injury was categorised as overuse if it was Overall: 49.4 caused by repetitive micro trauma Match: 129.7 with no identifiable traumatic event. Training: 13.6

Bathgate et al. Match play: 3.85 Defined as an event that forced the Elite 1994-2000; 82 Match play: 7th (2002) (96) player to either leave the field or miss Australian Wallabies 1st joint & ligament a subsequent game. players over the seven sprain/tear: 19.8 seasons 2nd lacerations: 18.1 3rd musculotendinous sprain/tear: 15.9 4th contusion/haematoma: 7.69 5th fractures: 6.59 6th dislocation/subluxations: 4.94

Overall match injuries: 69.2

Lee et al. Concussion 5.59% (n = No definition of injury was reported. Schoolboys to 1169 men who had Concussion: 4th (2001) (46) 18) of all injuries reported Sub-elite previously participated 1st dislocations, strains and in a survey regarding sprains: 55.3% (n = 178) injuries during 1993- 2nd lacerations and contusions: 1994 season. 21.4% (n = 69) 3rd fractures: 10.6% (n = 34)

Overall injury data: n = 322

Marshall and Matches: 3.8 Injuries that result in time lost from Schoolboys Two teams; followed Concussion: 25% (n = 17) of Spencer Training: 1.5 games or team practices. for three years all injuries. (2001) (73) Overall injury rate: 46.0 Overall injury excluding

concussion: 34.7

Lee and Hard pitches: 0.35 An injury sustained on the field Sub-elite 26 senior rugby clubs Match play: Garraway Heavy: 0.59 during a competitive match on a in SRU during 1993- Firm or hard pitches: 3rd (2000) (83) Saturday that prevented the player 1994 season; 1169 1st lower limb fractures: 0.94 from playing rugby football from the players 2nd upper limb fractures: 0.70 time of the injury or from the end of Heavy, slippery or yielding the match in which the injury was pitches: 2nd sustained. 1st upper limb fractures: 0.65

Overall injury rate: 13.6

Overall injury rate by pitch Condition: Heavy: 11.5 Hard: 16.7

Durie and 0.87 (n = 6) Injury was grouped as: Schoolboys One season; 23 teams; Match play concussions: Monroe - minor: able to play again in 7 days 442 schoolboys Minor injuries: 24th (2000) (91) - moderate: unable to play the Moderate injuries: 9th following 1-3 weeks Severe injuries: 1st - severe: unable to play for more than 3 weeks. Overall injury rate: 27.5 Overall training injuries: 3.4

Bird et al. Match: 4.5% (n = 22) of The use of the terms injury incidence Schoolboys to One season; 356 male Match play: 5th (1998) (7) all injuries. and injury incidence rate as reported sub-elite and female players; 20 1st sprain/strain: 46.7% in this paper is based on the teams 2nd haematoma: 23.9% Training: 0.9% (n = 1) of definition provided by Last (1988). 3rd laceration: 8.8% all injuries. 4th fracture: 5.7%

Training: 5th 1st sprain/strain: 76.1% 2nd haematoma: 10.7%

= 3rd laceration: 2.6% = 3rd fracture: 2.6%

Total injuries: 671 Match injuries: 462 (69%) Training injuries: 107 (16%)

Jakoet and 1.37 (n = 3) Rugby injury defined as a new injury Elite 416 players; 16 Match play: 5th Noakes that necessitated the player’s leaving countries; 1995 Rugby 1st ligament/joint injuries: 15.5 (1998) (97) the field of play for the remainder of World Cup 2nd lacerations: 12.31 the game. All lacerations were 3rd muscle injuries/ contusions: included, whether or not the player 10.94 4th returned to the same match. fractures/dislocations: 5.01

Overall incidence: 32.0

Watson Concussions 6.6% (n = 8) Any injury that required medical Schoolboys 12 months; 19 physical Match play: 6th (1997) (49) of all injuries reported. treatment or that disrupted training or education teachers 1st: strain: 26.2% matches was included in the survey. recorded injuries of 2nd sprain of ankle: 11% students. 3rd contusion: 9.9 4th wound: 8.8% 5th sprain, other: 7.7%

Total injuries: 118.

Lee and Match play: An injury sustained on the field Schoolboys and 1705 players from nine Match play: Garraway Schools: 10.6 during a competitive match, during a sub-elite schools and 1169 Schools: 2nd (1996) (69) Clubs: 17.1 practice game, or during other players from 26 SRU 1st fracture: 16.4 training activity directly associated clubs; Clubs: 9th with rugby football, which prevented 1st knee dislocations the player from training or playing /sprain/strain: 61.6 rugby football from the time of the 2nd shoulder dislocations/ injury or from the end of the match or strain/sprain: 41.1 practice session in which the injury 3rd back sprains and strains:

was sustained. 38.5 4th hip and thigh dislocation/ sprain/strain: 34.2 5th laceration and contusions: 31.7 6th ankle and foot dislocation/ sprain/strain: 24.8 7th lacerations and contusions: 20.5 8th fractures: 18.8

Overall injuries: Schools: 86.8 Clubs: 367.0

Seward et al. Concussions 5.3% (n = Survey definition of an injury was: Elite Nine teams; one Match play: 2nd (1993) (52) NR) of all injuries 1. Any injury which caused a player season; NSW Waratah 1st head and facial lacerations: reported. to be unavailable for selection in a team 20% match, or participation in a training session; or Overall injury incidence: 2. Any other injury which required First grade: 62 specific medical treatment, other than All: 53 routine conservative measures. Overall training injuries: 1.1%

Clark et al. Concussion 10% (n = 11) An injury that prevented a man from Schoolboys to 8 teams; one season. 85% (97) injuries occurred in (1990) (85) of overall injuries. playing rugby for 7 or more days or sub-elite matches; 15% (17) in practice. that required medical or surgical treatment. Match play: 4th 1st muscle:33% 2nd ligament: 32% 3rd fracture:11%

Overall incidence injury rate:

1/171 playing hours; 1/780 playing hours of practice

Addley and Concussion 4% (n = 3) of The presence of pain, discomfort or Sub-elite One season; five teams Match play: Equal 4th Farren (1988) overall injuries. disability arising during and as a 1st muscle/tendon strain: 28% (84) result of playing in a rugby match. 2nd ligament/joint sprain and bruising:23.5% 3rd wounds: 13% 4th joint dislocation: 4%

Davidson Concussion: 0.19 Injuries are classified retrospectively Schoolboys 18 seasons; 1444 boys Match play (severe injuries): (1987) (68) as severe or minor on a clinical seen in total 2nd Superficial blow to the assessment. Those injuries graded as 1st fractures: 1.16 head or neck resulting in severe included concussions and Overall injury rate: 17.58 symptoms of headaches, most fractures and dislocations and nausea and dizziness: 2.63 comprised mainly those injuries that resulted in some degree of incapacity. The less severe injuries included some sprains, lacerations and some fractures and dislocations, such as those that involved the small bones of the hands and feet.

Roux et al. 0.19 (n = 22) Severe enough to prevent the player Schoolboys One season; 18 weeks; Overall injury incidence: 4th 1st (1987) (88) from returning to rugby for at least 7 26 high school teams fracture: 0.43 days. All concussion injuries had to 2nd ligament/tendon: 0.40 be reported even if the player 3rd muscle injury: 0.27 continued to play (Nathan et al., 1983). Overall injury incidence: 1.6

McKenna Concussion injury rate Accident description was searched All levels 1981-1982; 2970 Match play: 2nd (1986) (54) among registered players: for mention of an injury resulting patients admitted to 1st fractures: 0.50% of 0.22% specifically from playing sport. public hospitals with a registered players

rugby injury

Sparks (1985) 1.23 (n = 49) No definition of injury was reported. Schoolboys One English public Match play: 1st (86) school; 1980-1983 Overall injury rate: 19.4

Nathan et al. 0.55 (n = 17) One which is severe enough to Schoolboys One season; 1982; one Match play and practices: (1983) (87) prevent the player from returning to school; 31 teams Equal 1st with muscle injuries rugby for at least seven days after the injury. Overall injury incidence: 2.53

Myers (1980) 2.87 (n = 24) Only those incidences that presented Schoolboy One season; 221 Match play: 4th (92) for treatment to the medical officer. matches 1st lacerations: 11.1 2nd soft tissue: 8.13 3rd joint sprain: 5.62

Overall injury rate: 32.0

Note. ‡: Study data was not included in the meta-analysis; IRB: International Rugby Board; RFU: Rugby Football Union; PNS: peripheral nervous system; N/A: not applicable; RWC: Rugby World Cup; SRU: Super Rugby Union; NSW: New South Wales; n: number;