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Original Article

Surveillance of injuries among Kenya (KRU) players — Season 2010

Authors: Muma N1 MBChB, MMed, Saidi H2 MBChB, MMed, FACS, Githaiga3 JW MBChB, MMed Affiliation: 1- Kijabe Hospital, Kenya 2- Department Human Anatomy, University of Nairobi 3- Department of Surgery, University of Nairobi. Correspondence: Dr. Muma Nyagetuba; Kijabe Hospital, Kenya Email

Abstract Objective: To determine the incidence and characteristics of (mph), (44.2 for forwards and 40.8 for backs). Lower limb injuries were injury amongst players and associated the most common (41.2%). Players were most prone to injuries in the in factors. tackle scenario (63.7%), at the beginning of the season (47.1%), and in Design: A whole population prospective cohort study. the last quarter (50%) of a game. Methods: 364 registered Kenya rugby union (KRU) players were stud- Conclusion: The injury incidence recorded contrast the earlier Kenyan ied throughout the 2010 season. Data on their demographics, injury data but is comparable to international amateur level incidence, incidence, pattern and severity were gathered. The study tool used was uniqueness of the Kenyan environment notwithstanding. The higher the Rugby International Consensus Group (RICG) Statement. rates associated with the tackle/tackled scenario, earlier part of the season and later part of the game, suggest interventions can target Results: There were 173 backs and 191 forwards. One hundred and two player conditioning, and use of protective gear. 1 injuries for 60 league games (2400match player hours) were recorded. The incidence of injuries was 42.5/1000 match player hours

Introduction Methodology Rugby is a high velocity and collision sport attended by The prospective whole population cohort study of 364 one of the highest rates of injuries in team sports (1-3). players was conducted in the 2010 15-aside season. It As is the trend in the global scene, rugby is increasingly a comprised of the (KC) division one and Eric popular . Competition is higher, the game Shirley shield (ESS) division two leagues. All players faster and the players stronger. The combination of fac- were KRU registered and had to be above 18years of age. tors is fodder for rising rates of injury (1-7) with signifi- The clinical officers in charge of data collection were cant impact on player and team performance. trained for two weeks to use the instrument of data col- A ‘prevention is better than cure’ approach to rugby in- lection followed by a proficiency exam using preseason jury is made possible by understanding the characteris- matches. tics and magnitude of the problem. An earlier Kenyan Blood bin injuries defined by Law 3.11(a) of study suggested comparatively higher rates of rugby re- International Rugby Board ( IRB) were excluded unless a lated injuries but did not establish models of relation- training session or match was subsequently missed ships with risk factors (8). Internal and external factors because of the said injury. shown to influence the outcome of injury include player Age, height, weight, injury status at that time and posi- fitness, part of the season, phase of play, player position, tion played were documented preseason. state of the pitch and player physique (9-14). Accord- The players were clustered into forwards (positions 1 to ing to Brooks for example, injuries that cause the most 8) and backs (positions 9 to 15). significant absence from the field of play for forwards Data analysis was performed using SPSS version 17 soft- and backs are anterior cruciate ligament and hamstring ware. Incidence was calculated as injuries per 1000 match injury respectively (6). player hours (mph) (95% CI). Student t-test was used to This paper explores the injury experience and the asso- compare the means between injured and non-injured for ciated risk profile during the Kenya 2010 15-side rugby continuous vari- ables i.e. age, weight, height, BMI. season. Match exposure was calculated on the basis of 15 players (8 forwards, 7 backs) per team exposed for 80 minutes (first(first half 00-20,–20, 20-40,20–40, second second half half 40-60,40–60, 60-80min 60–80min- The AnnAls of AfricAn surgery • Volume 9 • July 201225

88 The ANNALS of AFRICAN SURGERY. July 2012 Volume 9 Issue 2 Original Original article Articlearticle The ANNALS of AFRICAN SURGERY | www.sskenya.org

SurveillancSuerveillanc of injuriee so f amon injuriegs K amonenya Rugg Kebnyy Unioa Rugn b(Ky UnioRU) npl a(KyersRU-) Seasoplayersn- 2010Seaso n 2010 Muma NyagetubaMumNyagetubaa Nyagetuba, Hassa M,n Saidi Saidi, Hassa H,, Githaig Githaigan Saidia JW, JWGithaig a JW

Table 1: ComparisoTable 1n: Coomparisof anthropometrin of anthropometric measures bec measuretween KsC beandtw een KC and Table 3: IncidenTablce oef 3 injur: Incideny as ac efunctio of injurn yo fa locatios a function ofn body of locatio n of body ESS players ESS players Site Site Backs Backs Forward Forward Total Total CharacteristicCharac teristiKC(n=169c ) KC(n=169ESS (n=195)) ESS (n=195) Count % Coun95%Ct % I C95%Count I% 95%CCountI % 95%CI % % Mean(SD) Mean(SDMean(SD) ) Mean(SD95% CI) 95% CI Head face Head face1 1 10.78 11 4.7 t10.7o 16.88 124. 7 to 16.11.88 5. 152 to 1811. 82 35. 5 to 1822.5 23 22.5 Age Age 21.41 (3.07)21.4 24.41 (3.070 (3.78) )24.4 -3.60 (3.789 to -)2.28 -3.6 9 to -2.28 Neck Cervical SpinNecek Cervica0 l Spin0e 0 0 0 40 3.9 0.41 to 7.73. 9 4 0.1 to 7.3.97 4 3.9 Weight Weight 78.29 (12.2578.2) 85.99 (12.251 (11.70) 85.9) -10.11 (11.700 to -)5.13 -10.1 0 to -5.13 Sternum Ribs Sternum Rib0 s 0 0 0 0 30 2.9 -0.3 4 to 6.2.2 9 3 -0.4 to 6.2.92 3 2.9 Height Height 1.74 (0.072)1.7 41.7 (0.0727 (0.07) ) 1.7-70.0 (0.074 to) -0.01-0.0 4 to -0.01 Upper Back Upper Back BMI BMI 25.76 (3.78)25.7 267 (3.78.54 (3.44) ) 2 7 .5-2.54 (3.443 to -)1.03 -2.5 3 to -1.03 Abdomen Abdomen0 0 0 0 0 10 1.0 -0.1 9 to 2.1.9 0 1 -0.9 to 2.1 9 1 1

Lower back Lower bac1k 0.98 1 -0.90.9 to 2.8 9 3- 0.9 to 2.9 -30. 4 to 6.2.2 9 4 -0.4 to 6.3.92 4 3.9 Shoulder ClaviclShouldee r Clavicl11 e 10.78 11 4.7 t10.7o 16.8 8 74. 7 to 16.6.98 1.79 to 11.6.89 1 81. 9 to 11.178.6 18 17.6 Table 2: ComparatiTable 2v: eC anthropometromparative anthropometry between injurey betdw eeannd noninjure- d and non- Upper Arm Upper Arm1 0.98 1 -0.90.9 to 2.8 9 0- 0.9 to 02. 9 00 0 1 0 1 1 1 injured playersinjure d players Elbow Elbow 0 0 0 0 0 10 1 -10. 9 to 2.19 1 -0.9 to 2.1 9 1 1 CharacteristicCharacs teristicNon-injured(ns Non= 92)-injured(n = 92) Forearm Forearm 0 0 0 0 0 20 2 -20. 7 to 4.27 2 -0.7 to 4.27 2 2 Mean(SD) Mean(SDInjure) d (n=273)Injure d (n=273) Wrist Wrist 0 0 0 0 0 10 1 -10. 9 to 2.19 1 -0.9 to 2.1 9 1 1 Mean (SD) Mean (SD95)% CI 95% CI Hand Finger ThumHanbd Finge1 r Thum0.9b 8 1 -0.90.9 to 2.8 9 1- 0.9 to 12. 9 -10. 9 to 2.19 2 -0.9 to 2.2 9 2 2 Age Age 22.57(3.77) 22.57(3.7723.47 )(3.52 )23.4 -1.77 (3.528 to -)0.02 -1.7 8 to -0.02 Hip Groin Hip Groin3 2.94 3 -0.42.9 to 6.4 2 1- 0.4 to 16. 2 -10. 9 to 2.19 4 -0.9 to 2.3.99 4 3.9 Weight Weight 80.89 (13.06)80.8 84.69 (13.06)2 (10.60 84.6) -0.042 (10.601 to -)0.01 -0.04 1 to -0.01 Posterior ThighP osterior Thig2 h 1.96 2 -0.71.9 to 4.6 7 0- 0.7 to 04. 7 00 0 2 0 2 2 2 Height Height 1.74 (0.07) 1.741.7 (0.07)7 (0.06 ) 1.7-76.7 (0.060 to) -0.77-6.7 0 to -0.77 Knee Knee 9 8.82 9 3.3 t8.8o 14.2 4 73. 3 to 14.6.94 1.79 to 11.6.89 1 61. 9 to 11.15.78 16 15.7 BMI BMI 26.46 (3.87)26.4 26.96 (3.87)6 (3.26 )26.9 -1.36 (3.268 to -)0.39 -1.3 8 to -0.39 Ankle Ankle 10 9.8 10 4.0 t9.o 815. 6 64. 0 to 15.5.96 1.63 to 10.5.59 1 61. 3 to 10.15.75 16 15.7

Foot Toe Foot Toe 0 0 0 0 0 40 3.9 0.41 to 7.73. 9 4 0.1 to 7.3.97 4 3.9 Total Total 49 48 49 38.34 t8o 57.8 538.3 3 to5 527 . 8 42.532 to 61.527 10 42.2 2 to 61.1007 102 100

utes). Apprutes).oval Apprfor studyoval forwas study obtained was obtainedfrom the fromKeny atthe- KenyatAnthropomet- Anthropometry in relationry in relationto level ofto plleavely of play ta Nationalta NationalHospital HospitalEthics and Ethics Research and RCommitteeesearch Committee The KenyThean pl Kayenyer’ans meanplayer ’ages mean was age22.80 w as y ears 22.80 (SD y ears (SD and the KRUand board.the KRU board. 3.724) with3.724) a mean with w aeight mean of w8eight1.83kg of (SD12.57)81.83kg (SD12.57) and and mean heightmean of height1.75(SD of 0.1.75(SD70). 0.70). ResultsResults The KC plTheayer KwCas pl olderayer w(pas

forwards) for forw ards)KC and for 195KC and(97 backs195 (97 98 backsforwards) 98 forforw ards) for ESS. The 3ESS.0 K CThe and 3 03 K0 CESS and games 30 ESS pl aygamesed constituted played constituted a Anthropometa Anthropometry betweenry bet injuredween andinjured non and-injured non -injured total 2400total mph. 2400 The mph. season The lasted season lasted The 102 injuriesThe 102 occurred injuries occurredamongst 92amongst player s92. The play iner-s . The in- 4 months4 during months which during 10 2which injuries 10 2 w injuriesere recorded. were recorded.The Thejured playjureder was pl olderayer w(pas 0.046), older (p he 0.046),avier (p he 0.a0vier14), (p taller 0.014), taller incidence incidence of injuries of winjuriesas 42. 5 w0/as1000mph 42.50/1 000mph(Forwards ( Forwards(p 0.004),(p and 0.004), with anda larger with BMI a larger (p 0.2 BMI71), (p (T 0.2able7 1), 2). ( Table 2). 44.17; Backs44.17; 40.83). Backs 40.83). The ages ofThe the ages play ofers the ranged players from ranged 18 tofrom 40 y18ears to with40 y ears withDistribution Distribution of injury ofbased injur yon based location on locationof body of body a mean ofa 22.80 mean yofears 22.80 (SD y3.724).ears (SD The 3.724). mean Theweight mean w asw eight wasThe forwardsThe forhadw ardsan injury had anincidence injury incidenceof 44.17injuries of 44.17injuries 81.83kg (SD12.57)81.83kg (SD12.57) with a mean with height a mean of height1.75metres of 1.75metres per 1000mphper 1compared000mph compared to 40.83 injuriesto 40.83 per injuries 1000mph per 1 000mph (SD 0.70) (SDand 0.a7 mean0) and BMI a mean of 26.59(SD BMI of 26.59(SD 3.73). 3.73). for the backsfor the (p backs0.52). (p The 0.52). most The common most commonregions regions KC accountedKC accounted for 64.6% for of 64.6%injuries of which injuries translated which translated to toinjured winjuredere the wlowereer the limb low (er41.2%), limb (upper41.2%), limb upper limb an incidencean incidenceof 55 injuries/ of 55 1 000mphinjuries/ 1and000mph 30 injuries and 30 injuries(24.6%) and(24.6%) head andand headneck and(26.4%). neck (26.4%). /1000mph/1 000mphfor the ESS for (p<0.00the ESS01). (p<0.00 There0 1).was There no career was no careerThe most The common most commontypes of injuriestypes of w injuriesere ligamentous were ligamentous ending injurendingy. injury. (38.2%) and(38.2%) concussion and concussion (8.9%) (table4). (8.9%) (table4).The types Theof types of

26 July 201262 •Jul Volumy 201e2 9 • • V Theolum Anne 9 • A Thels Annof AfricAlsA ofn Afric surgeAnr ys urgery The ANNALS of AFRICAN SURGERY. July 2012 Volume 9 Issue 2 89 The ANNALS of AFRICAN SURGERY | www.sskenya.org

T ype Backs Forwards Total Table 5: Incidence of injury as a function of time Count % 95%CI Count % 95%CI Count % Seasonal distribution Game distribution C oncussion 2 2 -0.7– 4.7 5 4.9 0.7- 9.1 7 6.9 Time Frequency Percentage Frequency Percentage F racture 2 2 -0.7- 4.7 3 2.9 -0.4-6.2 5 4.9 First Quarter 48 47.1 24 23.5 D islocation 5 4.9 0.7- 9.1 3 2.9 -0.4- 6.2 8 7.8 Second Quarter 23 22.5 9 8.8 S prain Ligament Injury 21 20.6 12.7-28.5 18 17.6 10.2- 25.1 39 38.2 Third Quarter 12 11.8 18 17.6 Muscle Rupture Fourth Quarter 19 18.6 51 50.0 Strain Tear Cramps 5 4.9 0.7- 9.1 8 7.8 2.6- 13.1 13 12.7 Total 102 100.0 102 10 Tendon/bursa Injury 0 0 0 2 2 -0.7- 4.7 2 2 Hematoma/ Contusion/ Bruise 3 2.9 -0.4- 6.2 2 2 -0.7-4.7 5 4.9 120

Abrasion 2 2 -0.7- 4.7 0 0 0 2 2 100 Laceration 4 3.9 0.1- 7.7 6 5.9 1.3- 10.5 10 9.8 80 Visceral Injury 0 0 0 1 1 -0.9- 2.9 1 1 60 40

Mixed 5 4.9 0.7- 9.1 5 4.9 0.7- 9.1 10 9.8 20

0 Total 49 48 38.3 53 52 42.2 102 100 Tackled Tackling Maul Ruck Line Out Scrum Collision Total Frequency 35 21 2 10 2 12 6 102 Percent 39.8 23.9 2.3 11.4 2.3 13.6 6.8 100 Table 4: Types of rugby injuries

Figure 2: Association to trauma

injuries were generally of similar amongst the forwards being linked with dangerous play. and backs. (Table 3) A player in KC had higher overall risk to injury as com- pared ESS, odds ratio 2.18 (p 0.006). Distribution of injuries based on mechanism of injury Discussion Majority of the injuries, 94.9% were a result of contact. The purpose of this study was to report the incidence of The tackling/tackled scenario with a cumulative inci- injury and associated factors in amateur rugby in Kenya. dence of 63.7%, accounted for a majority of incidences Injury incidence was 42.50 injuries per 1000mph. in mechanism of injury. The line out and the maul ac- The Kenyan players were younger and lighter in weight counted for the list incidence. (Figure 2) when compared to players in professional leagues (9). This result is consistent with previous data that depict Distribution of injury as a factor of time that bigger body sizes are associated with higher rates of The first quarter of the season had 47.1% of injuries, injuries (9, 15). Compared to Kenya Cup (K), Eric Shir- doubling any other quarter in the season. The frequency ley Shield (ESS) players were smaller and younger. With of injuries was highest in the first half of the season with a less stringent age of inclusion criteria; the differences a cumulative of 69.6%. (Table 5) may have been more dramatic. Most injuries occurred in the last quarter of the game, Our overall injury incidence is consistent with armature and a total 73.5% of injuries occurring in the extreme level play. It is however one third that reported in the quarters of the game. earlier Kenyan study (8). We contend that the discrep- The proportion of injuries associated with foul play and ancy is occasioned by the exclusion of minor injuries dangerous play was 11.6% and 10.78%

The AnnAls of AfricAn surgery • Volume 9 • July 27 90 The ANNALS of AFRICAN SURGERY. July 2012 Volume 9 Issue 2 The ANNALS of AFRICAN SURGERY | www.sskenya.org Original OriginalOriginal article aArticlerticle The ANNALS of AFRICAN SURGERY | www.sskenya.org

SurveillancSuerveillanc of injuriee so famon injuriegs K amonenya Rugg Kebnyy Unioa Rugn b(Ky RUnioU) npl a(KyersRU-) Seasoplayersn- 2010Seaso n 2010 Nyagetuba M, Saidi H, Githaiga JW Muma NyagetubaMuma ,Nyagetuba Hassan Saidi, Hassa, Githaign Saidia JW, Githaig a JW

including includingblood bin bloodinjuries bin ( 8injuries). (8). the cooperationthe cooperation and Dr. O andnyuma Dr. theOn yumastudy thestat -study stat-

The tackle/tacklingThe tackle/tackling scenario w scenarioas responsible was responsible for the high for- the highistician.- istician. T ype Backs Forwards Total Table 5: Incidence of injury as a function of time est injury estincidenc injurye , incidenc as previouslye, as previously reported (reported7,9,16,1 7()7,9,16. ,17The). study Thewas studyfully fundedwas fully by funded the author by thes. There author wsas. There no was no Count % 95%CI Count % 95%CI Count % Seasonal distribution Game distribution In the presentIn the study present how studyever, mosthowe vinjurieser, most afflicted injuries theafflicted thesource of sourceexternal of funding. external funding. Concussion 2 2 -0.7– 4.7 5 4.9 0.7- 9.1 7 6.9 Time Frequency Percentage Frequency Percentage tackler contrastingtackler contrasting recent trend recents. An trend entrys. pointAn entry for pointpre- for preThere- is noThere competing is no competing or conflict or of conflict interest of b yinterest any of by any of F racture 2 2 -0.7- 4.7 3 2.9 -0.4-6.2 5 4.9 First Quarter 48 47.1 24 23.5 vention wvouldention be wtheould acquisition be the acquisition of protecti ofve protecti gear andve gear andthe authorthes. authors. D islocation 5 4.9 0.7- 9.1 3 2.9 -0.4- 6.2 8 7.8 Second Quarter 23 22.5 9 8.8 coaching coachingof skillful oftackling skillful techniquestackling techniques (9, 18).Most (9, 18)in- .Most in - S prain Ligament Injury 21 20.6 12.7-28.5 18 17.6 10.2- 25.1 39 38.2 Third Quarter 12 11.8 18 17.6 juries occurredjuries inoccurred the first in quarter the first of quarter the season. of the Similar season. SimilarReferences References Muscle Rupture Fourth Quarter 19 18.6 51 50.0 results previouslyresults previously have ascribed have thisascribed to preseason this to preseason condi- condi1.- Junge A1., Cheun Jungge AK, CheunEdwardgs KT, etEd alw. ardComparisos T et al. Comparison of incidencn eof incidence Strain Tear Cramps 5 4.9 0.7- 9.1 8 7.8 2.6- 13.1 13 12.7 Total 102 100.0 102 10 tioning (12,tioning 14). (Coaches12, 14) . andCoaches fitness and instructors fitness instructors invest invest and Injuriesan idn Injurieyouth s amateuin youtr hsocce amateur andr soccerugbyr anBrd J rugSportbys Br J Sports Tendon/bursa Injury 0 0 0 2 2 -0.7- 4.7 2 2 time and resourcestime and resourcesin player fitnessin play eracquisition fitness acquisition and early and early Med 2004; Me38:d 168 2004-172.; 38 : 168-172. Hematoma/ Contusion/ rehabilitationrehabilitation for the injured for the toinjured mitigate to againstmitigate early against early2. Doris W2. an Dorid Brs oWwn ane dC . Br Injurowney Cto. rugInjurbyy an tod rugassociationby and association Bruise 3 2.9 -0.4- 6.2 2 2 -0.7-4.7 5 4.9 season injuriesseason ( 14injuries). (14). football Br footbalJ Sportsl MeBr Jd Sport1974s; Me8: 183d 1974-187.; 8 : 183-187. Abrasion 2 2 -0.7- 4.7 0 0 0 2 2 CorroboratingCorroborating earlier studies earlier (1, studies10,15), (1, the1 0,1results5), the of resultsthe of the3. Nicholl3 .J P , NicholColemal Jn P P, ,Colema Williamns PB, WilliamT, et al. sTh Be T epidemiology, et al. The epidemiology Laceration 4 3.9 0.1- 7.7 6 5.9 1.3- 10.5 10 9.8 present studypresent further study sh furtherow that sh oapproximatelyw that approximately 50% of 50% of of sports anodf sportexerciss ean related exercisd injure relatey in dth injure Unitey ind thKingdom.e United Kingdom. injuries occurredinjuries inoccurred the last in quarter the last of quarter the gam ofe ,the pos gam- e, pos- Br J Sports MeBr Jd Sport1995s; Me29:232d 1995–8.; 29:232–8. Visceral Injury 0 0 0 1 1 -0.9- 2.9 1 1 sibly due siblyto fatigu duee ,to reduced fatigue , selfreduced-awareness self- aw andareness protec and- protec4.- Jakoet I4,. Noake Jakoes t TI ,D Noake. A higs hT rat D.e Ao fhig injurh raty edurin of injurg thye durin1995g the 1995 Mixed 5 4.9 0.7- 9.1 5 4.9 0.7- 9.1 10 9.8 tion (3,8,9tion). Therefor (3,8,9).e , Thereforimprovinge, impr playoerving endurance player endurance and and Rugby WorlRd ugCupby .W Sorl Afdr MeCupd . J S1998 Afr ;Me 88d: J45 1998–7. ; 88: 45–7. Total 49 48 38.3 53 52 42.2 102 100 conditioningconditioning might aid. might aid. 5. Best J P5, . McIntos Best Jh P , AMcIntos S, and h S avA agS,e an Td N S. avRugagbey T W Norl. Rdug Cupby W orld Cup The incidenceThe incidenceand pattern and of pattern injuries of w injuriesas similar w as be similar- be- 2003 injury2 0sur03v eillancinjury e sur projectveillanc. Be r projectJ Sport.s BMer Jd Sport 2005s; Me 39:d 2005; 39: Table 4: Types of rugby injuries tween fortwwardseen forandw ardsback sand and back consistents and consistent with other with other 812–817. 812–817. Figure 2: Association to trauma reported reporteddata (9) . dataThe (result9). The on result anatomical on anatomical regions regions6. Brooks6 J. H BrookM, Fulles J rH C M W, ,Fulle Kemr pC S W P, TK,em et pal .S AP prospectiT, et al. Ave prospecti ve involved inechoesvolved previous echoes previousreports ( 5,reports 9, 17 )(. 5,The 9, head,17). The head, study of injuriestudys oanf dinjurie trainins gan damongs trainintg th amongse Englant dth e2 0Englan03 d 2003

shoulder andshoulder ankle and were ankle the wmostere thevulnerable most vulnerable to injury, to injury, Rugby WorlRd ugCubyp Wsquadorld . CuBrp J squadSports. MeBr Jd Sport2005s; Me39:d 288 200–593.; 39 : 288–93. probably probablyrelated to related exposure to exposureand inv ol andvement inv olinv mostement in most7. Holtzhause7. Holtzhausen L J, Schwnellnu L J,s Sch M wPellnu, Jakoes tM I , Pe, t Jakoeal. Tht eI, inciet al- . The inci-

phases of phasescontact. of Therecontact. are Theredata toare sh dataow thatto sh injuriesow that injuries dence and dencnaturee an ofd injurie natures oinf injurieSouth s Africa in Soutn rugh bAfricay plany ersrug by players occasionedoccasioned by exposure by exposureand inv olandvement inv olofv ementthe head of the head in the rugbiyn Supethe rugr 1b2y competitionSuper 12 competition. S Afr Med. SJ 2Af006r Me; 96:d J 2006; 96: injuries were generally of similar amongst the forwards being linked with dangerous play. can be precanvented be pre byv enteduse of bheady use gearof head (19 , gear20). Mus(19, cle20 ). Muscle 1260–5. 1260–5. and backs. (Table 3) A player in KC had higher overall risk to injury as com- strengtheningstrengthening exercises exercisesand use ofand shoulder use of shoulderpads can pads can8. Wekesa8 .M , WAsembekesao MJ ,M Asemb, Njororao J iM W, Njorora S. Injuri y Wsur Sv. eillancInjurye sur inv eillance in pared ESS, odds ratio 2.18 (p 0.006). reduce shoulderreduce injuriesshoulder (2 injuries0). Ankle (2 0)injuries. Ankle on injuries the other on the other a rugby tournamenta rugby tournament. Br J Sports. MeBr Jd Sport1996s; Me30:d 6 11996–3. ; 30: 61–3.

Distribution of injuries based on mechanism of hand are handpossibly are exacerbatedpossibly exacerbated by poor pitchby poor condition pitch scondition, 9s., Fuller C9. W ,Fulle Labordr Ce WF,, WLabordeatheer RF, JW, eeathet al. rInternationa R J, et al. International Rugby l Rugby injury Discussion a relationshipa relationship not explored not exploredin this stud in ythis. Pre stud-matchy. Pre -match Board rugbyBoar world drug cubyp w20orl07d injurcup y2 0sur07 v eillancinjury e sur studveillancy. Bre J study. Br J Majority of the injuries, 94.9% were a result of contact. The purpose of this study was to report the incidence of warming andwarming conditioning and conditioning would limit would the ligamentouslimit the ligamentous Sports Med Sport2008s; Me42:d 452 2008-459.; 42 : 452-459. The tackling/tackled scenario with a cumulative inci- injury and associated factors in amateur rugby in Kenya. strains andstrains muscle and pullsmuscle which pulls w erewhich common were commonin in10. Gérard 1D0. F ,Gérar Walledr DA EF, anWdalle Birr Ad YE Nan.d Th Bire Ned Yw N Zealan. The Ned Rwug Zealanby d Rugby dence of 63.7%, accounted for a majority of incidences Injury incidence was 42.50 injuries per 1000mph. these regionsthese (1, regions 9). (1, 9). Injury and Injur Performancy and Peerformanc Project: IIe . ProjectPreviou: s II .injur Previouy experis injur- y experi- in mechanism of injury. The line out and the maul ac- The Kenyan players were younger and lighter in weight The degreeThe of degreefoul pl ofay foulinvol plvementay inv olwvasement low (w2)as. Thislow (2). This ence of a rugencbey -plofa yina rugg bcohorty-playin. Bg r Jcohort Sport. s BMer Jd Sport 1994s ; Me 28:d 1994; 28: counted for the list incidence. (Figure 2) when compared to players in professional leagues (9). was laudablewas laudableand probably and probablya pointer ato pointer the stringent to the stringent 229-233. 229-233. This result is consistent with previous data that depict measures measuresby the IRB b yto the counter IRB to foul counter play . foul play. 11. Gabbett1 1 .T JGabbet. Incidenct Te ,J . sitIncidence, and enatur, sitee, anofd injurie naturse ionf amateurinjuries in amateur Distribution of injury as a factor of time that bigger body sizes are associated with higher rates of In conclusion,In conclusion, the study thehas studyprovided has prbenchmarkovided benchmark val- val- rugby leaguruge ovbyer leaguthreee consecutiover threvee consecuti seasons. vBe r seasonJ Sportss. MedBr J Sport s Med The first quarter of the season had 47.1% of injuries, injuries (9, 15). Compared to Kenya Cup (K), Eric Shir- ues for theues injury for theincidence injury incidenceand characteristics and characteristics in Kenya. in Kenya. 2000; 34:982–000103.; 34:98 –103. doubling any other quarter in the season. The frequency ley Shield (ESS) players were smaller and younger. With The injuryThe rate injury recorded rate recordedis much lowis mucher than low previouslyer than previously 12 . Bird Y 12N,. W Biralled rY S N W, ,W Marshalaller S lW S, MarshalW, et all. ThS We ,Ne et wal .Zealand The Ne w Zealand of injuries was highest in the first half of the season with a less stringent age of inclusion criteria; the differences documented.documented. rugby injuryrug anbyd injurperformancy and performance project. Ve. Epidemiologproject. V. Epidemiology of a y of a a cumulative of 69.6%. (Table 5) may have been more dramatic. season of rugseasoby nunion of rug. Bbry J unionSports. MeBr Jd Sport1998s; Me32:d 3 191998–25.; 32 : 319–25. Most injuries occurred in the last quarter of the game, Our overall injury incidence is consistent with armature Acknowledgements:Acknowledgements: 13. Lee A J13, Garr. Leawae Ay J ,W Garr Mawa. Epidemiologicay W M. Epidemiological comparisoln compariso of in- n of in- and a total 73.5% of injuries occurring in the extreme level play. It is however one third that reported in the AcknowledgementsAcknowledgements go to the gomedical to the directormedical KRU director who KRU who juries in schoojuriel san ind schooseniorl cluandb seniorugbyr. cluBr bJ Sportrugbys. MeBr dJ Sport1996;s Med 1996; quarters of the game. earlier Kenyan study (8). We contend that the discrep- coordinatedcoordinated club level clubparticipation, level participation, the entire the KRU entire for KRU for 30: 213–17.3 0: 213–17. The proportion of injuries associated with foul play and ancy is occasioned by the exclusion of minor injuries 14. Lee A J14, Garr. Leawae Ay J ,W Garr M awaandy ArneiW Ml anD dW Arnei. Influencl D We . o Influencf pre- e of pre- dangerous play was 11.6% and 10.78%

The AnnAls of AfricAn surgery • Volume 9 • July 27 28 July 201282 •Jul Volumy 201e 29 • • VTheolum Anne 9 •A Thels Annof AfricAlsA ofn Afric surgeAnry s urgery The ANNALS of AFRICAN SURGERY. July 2012 Volume 9 Issue 2 91 The ANNALS of AFRICAN SURGERY | www.sskenya.org

season training, fitness, and existing injury on 17. Brooks J H M, Fuller C W, and Kemp S P T et al .Epidemiol- ogy of injuries in English professional rugby subsequent rugby injury. Br J Sports Med 2001; 35: 412- 417. union: match injuries. Br J Sports Med 2005; 39: 767–75.

15. Bathgate A, Best J P, Craig G, et al. A prospective study of in- 18. Gabbett T J. Incidence, site, and nature of injuries in amateur juries to elite Australian rugby union players. Br J Sports Med rugby league over three consecutive seasons. Br J Sports Med 2002; 36: 265–9. 2000; 34: 98–103. 16. Fuller C W, Molloy M G, Bathgate C, et al. Consensus state- 19. International Rugby Board(2006) viewed January 27th 2010 ment on injury definitions and data collection procedures www.irb.com for studies of injuries in rugby union. Br J Sports Med 2007; 20. Gerrald D F. The use of padding in rugby union. Br J Sports 41: 328–31. Med 1998; 25: 329–32.

The AnnAls of AfricAn surgery • Volume 9 • July 29 92 The ANNALS of AFRICAN SURGERY. July 2012 Volume 9 Issue 2