Injuries in Amateur Male and Female Rugby Union Caithríona Yeomans, MSc, BSc Supervisors Dr Thomas Comyns Dr Ian Kenny Dr Róisín Cahalan Thesis submitted to the University of Limerick, in fulfilment of the requirements for the degree of Doctor of Philosophy Submitted to the University of Limerick, January 2020 Abstract Title: Injuries in Amateur Male and Female Rugby Union Author: Caithríona Yeomans Rugby Union (RU) is a physically demanding team sport, and while comprehensive injury surveillance has been conducted in professional cohorts, there is little consensus regarding the incidence of injury in the amateur game. Aim: To establish and compare the incidence, nature and mechanism of injuries occurring in male and female amateur RU in Ireland. Methods: A systematic research strategy was undertaken, comprising; 1) A critical review of existing literature, 2) A national survey investigating injury monitoring practices in Irish amateur RU, 3) The design and development of a bespoke web-based surveillance system, and 4) An investigation into injury incidence and aetiology in amateur RU. Results: A pooled incidence rate of 46.8/1,000 player hours was calculated from six previously published epidemiological studies. Injury monitoring in Irish amateur RU varied widely and lacked a systematic approach, therefore a comprehensive surveillance system was designed and developed. Injury data were recorded from 25 male teams (959 players; 38±8 players/team) and eight female teams (234 players; 29±13 players/team) over two seasons. Females had a lower match injury incidence rate compared to males (35.6/1,000 player hours versus 49.1/1,000 player hours). Concussion and ankle sprains were the most common diagnoses. A high rate of injuries occurred in the first three months of the season, with females sustaining more strains and sprains, and males sustaining more fractures and dislocations during this period. Females had a high injury incidence in the second match quarter, whereas males had the highest injury occurrence in the third quarter. Conclusion: These findings add to the existing literature on injury surveillance strategies and injury in RU. Ultimately, this thesis serves to inform future injury reduction strategies and enhance player welfare and safety. i Declaration I hereby declare that the work contained in this thesis is my own, and was completed under the supervision of Dr Thomas M. Comyns and Dr Ian C. Kenny, of the Department of Physical Education and Sport Sciences, and Dr Róisín Cahalan, of the School of Allied Health, University of Limerick. This work has not been submitted for any academic award at this, or any other, third level institution. Chapter Two was published in Sports Medicine in January 2018. Chapter Three was published in Physical Therapy in Sport in September 2018. Chapter Four was published in Physical Therapy in Sport in January 2019. Chapter Six was published in Physical Therapy in Sport in November 2019. Finally, Chapter Five will be submitted for consideration for publication in the Scandinavian Journal of Medicine and Science in Sports in January 2020. Signed: _________________________________ Caithríona Yeomans Signed: _________________________________ Dr Thomas Comyns Signed: _________________________________ Dr Ian Kenny Signed: _________________________________ Dr Róisín Cahalan Date: January 2020 ii Acknowledgements There are a number of people who, without their support over the last three and a half years, the completion of this thesis would not have been possible. Firstly, I would like to thank my supervisors, Dr Tom Comyns, Dr Ian Kenny and Dr Róisín Cahalan, for providing me with the opportunity to pursue this research and be part of the IRIS Research Team. Thank you for your never-ending support, guidance and patience throughout my PhD journey, and in particular for the generosity with which you shared your experience, knowledge and time. To the IRIS Research Team, particularly my fellow IRIS PhD Researchers, it has been a pleasure collaborating with you. Thank you for the endless encouragement and inspiration. To my fellow postgraduate students, particularly those in the ‘PESS Outcast Office’. You were always there with an ear to listen, and an unending supply of coffee and chocolate. You provided the most enjoyable and supportive workplace, filled with friendship, good humour and lively debates. To the IRFU, the Rugby clubs, physiotherapists, doctors, club staff and players who facilitated this study, a sincere thanks for your co-operation, dedication and feedback; without you, this research would not have been possible. To my wonderful friends and family, thank you for taking an interest in my research, the hours of proof-reading and the words of encouragement. Finally, to my parents, a mere ‘thank you’ isn’t enough for all your unconditional support and encouragement over the years. You have always pushed me to chase my dreams and have supported me every step of the way. You provided me with the strength and motivation to continue on this PhD journey. iii Table of Contents Abstract .............................................................................................................................. i Declaration ........................................................................................................................ ii Acknowledgements ........................................................................................................... iii Table of Contents .............................................................................................................. iv List of Publications ........................................................................................................... ix List of Tables ................................................................................................................... xii List of Figures ................................................................................................................. xiii List of Appendices ........................................................................................................... xv List of Abbreviations ...................................................................................................... xvi Glossary of Terms ........................................................................................................... xix Chapter One: Introduction .................................................................................................. 1 1.1 Background .............................................................................................................. 2 1.2 Thesis Aims .............................................................................................................. 8 1.3 Thesis Structure ........................................................................................................ 8 Chapter Two: The Incidence of Injury in Amateur Male Rugby Union: A Systematic Review and Meta-Analysis ........................................................................................................... 11 2.1 Preface ................................................................................................................... 12 2.2 Abstract .................................................................................................................. 13 2.3 Key Findings .......................................................................................................... 14 iv 2.4 Introduction ............................................................................................................ 15 2.5 Aim ........................................................................................................................ 17 2.6 Methods ................................................................................................................. 17 2.7 Results ................................................................................................................... 21 2.8 Discussion .............................................................................................................. 28 2.9 Limitations ............................................................................................................. 34 2.10 Conclusions and Future Directions ....................................................................... 35 2.11 Declarations ......................................................................................................... 36 2.12 Addendum ............................................................................................................ 36 Chapter Three: Current Injury Monitoring and Player Education Practices in Irish Amateur Rugby Union ................................................................................................................... 39 3.1 Preface ................................................................................................................... 40 3.2 Abstract .................................................................................................................. 41 3.3 Highlights .............................................................................................................. 42 3.4 Introduction ............................................................................................................ 43 3.5 Methods ................................................................................................................. 45 3.6 Results ..................................................................................................................