Rugby injury surveillance and prevention programmes: are they effective?
BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1587 (Published 21 April 2015) Cite this as: BMJ 2015;350:h1587
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As both an ex Rugby Union player with 12 years experience of competitive rugby at both junior and adult levels and a junior doctor interested in orthopaedics, it was with some interest that I read this article.
Rugby has many benefits to offer besides physical fitness, including learning to work in a team, make decisions under pressure and gaining a sense of camaraderie. I would argue that in many ways it is the intensity and physicality of the game which particularly lends it to the development of these attributes. An increase in participation in rugby at school age can only be positive for the sport's continued development and longevity.
Having said this, the nature of the sport means that it is not without risk, as highlighted by the authors. We need to be conscious about ensuring that young people come away with a positive experience of rugby if we they are to be involved for a sustained period. For many, an important part of this is ensuring they are as safe as possible.
In my experience, a large number of injuries come about as a result of poor technique in and around the contact area. It is therefore concerning that there appears to be no existing or planned nationwide programme to promote safe techniques for people participating in the sport. Given the success of programmes like RugbySmart at reducing injury rates in other countries, the lack of plans for a similar scheme across the UK seems to be somewhat indefensible.
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One problem faced by those who are concerned about safety is that those children (and adults) who enjoy rugby (and boxing, MMA etc) are drawn to them because there is an element of danger, not despite there being an element of danger.
Of course many children don't enjoy them, and they certainly shouldn't be pushed into competing in full contact sports, if they don't want to. That's merely a way of deterring children from exercise for life.
The problems arise from those who do want to compete. For them, I suspect that some form of martial art is a good deal safer that rugby, if only because you are matched by weight and by ability for muay thai, boxing and MMA.
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I've read this article with great interest and concern. Having worked in child health promotion and protection, I would like to ask whether, given the approximately 12% chance of injury to each child per season quoted, there are child protection issues here? Also, what are the insurance implications for schools if a child is seriously injured on the pitch?
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Dear Sir,
Having posted a rather flippant response, I would like to follow up by thanking the authors for a clear and informative article. My interest is purely personal, having 2 teenage sons who play rugby: both have certainly sustained play- restricting injuries and the eldest has now stopped due to several epsiodes of concussion.
From the sidelines, I dread every point of contact but I think most players/ parents go into the sport with eyes open to the fact that injuries will occur even with the best of regulations. To monitor the sport and adjust rules to reduce the more severe eg spinal injuries can only be beneficial.
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Happened to notice that the photograph used for the article clearly illustrates one potential cause of injury - lack of gum shield !
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The short answer is no. This will be viewed by those as hostile who are involved in the game. There is an obsession with physicality in the game currently, which is being mirrored at the younger age groups. I have come to be alarmed by the bulk and size of kids at u13, 14, 15. They are obviously being encouraged to partake in extra gym sessions. I believe that kids would be better served working on the technical, skills part of the game. It is pretty obvious that children are being encouraged through peer pressure and other means to use bulking agents.
In Boxing kids are matched through weight for obvious reasons. It is not unknown for the differentiation in weight to be as much as 84 pounds.
I am also alarmed by the obvious use of steroids such as GHG and the like in the professional game. It is only a matter of time that this will be reflected at grass route levels. Testing for banned substances is obviously not fit for purpose. I hold a degree in Sports Science and am a former P.E Teacher and professional coach [ soccer].
Regards
Vinny
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I am a member of the board of Rugby League Ireland, and an ex-professional Rugby League player, who has the scars of several operations that were required to try to fix some of the injuries incurred during my career. Unlike Brian Moore I completely agree with Prof. Allyson Pollock, that full contact rugby is inherently dangerous and that governments should not be promoting the game in its full-tackle form in schools.
We (rugby League Ireland) have tried to develop a semi-contact version of the game, that can be used as a broad participation version and also a pathway for those who may want to play the full game after school. With that in mind we have codified a set of rules that, not only reduces the chances of collision injuries, but develops the rugby skills that an over-emphasis on collisions often neglects. We have called it EuroTag Rugby League (it has a facebook page with videos of the game in action a link to the rules).
Touch rugby often gets dismissed by the likes of Brian Moore as being too soft, but EuroTag, with its limited contact might just appease some of the people who are critical of Prof. Pollock's stance. Our version takes away the physical advantage that early developers have, It allows some level of contact (maybe just a little bit higher than basketball) and even though full tackles are not allowed, getting a 'tag' on the ball requires defenders to get their feet closer to the ball carrier than conventional touch and tag, and so our version is better preparation for actual tackling, should that person wish to continue to play the game. Ball handling and evasion skills are required to play the game and developing these skills will determine which team comes out on top. Participants would still get the camaraderie and the life lessons that winning and losing as a team can bring, but with a massively reduced injury risk that union rucks and scrums, and union and league tackles bring.
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Re: Rugby injury surveillance and prevention programmes: are they effective?
I detested rugby when forced to play it as a child at school and took pride in running away from the ball so as to avoid the risk of injury. I detested rugby when my children were forced in turn to play it at school and encouraged them to do the same. It is self-evident that it is a violent game, which carries a risk of serious injury, and Pollock's paper provides strong evidential support for that sentiment.
I think the question here is one of informed consent. Currently, many schools compel children to play rugby, against a very real risk of injuries, some of them serious. I don't see informed consent being sought from parents for children's participation in this dangerous activity. Even if it were being sought, I think it's moot that parents should be allowed to consent to their children participating in such a dangerous activity. What's the point of this risk of serious injury when you can play touch rugby or one of a number of other, much safer, non-contact, competitive team ball games? Isn't this view of violence and risk of injury as being somehow ennobling and character-building outdated? It's 2015, people, not 1915.
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