Injury and chronic pain in Rugby

Professional athletes are often at risk of injury or developing long conditions where chronic pain is a factor.

Rugby is a sport played by over 8.5 million people around the world and unfortunately carries an exceptionally high level of risk.  Research conducted as part of the Global Rugby Codes Health Research Programme found that compared to athletes from non-contact sports, retired elite and amateur rugby players were between two and ten times more likely to suffer from injuries – including concussion and knee-ligament injuries.[1]

The frequency of injury in rugby has recently come to head in England, as a group of ex-rugby union internationals have set out to sue the national governing body for the part they played in not protecting players from the threat of brain damage.[2]

While injury audits are regularly conducted by governing bodies at the semi-professional and professional levels to understand how to better help players prevent and recover from injuries, these studies are often limited to one or two seasons. This makes it difficult to see the longer-term injury toll for players, something the recent study has attempted to combat.

The study revealed that past participation in rugby was associated with a higher total number of injuries and recurrent injuries, with retired players being two to seven times more likely to report experiencing an injury. Former elite rugby players suffered an average of 1.6 injuries per season, while former amateur players suffered an average of 0.9 injuries per season. In comparison, non-contact athletes sustained an average of just 0.2 injuries per season. These figures are particularly shocking when you consider that the average rugby career lasts for 24-25 years.

Concussion was the most frequently reported injury for elite (81%) and amateur (76%) rugby players, with knee-ligament injuries affecting 68% of elite players and 48% of amateur players. In addition, these injuries were more likely to recur. This suggests that players might be returning to the field too soon, or repeatedly exposing themselves to risk.

Many former players, particularly those from the highest levels of the sport, claim that previous injuries continue to bother them years after retirement. Compared to retired athletes from non-contact sports, rugby players are two to ten times more likely to report long-term impact from an injury.

The injuries most likely to affect former players during retirement were found to be concussion, neck injuries, shoulder dislocation and knee ligament injuries. There have been concerns over the risk of recurring concussion due to the increasing evidence showing a link between concussion and reduced neurovascular and brain function.

80% of former elite rugby players were also found to suffer from back pain, with 64% suffering from severe and regular joint pain. The risk of osteoarthritis is also twice as high in elite players. Given that the average age of former elite players in the Global Rugby Codes Health Research Programme study was 43 years, this suggests the premature onset of this disease.

In attempts to quell the continued onset of long-term pain and injury for rugby players, rule changes have been made and programmes introduced to help mitigate the risk. Professional clubs have started to utilise advanced medical support to carefully monitor training. The Rugby Ready programme has been introduced to give rugby union players and coaches advice on rules, safe tackling techniques, conditioning, and injury management.

However, as a fan of the game and someone interested in the world of pain, I feel that we need to quicken efforts to minimise concussion and musculoskeletal injuries in rugby, but also support retired players who have already been burdened with long-term pain from the sport. Research identifies the pressing need for educational, rehabilitation and injury management support for players post-retirement and I strongly support these calls to action.



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