Injury rehabilitation and return to play criteria in South African schoolboy rugby union
Wall, Christina Magdalena
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Professional rugby union has grown to become the third most popular team contact sport in the world. The physical nature of the game results in a high prevalence of injuries on all levels of play. Injury prevalence as high as 83.9 injuries per 1000 playing hours has been reported for the 2007 Rugby World Cup in France. Although research indicates schoolboy rugby union to be safer than professional rugby, injury rates as high as 65.8 injuries per 1000 playing hours have been reported. These injuries are mostly caused by the tackle situation, with the knee– and shoulder–joints being the most injured site. The risk of injuries in rugby union is heightened by professionalism, previous injuries, higher training demands, intrinsic factors and psychological issues. Due to the professional nature the game has taken on, the management of rugby union injuries has become increasingly more important. This should include prehabilitation or injury prevention programs, rehabilitation up until the final, sport specific phase as well as structured return to play testing. Another important aspect of injury management is the education of coaches, players and other persons involved in the sport. Objectives: The first objective of the study was to observe the prevalence and nature of injuries in South African schoolboy rugby union players. Secondly, the treatment of these injuries was observed as well as the return to play criteria used to determine readiness to return to play after injury. The association between the treatment of injuries and the severity of injuries was then obtained. Lastly re–injury prevalence was compared to treatment received and return to play criteria used to determine readiness. Methods: Ten schools from across South Africa partook in the study. The schools were all identified by the NWU–PUK as elite schools due to performances in the previous year (2008). Only the first team squad of each school was participated, amounting to a total number of 194 boys answering questionnaires conducted by the researcher for each of their injuries. The questionnaires included injury severity and site, recurrence of injury, cause of injury, treatment procedures and criteria used for return to play. Severity was defined in terms of game and training days missed due to injury and are describe as slight (0 – 1 day), minimal (2 - 3 days), mild (4 - 7 days), moderate (8 - 28 days) or severe (>28 days). The results were then analyzed and presented through descriptive statistics. Statistical significance was indicated by p <= 0.05. Practical significance was described by the Phi–coefficient. The practical significance indicated by phi, was indicated as large if phi >= 0.5. Results: A total number of 118 injuries were reported amounting to 78.51 injuries per 1000 playing hours. New injuries accounted for 68.64% (n=81) while recurrent injuries was reported to be 31.36% (n=37). The most frequent site of injury was the knee (n=26), followed by the shoulder (n=21). The event leading to injury that was most frequently reported, was the tackle (including making the tackle and being tackled) (n=49). Most injuries were slight (48%) but a high rate of moderate and severe injuries (39%) were reported. These moderate to severe injuries resulted in a minimum total of 360 days missed. Severe injuries were more likely to be treated by a doctor. Treatment by a doctor for severe injuries indicated the only significance in the study (p = 0.7). No fixed return to play protocol was in place for deciding if a player should be allowed to return to play. Thirteen of the injuries were however investigated through further testing (either through isokinetic or on–field testing). Conclusion: Injury prevalence amongst top teams in South African schoolboy rugby union is very high. Rehabilitation does not follow a structured program or guidelines and there is no definite return to play protocols available. Re–injury rates are high, possibly due to the lack of structured rehabilitation and return to play protocols.