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The Professional Rugby Injury Surveillance Project

The 2014-15 Professional Rugby Injury Surveillance Project (PRISP) has been published which monitors and analyses the injury risk of Premiership Rugby players in Premiership Rugby, European and National competition and training.

The study is the most comprehensive and longest running injury surveillance project in professional rugby and to read the report in full click here

Results from the latest study show the overall likelihood of a player sustaining a match or training injury remained stable last season and within the expected range of variation seen since the project began in 2002.

The severity of match and training injuries (the time taken to return to play) was the highest reported. Although the average severity of 29 and 28 days respectively, still falls within the expected range, there appears to be a trend for an increasing severity of injuries.

While the precise reasons for this trend are still unclear they are likely to reflect a number of factors. Last season saw a small increase in a number of relatively uncommon injuries causing more than 84 days absence that have a disproportionate effect on the mean severity. Specifically the incidence of Anterior Cruciate Ligament (ACL) and Medial Collateral Ligament (MCL) injuries to the knee was double that seen in 2013-14.   

The overall risk of training injuries was lower than that seen in the previous two seasons.

Concussion was the most commonly reported match injury for the fourth consecutive season amounting to approximately 17% of all match injuries. 95% of all concussion occurred in games with 110 reported cases from 70 Premiership Rugby, 23 European Competition and 17 National Cup matches played.

It is likely that the continued focus on improving concussion awareness among players, coaches, referees and medical staff together with the ongoing development of more specific and inclusive criteria as part of the Head Injury Assessment (HIA) process have both contributed to the rise in reported cases.

The average time that a player remained away from rugby after a match concussion was 12 days which remained stable compared to previous seasons.

England Rugby’s three key stakeholders, Premiership Rugby, the RFU and the RPA, have improved concussion awareness among players, coaches, referees and medical teams with concussion management being a major focus of the English professional game and this is likely to have contributed to the continued rise in awareness and the number of concussions reported.

Again this season, more than 1,600 professional players, coaches and referees in England have completed a world-leading mandatory concussion education programme.

The joint initiative explains what concussion is, how to recognise its symptoms, on and off the field, and how it feels when a player has experienced a concussion.

The education programme informs participants of the short, medium and long-term consequences of the injury and the protocols that have been put in place to ensure a safe return to play.

Changes to the nature of the professional game (i.e. more powerful players and/or an increasing frequency of contact events) have been suggested as factors underpinning the increase in concussion incidence. However, it should be noted that the risk of all other (non-concussion) match contact injuries has remained stable.

Effective concussion prevention is a key area for the game, with a combination of coaching, law-making and refereeing initiatives all likely to be needed. It is expected that the current World Rugby video analysis study investigating the game events associated with head injuries will provide key insights to help reduce the chance of concussion. Data recorded in the PRISP study is being used as part of World Rugby's analysis.

Detailed analysis of the return to play pathway after match concussion continued last season. Analysis of the two previous seasons were recently published in the British Journal of Sports Medicine. This is the largest study reporting the return to play after concussion in professional rugby. It will help to inform the ongoing development of the protocol with an emphasis on active rehabilitation of the systems likely impacted by the injury with the aim of reducing the risk of all injury following return from concussion.

The study reported 11 players retired as a result of injury and one retired as a result of illness last season. In comparison, 23 players retired as a result of injury and two players retired through illness in 2013-14.

There was a reduction of recurrent match injuries, continuing the trend seen since 2007-08. This was the result of the continued delivery of effective rehabilitation of injuries by club medical and conditioning teams.

The incidence of non-time loss and time-loss injury in matches played on artificial turf (Allianz Park and Kingston Park) was again compared with those played on natural turf. There were no clear differences in the incidence, severity or overall injury burden of time-loss and non-time-loss injuries between matches played on artificial turf and natural grass.

The relationship between training load and subsequent injury risk was investigated for the first time at four clubs with players at an increased risk of injury if they had high one-week cumulative loads or large week-to-week changes in load. This important area of analysis has been expanded for the 2015-16 season with data being collected at all 12 clubs.

Simon Kemp, RFU Chief Medical Officer said: "This longstanding study provides objective evidence to help us understand the effects playing the professional game has on players’ health and to develop approaches to improve player welfare. While the injury rate has remained relatively stable since the study began in 2002, we can’t ignore the recent trend for an increasing mean severity of injury. Further research is needed to establish the underlying reasons for this.  

"In terms of concussion, we are continuing to work hard on education, game day management and return to play based on the best medical and scientific evidence we have available to us. Our awareness programme has very significantly changed players, coaches and referees understanding of the injury and we believe that the principles of recognise and remove, recover and return are being consistently delivered.
"Research findings from the study will inform the 2016 Berlin Consensus conference that will review research from around the world prior to any revisions to the Consensus. A key objective for rugby has to be to try and reduce the numbers of concussions while preserving the essential characteristics of the game and we are hopeful that video clips, collected as part of this study, will help inform the analysis that is being led by World Rugby."
Corin Palmer Head of Rugby Operations at Premiership Rugby said: "Player welfare is Premiership Rugby's No 1 priority and alongside our 12 clubs we have established world class standards when it comes to treating any player who has been injured.

"We value and respect our players and will always strive to set the highest standards in caring for them.

"Cultural change amongst everyone involved in rugby union at every level is the key to the treatment of concussion.

"The Concussion Education programme run in England by ourselves the RFU and the RPA is changing the way we all see concussion and reinforcing the key principles of Recognise and Remove.

"The 12 Premiership Rugby clubs have made huge strides in recent years on the understanding and treatment of concussion and their commitment to do whatever possible to ensure that we are at the forefront of research into developing a tool to recognise concussion and establish the long term effects is hugely significant."

Richard Bryan the Rugby Director for the Rugby Players’ Association said: "The injury audit continues to be an essential piece of work and reference point for the professional game. With the increased number of reported concussions and concussion remaining the most common match injury, education and raising awareness are clearly having an effect.

"Nevertheless the game needs to continue with its work of exploring all avenues for concussion prevention measures and we are pleased that the report expressly references this. With the severity of match injuries in general also showing a trend of increasing, injury prevention measures across the game will continue to be a focus for all stakeholders."

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