Rugby

Introduction

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Rugby Union (rugby) is a continuous, multiple-sprint, unhelmeted (padded headgear is permitted) collision team sport (>200 tackles per game) played by men and women, boys and girls, in 120 countries across six continents.
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The game lasts for 80 minutes with a 10-minute half-time interval.
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The fifteen-a-side version is the traditional and most popular version, but seven-a-side and ten-a-side versions are also played.
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The differentiating feature from American Football is that rugby is continuous in nature with no “time outs”; this requires injured players to be assessed during play before a decision is made whether to replace them with one of eight reserves.
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The international federation, World Rugby (WR) (formerly the International Rugby Board), governs the sport.

Epidemiology

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Rugby has one of the higher overall rates of injury (69/1000 player hours) compared to soccer (28/1000 player hours) and ice hockey (53/1000 player hours).
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Risk of injury increases with age and rugby level; this has been attributed to greater size, speed, increased competitiveness, more aggression and foul play.
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Risk of injury is higher in men than in women with the distribution of injuries varying by sex.
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Different facets of the game allow players of differing physiques and talents to contribute in different positions. All players may run or kick the ball, tackle and be involved in rucks and mauls.
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The forwards are divided into tight forwards comprising two props, a hooker, and two locks; they are largely responsible for the set pieces of play such as scrums and lineouts, and three “loose forwards” who are also involved in set pieces but who have a mandate to roam more.
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Forwards tend to be heavier and place an emphasis on strength and power.
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The seven backs tend to be smaller in stature with speed, agility, and skill being the assets.
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Because of the different player profiles, large discrepancies in size may occur resulting in physical challenges for smaller players.

General Principles

Rules

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Field-based team sport lasting up to 80 minutes with 30 players involved in continuous play interrupted only by:
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  Set play—scrums and lineouts
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  Penalties
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  Injury
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  Half time (10 minutes)

Terminology

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Scrum: Formation used in the set play re-starting play after a knock-on (spilling the ball forward) or forward pass; the forwards from each side bind together and then the two packs (groups of forwards) come together to allow the scrumhalf to deliver the ball to the scrum. A scrum can also be awarded or chosen in different circumstances by the referee ( Fig. 68.1A, B ).

Figure 68.1

Position terminology.

( B and D from South African Rugby Union; C reused with permission from Gallo Images.)
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Lineout: The set play re-starting play after the ball has been carried or kicked to touch (out of bounds); both sets of forwards will line up opposite each other with one team throwing the ball between the two lines of forwards. The throw must be directly down the middle of the two lines ( Fig. 68.1C ).
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Ruck: Typically, after a runner has come into contact with another player and the ball has been delivered to the ground, once any combination of at least three players have bound themselves over the ball, a ruck has been formed. The primary difference from the maul is that the ball is on the ground.
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Tackle: The act of physically bringing an opposing player who has the ball to the ground; the rugby tackle involves leading with the shoulder and wrapping arms around and placing the head behind the ball carrier; legal tackles must not be around the neck or head and tacklers are required to use both arms and not tip the tackled player head first into the ground ( Fig. 68.1D )
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“Blood bin”: A 15-minute period during which players who are bleeding or have open wounds may be removed from the field and temporarily replaced whilst their wounds are attended to and the bleeding stopped
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Head Injury Assessment (HIA): A 10-minute period during which players suspected of having suffered a concussion may be removed from the field and evaluated; this applies only to professional rugby.

Injuries

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Injury patterns are influenced by position: forwards suffer more knee, shoulder, and ankle injuries, whereas backs have a greater incidence of thigh (particularly hamstring) injuries.

Injury Prevention

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Rugby is the first professional sport to produce tournament player welfare standards, a compulsory checklist for players before international competition. These include:
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  Confirmation before a tournament by the team doctor or Union chief medical officer that all players are medically, mentally, dentally, and physically fit to participate
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  Confirmation that each player has completed the WR cardiac screening questionnaire and that a cardiac examination as described (which includes a mandatory ECG) has been completed
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  Completion by all team and match day medical staff of the following WR education modules: Concussion Management; Keep Rugby Clean anti-doping module; and Keep Rugby Onside anti-corruption module
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  Completion of WR Level 2 ICIR accreditation (or equivalent) by all Team Medical Staff and Match-Day Doctors
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  The host union must indicate to WR what medical staff will be in place on match day at each venue. The following medical staff must be in attendance: (i) match doctor, (ii) surgery doctor, (iii) surgery nurse, (iv) ALS paramedic, (v) an on-site ILS ambulance (staffed), (vi) minimum of four BLS paramedics.
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  Completion of a concussion education session by all players and team management within the year before commencement of the tournament; this education session should at least cover the essential information outlined in the HIA protocol document.
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  Completion of a baseline concussion assessment for each player and, as a minimum, using the SCAT 3. It is recommended that teams also include neurocognitive computer assessments.
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  Confirmation that a concussion risk stratification has been completed on all players to support concussion management on an individual basis
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  Acknowledge that the tournament has an untoward incident review system for potential medical mismanagement and specifically for incidents where criteria, identified in the HIA, for permanent removal from play following a head injury are not enforced. All team staff acknowledge that they will participate if requested in any untoward incident review and that a charge of misconduct can be applied following an untoward incident review.
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  Acknowledgement that the match-day doctor has the power to unilaterally remove an injured player from further game participation
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  Capture of all match injury data on an Injury Data Capture App required for the Injury Surveillance Monitoring System

Neck Strengthening

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Specific neck strengthening programs may help reduce the incidence of neck injuries.

Equipment

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Neither rugby headgear nor mouth guards have been shown to prevent concussion.
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Mouthguards have been unequivocally shown to reduce the incidence of dental and orofacial injuries. Customized mouthguards may be better tolerated and improve compliance.

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