Which is senior rugby or English football


Injuries in rugby: tough contact sport with high risk

Dear Sirs and Madames,

In many countries around the world, rugby is what football is in this country. The sport with the "egg" as play equipment is considered to be one of the toughest in the world and will be Olympic again in Rio de Janeiro for the first time since 1924 in the coming year. The 20-team World Cup will take place in England by the end of the month. After the Olympics and the World Cup, the Rugby World Cup is the third largest sporting event in the world, with around 470,000 visitors from all over the world expected. The current newsletter describes why rugby is becoming so popular, what the special dangers are in the crush and tackling - and examines the question of whether the hard sport is not too dangerous despite all the rules.

Already today we would like to draw your attention to the 31st annual congress of the Society for Orthopedic-Traumatological Sports Medicine (GOTS), which will take place from June 17 to 18, 2016 in Munich. You can make an active contribution to the scientific program - and submit an abstract on the following main topics from now until December 01, 2015 via the congress website gots-kongress.org:

  • Sports injury monitoring and prevention
  • Tendinopathies and muscle injuries
  • meniscus
  • Osteoarthritis and exercise
  • Free topics

With best regards
Andreas Bellinger, [email protected]


Injuries in rugby: tough contact sport with high risk

Rugby is a popular sport around the world. Hard team sport is still not particularly widespread in Germany, but that may soon change. Because at the 2016 Summer Olympics in Rio de Janeiro, rugby is part of the canon of Olympic sports for the first time since 1924. Rugby is an extreme contact sport that unites many player personalities and types of different constitution in one team. Standards and collisions that seem hard and brutal to outsiders are specially trained to adapt the muscles to the loads. In the statistics, rugby is rated relatively high in terms of the risk of injury.

Compared to other sports, the extreme physical contact in rugby is a bit rougher. While one team wants to carry the ball into the opposing field or kick it past the opponent, the opposing team tries to prevent this by attacking the player carrying the ball. These typical game situations, in which one can only pass backwards within the team, already harbor the risk of injury. Points are scored when a team manages to get the ball into the in-goal.

Challenges and risks
Rugby demands a high degree of strength and stamina, but also skills such as technique and game intelligence as well as above-average physical robustness. In most cases, the injuries, such as bruises, are less serious. In rugby, a player is only considered injured if he has to leave the field during the game or if he can no longer participate in the competition. The loads in the storm with the predominantly static game situations - comparable to the so-called standards in football - differ significantly from those in the back team.

In the “scrum”, a self-contained formation of eight players presses against the equally formed opponent. On command, the players try to push their bodies over the ball with their shoulders and heads resting on those of the opponents. Forces of several hundred kilograms act particularly on the cervical and lumbar spine.


Injuries to the ear with a bruise in the auricle can also occur.
A cauliflower ear (ring ear, right) can develop from this injury. Head protection can be worn for protection (picture below).

In the "alley" the ball is thrown from the touchline into the playing field; the players try to catch the ball at heights of up to four meters by lifting a teammate. The street catchers often fall to the ground - with the corresponding risk of injury to ankles and thorax.

The back team tries to carry the ball into the opposing half by catching it quickly and playing it, in order to place it behind the bars (goals) in the in-goal and to receive a so-called attempt. Fast changes of direction are practiced - or an attempt is made to recapture the ball by consistently blocking the opponent (tackling or holding down). There is a risk of injuries, especially to the ligaments of the ankle, knee and shoulder joints, the thorax and the muscles.

Type and frequency of injuries
According to the French Public Health Service (InVS), muscles are affected in 30 percent of all injuries - which applies to both amateurs and professionals. While young players are more likely to break, older players are more likely to bruise and sprain.

Injuries to the face, which often bleed profusely, usually look worse than they are. A face mask (picture) is worn to protect the teeth. Since mouthguards became mandatory in New Zealand, rugby-related tooth and jaw injuries there have decreased by 47 percent.

The most common injury in rugby, however, is ankle distortion. Overstretching can damage the joint capsule and the outer ligaments on the outside. As a result of the strong pressure on the inside of the ankle, cartilage damage can occur in the talus and lower leg. Depending on the severity of the injury, the tissue is overstretched or torn on the outside. Just like a skin wound, the damaged tissue heals by itself. However, this does not apply to muscles and tendon tissue, they have to be trained. For this purpose, simple balance exercises and stabilizing exercises are carried out.

The knee is the second most common injured joint in rugby. Twisting can damage ligaments and menisci. The thumb is also at risk: an acute thumb injury often occurs when the opponent is held on during the "tackle". The ligaments and capsule are overstretched or even tear. A complete torn ligament can be less painful because the damaged ligament is no longer under tension. In this case, the thumb appears unnaturally flexible. Injured joints can be supported and stabilized with tape or bandages. Using ice can prevent bleeding and further swelling and reduce recovery time.

An actor who suffers a concussion must be removed from the game immediately and withstand training and competition for at least three weeks. Training can only be started again when the doctor gives his okay and the athletic ability has been regained. Before an athlete returns to the field and to competition, however, it is imperative that they have fully recovered. Only when muscle strength, full mobility, coordination and balance have been regained does the gradual "return to play" with sport-specific training make sense.

Injuries in rugby: facts and causes
Rugby is a team sport with fast movements and high intensity. Injuries are statistically three times more common than in soccer or American football. Because of the higher level of stress, injuries generally occur more frequently in matches than in training. Armor is generally not allowed, so many players are more aware of the risk of injury and the need for specific training. This can greatly reduce the incidence of serious injuries.

Most injuries occur in teenagers between the ages of 10 and 18 years. Boys are affected in 90 percent of cases. The players are at the highest risk of injury in the “backs”, “wings”, “fullbacks” and “centers” parts of the team. Most facial injuries and the so-called cauliflower ear occur in a scrum. Players who fight for the ball in the “rucks” and “mauls” usually suffer injuries to their thumbs and other fingers, as well as abrasions and lacerations from the studs.

Every fourth player suffers an injury per season. The so-called "hookers" and "flankers", who occupy the outside in the crowd, get the most injuries. Strikers are injured more often than their backs; because they are exposed to more physical collisions and "tackles" (picture).

On average, every rugby player has between 20 and 40 tackles per game. Almost 25 percent of all neck injuries occur in the front rows of a crowd. Compared to training, more injuries occur in games (57 percent); mostly in the second half of a game, when strength and concentration decline. About half of all injuries occur while tackling or when a player is being tackled.

More than 40 percent of injuries are strains, bruises (bruises), or affect the muscles; 30 percent are sprains, dislocations - followed by broken bones, cuts and overuse injuries. Every seventh injury is a sprained or pulled ankle. 5 to 25 percent of rugby injuries are head injuries, including concussions.

In adolescents between 10 and 18 years of age, bone fractures occur in 35 percent of injuries, of which 24 percent involve the collarbone. Superficial injuries represent 20 percent of rugby injuries - followed by head injuries and sprains (16 percent). Of the head injuries, 44 percent are concussions (contusion).

Injuries to different parts of the body

24%Head / face / neck27%
21%upper extremity31%
48%lower extremity22%


Prevention and security

Passive preventive measures:

  • Mouthguards (since mouthguards became mandatory in New Zealand, rugby-related tooth and jaw injuries have decreased by 47 percent)
  • Shoes (studs / soles should be adapted to the weather and the ground)
  • head protection
  • Padded equipment

The equipment must comply with the rules of the International Rugby Federation (IRB) and be approved. A player is not protected from major injuries despite wearing this padded equipment. Above all, however, they must not be used as protection for a not yet fully regenerated player.

Active preventive measures:

  • intensive preparation (slowly increasing intensity and duration)
  • special attention to "defensive skills"
  • Fall technique training
  • Tackling strategies (minimizing impact forces)
  • Strengthening the neck muscles
  • Techniques for contact phases

Injuries occur again and again, especially with the "tackles". Therefore, special strategies for prevention as well as the knowledge and application of the basic rules of "tackles" are of particular importance and a constantly recurring focus of training.

About the authors:
Prof. Dr.Holger Schmittpractices at the ATOS Clinic in Heidelberg, where he is head of the Center for Sports Traumatology Surgery. The specialist in orthopedics and trauma surgery, special orthopedic surgery and rheumatology was President of GOTS from 2008 to 2013.
Dr. Frank Fleischmann is a specialist in orthopedics, trauma surgery and sports medicine and practices in Heusenstamm. Fleischmann is the association doctor of the German Rugby Association (DRV).