Introduction

Rugby is a high velocity and collision sport attended by one of the highest rates of injuries in team sports (1-3). As is the trend in the global scene, rugby is increasingly a popular sport in Kenya. Competition is higher, the game faster and the players stronger. The combination of fac-tors is fodder for rising rates of injury (1-7) with signifi-cant impact on player and team performance. 'prevention is better than cure’ approach to rugby in-jury is made possible by understanding the characteris-tics and magnitude of the problem. An earlier Kenyan study suggested comparatively higher rates of rugby re-lated injuries but did not establish models of relation-ships with risk factors (8). Internal and external factors shown to influence the outcome of injury include player fitness, part of the season, phase of play, player position, state of the pitch and player physique (9-14). Accord-ing to Brooks for example, injuries that cause the most significant absence from the field of play for forwards and backs are anterior cruciate ligament and hamstring injury respectively (6).

 

This paper explores the injury experience and the asso-ciated risk profile during the Kenya 2010 15-side rugby season.

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Methodology

The prospective whole population cohort study of 364 players was conducted in the 2010 15-aside season. It comprised of the Kenya cup (KC) division one and Eric Shirley shield (ESS) division two leagues. All players were KRU registered and had to be above 18years of age. The clinical officers in charge of data collection were trained for two weeks to use the instrument of data col-lection followed by a proficiency exam using preseason matches.

 

Blood bin injuries defined by Law 3.11(a) of International Rugby Board ( IRB) were excluded unless a training session or match was subsequently missed because of the said injury. Age, height, weight, injury status at that time and posi-tion played were documented preseason. The players were clustered into forwards (positions 1 to 8) and backs (positions 9 to 15).

Data analysis was performed using SPSS version 17 soft-ware. Incidence was calculated as injuries per 1000 match player hours (mph) (95% CI). Student t-test was used to compare the means between injured and non-injured for continuous vari- ables i.e. age, weight, height, BMI. Match exposure was calculated on the basis of 15 players (8 forwards, 7 backs) per team exposed for 80 minutes (first half 0-20, 20-40, second half 40-60, 60-80minutes). Approval for study was obtained from the Kenyat-ta National Hospital Ethics and Research Committee and the KRU board.

 

 

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Results

Players enrolled in the study were 169 (76 backs and 93 forwards) for KC and 195 (97 backs 98 forwards) for ESS. The 30 KC and 30 ESS games played constituted a total 2400 mph. The season lasted 4 months during which 102 injuries were recorded. The incidence of injuries was 42.50/1000mph (Forwards 44.17; Backs 40.83). The ages of the players ranged from 18 to 40 years with a mean of 22.80 years (SD 3.724). The mean weight was 81.83kg (SD12.57) with a mean height of 1.75metres (SD 0.70) and a mean BMI of 26.59(SD 3.73). KC accounted for 64.6% of injuries which translated to an incidence of 55 injuries/1000mph and 30 injuries /1000mph for the ESS (p<0.0001). There was no career ending injury.

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Anthropometry in relation to level of play

 

The Kenyan player’s mean age was 22.80 years (SD 3.724) with a mean weight of 81.83kg (SD12.57) and mean height of 1.75(SD 0.70).

The KC player was older (p <0.001), heavier (p <0.001) and taller (p0.002) (Table 1).

 

Anthropometry between injured and non-injured

The 102 injuries occurred amongst 92 players. The in-jured player was older (p 0.046), heavier (p 0.014), taller (p 0.004), and with a larger BMI (p 0.271), (Table 2).

 

Distribution of injury based on location of body

The forwards had an injury incidence of 44.17injuries per 1000mph compared to 40.83 injuries per 1000mph for the backs (p 0.52). The most common regions injured were the lower limb (41.2%), upper limb (24.6%) and head and neck (26.4%). The most common types of injuries were ligamentous (38.2%) and concussion (8.9%) (table4). The types of injuries were generally of similar amongst the forwards and backs. (Table 3)being linked with dangerous play.A player in KC had higher overall risk to injury as compared ESS, odds ratio 2.18 (p 0.006).

 

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Distribution of injuries based on mechanism of injury

 

Majority of the injuries, 94.9% were a result of contact. The tackling/tackled scenario with a cumulative inci-dence of 63.7%, accounted for a majority of incidences in mechanism of injury. The line out and the maul ac-counted for the list incidence. (Figure 2)

 

Distribution of injury as a factor of time

The first quarter of the season had 47.1% of injuries, doubling any other quarter in the season. The frequency of injuries was highest in the first half of the season with a cumulative of 69.6%. (Table 5) Most injuries occurred in the last quarter of the game, and a total 73.5% of injuries occurring in the extreme quarters of the game. The proportion of injuries associated with foul play and dangerous play was 11.6% and 10.78%

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Discussion

The purpose of this study was to report the incidence of injury and associated factors in amateur rugby in Kenya. Injury incidence was 42.50 injuries per 1000mph. The Kenyan players were younger and lighter in weight when compared to players in professional leagues (9). This result is consistent with previous data that depict that bigger body sizes are associated with higher rates of injuries (9, 15). Compared to Kenya Cup (K), Eric Shir-ley Shield (ESS) players were smaller and younger. With a less stringent age of inclusion criteria; the differences may have been more dramatic. Our overall injury incidence is consistent with armature level play. It is however one third that reported in the earlier Kenyan study (8). We contend that the discrep-ancy is occasioned by the exclusion of minor injuries including blood bin injuries (8).

 

The tackle/tackling scenario was responsible for the high-est injury incidence, as previously reported (7,9,16,17). In the present study however, most injuries afflicted the tackler contrasting recent trends. An entry point for pre-vention would be the acquisition of protective gear and coaching of skillful tackling techniques (9, 18).Most in-juries occurred in the first quarter of the season. Similar results previously have ascribed this to preseason condi-tioning (12, 14). Coaches and fitness instructors invest time and resources in player fitness acquisition and early rehabilitation for the injured to mitigate against early season injuries (14).

 

Corroborating earlier studies (1,10,15), the results of the present study further show that approximately 50% of injuries occurred in the last quarter of the game, pos-sibly due to fatigue, reduced self-awareness and protection (3,8,9). Therefore, improving player endurance and conditioning might aid.

 

The incidence and pattern of injuries  was similar  between  forwards  and  backs and consistent with other reported data (9). The result on

anatomical regions involved echoes previous  reports (5, 9, 17). The head, shoulder and ankle were the most vulnerable to injury, probably related  to exposure and involvement in most phases of contact.  There are data to show that injuries occasioned by exposure and

involvement of the head can be prevented by use of head gear (19,20). Muscle strengthening exercises and use of shoulder pads can

reduce shoulder injuries (20). Ankle injuries on the other hand are possibly exacerbated by poor pitch conditions, a relationship not explored

in  this  study.  Pre-match warming and conditioning would limit the ligamentous strains  and muscle pulls which were common in these regions (1, 9).

 

The degree of foul play involvement was low (2). This was laudable and  probably a pointer to the stringent measures by the IRB to counter

foul play. In conclusion, the study has provided benchmark val-ues for the injury incidence and characteristics in Kenya. The injury rate recorded is much lower than previously documented.

 

Acknowledgements:

Acknowledgements go to the medical director KRU who coordinated club level participation, the entire KRU for the cooperation and Dr. Onyuma the study stat-istician. The study was fully funded by the authors. There was no source of external funding. There is no competing or conflict of interest by any of the authors.

 

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