Injury incidence and physiological requirements of a domestic amateur women's rugby union team in New Zealand : a thesis submitted to Massey University in fulfilment of the degree of Doctor of Philosophy at Massey University, Palmerston North, New Zealand

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Women’s rugby union has undergone a period of transition to become, reportedly, the fastest growing form of the game worldwide. Although the game is played nationally and internationally, it was not until 1991 that the first Rugby World Cup for women (RWC(W)) was held. Despite increased popularity and growth, the published studies investigating the epidemiological aspects of match and training in women’s rugby union is limited. Of the published studies to date, none have reported on aspects related to women’s rugby union participants in New Zealand. Therefore, the overall aim of this thesis was to explore and document the epidemiology of injuries in an amateur women’s rugby union team in New Zealand. As fatigue has been indicated as a possible injury risk factor, the physiological demands of match participation in amateur women’s rugby union were also assessed. Specific aims of the thesis were (1) The identification of the physiological and heart-rate demands of match participation for amateur women rugby union players; (2) The identification of the most common site, type, severity, and frequency of injuries that occur to women in rugby union training and match related activities (Systematic Review); (3) The identification of the most common site, type, severity, and frequency of injuries that occur to women in rugby union training and match related activities in New Zealand. The methodological approaches utilised in this thesis included an epidemiological analysis (Chapter 3), and a prospective observational cohort analysis (Chapters 2, 4 and 5). In measuring the movement demands of amateur domestic women’s rugby union (Chapter 2), player movements were monitored using microtechnology GPS devices. Players’ heart rates were also continuously monitored during match participation using a portable monitor. A mean total distance per match of 3,546.6 ±1,329.2 m was recorded over 28 matches. This resulted in a mean distance of 38.3 ±13.7 m.min-1 which was less than women’s football (79.3 to 118.0 m.min-1: mean 101.0 ±11.9 m.min-1), hockey (79.0 to 115.0 m.min-1: mean: 98.5 ±15.6 m.min-1) and women’s elite rugby union (54.8 to 68.0 m.min-1; mean: 61.4 ±9.3 m.min-1). Although Forwards recorded a lower total distance (3,409.7 ±1,201.9 m vs. 3,692.3 ±1,440.5 m) and m.min-1 (36.7 ±12.4 m.min-1 vs. 40.0 ±14.9 m.min-1) than Backs, they had a similar player-load (PL) (3.8 ±1.3 au.min-1 vs. 3.9 ±1.4 au.min-1), PL 2-dimensional (2.9 ±1.0 au.min-1 vs. 2.9 ±1.1 au.min-1), PL Forward (1.8 ±0.7 au.min-1 vs. 1.7 ±0.7 au.min-1), PL side (1.9 ±0.7 au.min-1 vs. 1.9 ±0.7 au.min-1) and PL vertical (2.9 ±1.0 au.min-1 vs. 3.0 ±1.2 au.min-1) when compared to Backs. Forwards recorded a higher maximum heart rate than Backs (191 b.min-1 vs. 188 b.min-1), indicating a higher cardiovascular stress and physiological strain for Forwards compared with Backs. The results of this study suggested that the physical and physiological profile of the playing group, at the amateur domestic level of women’s rugby union, were quite similar and may be suggestive of generalised, rather than specialised, training regimes that fail to prepare players for the position specific demands needed at higher levels of competition. The systematic review (Chapter 3) of literature reporting on women’s rugby union incorporated both rugby-15 and rugby-7s match and training related published studies. Only 10 articles identified through systematic searches of PubMed, SPORTDiscus, Web of Science Core Collection, Scopus, CINAHL(EBSCO) and ScienceDirect databases using keywords were included in the review. The incidence of injuries in rugby-15s varied from 3.6 (95% CI: 2.5-5.3) per 1,000 match-hr (including training and games) to 37.5 (95% CI: 26.5-48.5) per 1,000 match-hr, with a pooled incidence of 19.6 (95% CI: 17.7-21.7) per 1,000 match-hr. For rugby-7s, the injury incidence varied from 46.3 (95% CI: 38.7-55.4) per 1,000 match-hr to 95.4 (95% CI: 79.9-113.9) per 1,000 match-hr with a pooled incidence of 62.5 (95% CI: 54.7-70.4) per 1,000 player-hr. The tackle was the most commonly reported injury cause, with the ball carrier recording more injuries than the tackler at the collegiate, and RWC(W) levels of participation. Concussions and sprains/strains were the most commonly reported injuries at the collegiate level of participation. The incidence of injury in women’s rugby-15s and rugby-7s was lower than in men’s professional rugby-15s and rugby-7s competitions, but similar to male youth rugby-15s players. Differences in reporting methodologies limited comparisons of results between studies. Of note, the systematic review failed to identify any New Zealand based studies in women’s rugby union. A key finding of the systematic review was that there were no women’s rugby union training-specific studies identified. By conducting a prospective cohort observational study on the training sessions of an amateur women’s rugby union team, over two-years (Chapter 4), it was identified that the total injury incidence was 11.4 (95% CI: 8.3 to 15.6) per 1,000 training hrs. There were 12 injuries that resulted in a time-loss injury incidence of 3.6 (95% CI: 2.0 to 6.3) per 1,000 training-hrs. The tackle was the most common cause for total (3.0 [95% CI: 1.6 to 5.6] per 1,000 training-hrs.) injuries, but collisions (1.5 [95% CI: 0.6 to 3.6] per 1,000 training-hrs.) with the ground or another person were the most common cause for time-loss injuries. The training injuries occurred most often to the lower limb and during the latter part of training sessions. These injuries were mostly minor in nature, resulting in minimal time-loss away from training. The time-loss injury incidence (3.6 [95% CI: 2.0 to 6.3] per 1,000 training-hrs.) for the amateur women’s rugby 15s team players was higher than that reported for National (1.2 [95% CI: 0.4 to 3.1] per 1,000 training-hrs.) and RWC(W) (0.2 [95% CI: 0.0 to 2.2] to 3.0 [95% CI: 1.8 to 5.0] per 1,000 training-hrs.) competitions. The incidence of match injuries (Chapter 5) was conducted utilising a prospective cohort observational study on an amateur women’s rugby union, over two consecutive seasons. A total of 138 injuries were recorded resulting in an injury incidence of 247.0 (95% CI: 209.1 to 291.9) per 1,000 match-hrs. A total of 57 injuries resulted in a time-loss injury incidence of 102.0 (95% CI: 78.7 to 132.3) per 1,000 match-hrs. Although Forwards (261.8 [95% CI: 209.7 to 326.9] per 1,000 match-hrs.) recorded a higher total injury incidence than Backs (230.2 [95% CI: 178.7 to 296.4] per 1,000 match-hrs.), Backs recorded higher time-loss injury incidence (107.4 [95% CI: 74.2 to 155.6] per 1,000 match-hrs.) than Forwards (97.3 [95% CI: 67.6 to 140.1] per 1,000 match hrs). The lower limb sustained the highest injury incidence, with the knee having the greatest proportion of these injuries for both total (48.3 [95% CI: 33.1 to 70.5] per 1,000 match-hrs.) and time-loss (21.5 [95% CI: 12.2 to 37.8] per 1,000 match-hrs.) injuries. Sprains and strains recorded the highest incidence of all the injuries recorded and the lower limb body region recorded the most days lost and had the highest mean days lost per injury. The incidence of concussion (16.1 [95% CI: 8.4 to 31.0] per 1,000 match-hrs.) over the study was higher than previous studies reporting on women’s rugby union at the RWC(W) (3.5 [95% CI: 1.7 to 7.0] per 1,000 match hrs) and collegiate rugby union (1.6 [95% CI: 1.1 to 2.3] per 1,000 player match-hrs.) levels of participation. The tackle was recorded as being the most common injury cause and this was expected. Upon further analysis, it was identified that the action of being the ball carrier, rather than the tackler, during a tackle situation was associated with a notably higher injury incidence than any other match event. Future research is warranted to identify risk factors involved in the tackle unique to women participants. This PhD thesis has contributed knowledge regarding the incidence of injuries in amateur women rugby union players in New Zealand which has not been undertaken before. In addition, this PhD thesis has contributed further knowledge regarding the physiological demands of amateur women’s rugby union match participation (see Chapter 6).
Rugby football for women, Rugby Union football, Rugby Union football players, Wounds and injuries, Physiology, New Zealand