The Epidemiology of Ankle Injuries in Professional Rugby Union Players

Abstract

Background:

Ankle injuries represent a considerable proportion of injuries to professional rugby union players; however, there is a scarcity of detailed epidemiology about these injuries.

Purpose:

To describe the epidemiology and assess the risk factors associated with ankle injuries sustained by a cohort of professional rugby union players.

Study Design:

Descriptive epidemiology study.

Method:

Medical personnel prospectively reported time-loss injuries in professional rugby union in England, and the ankle injuries were evaluated.

Results:

Lateral ankle ligament injuries were the most common injury reported during matches and training, and together with Achilles tendon injuries, they accounted for more than half of the absence due to injury. The incidence rate of injuries was highest in second-row forwards. More than a quarter of injuries were recurrences.

Conclusion:

Lateral ankle ligament injuries and Achilles tendon injuries should be a focus of injury prevention, treatment, and rehabilitation strategies in professional rugby union players.

Keywords

risk factors injury surveillance ankle ligament injuries Achilles tendon injuries

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References

Alfredson

Pietilä

Jonsson

Lorentzon

. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26:360–366.

Bathgate

Best

Craig

Jamieson

. A prospective study of injuries to elite Australian rugby union players. Br J Sports Med. 2002;36:265–269.

Best

McIntosh

Savage

. Rugby World Cup 2003 injury surveillance project. Br J Sports Med. 2005;39:812–817.

Bottini

Poggi

Luzuriaga

Secin

, Incidence and nature of the most common rugby injuries sustained in Argentina (1991–1997). Br J Sports Med. 2000;34:94–97.

Brooks

Fuller

Kemp

Reddin

. Epidemiology of injuries in English professional rugby union, part 1: Match injuries. Br J Sports Med. 2005;39:757–766.

Brooks

Fuller

Kemp

Reddin

. Epidemiology of injuries in English professional rugby union, part 2: Training injuries. Br J Sports Med. 2005;39:767–775.

Clement

Taunton

Smart

. Achilles tendinitis and peritendinitis: Etiology and treatment. Am J Sports Med. 1984;12:179–184.

Cordova

Scott

Ingersoll

LeBlanc

. Effects of ankle support on lower-extremity functional performance: A meta-analysis. Med Sci Sports Exerc. 2005;37:635–641.

Fahlström

Jonsson

Lorentzon

Alfredson

. Chronic Achilles tendon pain treated with eccentric calf-muscle training. Knee Surg Sports Traumatol Arthrosc. 2003;11:327–333.

10.

Fong

Hong

Chan

Yung

Chan

. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37:73–94.

11.

Fyfe

Stanish

. The use of eccentric training and stretching in the treatment and prevention of tendon injuries. Clin Sports Med 1992;11:601–624.

12.

Garraway

Lee

Hutton

Russell

Macleod

. Impact of professionalism on injuries in rugby union. Br J Sports Med. 2000;34:348–351.

13.

Gissane

Jennings

White

Curnine

. Injury in summer rugby league football: The experiences of one club. Br J Sports Med. 1998;32:149–152.

14.

Giza

Fuller

Junge

Dvorak

. Mechanisms of foot and ankle injuries in soccer. Am J Sports Med. 2003:31:550–554.

15.

Gutierrez

Jackson

Dorr

Margiotta

Kaminski

. Effect of fatigue on neuromuscular function at the ankle. J Sport Rehabil. 2007:16:295–306.

16.

Hawkins

Fuller

. A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med. 1999;33:196–203.

17.

Hughes

Fricker

. A prospective survey of injuries to first-grade rugby union players. Clin J Sport Med. 1994;4:249–256.

18.

Hume

Gerrard

. Inversion sprains in rugby union and the effectiveness of external ankle support. Sports Med. 1998;25:285–312.

19.

James

Bates

Osternig

. Injuries to runners. Am J Sports Med. 1978;6:40–50.

20.

Kirkwood

Sterne

JAC

. Essential Medical Statistics. Oxford, England: Blackwell Science; 2003.

21.

Kvist

. Achilles tendon injuries in athletes. Ann Chir Gynaecol. 1991;80:188–201.

22.

Maffulli

Kader

. Tendinopathy of tendo Achillis. J Bone Joint Surg Br. 2002;84:1–8.

23.

Mafi

Lorentzon

Alfredson

. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2001;9:42–47.

24.

Mahieu

Witvrouw

Stevens

Van Tiggelen

Roget

. Intrinsic risk factors for the development of Achilles tendon overuse injury: A prospective study. Am J Sports Med. 2006;34:226–235.

25.

Marshall

Waller

Dick

Pugh

Loomis

Chalmers

. An ecologie study of protective equipment and injury in two contact sports. Int J Epidemiol. 2002;31:587–592.

26.

McGuine

Greene

Best

Leverson

. Balance as a predictor of ankle injuries in high school basketball players. Clin J Sport Med. 2000;10:239–244.

27.

McGuine

Keene

. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med. 2006;34:1103–1111.

28.

McHugh

Tyler

Tetro

Mullaney

Nicholas

. Risk factors for noncontact ankle sprains in high school athletes: The role of hip strength and balance ability. Am J Sports Med. 2006;34:464–470.

29.

McKay

Goldie

Payne

Oakes

. Ankle injuries in basketball: Injury rate and risk factors. Br J Sports Med. 2001;35:103–108.

30.

Öhberg

Alfredson

. Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis? Knee Surg Sports Traumatol Arthrosc. 2004;12:465–470.

31.

Öhberg

Lorentzon

Alfredson

. Eccentric training in patients with chronic Achilles tendinosis: Normalised tendon structure and decreased thickness at follow up. Br J Sports Med. 2004;38:8–11.

32.

Orchard

. Orchard sports injury classification system (OSICS). Available at: http://www.injuryupdate.com.au/research/OSICS8.pdf. Accessed July 27, 2006.

33.

Orchard

Seward

. Epidemiology of injuries in the Australian Football League, seasons 1997–2000. Br J Sports Med. 2002;36:39–45.

34.

Paavola

Kannus

Jarvinen

Khan

Jozsa

Jarvinen

. Achilles tendinopathy. J Bone Joint Surg Am. 2002;84:2062–2076.

35.

Seward

Orchard

Hazard

Collinson

. Football injuries in Australia at elite level. Med J Aust. 1993;159:298–301.

36.

Sitler

Ryan

Wheeler

. The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball. Am J Sports Med. 1994;22:454–461.

37.

Stewart

Burden

. Does generalised ligamentous laxity increase seasonal incidence of injuries in male first division club rugby players? Br J Sports Med. 2004;38:457–460.

38.

Targett

SGR

. Injuries in professional rugby union. Clin J Sport Med. 1998;8:280–285.

39.

Trojian

McKeag

. Single leg balance test to identify risk of ankle sprains. Br J Sports Med. 2006;40:610–613.

40.

Verhagen

van der Beek

Twisk

Bouter

Bahr

van Mechelen

. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: A prospective controlled trial. Am J Sports Med. 2004;32:1385–1393.

41.

Verhagen

van der Beek

Bouter

Bahr

van Mechelen

. A one season prospective cohort study of volleyball injuries. Br J Sports Med. 2004;38:477–481.

42.

Verhagen

van Mechelen

de Vente

. The effect of preventive measures on the incidence of ankle sprains. Clin J Sport Med. 2000;10:291–296.

43.

Willems

Witvrouw

Delbaere

Mahieu

De Bourdeaudhuij

De Clercq

. Intrinsic risk factors for inversion ankle sprains in male subjects: A prospective study. Am J Sports Med. 2005;33:415–423.

44.

Woods

Hawkins

Hulse

Hodson

. The Football Association Medical Research Programme, an audit of injuries in professional football: An analysis of ankle sprains. Br J Sports Med. 2003;37:233–238.

45.

Yard

Comstock

. Injuries sustained by rugby players presenting to United States emergency departments, 1978 through 2004. J Athl Train. 2006;41:325–331.