World Rugby and unions advancing evidence-based approach to injury-prevention


World Rugby has set out its 2019 plan to further mitigate the risk of injury in the sport, beginning with a dedicated laws forum in March.

In a year set to see the most rigorous tournament player welfare standards ever at Rugby World Cup 2019, the focus areas build on significant progress in the management of injuries, particularly concussion (the latest Professional Rugby Injury Surveillance Project for the English elite game published this week demonstrates a 14.3 per cent drop in concussion incidence, which is in line with other elite competitions). This reflects the international federation’s continued commitment to making the game as safe and simple to play as possible.

The plan is centred on detailed research and a comprehensive understanding of the causes of injury, both in a match and training environment, as well as a sustained and aligned approach to the implementation of prevention strategies across the game, from coaches, players and medics to referees. Approved by Council in November 2018, it focuses on five key pillars:

·         Law review: World Rugby, in collaboration with its unions and player representatives, will host a dedicated injury prevention laws review forum in Paris in March, kicking-off the quadrennial laws review cycle. With the tackle responsible for up to 50 per cent of match injuries and 73 per cent of concussions in elite rugby, stakeholders will review the latest global injury surveillance data and consider the three-phase* approach to lowering the tackle height, while being encouraged to table suggestions for innovative and robust injury-prevention via possible law alteration.


·         Training load: Any player competing at Rugby World Cup 2019 must have a ‘load passport’ to encourage best-practice training load management between club and country environments (approved by the World Rugby Council in November 2018 and presented to tier one coaches), while all unions are encouraged to optimally manage load between club and national team environments based on published best-practice and guidance.


·         Injury surveillance: Under the revised premium standards for elite competitions approved by the World Rugby Executive Committee in September from 1 January 2019 any competition applying to operate the Head Injury Assessment (HIA) process must now: a) undertake detailed injury surveillance in line with World Rugby standards to create one comprehensive annual set of comparable and definitive global data, b) operate a Match-day Doctor at every match, c) implement minimum video review standards and d) enable World Rugby representation on any HIA review panel.


·         Game preparation: Unions encouraged to adopt the Activate injury-prevention warm-up programme developed by the RFU and University of Bath, which has demonstrated a 60 per cent reduction in adult concussions and a 70 per cent injury reduction at youth community level when used three times or more a week (more info here).


·         Tackle education: All unions encouraged to ensure professional environments provide comprehensive training to all young professional players in best-practice tackling techniques as educated within community rugby programmes such as Rugby Ready. (The FFR announced in December 2018 that they will host seminars with all professional clubs in France).

World Rugby Chairman Bill Beaumont said: “World Rugby, working in partnership with unions and leading independent experts, continues to be committed to making the sport as simple and safe as possible for all, reflected within our ongoing global injury-prevention strategy.

“Much progress has been made, particularly in the priority area of concussion, which is testament to the injury-management programmes implemented across the game. However, we continually strive for improvement, and with the full support of our unions and their respective clubs, we can make further preventative advances, particularly in the area of training load management, which is a key contributor to match injuries.

“Our major focus is the tackle, which is the most common facet of the game, and this year we will complete the initial analysis on the reduced tackle height trials. We are also hosting a wide-ranging laws forum in Paris in March, with a focus on injury-prevention and how evaluation and evolution of the laws might positively impact this area within the next four-year laws review cycle.

The focus areas are central to World Rugby’s continued prioritisation of player welfare, driven by the annual Medical Commission Conference, which brings together union medics, player representatives and leading independent medical experts to review the latest data and trends and identify new evidence-based areas of injury-prevention focus.

World Rugby Chief Medical Officer Dr Martin Raftery added: “While the number of rucks and ball in play time has increased over the past five years, the overall global incidence of injury has not increased, which means that the sport’s medical standards and injury-prevention programmes in elite adult rugby are having a positive impact.

“As a sport, we are continuing to drive evidence-based interventions to further reduce that injury risk and this should begin with training load management. Training accounts for approximately 90 per cent of all player load and is a significant contributor to match injuries, particularly non-contact injuries (35 per cent of all injuries). Behavioural change is required in the understanding and management of individual player load and we will be launching research-based player load guidance in partnership with International Rugby Players this year.

“We will also continue to focus on changing player behaviour in the tackle to reduce risk. The tackle trials continue and will provide important data for us to analyse and make recommendations to the Rugby Committee. The initial feedback on the trials, particularly the high tackle warning system which operated at the World Rugby U20 Championship, has been very encouraging, but we need to see a full set of data before drawing conclusions.”

New alterations to the laws of the game

Meanwhile, the World Rugby Executive Committee has approved to adopt the revised Television Match Official (TMO) protocol into Law 6.16. This operated as a trial in the November window with the aim of reducing time impact and placing greater decision-making responsibility on the referee. The protocol can be viewed here 

Law 15 (Ruck): The Executive Committee has also approved amendments to Law 15.4 to further clarify the laws regarding offside lines at the tackle and ruck. The revised law can be found here

These changes have immediate effect, with the exception of the revised TMO protocol which should be adopted for all competitions which commence after 1 January, 2019. This includes Super Rugby, the Six Nations and Rugby World Cup. Competitions that are already underway may continue under the old protocol until the current competition concludes. If these competitions wish to adopt the revised protocol now, they can do so.

Editors’ Notes
World Rugby’s Medical Commission Conference has grown into the leading forum for player welfare in rugby involving unions, player representatives and independent area experts and is a major catalyst and driver of leading programmes that are benefiting the game, including:

·         Global tournament player welfare standards and mandatory medical education and accreditation

·         The Head Injury Assessment programme, which has revolutionised standards of concussion identification and removal in elite rugby

·         The Graduated Return to Play protocol that monitors players’ return from a concussion in medically-supervised steps.

·         Three levels of Immediate Pitch-Side Care in Rugby courses, standardising medical care

·         The Mindset Mental Wellbeing programme in partnership with International Rugby Players that delivers mandatory awareness and referral programmes to elite doctors

·         Global concussion awareness and education programmes that have changed behaviour and attitudes in the sport

·         Centralised injury-surveillance programmes across all elite competitions to enable an accurate global view of trends

·         The research-driven scrum engagement sequence revision, which has reduced forces on engagement

·         Unprecedented study of the major causes of head injury in the sport, resulting in the three-phase tackle height reduction programme currently being trialled
World Rugby’s three-phased approach to reducing injurious high tackles:

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