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World Rugby
Surveillance Studies
Sevens World Series (Women)
Summary of Results: 2011/12 to 2018/19
Colin Fuller and Aileen Taylor
24 September 2019
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 2 of 17
Summary of key points
Due solely to the smaller number of Tournaments (5/6 v 10) and the smaller
number of core teams (11 v 15) involved in the women’s Sevens World Series, the
total number of match injuries typically recorded in each Series is about one third
of those reported in each men’s Sevens World Series. This precludes reporting
meaningful Series-specific data for some parameters in the women’s Sevens World
Series. The average injury surveillance data recorded and reported for the period
2011/12 to 2018/19 does, however, provide a high quality and reliable source of
information about the risks of injury associated with women’s elite Rugby-7s.
Based on the combined data from the women’s Sevens World Series over the 8-
year period from 2011/12 to 2018/19, the following general conclusions can be
presented:
• Rugby-7s forwards are older, taller and heavier than the backs.
• There is a statistically significant reducing trend in the age of forwards but
no statistically significant change in backs’ age.
• There has been a statistically significant increasing trend in the stature of
backs but no statistically significant change in the stature of forwards.
• There have been no statistically significant changes in the body mass of
backs or forwards.
• The incidence of injury in women’s Rugby-7s is significantly higher than that
in women’s Rugby-15s but significantly lower than that in men’s Rugby 7s.
• Backs have a statistically significant higher incidence of injury than forwards.
• Significantly more injuries occur in the second half of games (first half:
40%; second half: 60%), which is similar to the situation in the men’s
Sevens World Series.
• The mean severity of injuries sustained in the women’s Sevens World Series
is significantly higher than that reported for the men’s Sevens World Series
(women: 53.0 days; men: 44.5 days).
• Overall, the knee, head and ankle are the most commonly injured sites in
the women’s Series, which is similar to the men’s Sevens World Series.
• Ligament sprain, muscle strain and concussion are the most common types
of injury reported in the women’s Sevens World Series, which is similar to
the men’s Sevens World Series.
• Concussion remains the most common specific injury for backs (13%) and
forwards (20%). Anterior cruciate ligament injuries, however, are
responsible for the most days-absence for both backs (17%) and forwards
(23%).
• The majority of injuries sustained in the women’s Sevens World Series are
acute in nature (backs: 95%; forwards: 95%) and most injuries result from
contact events (backs: 89%; forwards: 89%).
• Being-tackled (backs: 39%; forwards: 32%) and tackling (backs: 28%;
forwards: 27%) are the match events responsible for the most injuries.
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 3 of 17
1 Introduction
World Rugby is committed to implementing injury surveillance studies at all major
World Rugby Tournaments and to disseminate the results within the Rugby
community.
The aims of these studies are:
• to record and analyse injuries and illnesses sustained by male and female
players at individual Tournaments,
• to identify changing patterns of injury, and
• to bring injury-related areas of concern to the attention of World Rugby’s
Chief Medical Officer.
Previous surveillance studies in women’s Rugby Sevens reported the incidence and
nature of match and training injuries sustained during the women’s Sevens World
Series (SWS) from 2011/12 to 2017/18. This report continues the on-going study
of the women’s Sevens World Series by reporting match and training injuries and
illnesses sustained during the 2018/19 Series.
This review also combines the women’s 2018/19 Sevens World Series data with the
data reported previously in order to provide an updated overview of the risks of
injury and illness in elite women’s Rugby Sevens.
2 Methods
All studies were conducted in accordance with the definitions and protocols
described in the World Rugby approved consensus statement on definitions and
procedures for injury surveillance studies in Rugby (Fuller et al., 2007).
The definition of injury was: ‘Any injury sustained during a Sevens World Series
Tournament match or training activity that prevents a player from taking a full part
in all normal training activities and/or match play for more than one day following
the day of injury’. A recurrent injury was defined as: ‘An injury (as defined above)
of the same type and at the same site as an index injury and which occurs after a
player’s return to full participation from the index injury’.
Specific injuries were classified using OSICS 8 (Orchard, 2010). Injury location,
type and cause together with the event leading to the injury were also recorded.
The definition of an illness used in this study was: ‘Any medical condition sustained
while travelling to a Sevens World Series Tournament, while at a Tournament or
while travelling home at the end of a Tournament that prevents a player from
taking a full part in all training activities and/or match play for more than one day
following the day of onset of the illness.’
Injuries and illnesses not related directly to Sevens World Series rugby-related
activity were not included.
Injury/illness severity was determined by the number of days a player was
injured/ill: a player was deemed to be ‘injured/ill’ until she could undertake full,
normal training and be available for match selection, whether or not she was
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 4 of 17
actually selected. Medical staff were required to make an informed clinical
judgement about a player’s fitness to train/play on those days when players were
not scheduled to train or play. Injured/ill players were followed up after each
Tournament to obtain their return to play date: the return to play dates for players
with injuries/illnesses that remained unresolved 3 months after the final day of the
final Tournament in the Series were estimated on the basis of the clinical
judgement and prognosis provided by the injured player’s medical staff.
The complete lists of categories and sub-categories used for categorising injury
locations and injury types are provided in the rugby injury consensus publication
(Fuller et al., 2007).
Differences in players’ anthropometric data were assessed using unpaired t-tests;
differences in incidences, mean severity and proportions of injuries using z-tests;
and differences in median severity using a Mann-Whitney U test. Differences in
injury numbers were assessed using the chi-squared test. Trends in data over time
were assessed using linear regression analyses. Statistical significance was
accepted at the p=0.05 level, although it is recognised that this could identify some
differences that occurred by chance due to the large number of statistical
comparisons being made in the study.
3 Data collection
At the beginning of each women’s Sevens World Series, the team’s medical staff
were asked to explain to squad players the purpose of the epidemiological study.
Each player’s baseline anthropometric information was recorded on a Player
Baseline Information Form (playing position [back, forward]; date of birth; body
mass [Kg]; stature [cm]). Players joining a country’s squad at a later date were
added to the list of players and the anthropometric data recorded at the time the
player joined the squad.
Medical staff recorded injuries/illnesses sustained during each Tournament on a
Tournament Summary of Injuries and Illnesses Report Form, which was returned to
the study co-ordinator at the end of the Tournament. A member of the team’s
medical staff also recorded detailed information about each injury and illness on an
Injury/Illness Report Form (date of injury/illness, date of return to play, location
and type of injury/illness, cause of injury/illness, event leading to injury/illness).
Injury/illness Report Forms were returned to the study co-ordinator when the final
piece of information had been entered on the Form (normally the return-to-play
date).
4 Results
Results for previous women’s Sevens World Series have been presented in earlier
World Rugby reports (Fuller and Taylor, 2018). The women’s Sevens World Series
2018/19, which consisted of 6 Tournaments in USA, Dubai, Australia, Japan,
Canada and France, took place over the period 20 October 2018 to 16 June 2019.
This study recorded players’ anthropometric data and match and training injuries
and illnesses sustained by the eleven core teams (Australia, Canada, China,
England, Fiji, France, Ireland, New Zealand, Russia, Spain, USA) taking part in all
six of the 2018/19 Sevens World Series Tournaments. Teams’ match and
Tournament-based training activities were also recorded.
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 5 of 17
4.1 Players’ anthropometric data
Table 1 summarises the numbers and anthropometric data for players categorised
as backs, forwards and all players in the 2018/19 Sevens World Series together
with values averaged over the period 2011/12 to 2018/19.
Table 1: Players’ anthropometric data: 2018/19 Sevens World Series.
Series /
Measure
Mean (Standard deviation, number of players)
Backs Forwards ALL players
2018/19
Stature, cm 167.6 (5.0, 120) 172.2 (5.6, 96) 169.6 (5.8, 216)
Body mass, Kg 66.2 (5.3, 120) 73.4 (6.9, 96) 69.4 (7.1, 216)
Age, years 23.1 (3.6, 120) 24.0 (4.0, 96) 23.5 (3.8, 216)
All Series (2011/12 – 2018/19)
Stature, cm 167.0 (5.3, 816) 170.7 (5.7, 627) 168.6 (5.8, 1443)
Body mass, Kg 65.5 (5.5, 817) 71.4 (6.2, 630) 68.1 (6.5, 1447)
Age, years 23.6 (3.7, 818) 24.5 (3.8, 630) 24.0 (3.8, 1448)
Based on the all-series data, forwards are significantly older (p<0.001), heavier
(p<0.001) and taller (p<0.001) than backs.
Trends in players’ age, stature and body mass over the period 2011/12 to 2018/19
are shown in Figures 1 to 3, respectively.
Fig 1. Trends in players’ age (years)
22	
23	
24	
25	
26	
2011/12	
2012/13	
2013/14	
2014/15	
2015/16	
2016/17	
2017/18	
2018/19	
Age,	years	
Backs	 Forwards
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 6 of 17
Fig 2. Trends in players’ stature (cm)
Fig 3. Trends in players’ body mass (Kg)
160	
165	
170	
175	
2011/12	
2012/13	
2013/14	
2014/15	
2015/16	
2016/17	
2017/18	
2018/19	
Stature,	cm	
Backs	 Forwards	
60	
65	
70	
75	
2011/12	
2012/13	
2013/14	
2014/15	
2015/16	
2016/17	
2017/18	
2018/19	
Body	mass,	Kg	
Backs	 Forwards
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 7 of 17
Backs have been getting significantly taller (p=0.020) but the changes for forwards have
not reached statistical significance (p=0.265). There have been no statistically significant
changes in the body mass of backs (p=0.188) or forwards (p=0.536) over the period
2011/12 to 2018/19. There has been a significant reducing trend in the age of forwards
(p=0.001) over this period but no significant trend in the age of backs (p=0.492).
4.2 Match injuries
4.2a Incidence of injury
Table 2 summarises the numbers of match injuries, match exposures and incidence
of match injuries recorded for backs, forwards and all players during the 2018/19
women’s Sevens World Series and the equivalent values over the period 2011/12 to
2018/19.
Table 2: Number, match exposure (player-hours) and incidence (injuries/1000
player-match-hours, 95% confidence interval) of match injuries: 2018/19 Sevens
World Series.
Series /
Measure
Backs Forwards ALL players
2018/19
Injuries 55 20 75
Exposure 352.8 264.6 617.4
Incidence 155.9 (119.7 – 203.1) 75.6 (48.8 – 117.2) 121.5 (96.9 – 152.3)
All Series (2011/12 – 2018/19)
Injuries 240 134 374
Exposure 2130.0 1597.5 3727.5
Incidence 112.7 (99.3 – 127.9) 83.9 (70.8 – 99.4) 100.3 (90.7 – 111.0)
The difference in incidence of injury between backs and forwards during the
2018/19 Series was statistically significant (p=0.006) and the long-term difference
between backs and forwards is also statistically significant (p= 0.006).
Despite the much higher incidence of injury observed for backs during the 2018/19
Series, there remain no statistically significant trends in the incidences of injury for
backs (p=0.361) or forwards (p=0.920) over the period 2011/12 to 2018/19; see
Figure 4. The high incidence of injury sustained by backs in 2018/19 merits careful
on-going examination, as it may reflect a potential change in the playing style of
backs in the women’s Sevens World Series.
The higher incidence of injury observed for backs compared to forwards reflects a
similar difference seen in the men’s Sevens World Series (Fuller and Taylor, 2019).
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 8 of 17
Fig 4. Trends in the incidence of injury
4.2b Severity of injury
Table 3 summarises the mean and median severities of injuries sustained during
the 2018/19 women’s Sevens World Series for backs, forwards and all players and
the equivalent average values observed over the period 2011/12 to 2018/19.
Table 3: Mean and median severities of match injuries: 2018/19 women’s Sevens
World Series.
Series /
Measure
Severity (95% Confidence interval), days
Backs Forwards ALL players
2018/19
Mean 53.7 (35.9 – 71.5) 51.1 (22.6 – 79.6) 53.0 (38.0 – 68.0)
Median 25.0 (18 – 40) 18.0 (10 – 64) 24.0 (18 – 39)
All Series (2011/12 – 2018/19)
Mean 54.1 (46.0 – 62.1) 51.9 (40.8 – 62.9) 53.3 (46.6 – 59.8)
Median 32.0 (28 – 37) 29.0 (22 – 34) 30.0 (28 – 34)
There are no statistically significant differences in the mean (p=0.881) or median
(p=0.510) severities of injuries sustained by backs and forwards during the
2018/19 Series. There are also no statistically significant differences in the long-
term (2011/12 – 2018/19 Series) mean (p=0.749) and median (p=0.260)
severities of injuries sustained by backs and forwards.
Over the period 2011/12 to 2018/19, there are no statistically significant trends in
the mean severity for backs (p=0.624) or forwards (p=0.477), Figure 5. The
decreasing trends observed for median severity has reached statistical significance
for forwards (p=0.048) but not for backs (p=0.477), Figure 6.
0	
50	
100	
150	
2011/12	
2012/13	
2013/14	
2014/15	
2015/16	
2016/17	
2017/18	
2018/19	
Injuries/1000	player-hours	
Backs	 Forwards
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 9 of 17
Fig 5. Trends in mean severity
Fig 6. Trends in median severity
The mean severity of injuries sustained in the women’s Sevens World Series is
significantly higher than that reported for the men’s Sevens World Series
(p=0.004).
Because injuries falling in the >28 days severity category make up over 50% of all
injuries sustained by both backs (56%) and forwards (51%), this category has
been sub-divided into ‘severe’ (29 – 90 days) and ‘major’ (>90 days) injuires.
Figures 7 and 8 show the proportions of injuries falling within the five revised
severity categories for backs and forwards over the period 2011/12 to 2018/19:
0	
20	
40	
60	
80	
100	
120	
2011/12	
2012/13	
2013/14	
2014/15	
2015/16	
2016/17	
2017/18	
2018/19	
Mean,	days	
Backs	 Forwards	
0	
20	
40	
60	
2011/12	
2012/13	
2013/14	
2014/15	
2015/16	
2016/17	
2017/18	
2018/19	
Median,	days	
Backs	 Forwards
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 10 of 17
Minimal: 2 – 3 days
Mild: 4 – 7 days
Moderate: 8 – 28 days
Severe: 29 – 90 days
Major: > 90 days.
Fig 7. Trends in injury severity categories for backs
Fig 8. Trends in injury severity categories for forwards
0	
25	
50	
75	
2011/12	
2012/13	
2013/14	
2014/15	
2015/16	
2016/17	
2017/18	
2018/19	
Proportion	of	injuries,	%	
Minimal	 Mild	 Moderate	 Severe	 Major	
0	
25	
50	
75	
2011/12	
2012/13	
2013/14	
2014/15	
2015/16	
2016/17	
2017/18	
2018/19	
Proportion	of	injuries,	%	
Minimal	 Mild	 Moderate	 Severe	 Major
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 11 of 17
4.2c Location of injury
The number of injuries sustained in a single women’s Series is too small to provide
a meaningful Series-specific analysis of the sub-locations of injuries sustained by
backs and forwards. Table 4, however, summarises the average results for the
main and sub-locations of injuries sustained by backs, forwards and all players over
the period 2011/12 to 2018/19.
Table 4: Locations of match injuries: 2011/12 to 2018/19 Sevens World Series.
Series /
Location of injury
Proportion, % (95% Confidence interval)
Backs Forwards ALL players
All Series (2011/12 – 2018/19)
Head/neck 21.3 (16.1 – 26.4) 26.9 (19.4 – 34.4) 23.3 (19.0 – 27.5)
Head/face 18.3 (13.4 – 23.2) 26.1 (18.7 – 33.6) 21.1 (17.0 – 25.3)
Neck/cervl
spine 2.9 (0.8 – 5.0) 0.7 (0 – 2.2) 2.1 (0.7 – 3.6)
Upper limbs 20.4 (15.3 – 25.5) 23.1 (16.0 – 30.3) 21.4 (17.2 – 25.5)
Shoulder/clavicle 7.5 (4.2 – 10.8) 11.9 (6.4 – 17.4) 9.1 (6.2 – 12.0)
Upper arm 0.8 (0 – 2.0) 0.0 ( - ) 0.5 (0 – 1.3)
Elbow 2.1 (0.3 – 3.9) 0.7 (0 – 2.2) 1.6 (0.3 – 2.9)
Forearm 1.3 (0 – 2.7) 2.2 (0 – 4.7) 1.6 (0.3 – 2.9)
Wrist 2.1 (0.3 – 3.9) 1.5 (0 – 3.5) 1.9 (0.5 – 3.2)
Hand/fingers 6.7 (3.5 – 9.8) 6.7 (2.5 – 11.0) 6.7 (4.2 – 9.2)
Trunk 6.3 (3.2 – 9.3) 9.0 (4.1 – 13.8) 7.2 (4.6 – 9.8)
Ribs/upper back 4.6 (1.9 – 7.2) 5.2 (1.5 – 9.0) 4.8 (2.6 – 7.0)
Abdomen 0.4 (0 – 1.2) 0.7 (0 – 2.2) 0.5 (0 – 1.3)
Low back 0.8 (0 – 2.0) 2.2 (0 – 4.7) 1.3 (0.2 – 2.5)
Sacrum/pelvis 0.4 (0 – 1.2) 0.7 (0 – 2.2) 0.5 (0 – 1.3)
Lower limbs 52.1 (45.8 – 58.4) 41.0 (32.7 – 49.4) 48.1 (43.1 – 53.2)
Hip/groin 1.3 (0 – 2.7) 3.0 (0.1 – 5.9) 1.9 (0.5 – 3.2)
Thigh, anterior 4.2 (1.6 – 6.7) 2.2 (0 – 4.7) 3.5 (1.6 – 5.3)
Thigh, posterior 5.4 (2.6 – 8.3) 6.0 (2.0 – 10.0) 5.6 (3.3 – 7.9)
Knee 21.7 (16.5 – 26.9) 14.2 (8.3 – 20.1) 19.0 (15.0 – 23.0)
L-Leg/Achilles 4.2 (1.6 – 6.7) 5.2 (1.5 – 9.0) 4.5 (2.4 – 6.7)
Ankle 12.9 (8.7 – 17.2) 9.0 (4.1 – 13.8) 11.5 (8.3 – 14.7)
Foot/toe 2.5 (0.5 – 4.5) 1.5 (0 – 3.5) 2.1 (0.7 – 3.6)
The majority of injuries sustained by both backs (52.1%) and forwards (41.0%) are
located in the lower limbs. Overall, the knee (21.7%), head/face (18.3%) and ankle
(12.9%) are the most common locations for backs. For forwards, the most common
are the head/face (26.1%), knee (14.2%) and shoulder/clavicle (11.9%). Based on
the 95% confidence intervals for each sub-category, there are no statistically
significant differences in the sub-locations of injuries sustained by backs and
forwards.
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 12 of 17
4.2d Type of injury
Similarly, there are too few injuries sustained during a single Series to provide a
meaningful Series-specific analysis of the sub-types of injuries sustained by backs
and forwards. Table 5 summarises the types of injuries sustained by backs,
forwards and all players over the period 2011/12 to 2018/19.
Table 5: Types of match injuries: 2011/12 to 2018/19 Sevens World Series.
Series /
Type of injury
Proportion, % (95% Confidence interval)
Backs Forwards ALL players
All Series (2011/12 – 2018/19)
Bone 12.9 (8.7 – 17.2) 16.4 (10.1 – 22.7) 14.2 (10.6 – 17.7)
Fracture 10.4 (6.6 – 14.3) 14.9 (8.9 – 21.0) 12.0 (8.7 – 15.3)
Other bone 2.5 (0.5 – 4.5) 1.5 (0 – 3.5) 2.1 (0.7 – 3.6)
CNS/PNS 14.6 (10.1 – 19.0) 20.9 (14.0 – 27.8) 16.8 (13.1 – 20.6)
Concussion 12.9 (8.7 – 17.2) 19.4 (12.7 – 26.1) 15.2 (11.6 – 18.9)
Nerve 1.7 (0.0 – 3.3) 1.5 (0 – 3.5) 1.6 (0.3 – 2.9)
Joint (non-bone)/ligt
47.5 (41.2 – 53.8) 38.1 (29.8 – 46.3) 44.1 (39.1 – 49.1)
Dislocation/subluxn
5.8 (2.9 – 8.8) 7.5 (3.0 – 11.9) 6.4 (3.9 – 8.9)
Lesion meniscus 5.4 (2.6 – 8.3) 5.2 (1.5 – 9.0) 5.3 (3.1 – 7.6)
Ligament sprain 36.3 (30.2 – 42.3) 25.4 (18.0 – 32.7) 32.4 (27.6 – 37.1)
Muscle/tendon 22.9 (17.6 – 28.2) 23.1 (16.0 – 30.3) 23.0 (18.7 – 27.3)
Haematoma/etc 11.7 (7.6 – 15.7) 11.2 (5.9 – 16.5) 11.5 (8.3 – 14.7)
Muscle strain/etc 8.3 (4.8 – 11.8) 11.2 (5.9 – 16.5) 9.4 (6.4 – 12.3)
Tendon injury/etc 2.9 (0.8 – 5.0) 0.7 (0 – 2.2) 2.1 (0.7 – 3.6)
Skin 0.8 (0 – 2.0) 1.5 (0 – 3.5) 1.1 (0.0 – 2.1)
Abrasion 0.0 ( - ) 0.0 ( - ) 0.0 ( - )
Laceration 0.8 (0 – 2.0) 1.5 (0 – 3.5) 1.1 (0.0 – 2.1)
Other injuries 1.3 (0 – 2.7) 0.0 ( - ) 0.8 (0 – 1.7)
CNS/PNS: Central and peripheral nervous systems
Joint (non-bone)/ligament injuries are the most common main injury type
sustained by backs (47.5%) and forwards (38.1%). For backs, ligament sprain
(36.3%), concussion (12.9%) and haematoma (11.7%) are the most common
types of injury; while, for forwards, the most common are ligament sprain (25.4%),
concussion (19.4%) and bone fracture (14.9%). Based on the 95% confidence
intervals for each sub-category, there are no statistically significant differences in
the sub-types of injuries sustained by backs and forwards.
Figure 9 shows trends in the incidence of concussion and the proportion of all
injuries that were diagnosed as concussions over the period 2011/12 to 2018/19.
Although there are slight increases for both the incidence of concussion and the
proportion of all injuries diagnosed as concussions during the 2018/19 Series
compared to 2017/18, both values remain below the high levels recorded during
the 2015/16 and 2016/17 Series.
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 13 of 17
Fig 9. Incidence and percentage of concussions sustained in the period 2011/12 to
2018/2019.
4.2e Most common and highest risk injuries
Table 6 lists the five most common specific injuries sustained by backs and
forwards over the period 2011/12 to 2018/19.
Table 6: Five most common injuries sustained by backs and forwards: Sevens
World Series 2011/12 – 2018/19 (% of total number of injuries reported).
Backs Forwards
Injury % Injury %
Concussion 13.0 Concussion 19.7
Knee MCL sprain 8.4 Hamstring muscle strain 5.3
Hamstring muscle strain 5.0 Shoulder dislocatn
/instability 4.5
Anterior cruciate ligament injury 4.2 Anterior cruciate ligament injury 4.5
Infr
tib-fib syndesmosis injury 3.8 Hand/finger fractures 3.8
Ankle lateral ligament sprain 3.8
The injuries listed in Table 6 represent 34% of all injuries sustained by backs and
42% of all injuries sustained by forwards.
Table 7 lists the five injuries resulting in the greatest injury burden (total days lost)
for backs and forwards over the period 2011/12 to 2018/19.
0	
5	
10	
15	
20	
25	
0	
5	
10	
15	
20	
25	
2011/12	
2012/13	
2013/14	
2014/15	
2015/16	
2016/17	
2017/18	
2018/19	
Concussion,	%	of	all	injuries	
Incidence,	concussions/1000	player-hrs	
(line)	
Percentage	 Incidence
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 14 of 17
Table 7: Five injuries resulting in the greatest injury burden (% of total reported
days absence) for backs and forwards: Sevens World Series 2011/12 – 2018/19.
Backs Forwards
Injury Injury
burden
%
Injury Injury
burden
%
Anterior cruciate ligament injury 16.6 Anterior cruciate ligament injury 22.9
Knee MCL sprain 9.9 Concussion 7.8
Knee cartilage injuries 5.3 Hamstring muscle strain 7.7
Infr
tib-fib syndesmosis injury 4.9 Shoulder dislocatn
/instability 5.7
Concussion 4.9 Lower leg fracture 3.5
The injuries listed in Table 7 are responsible for 42% of all days absence by backs
and 48% of all days absence by forwards.
4.2f Nature of onset of injury
Table 8 summarises the nature of onset of injuries sustained in the period 2011/12
to 2018/19 by backs, forwards and all players.
Table 8: Nature of onset of injury: 2011/12 to 2018/19 Sevens World Series.
Series /
Nature of onset
Proportion, % (95% Confidence interval)
Backs Forwards ALL players
All Series (2011/12 – 2018/19)
Acute 94.6 (91.7 – 97.4) 94.8 (91.0 – 98.5) 94.7 (92.4 -96.9)
Gradual 5.4 (2.6 – 8.3) 5.2 (1.5 – 9.0) 5.3 (3.1 – 7.6)
Ninety-five per cent of all match injuries sustained are acute in nature. There is no
statistically significant difference between the results for backs and forwards
(p=0.936).
4.2g Cause of onset of injury
Table 9 summarises the cause of onset of injuries sustained in the period 2011/12
to 2018/19 by backs, forwards and all players.
Table 9: Cause of onset of injury: 2011/12 to 2018/19 Sevens World Series.
Series /
Cause of onset
Proportion, % (95% Confidence interval)
Backs Forwards ALL players
All Series (2011/12 – 2018/19)
Contact 88.5 (84.4 – 92.6) 88.5 (83.1 – 94.0) 88.5 (85.3 – 91.8)
Non-contact 11.5 (7.4 – 15.6) 11.5 (6.0 – 16.9) 11.5 (8.2 – 14.7)
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 15 of 17
Almost 90% of all injuries are the result of contact activities. There is no
statistically significant difference between the results for backs and forwards
(p=0.992).
4.2h Match events leading to injury
Table 10 summarises the specific match activities causing the injuries sustained by
backs, forwards and all players in the period from 2011/12 to 2018/19.
Table 10: Match events leading to injury: 2011/12 to 2018/19 Sevens World Series.
Series /
Cause of onset
Proportion, % (95% Confidence interval)
Backs Forwards ALL players
All Series (2011/12 – 2018/19)
Collision 10.6 (6.7 – 14.6) 18.9 (12.3 – 25.6) 13.6 (10.1 – 17.1)
Kicking 0.9 (0 – 2.0) 0.0 ( - ) 0.5 (0 – 1.0)
Lineout 0.9 (0 – 2.0) 0.8 (0 – 2.2) 0.8 (0 – 1.7)
Maul 0.0 ( - ) 0.0 ( - ) 0.0 ( - )
Ruck 9.8 (6.0 – 13.6) 7.6 (3.1 – 12.1) 9.0 (6.1 – 11.9)
Running 7.2 (3.9 – 10.5) 9.1 (4.2 – 14.0) 7.9 (5.1 – 10.7)
Scrum 0.0 ( - ) 0.8 (0 – 2.2) 0.3 (0 – 0.8)
Tackled 39.1 (32.9 – 45.4) 31.8 (23.9 – 39.8) 36.5 (31.6 – 41.4)
Tackling 28.1 (22.3 – 33.8) 27.3 (19.7 – 34.9) 27.8 (23.2 – 32.4)
Other 3.4 (1.1 – 5.7) 3.8 (0.5 – 7.0) 3.5 (1.7 – 5.4)
Being tackled (backs: 39.1%; forwards: 31.8%), tackling (backs: 28.1%; forwards:
27.3%) and collisions (backs: 10.6%; forwards: 18.9%) are the events responsible
for most injuries to backs and forwards.
The most common activities leading to concussion injuries are tackling (backs:
45.2%; forwards: 34.6%), collisions (backs: 19.4%; forwards: 42.3%) and being
tackled (backs: 22.6%; forwards: 34.6%).
4.2i Time of injury
Table 11 provides a summary of the period in a match when injury events take
place as a function of playing position.
Table 11: Time that injuries are sustained during matches: 2011/12 to 2018/19
Sevens World Series.
Time of injury
Proportion, % (95% Confidence interval)
Backs Forwards ALL players
All Series (2011/12 – 2018/19)
First half 37.3 (31.1 – 43.6) 43.4 (34.9 – 52.0) 39.5 (34.5 – 44.5)
Second half 62.7 (56.4 – 68.9) 56.6 (48.0 –65.1) 60.5 (55.5 – 65.5)
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 16 of 17
There are significantly (p=0.019) more injuries sustained in the second half
compared to the first half of games (risk ratio: 1.7), which is similar to the situation
reported for the men’s Sevens World Series (Fuller et al., 2017).
4.2j Removal from play
During the 2018/19 Series, 39% of all injured players were immediately removed
from play, 15% were removed later in the game and 46% completed the match.
Over the period 2011/12 to 2018/19, the figures are immediately: 45%; later:
18%; completed the game: 37%.
For concussion, during the 2018/19 Series, 46% of players were removed from play
immediately; 27% were removed later in the game; 27% completed the game.
Over the period 2011/12 to 2018/19, the figures are immediately: 55%; later:
18%; completed the game:27%
4.3 Training injuries
Six time-loss training injuries (backs: 1; forwards: 5) were recorded during the
2018/19 Series. These injuries resulted from 5,453 (backs: 2,812; forwards:
2,641) player-training-hours, which equates to an incidence of injury of 1.1
injuries/1000 player-training-hours (backs: 0.4; forwards: 1.9).
The six time-loss training injuries were the result of – contact-rugby skills: 1; non-
contact rugby-skills: 2; non-weights conditioning: 2; pre-match warm-up: 1.
Due to the small numbers involved, further analysis of the training injuries is not
justified.
4.4 Illnesses
Two time-loss illnesses were recorded during the 2018/19 women’s Sevens World
Series (respiratory: 1; dermatological: 1). One illness occurred during a
tournament and one while travelling home post-tournament.
Due to the small numbers involved, further analysis of the illnesses is not justified.
Rugby Sevens (Women) 2011 - 2019
© Dr C Fuller (24 September 2019) Page 17 of 17
6. References
Fuller CW, Molloy MG, Bagate C, et al. Consensus statement on injury definitions
and data collection procedures for studies of injuries in rugby union. Br J Sports
Med 2007;41;328-331.
Fuller CW, Taylor A. World Rugby. Surveillance Studies: Sevens World Series
(Women). Summary of Results: 2011/12 to 2017/18. World Rugby; Dublin:
September 2018.
Fuller CW, Taylor A. World Rugby. Surveillance Studies: Sevens World Series
(Men). Summary of Results: 2008/09 to 2018/19. World Rugby; Dublin:
September 2019.
Orchard J, Rae K, et al., Revision, uptake and coding issues related to the open
access Orchard Sports Injury Classification System (OSICS) versions 8, 9 and
10.1. Open Access Journal of Sports Medicine 2010:1;207-214.
7. Acknowledgements
The authors acknowledge the valuable support provided by many team physicians
and physiotherapists during the collection of the data analysed in this report.
Unfortunately, the authors are not always aware of the specific people providing the
data, as many medical teams change from Tournament-to-Tournament and Series-
to-Series. The authors would therefore like to apologise if anyone who provided
data for the study is not included in the list of acknowledgements below:
Australia: Claire Deane, Francesca Faulkner, Katie Ryan, Laura Schwab, Liz
Monk, Michael Moran
Brasil: Juninho Alves, Paulo Cerutti
Canada: Adrienne Stinson, Brad Curry, Isabel Grondin, Jason White, Kim
Osland, Lori Silver, Nicole Allen, Sandeep Nandhra
China: Jack Lau, Li Yaping
England: Angela Sells, Brett Davison, Celia Gilbe, Isobel Freeman, Julie
Snow, Penny Porter
Fiji: Aileen Sullivan, Jennifer Khalik, William Koong
France: Jacques Girardin, Philippe Bordes, Virginie Pecourneau
Ireland: Eimear Fallon, Joanne Montgomery, Lorcan McGee
Japan: Atsushi Tasaki, Haruko Hirai, Keitaro Abe, Kiyokazu Gotanda
Netherlands: Bas Besselink, Sven Vos
New Zealand: Jacinta Horan, Nicole Armstrong
Portugal: Goncalo Ramos
Russia: Alexander Borodin, Alexandra Smirnova, Levan Tsiklauri, Masha
Anderson
South Africa: Tanushree Pillay
Spain: Alberto Herrero Garcia, Arturo Carrera, Borja Vera Garcia-Portillo,
Carmen Rodriguez de Tembleque Buitrago, Hugo Garcia
Fernandez, Iago Vazquez GarridoJose Carlos Salo Cuenca, Keith
Chapman, Sara Bonilla,
USA: Nicole Titmas, Sarah Leslie

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Estadísticas HSBC Rugby Sevens Series Femeninas 2008-2019

  • 1. World Rugby Surveillance Studies Sevens World Series (Women) Summary of Results: 2011/12 to 2018/19 Colin Fuller and Aileen Taylor 24 September 2019
  • 2. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 2 of 17 Summary of key points Due solely to the smaller number of Tournaments (5/6 v 10) and the smaller number of core teams (11 v 15) involved in the women’s Sevens World Series, the total number of match injuries typically recorded in each Series is about one third of those reported in each men’s Sevens World Series. This precludes reporting meaningful Series-specific data for some parameters in the women’s Sevens World Series. The average injury surveillance data recorded and reported for the period 2011/12 to 2018/19 does, however, provide a high quality and reliable source of information about the risks of injury associated with women’s elite Rugby-7s. Based on the combined data from the women’s Sevens World Series over the 8- year period from 2011/12 to 2018/19, the following general conclusions can be presented: • Rugby-7s forwards are older, taller and heavier than the backs. • There is a statistically significant reducing trend in the age of forwards but no statistically significant change in backs’ age. • There has been a statistically significant increasing trend in the stature of backs but no statistically significant change in the stature of forwards. • There have been no statistically significant changes in the body mass of backs or forwards. • The incidence of injury in women’s Rugby-7s is significantly higher than that in women’s Rugby-15s but significantly lower than that in men’s Rugby 7s. • Backs have a statistically significant higher incidence of injury than forwards. • Significantly more injuries occur in the second half of games (first half: 40%; second half: 60%), which is similar to the situation in the men’s Sevens World Series. • The mean severity of injuries sustained in the women’s Sevens World Series is significantly higher than that reported for the men’s Sevens World Series (women: 53.0 days; men: 44.5 days). • Overall, the knee, head and ankle are the most commonly injured sites in the women’s Series, which is similar to the men’s Sevens World Series. • Ligament sprain, muscle strain and concussion are the most common types of injury reported in the women’s Sevens World Series, which is similar to the men’s Sevens World Series. • Concussion remains the most common specific injury for backs (13%) and forwards (20%). Anterior cruciate ligament injuries, however, are responsible for the most days-absence for both backs (17%) and forwards (23%). • The majority of injuries sustained in the women’s Sevens World Series are acute in nature (backs: 95%; forwards: 95%) and most injuries result from contact events (backs: 89%; forwards: 89%). • Being-tackled (backs: 39%; forwards: 32%) and tackling (backs: 28%; forwards: 27%) are the match events responsible for the most injuries.
  • 3. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 3 of 17 1 Introduction World Rugby is committed to implementing injury surveillance studies at all major World Rugby Tournaments and to disseminate the results within the Rugby community. The aims of these studies are: • to record and analyse injuries and illnesses sustained by male and female players at individual Tournaments, • to identify changing patterns of injury, and • to bring injury-related areas of concern to the attention of World Rugby’s Chief Medical Officer. Previous surveillance studies in women’s Rugby Sevens reported the incidence and nature of match and training injuries sustained during the women’s Sevens World Series (SWS) from 2011/12 to 2017/18. This report continues the on-going study of the women’s Sevens World Series by reporting match and training injuries and illnesses sustained during the 2018/19 Series. This review also combines the women’s 2018/19 Sevens World Series data with the data reported previously in order to provide an updated overview of the risks of injury and illness in elite women’s Rugby Sevens. 2 Methods All studies were conducted in accordance with the definitions and protocols described in the World Rugby approved consensus statement on definitions and procedures for injury surveillance studies in Rugby (Fuller et al., 2007). The definition of injury was: ‘Any injury sustained during a Sevens World Series Tournament match or training activity that prevents a player from taking a full part in all normal training activities and/or match play for more than one day following the day of injury’. A recurrent injury was defined as: ‘An injury (as defined above) of the same type and at the same site as an index injury and which occurs after a player’s return to full participation from the index injury’. Specific injuries were classified using OSICS 8 (Orchard, 2010). Injury location, type and cause together with the event leading to the injury were also recorded. The definition of an illness used in this study was: ‘Any medical condition sustained while travelling to a Sevens World Series Tournament, while at a Tournament or while travelling home at the end of a Tournament that prevents a player from taking a full part in all training activities and/or match play for more than one day following the day of onset of the illness.’ Injuries and illnesses not related directly to Sevens World Series rugby-related activity were not included. Injury/illness severity was determined by the number of days a player was injured/ill: a player was deemed to be ‘injured/ill’ until she could undertake full, normal training and be available for match selection, whether or not she was
  • 4. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 4 of 17 actually selected. Medical staff were required to make an informed clinical judgement about a player’s fitness to train/play on those days when players were not scheduled to train or play. Injured/ill players were followed up after each Tournament to obtain their return to play date: the return to play dates for players with injuries/illnesses that remained unresolved 3 months after the final day of the final Tournament in the Series were estimated on the basis of the clinical judgement and prognosis provided by the injured player’s medical staff. The complete lists of categories and sub-categories used for categorising injury locations and injury types are provided in the rugby injury consensus publication (Fuller et al., 2007). Differences in players’ anthropometric data were assessed using unpaired t-tests; differences in incidences, mean severity and proportions of injuries using z-tests; and differences in median severity using a Mann-Whitney U test. Differences in injury numbers were assessed using the chi-squared test. Trends in data over time were assessed using linear regression analyses. Statistical significance was accepted at the p=0.05 level, although it is recognised that this could identify some differences that occurred by chance due to the large number of statistical comparisons being made in the study. 3 Data collection At the beginning of each women’s Sevens World Series, the team’s medical staff were asked to explain to squad players the purpose of the epidemiological study. Each player’s baseline anthropometric information was recorded on a Player Baseline Information Form (playing position [back, forward]; date of birth; body mass [Kg]; stature [cm]). Players joining a country’s squad at a later date were added to the list of players and the anthropometric data recorded at the time the player joined the squad. Medical staff recorded injuries/illnesses sustained during each Tournament on a Tournament Summary of Injuries and Illnesses Report Form, which was returned to the study co-ordinator at the end of the Tournament. A member of the team’s medical staff also recorded detailed information about each injury and illness on an Injury/Illness Report Form (date of injury/illness, date of return to play, location and type of injury/illness, cause of injury/illness, event leading to injury/illness). Injury/illness Report Forms were returned to the study co-ordinator when the final piece of information had been entered on the Form (normally the return-to-play date). 4 Results Results for previous women’s Sevens World Series have been presented in earlier World Rugby reports (Fuller and Taylor, 2018). The women’s Sevens World Series 2018/19, which consisted of 6 Tournaments in USA, Dubai, Australia, Japan, Canada and France, took place over the period 20 October 2018 to 16 June 2019. This study recorded players’ anthropometric data and match and training injuries and illnesses sustained by the eleven core teams (Australia, Canada, China, England, Fiji, France, Ireland, New Zealand, Russia, Spain, USA) taking part in all six of the 2018/19 Sevens World Series Tournaments. Teams’ match and Tournament-based training activities were also recorded.
  • 5. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 5 of 17 4.1 Players’ anthropometric data Table 1 summarises the numbers and anthropometric data for players categorised as backs, forwards and all players in the 2018/19 Sevens World Series together with values averaged over the period 2011/12 to 2018/19. Table 1: Players’ anthropometric data: 2018/19 Sevens World Series. Series / Measure Mean (Standard deviation, number of players) Backs Forwards ALL players 2018/19 Stature, cm 167.6 (5.0, 120) 172.2 (5.6, 96) 169.6 (5.8, 216) Body mass, Kg 66.2 (5.3, 120) 73.4 (6.9, 96) 69.4 (7.1, 216) Age, years 23.1 (3.6, 120) 24.0 (4.0, 96) 23.5 (3.8, 216) All Series (2011/12 – 2018/19) Stature, cm 167.0 (5.3, 816) 170.7 (5.7, 627) 168.6 (5.8, 1443) Body mass, Kg 65.5 (5.5, 817) 71.4 (6.2, 630) 68.1 (6.5, 1447) Age, years 23.6 (3.7, 818) 24.5 (3.8, 630) 24.0 (3.8, 1448) Based on the all-series data, forwards are significantly older (p<0.001), heavier (p<0.001) and taller (p<0.001) than backs. Trends in players’ age, stature and body mass over the period 2011/12 to 2018/19 are shown in Figures 1 to 3, respectively. Fig 1. Trends in players’ age (years) 22 23 24 25 26 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Age, years Backs Forwards
  • 6. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 6 of 17 Fig 2. Trends in players’ stature (cm) Fig 3. Trends in players’ body mass (Kg) 160 165 170 175 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Stature, cm Backs Forwards 60 65 70 75 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Body mass, Kg Backs Forwards
  • 7. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 7 of 17 Backs have been getting significantly taller (p=0.020) but the changes for forwards have not reached statistical significance (p=0.265). There have been no statistically significant changes in the body mass of backs (p=0.188) or forwards (p=0.536) over the period 2011/12 to 2018/19. There has been a significant reducing trend in the age of forwards (p=0.001) over this period but no significant trend in the age of backs (p=0.492). 4.2 Match injuries 4.2a Incidence of injury Table 2 summarises the numbers of match injuries, match exposures and incidence of match injuries recorded for backs, forwards and all players during the 2018/19 women’s Sevens World Series and the equivalent values over the period 2011/12 to 2018/19. Table 2: Number, match exposure (player-hours) and incidence (injuries/1000 player-match-hours, 95% confidence interval) of match injuries: 2018/19 Sevens World Series. Series / Measure Backs Forwards ALL players 2018/19 Injuries 55 20 75 Exposure 352.8 264.6 617.4 Incidence 155.9 (119.7 – 203.1) 75.6 (48.8 – 117.2) 121.5 (96.9 – 152.3) All Series (2011/12 – 2018/19) Injuries 240 134 374 Exposure 2130.0 1597.5 3727.5 Incidence 112.7 (99.3 – 127.9) 83.9 (70.8 – 99.4) 100.3 (90.7 – 111.0) The difference in incidence of injury between backs and forwards during the 2018/19 Series was statistically significant (p=0.006) and the long-term difference between backs and forwards is also statistically significant (p= 0.006). Despite the much higher incidence of injury observed for backs during the 2018/19 Series, there remain no statistically significant trends in the incidences of injury for backs (p=0.361) or forwards (p=0.920) over the period 2011/12 to 2018/19; see Figure 4. The high incidence of injury sustained by backs in 2018/19 merits careful on-going examination, as it may reflect a potential change in the playing style of backs in the women’s Sevens World Series. The higher incidence of injury observed for backs compared to forwards reflects a similar difference seen in the men’s Sevens World Series (Fuller and Taylor, 2019).
  • 8. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 8 of 17 Fig 4. Trends in the incidence of injury 4.2b Severity of injury Table 3 summarises the mean and median severities of injuries sustained during the 2018/19 women’s Sevens World Series for backs, forwards and all players and the equivalent average values observed over the period 2011/12 to 2018/19. Table 3: Mean and median severities of match injuries: 2018/19 women’s Sevens World Series. Series / Measure Severity (95% Confidence interval), days Backs Forwards ALL players 2018/19 Mean 53.7 (35.9 – 71.5) 51.1 (22.6 – 79.6) 53.0 (38.0 – 68.0) Median 25.0 (18 – 40) 18.0 (10 – 64) 24.0 (18 – 39) All Series (2011/12 – 2018/19) Mean 54.1 (46.0 – 62.1) 51.9 (40.8 – 62.9) 53.3 (46.6 – 59.8) Median 32.0 (28 – 37) 29.0 (22 – 34) 30.0 (28 – 34) There are no statistically significant differences in the mean (p=0.881) or median (p=0.510) severities of injuries sustained by backs and forwards during the 2018/19 Series. There are also no statistically significant differences in the long- term (2011/12 – 2018/19 Series) mean (p=0.749) and median (p=0.260) severities of injuries sustained by backs and forwards. Over the period 2011/12 to 2018/19, there are no statistically significant trends in the mean severity for backs (p=0.624) or forwards (p=0.477), Figure 5. The decreasing trends observed for median severity has reached statistical significance for forwards (p=0.048) but not for backs (p=0.477), Figure 6. 0 50 100 150 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Injuries/1000 player-hours Backs Forwards
  • 9. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 9 of 17 Fig 5. Trends in mean severity Fig 6. Trends in median severity The mean severity of injuries sustained in the women’s Sevens World Series is significantly higher than that reported for the men’s Sevens World Series (p=0.004). Because injuries falling in the >28 days severity category make up over 50% of all injuries sustained by both backs (56%) and forwards (51%), this category has been sub-divided into ‘severe’ (29 – 90 days) and ‘major’ (>90 days) injuires. Figures 7 and 8 show the proportions of injuries falling within the five revised severity categories for backs and forwards over the period 2011/12 to 2018/19: 0 20 40 60 80 100 120 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Mean, days Backs Forwards 0 20 40 60 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Median, days Backs Forwards
  • 10. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 10 of 17 Minimal: 2 – 3 days Mild: 4 – 7 days Moderate: 8 – 28 days Severe: 29 – 90 days Major: > 90 days. Fig 7. Trends in injury severity categories for backs Fig 8. Trends in injury severity categories for forwards 0 25 50 75 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Proportion of injuries, % Minimal Mild Moderate Severe Major 0 25 50 75 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Proportion of injuries, % Minimal Mild Moderate Severe Major
  • 11. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 11 of 17 4.2c Location of injury The number of injuries sustained in a single women’s Series is too small to provide a meaningful Series-specific analysis of the sub-locations of injuries sustained by backs and forwards. Table 4, however, summarises the average results for the main and sub-locations of injuries sustained by backs, forwards and all players over the period 2011/12 to 2018/19. Table 4: Locations of match injuries: 2011/12 to 2018/19 Sevens World Series. Series / Location of injury Proportion, % (95% Confidence interval) Backs Forwards ALL players All Series (2011/12 – 2018/19) Head/neck 21.3 (16.1 – 26.4) 26.9 (19.4 – 34.4) 23.3 (19.0 – 27.5) Head/face 18.3 (13.4 – 23.2) 26.1 (18.7 – 33.6) 21.1 (17.0 – 25.3) Neck/cervl spine 2.9 (0.8 – 5.0) 0.7 (0 – 2.2) 2.1 (0.7 – 3.6) Upper limbs 20.4 (15.3 – 25.5) 23.1 (16.0 – 30.3) 21.4 (17.2 – 25.5) Shoulder/clavicle 7.5 (4.2 – 10.8) 11.9 (6.4 – 17.4) 9.1 (6.2 – 12.0) Upper arm 0.8 (0 – 2.0) 0.0 ( - ) 0.5 (0 – 1.3) Elbow 2.1 (0.3 – 3.9) 0.7 (0 – 2.2) 1.6 (0.3 – 2.9) Forearm 1.3 (0 – 2.7) 2.2 (0 – 4.7) 1.6 (0.3 – 2.9) Wrist 2.1 (0.3 – 3.9) 1.5 (0 – 3.5) 1.9 (0.5 – 3.2) Hand/fingers 6.7 (3.5 – 9.8) 6.7 (2.5 – 11.0) 6.7 (4.2 – 9.2) Trunk 6.3 (3.2 – 9.3) 9.0 (4.1 – 13.8) 7.2 (4.6 – 9.8) Ribs/upper back 4.6 (1.9 – 7.2) 5.2 (1.5 – 9.0) 4.8 (2.6 – 7.0) Abdomen 0.4 (0 – 1.2) 0.7 (0 – 2.2) 0.5 (0 – 1.3) Low back 0.8 (0 – 2.0) 2.2 (0 – 4.7) 1.3 (0.2 – 2.5) Sacrum/pelvis 0.4 (0 – 1.2) 0.7 (0 – 2.2) 0.5 (0 – 1.3) Lower limbs 52.1 (45.8 – 58.4) 41.0 (32.7 – 49.4) 48.1 (43.1 – 53.2) Hip/groin 1.3 (0 – 2.7) 3.0 (0.1 – 5.9) 1.9 (0.5 – 3.2) Thigh, anterior 4.2 (1.6 – 6.7) 2.2 (0 – 4.7) 3.5 (1.6 – 5.3) Thigh, posterior 5.4 (2.6 – 8.3) 6.0 (2.0 – 10.0) 5.6 (3.3 – 7.9) Knee 21.7 (16.5 – 26.9) 14.2 (8.3 – 20.1) 19.0 (15.0 – 23.0) L-Leg/Achilles 4.2 (1.6 – 6.7) 5.2 (1.5 – 9.0) 4.5 (2.4 – 6.7) Ankle 12.9 (8.7 – 17.2) 9.0 (4.1 – 13.8) 11.5 (8.3 – 14.7) Foot/toe 2.5 (0.5 – 4.5) 1.5 (0 – 3.5) 2.1 (0.7 – 3.6) The majority of injuries sustained by both backs (52.1%) and forwards (41.0%) are located in the lower limbs. Overall, the knee (21.7%), head/face (18.3%) and ankle (12.9%) are the most common locations for backs. For forwards, the most common are the head/face (26.1%), knee (14.2%) and shoulder/clavicle (11.9%). Based on the 95% confidence intervals for each sub-category, there are no statistically significant differences in the sub-locations of injuries sustained by backs and forwards.
  • 12. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 12 of 17 4.2d Type of injury Similarly, there are too few injuries sustained during a single Series to provide a meaningful Series-specific analysis of the sub-types of injuries sustained by backs and forwards. Table 5 summarises the types of injuries sustained by backs, forwards and all players over the period 2011/12 to 2018/19. Table 5: Types of match injuries: 2011/12 to 2018/19 Sevens World Series. Series / Type of injury Proportion, % (95% Confidence interval) Backs Forwards ALL players All Series (2011/12 – 2018/19) Bone 12.9 (8.7 – 17.2) 16.4 (10.1 – 22.7) 14.2 (10.6 – 17.7) Fracture 10.4 (6.6 – 14.3) 14.9 (8.9 – 21.0) 12.0 (8.7 – 15.3) Other bone 2.5 (0.5 – 4.5) 1.5 (0 – 3.5) 2.1 (0.7 – 3.6) CNS/PNS 14.6 (10.1 – 19.0) 20.9 (14.0 – 27.8) 16.8 (13.1 – 20.6) Concussion 12.9 (8.7 – 17.2) 19.4 (12.7 – 26.1) 15.2 (11.6 – 18.9) Nerve 1.7 (0.0 – 3.3) 1.5 (0 – 3.5) 1.6 (0.3 – 2.9) Joint (non-bone)/ligt 47.5 (41.2 – 53.8) 38.1 (29.8 – 46.3) 44.1 (39.1 – 49.1) Dislocation/subluxn 5.8 (2.9 – 8.8) 7.5 (3.0 – 11.9) 6.4 (3.9 – 8.9) Lesion meniscus 5.4 (2.6 – 8.3) 5.2 (1.5 – 9.0) 5.3 (3.1 – 7.6) Ligament sprain 36.3 (30.2 – 42.3) 25.4 (18.0 – 32.7) 32.4 (27.6 – 37.1) Muscle/tendon 22.9 (17.6 – 28.2) 23.1 (16.0 – 30.3) 23.0 (18.7 – 27.3) Haematoma/etc 11.7 (7.6 – 15.7) 11.2 (5.9 – 16.5) 11.5 (8.3 – 14.7) Muscle strain/etc 8.3 (4.8 – 11.8) 11.2 (5.9 – 16.5) 9.4 (6.4 – 12.3) Tendon injury/etc 2.9 (0.8 – 5.0) 0.7 (0 – 2.2) 2.1 (0.7 – 3.6) Skin 0.8 (0 – 2.0) 1.5 (0 – 3.5) 1.1 (0.0 – 2.1) Abrasion 0.0 ( - ) 0.0 ( - ) 0.0 ( - ) Laceration 0.8 (0 – 2.0) 1.5 (0 – 3.5) 1.1 (0.0 – 2.1) Other injuries 1.3 (0 – 2.7) 0.0 ( - ) 0.8 (0 – 1.7) CNS/PNS: Central and peripheral nervous systems Joint (non-bone)/ligament injuries are the most common main injury type sustained by backs (47.5%) and forwards (38.1%). For backs, ligament sprain (36.3%), concussion (12.9%) and haematoma (11.7%) are the most common types of injury; while, for forwards, the most common are ligament sprain (25.4%), concussion (19.4%) and bone fracture (14.9%). Based on the 95% confidence intervals for each sub-category, there are no statistically significant differences in the sub-types of injuries sustained by backs and forwards. Figure 9 shows trends in the incidence of concussion and the proportion of all injuries that were diagnosed as concussions over the period 2011/12 to 2018/19. Although there are slight increases for both the incidence of concussion and the proportion of all injuries diagnosed as concussions during the 2018/19 Series compared to 2017/18, both values remain below the high levels recorded during the 2015/16 and 2016/17 Series.
  • 13. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 13 of 17 Fig 9. Incidence and percentage of concussions sustained in the period 2011/12 to 2018/2019. 4.2e Most common and highest risk injuries Table 6 lists the five most common specific injuries sustained by backs and forwards over the period 2011/12 to 2018/19. Table 6: Five most common injuries sustained by backs and forwards: Sevens World Series 2011/12 – 2018/19 (% of total number of injuries reported). Backs Forwards Injury % Injury % Concussion 13.0 Concussion 19.7 Knee MCL sprain 8.4 Hamstring muscle strain 5.3 Hamstring muscle strain 5.0 Shoulder dislocatn /instability 4.5 Anterior cruciate ligament injury 4.2 Anterior cruciate ligament injury 4.5 Infr tib-fib syndesmosis injury 3.8 Hand/finger fractures 3.8 Ankle lateral ligament sprain 3.8 The injuries listed in Table 6 represent 34% of all injuries sustained by backs and 42% of all injuries sustained by forwards. Table 7 lists the five injuries resulting in the greatest injury burden (total days lost) for backs and forwards over the period 2011/12 to 2018/19. 0 5 10 15 20 25 0 5 10 15 20 25 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Concussion, % of all injuries Incidence, concussions/1000 player-hrs (line) Percentage Incidence
  • 14. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 14 of 17 Table 7: Five injuries resulting in the greatest injury burden (% of total reported days absence) for backs and forwards: Sevens World Series 2011/12 – 2018/19. Backs Forwards Injury Injury burden % Injury Injury burden % Anterior cruciate ligament injury 16.6 Anterior cruciate ligament injury 22.9 Knee MCL sprain 9.9 Concussion 7.8 Knee cartilage injuries 5.3 Hamstring muscle strain 7.7 Infr tib-fib syndesmosis injury 4.9 Shoulder dislocatn /instability 5.7 Concussion 4.9 Lower leg fracture 3.5 The injuries listed in Table 7 are responsible for 42% of all days absence by backs and 48% of all days absence by forwards. 4.2f Nature of onset of injury Table 8 summarises the nature of onset of injuries sustained in the period 2011/12 to 2018/19 by backs, forwards and all players. Table 8: Nature of onset of injury: 2011/12 to 2018/19 Sevens World Series. Series / Nature of onset Proportion, % (95% Confidence interval) Backs Forwards ALL players All Series (2011/12 – 2018/19) Acute 94.6 (91.7 – 97.4) 94.8 (91.0 – 98.5) 94.7 (92.4 -96.9) Gradual 5.4 (2.6 – 8.3) 5.2 (1.5 – 9.0) 5.3 (3.1 – 7.6) Ninety-five per cent of all match injuries sustained are acute in nature. There is no statistically significant difference between the results for backs and forwards (p=0.936). 4.2g Cause of onset of injury Table 9 summarises the cause of onset of injuries sustained in the period 2011/12 to 2018/19 by backs, forwards and all players. Table 9: Cause of onset of injury: 2011/12 to 2018/19 Sevens World Series. Series / Cause of onset Proportion, % (95% Confidence interval) Backs Forwards ALL players All Series (2011/12 – 2018/19) Contact 88.5 (84.4 – 92.6) 88.5 (83.1 – 94.0) 88.5 (85.3 – 91.8) Non-contact 11.5 (7.4 – 15.6) 11.5 (6.0 – 16.9) 11.5 (8.2 – 14.7)
  • 15. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 15 of 17 Almost 90% of all injuries are the result of contact activities. There is no statistically significant difference between the results for backs and forwards (p=0.992). 4.2h Match events leading to injury Table 10 summarises the specific match activities causing the injuries sustained by backs, forwards and all players in the period from 2011/12 to 2018/19. Table 10: Match events leading to injury: 2011/12 to 2018/19 Sevens World Series. Series / Cause of onset Proportion, % (95% Confidence interval) Backs Forwards ALL players All Series (2011/12 – 2018/19) Collision 10.6 (6.7 – 14.6) 18.9 (12.3 – 25.6) 13.6 (10.1 – 17.1) Kicking 0.9 (0 – 2.0) 0.0 ( - ) 0.5 (0 – 1.0) Lineout 0.9 (0 – 2.0) 0.8 (0 – 2.2) 0.8 (0 – 1.7) Maul 0.0 ( - ) 0.0 ( - ) 0.0 ( - ) Ruck 9.8 (6.0 – 13.6) 7.6 (3.1 – 12.1) 9.0 (6.1 – 11.9) Running 7.2 (3.9 – 10.5) 9.1 (4.2 – 14.0) 7.9 (5.1 – 10.7) Scrum 0.0 ( - ) 0.8 (0 – 2.2) 0.3 (0 – 0.8) Tackled 39.1 (32.9 – 45.4) 31.8 (23.9 – 39.8) 36.5 (31.6 – 41.4) Tackling 28.1 (22.3 – 33.8) 27.3 (19.7 – 34.9) 27.8 (23.2 – 32.4) Other 3.4 (1.1 – 5.7) 3.8 (0.5 – 7.0) 3.5 (1.7 – 5.4) Being tackled (backs: 39.1%; forwards: 31.8%), tackling (backs: 28.1%; forwards: 27.3%) and collisions (backs: 10.6%; forwards: 18.9%) are the events responsible for most injuries to backs and forwards. The most common activities leading to concussion injuries are tackling (backs: 45.2%; forwards: 34.6%), collisions (backs: 19.4%; forwards: 42.3%) and being tackled (backs: 22.6%; forwards: 34.6%). 4.2i Time of injury Table 11 provides a summary of the period in a match when injury events take place as a function of playing position. Table 11: Time that injuries are sustained during matches: 2011/12 to 2018/19 Sevens World Series. Time of injury Proportion, % (95% Confidence interval) Backs Forwards ALL players All Series (2011/12 – 2018/19) First half 37.3 (31.1 – 43.6) 43.4 (34.9 – 52.0) 39.5 (34.5 – 44.5) Second half 62.7 (56.4 – 68.9) 56.6 (48.0 –65.1) 60.5 (55.5 – 65.5)
  • 16. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 16 of 17 There are significantly (p=0.019) more injuries sustained in the second half compared to the first half of games (risk ratio: 1.7), which is similar to the situation reported for the men’s Sevens World Series (Fuller et al., 2017). 4.2j Removal from play During the 2018/19 Series, 39% of all injured players were immediately removed from play, 15% were removed later in the game and 46% completed the match. Over the period 2011/12 to 2018/19, the figures are immediately: 45%; later: 18%; completed the game: 37%. For concussion, during the 2018/19 Series, 46% of players were removed from play immediately; 27% were removed later in the game; 27% completed the game. Over the period 2011/12 to 2018/19, the figures are immediately: 55%; later: 18%; completed the game:27% 4.3 Training injuries Six time-loss training injuries (backs: 1; forwards: 5) were recorded during the 2018/19 Series. These injuries resulted from 5,453 (backs: 2,812; forwards: 2,641) player-training-hours, which equates to an incidence of injury of 1.1 injuries/1000 player-training-hours (backs: 0.4; forwards: 1.9). The six time-loss training injuries were the result of – contact-rugby skills: 1; non- contact rugby-skills: 2; non-weights conditioning: 2; pre-match warm-up: 1. Due to the small numbers involved, further analysis of the training injuries is not justified. 4.4 Illnesses Two time-loss illnesses were recorded during the 2018/19 women’s Sevens World Series (respiratory: 1; dermatological: 1). One illness occurred during a tournament and one while travelling home post-tournament. Due to the small numbers involved, further analysis of the illnesses is not justified.
  • 17. Rugby Sevens (Women) 2011 - 2019 © Dr C Fuller (24 September 2019) Page 17 of 17 6. References Fuller CW, Molloy MG, Bagate C, et al. Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. Br J Sports Med 2007;41;328-331. Fuller CW, Taylor A. World Rugby. Surveillance Studies: Sevens World Series (Women). Summary of Results: 2011/12 to 2017/18. World Rugby; Dublin: September 2018. Fuller CW, Taylor A. World Rugby. Surveillance Studies: Sevens World Series (Men). Summary of Results: 2008/09 to 2018/19. World Rugby; Dublin: September 2019. Orchard J, Rae K, et al., Revision, uptake and coding issues related to the open access Orchard Sports Injury Classification System (OSICS) versions 8, 9 and 10.1. Open Access Journal of Sports Medicine 2010:1;207-214. 7. Acknowledgements The authors acknowledge the valuable support provided by many team physicians and physiotherapists during the collection of the data analysed in this report. Unfortunately, the authors are not always aware of the specific people providing the data, as many medical teams change from Tournament-to-Tournament and Series- to-Series. The authors would therefore like to apologise if anyone who provided data for the study is not included in the list of acknowledgements below: Australia: Claire Deane, Francesca Faulkner, Katie Ryan, Laura Schwab, Liz Monk, Michael Moran Brasil: Juninho Alves, Paulo Cerutti Canada: Adrienne Stinson, Brad Curry, Isabel Grondin, Jason White, Kim Osland, Lori Silver, Nicole Allen, Sandeep Nandhra China: Jack Lau, Li Yaping England: Angela Sells, Brett Davison, Celia Gilbe, Isobel Freeman, Julie Snow, Penny Porter Fiji: Aileen Sullivan, Jennifer Khalik, William Koong France: Jacques Girardin, Philippe Bordes, Virginie Pecourneau Ireland: Eimear Fallon, Joanne Montgomery, Lorcan McGee Japan: Atsushi Tasaki, Haruko Hirai, Keitaro Abe, Kiyokazu Gotanda Netherlands: Bas Besselink, Sven Vos New Zealand: Jacinta Horan, Nicole Armstrong Portugal: Goncalo Ramos Russia: Alexander Borodin, Alexandra Smirnova, Levan Tsiklauri, Masha Anderson South Africa: Tanushree Pillay Spain: Alberto Herrero Garcia, Arturo Carrera, Borja Vera Garcia-Portillo, Carmen Rodriguez de Tembleque Buitrago, Hugo Garcia Fernandez, Iago Vazquez GarridoJose Carlos Salo Cuenca, Keith Chapman, Sara Bonilla, USA: Nicole Titmas, Sarah Leslie