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Introduction
Since the International Rugby Board (IRB) declared Rugby Union an 'open' game thus effectively ushering in professionalism, players have become faster and stronger. 1 Force equals mass multiplied by acceleration: logically increased force at collision will lead to more injuries. Surveillance studies and injury databases have provided comprehensive datasets which confirm changing patterns of injury in rugby. 2 We examine what is being done, and how safety can be improved in rugby.
Background
Rugby Union is experiencing unprecedented global growth. In total, 3.5 million men, women and children play worldwide, with 117 Unions in membership of the IRB. 3 Modern rugby is ever more physically demanding due to increases in ball in play time, and speed of play. A fourfold increase in tackles and rucks per game has been noted. 4-6 Teams with the tallest and heaviest players outperformed others in the Rugby World Cup. 7 The IRB have appointed a Chief Medical Officer, a safety consultant and working groups to ensure that safety is maintained.
Injury trends
Epidemiological data provide insight into changes in the nature and frequency of injuries. Some injuries are unavoidable and 'uncontrollable', whereas others result from dangerous play. An international consensus statement on definitions and procedures used for injury surveillance has allowed meaningful comparisons of results across studies. 8 The establishment of major event surveillance studies including the (2007) Rugby World Cup Injury Surveillance Study, 2 and national injury databases such as the England Rugby Injury and Training Audit monitor the frequency and patterns of injury in Rugby.
These have demonstrated: high incidence of injury in Rugby Union relative to other team sports;
an initial increase in injury risk since the advent of professionalism;
since 2000, injury rates have reverted to levels close to the preprofessional game;
reduction in injury incidence with decreasing age and competitive level;
higher incidence of injuries during matches compared with training and
the tackle is the most injurious event in the games, with collisions and scrums also more likely to result in an injury.
What can be done?
The IRB have demonstrated a readiness to introduce law changes, adapt sanctions, develop guidelines and educate players and officials in order to discourage dangerous play. Regular meetings between law makers, players and...