SAJSM vol 19 No. 5 2007 125

Introduction

Following the 1995 Rugby World Cup, the game of rugby was
introduced as a professional sport by the International Rugby
Board (IRB). Rugby league had a large following and was
tempting rugby union players with the promise of big salaries.
The professionalism of rugby union was seen as the way to
preserve the game and maintain the players. Despite the rule
changes accompanying the professionalism of rugby, there
has been a subsequent increase in rugby injuries.

1,6
Although

this may not seem relevant for club players, the study of Gar-
raway et al.

6
revealed increases in injuries for both senior

club (amateur) and professional rugby players from the 1993
- 1994 season (pre-professional) to the 1997 - 1998 season
(professional). It would appear that there is now a greater
emphasis placed on players’ speed, strength and endurance
than before the professional era.

The Stellenbosch Rugby Football Club (hereafter referred
to as SRFC) is made up of five senior teams (including one
women’s team), five junior teams (three under-20 and two
under-19 teams), as well as 45 hostel teams and has more
than 1 200 registered players. SRFC also has a proud history
of players who have proceeded to represent their province
and country. In 1973

10
and 1974 - 1975,

12
research studies

were conducted to investigate the nature and proportion of
total injuries occurring during these seasons at SRFC. In
2003, the University’s Rugby Injury Database was developed
to log and organise rugby injury data from SRFC for further
analysis.

Fellow researchers acknowledge a lack of a standardised
definition of injury, which makes comparison between studies
difficult.

1,3,6,7,9
However, regardless of the definition of injury

used, the reported incidences of rugby injury remain among
the highest in sport.

4
The major aim of this descriptive study

was to compare the nature and proportion of total injuries
occurring at SRFC between the years 1973 - 1975 and 2003
- 2005.

origiNAl reSeArch ArTicle

Nature and proportion of total injuries at the Stellenbosch
rugby Football club: a comparison of the years 1973 -
1975 with 2003 - 2005

Abstract

Objective. The purpose of this study was to compare the
nature and proportion of total injuries occurring at Stellen-
bosch Rugby Football Club in Stellenbosch, South Africa,
between the years 1973 - 1975 and 2003 - 2005.

Design. Retrospective, descriptive study.

Main outcome measures. Injured rugby players from the
Stellenbosch Rugby Football Club from the different time
periods were included in the study. Results from the 1973
- 1975 time period were obtained from two previously pub-
lished articles (Roy, 1974; Van Heerden, 1976), while data
from the 2003 - 2005 time period were available through
the Stellenbosch University Rugby Injury Database.

Results. An increase in the proportion of head and facial
injuries from 1973 - 1975 (21%) to 2003 - 2005 (42%) was
found as well as a doubling in the proportion of concus-
sions between the two time periods (12% - 23%). There
was an overall decrease in total injuries between the two
time periods.

Conclusion. The findings highlight the high and increased
proportion of head and facial injuries in the game of rugby
at the Stellenbosch Rugby Football Club. This is a matter
that should be further investigated.

CORRESPONDENCE:

Michelle Puren
Stellenbosch Biokinetics Centre
Private Bag X1
Matieland 7602
Tel: (021) 808-4735
E-mail: mspuren@gmail.com

M S Puren (BSc Sport Science, hons B Sport Science (Biokinetics))

J g Barnard (MA, DPhil Sport Science)

Department of Sport Science, Stellenbosch University

P l viviers (B Med Sc, hons B Med Sc, M Med Sc, MB chB, MSc (Sports Med))

Sport Performance Institute, Stellenbosch University

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126 SAJSM vol 19 No. 5 2007

Methods

Subjects

The subjects for this study came from the time periods of
1973, 1974 - 1975 and 2003 - 2005. The study population for
both time periods comprised rugby hostel and senior or jun-
ior club players from SRFC. Injured SRFC players were ex-
cluded from the study if the rugby player was injured during
an away rugby match, if the injured rugby player did not play
for a SRFC team or if the injury was not rugby-related. In the
1973 rugby season

10
the injured SRFC players were includ-

ed if the rugby player was injured during a rugby match or
practice and sought private medical treatment at the author’s
medical practice. The injured SRFC players for the 1974 -
1975 rugby season

12
were included if the rugby player was

injured during a rugby match or practice resulting in medi-
cal treatment at Stellenbosch University’s Student Health
Services. The injured SRFC players of the 2003 - 2005 rugby
season were included in the study if the rugby player was
injured during a rugby match or practice resulting in medical
treatment at the field.

Data collection

Injury definition: For the purposes of this study an injury
was defined as an event which resulted in a player seek-
ing medical assistance from the sports physician on duty at
the rugby game or practice, regardless of whether the player
stopped playing in the middle of the game or continued until
the end before seeking the assistance.

Data source: The injury results of the 1973 and 1974 -
1975 SRFC rugby seasons published in 1974

10
and 1976

respectively were compared with the injury findings of the
2003 - 2005 rugby seasons. The nature and proportion of
total injuries were investigated for the two time periods.

Measurement tool: All the research studies (i.e. Roy,
10

Van Heerden

12
and current) applied a questionnaire to

collect the injury data. Although these questionnaires were
not exactly the same, each provided information about the
player regarding the date of injury, age, height, weight, team,
competition or practice, weather conditions, playing surface,
shoe and stud type, position, phase of play, as well as site
and type of injury sustained. The 1973 and 1974 - 1975 data
were obtained from research published in 1974

10
and 1976,

respectively. However, the data from these studies were the
authors’ published data and not the raw data. The 2003 -

2005 data were accessed through Stellenbosch University’s
Rugby Injury Database. The method used for the injury data
collection of the 2003 - 2005 season involved the presence of
a sports physician and two postgraduate biokinetics students
during all home matches and contact practice sessions for on-
site acquisition of injury information. The sports physician was
responsible for the diagnosis of the injury and the students
on duty for the recording of the necessary information.

Data resource: The number of matches played in 1973
- 1975 and 2003 - 2005 were calculated from SRFC Annual
Reports for the respective years.

Injury categories: The category ‘head and face’ includes
injuries of the head, face, nose, eye, ear, mouth and jaw
but does not include injuries of the neck. The category
‘shoulder’ includes injuries of the shoulder and upper arm.
The categories ‘knee’ and ‘ankle’ pertain to injuries of the
knee and ankle respectively. These exact categories were
used in the study of Van Heerden

12
when he compared his

results with those of Roy.
10

Statistics

The study is of a descriptive nature and it was decided to cal-
culate the proportions of total injuries as percentages of the
total injuries for the time periods of 2003 and 2004 - 2005, in
keeping with those calculated by Roy

10
and Van Heerden

for the time periods of 1973 and 1974 - 1975, respectively.

Results

Table I indicates the number of matches played, the number
of teams involved and proportion of total injuries sustained,
for the years 1973 - 1975 and 2003 - 2005, for both hos-
tel and club teams. In 1973 - 1975 there were considerably
more hostel matches played than during 2003 - 2005. In 2003
- 2005, more club matches were played than during 1973 -
1975. Total match figures also include friendly matches. In
total, more rugby matches were played during 1973 - 1975
(1 807 matches) than during 2003 - 2005 (1 389 matches). In
1973 - 1975 there were slightly more hostel teams and slightly
fewer club teams than during 2003 - 2005. Considerably more
injuries were sustained during the period of 1973 - 1975 com-
pared with the 2003 - 2005 – more than double the amount.

Fig. 1 shows the most frequently injured anatomical site
for the years 1973, 1974 - 1975, 2003 and 2004 - 2005.

In 2003 (41%) and 2004 - 2005 (42%) there was a doubling
of the percentage of injuries for the category of head and face,

TABLE I. Number of hostel and club matches played, teams and total injuries for each year

Matches/injuries 1973 1974 1975 Total 2003 2004 2005 Total

Hostel matches
(teams) 498 (52) 567 (51) 469 (52) 1 534 280 (46) 290 (46) 217 (45) 787

Club matches
(teams) 123 (7) 74 (4) 76 (5) 273 226 (10) 210 (10) 166 (8) 602

Total matches 621 641 545 1 807 506 500 383 1 389

Total injuries 300 485 900 1 685 238 272 251 761

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SAJSM vol 19 No. 5 2007 127

while the percentage remained constant for 1973 (21%) and
1974 - 1975 (21%). The other three frequently injured sites
have remained relatively stable, with some minor changes.
There was a slight increase in the percentage of shoulder
injuries in 2003 and 2004 - 2005 (12% and 12%, respectively)
when compared with the 10% and 9% of the 1973 and 1974
- 1975 findings. The percentage of ankle injuries decreased
from 14% in 1973 to 11% in 1974 - 1975. In 2003 and 2004
- 2005 the incidence is similar at 11% and 11% respectively.
Slight fluctuations are evident with the knee injuries, which
increased from 14% in 1973 to 17% in 1974 - 1975 while in
2003 they decreased from 16% to 14% in 2004 - 2005.

Fig. 2 depicts the breakdown of head and facial injuries
into lacerations, concussions and other head and facial
injuries for the time periods 1973 - 1975 and 2003 - 2005.

Lacerations increased from 51% in 1973 - 1975 to 61%
in 2003 - 2005, and concussions doubled from 12% in 1973
- 1975 to 23% in 2003 - 2005. Other head and facial injuries
decreased from 37% in 1973 - 1975 to 16% in 2003 - 2005.

Discussion

The descriptive nature of this study and the limited possibili-
ties for statistical analysis of the data do not allow firm conclu-
sions to be drawn from the results obtained. A few limitations

were encountered in the collection, access and analysis of
the data, yet despite these limitations, the study still provides
some interesting information concerning the nature and pro-
portion of total injuries occurring at SRFC 30 years following
the initial two studies.

A total of 1 685 recorded injuries occurred between 1973
and 1975 compared with the total of 761 for 2003 - 2005.
The difference in total matches, played between the two time
periods, is 418 matches, with more matches being played
between 1973 and 1975 (1 807) compared with 2003 - 2005
(1 389). Almost two and a half times more injuries occurred
during 1973 - 1975. This is probably also an underestimation
of injuries, due to the inclusion criteria used. Van Heerden

also states that 35% of these injuries occurred in 1974 and
65% in 1975.

According to the proportion of total injuries by anatomical
site for the years 2003, 2004 and 2005, it is apparent that
the head and face hold the highest percentage of injuries
compared with the other anatomical sites, followed by the
knee, shoulder, and then ankle. These specific categories
were compared with the findings of Roy

10
and Van Heerden.

It would appear that there has been a large increase in the
proportion of head and facial injuries between the three
decades. The percentages for 1973 - 1975 doubled to
2003 - 2005. There was a 10% increase in the proportion
of lacerations obtained in head and facial injuries, while the
proportion of concussions has doubled.

On the topic of increased injuries since professionalism,
Garraway et al.

6
state: ‘…changes in the laws of rugby union

in recent years have been designed to encourage more open
play. This has probably resulted in more tackles involving a
higher degree of momentum or a greater degree of force’.
Perhaps this accounts for the increase in the proportion
of head and facial injuries observed. The other three sites
(knee, ankle and shoulder) remained relatively stable with
little fluctuations. The finding of head and face being the
most commonly injured anatomical site is consistent with the
studies of Targett,

11
Gabbett,

5
Bathgate et al.,

1
and Best et

al.
2
Although the studies of Gabbett

5
and Best et al.

2
also

included neck injuries in this category, this is not considered
a problem. Should neck injuries have been added to the
head and facial injuries investigated in this study, it would
have only made the percentage higher.

It is possible that the slightly higher percentage of
lacerations of the head and face, which was recorded during
the 2003 - 2005 time period, was because of the increased
strictness concerning injuries involving blood. It is also
possible that the doubling of concussions that was observed
is due to the stricter guidelines concerning a player who has
become concussed, resulting in more accurate reporting
of these injuries. Under the current IRB laws, concussed
players are subject to a ‘mandatory 3-week stand-down
period’ regardless of whether the concussion is considered
mild or severe.

8
In contrast, in 1974, Roy

10
stated: ‘There is

at present no set rule as to who is responsible for ordering
the removal of an injured player from the field… Permitting



Lacerations Concussion Other
0

75
1973-1975
2003-2005

P
ro

p
o

rt
io

n
o

f
to

ta
l

h
ea

d
an

d
fa

ci
al

in
ju

ri
es

Fig. 2. Proportion of lacerations, concussions and other
head and facial injuries.



Head/face Knee Ankle Shoulder
0

50
1973
1974-5
2003
2004-5

Most frequentlyinjuredanatomical site

F
re
q
u
en
cy
%

Fig.1. Most commonly injured anatomical site per year/
season.

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128 SAJSM vol 19 No. 5 2007

a player with concussion to continue playing should not be
tolerated.’

Conclusion

The three commonly injured sites of the knee, ankle and shoul-
der remained similar over the two time periods, 1973 - 1975
and 2003 - 2005, in contrast to the higher total injuries for 1973
- 1975 and increased proportion of head and facial injuries for
2003 - 2005. An increase in the proportion of these particu-
lar injuries took place over the last 30 years whereas the to-
tal number of injuries decreased. It is of concern to note that
concussion injuries have doubled. Could this be due to poor
tackling technique or some other skill which is lacking, or is
it merely due to an increase in the reporting thereof? In order
to obtain a better understanding of the findings observed, it
would be beneficial to undertake further studies in this regard.

References

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3. Bird YN, Waller AE, Marshall SW, Alsop JC, Chalmers DJ, Gerrard DF. The
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5. Gabbett TJ. Incidence, site and nature of injuries in amateur rugby league
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8. Marshall SW, Spencer RJ. Concussion in rugby: the hidden epidemic. J Athl
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Sports Medicine, An Issue of Physical Medicine and

Rehabilitation Clinics

By Gregory A. Strock, MD; and Ralph M. Buschbacher, MD, Clinical
Associate Professor and Interim Chair, Department of Physical Medicine and
Rehabilitation, Indiana University; Indiana University Medical Center;
Residency Program Director, Community Hospitals of Indiana, Indianapolis,
IN, USA

ISBN 1416039287 Ä Hardback Ä 240 Pages

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Treating an elite athlete or a weekend player has its challenges � mainly to get them back in
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