Shoulder injury risks in rugby union football: causes, contributing factors and prevention

In rugby union football, shoulder injury is the most common upper limb injury. Despite awareness of shoulder injury risks, few studies have been carried out with specific focus on understanding the incidence, causes and prevention of upper limb injury, in particular shoulder injury. The overall aim of the thesis was to investigate shoulder injury risk factors in rugby union football.Four projects were carried out. First, a study of the epidemiology of upper limb injuries in rugby union football across three levels of play, and over five rugby seasons was conducted. Second, a recursive model of injury causation was applied as a framework for the analysis of the aetiology of shoulder injuries in a two year prospective study of community rugby union players. This approach investigated the implication of shoulder pain and impairment as markers for exposure to an injury mechanism. Third, in order to understand better shoulder injury mechanisms, the causes and contributing factors to shoulder injuries were studied using qualitative video analysis methods in a cohort of professional New Zealand rugby players. Finally, although the tackle is regarded as the main mechanism for injury in rugby union, the impact force applied to the shoulder in the tackle has not been studied extensively. A biomechanical study of the shoulder force in active shoulder tackles using a novel instrumented tackle bag was undertaken on a cohort of recreational rugby players.The overall results identified that the acromioclavicular joint was the most frequently injured area of the shoulder and led to an average of 2.4 games missed per shoulder injury. The most common cause of shoulder injury was the tackle (72% to 88%). The upper limb and shoulder injury incidence rates decreased as the level of play increased. The shoulder forces on average in the tackle were 2000 N and not influenced in the study design by shoulder pads. The results suggest that injuries could be reduced through an improvement in the design of the currently available shoulder pads and, based on the shoulder injury mechanisms identified; reduction in the risk of shoulder injury may be achieved through effective coaching and training strategies