Match and training injury incidence in rugby league: A systematic review, pooled analysis, and update on published studies

Background: In studies reporting rugby league injuries, match injuries varied depending upon participation level. Objective: To review and update pooled data estimates for rugby league injury epidemiology and add information for participation levels in match and training environments. Methods: A systematic review and pooled analysis for published studies reporting rugby league match and training injuries. Results: The 51 studies included had a combined 419,045 exposure hrs. and 18,892 injuries (100.1 per 1,000 match-hrs.). (158,011 match-hrs and 15,815 match injuries = 100.1 [95%CI 98.5 to 101.7] per 1,000 match-hrs injury incidence; 261,034 training-hrs and 3,077 training injuries = 11.8 [95%CI 11.4 to 12.2] per 1,000 training-hrs injury incidence). Of included studies, 47.9% utilised a medical attention/treatment injury definition. There was a four-fold difference in injuries for the semi-professional participation level (431.6 per 1,000 match-hrs.) compared with professional (RR: 4.97; p<0.0001) and elite (RR: 4.24; p<0.0001) participation levels. The hooker recorded the highest pooled injury incidence (93.1 per 1,000 match-hrs). Compared to the 2014 analysis there was a 10-fold increase for head-neck region (RR: 10.7; p<0.0001) injury incidence, and more injuries for the ball carrier (RR: 1.1; p=0.0079) and tackler (RR: 1.2; p=0.0001). There was a three-fold decrease in injury incidence in the first half (RR: 2.9; p<0.0001) and a two-fold decrease in the second half (RR: 2.3; p