The Rugby World Cup has kicked off and from this Physios point of view it’s just as interesting to watch the game and also look at how the players are getting injured. It’s pretty common for every physio to sit there and watch a player hit the deck and say something along the lines of “ACL tear – he’s out of the tournament” or watch a player go from 100mph to pulling up with a hamstring tear and start calculating the average rehab times for that type of injury. Injuries can have a huge impact during international rugby games and can change the course of a game. For example if you lose an impact player or leader like the Italians lost their captain Sergio Parisse for their opener against France or Wales losing Leigh Halfpenny for the tournament. Injuries can also affect the strength and depth of a team (I think there might be only one country that could get away with picking their fourth string fly half and still win the World Cup – god bless The Beaver (that’s right, he gets capital letters). We will see, don’t count out England calling up Jonny Wilkinson if Farrell and Ford get injured. Wilkinson is one of the best examples of how high the injury rates can be for international rugby players. His injury list would be comparable to someone getting in the ring with Ronda Rousey for longer than five minutes after she just spoke about fighters getting banned for Marijuana use – you wouldn’t like her when she’s angry. Someone (not me) did a study on the injury statistics during the 2011 World Cup in New Zealand and found some interesting things. In 2011 there were 615 rugby players representing 20 teams between 5th Sept and 23rd Oct. They played 1,920 hours of rugby and trained for 15,628 hours. There were 171 injuries during matches of which 87 were suffered by the forwards and 84 by the backs. There were also 7 injuries during the warmups and 35 training injuries. The positions where you are most likely to be injured were the inside backs as they have the highest risk of injury, incidence and mean severity of injury. That’s why those players regularly appear on the biggest rugby hits compilations and the infamous ‘Smashed Em Bro’. In the games, not surprisingly, the place where the most injuries occur was during the tackle (forwards 43.6% of their injuries and backs 45.2%). However, forwards get injured more when tackling and backs get injured more when being tackled. Obvious right? This was because during that World Cup the average weight of each forward was 111.5kg and the backs were only 92.8kg. If you unsuccessfully try to tackle someone almost 20kg heavier than you, generally one of two things is going to happen. The first is what we will call the ‘Mike Catt vs Jonah Lomu experience’ and the second is that you might have that 111.5kg land on you, or worse if it’s Ben Tameifuna who weighs in at 134Kg. Once the impact of the tackle has occurred, the most common area for forwards to become injured is their face or head, then their knees, and then posterior thigh (hamstrings I assume), whereas for the backs they are most likely to injure their shoulders, posterior thigh and then head or face. That’s why some forwards have a similar appearance to Orcs (Lord of the Rings)….but not Richie though… everyone loves Richie. No player sustained a catastrophic injury during the 2011 tournament but one 32 year old forward retired from rugby following recurrence of medial meniscal tear. There were 59 MRIs, 26 U/S, 23 xrays and 8 CT scans. 16 injuries required surgery and 10 corticosteroid injections (Richie’s beloved foot probably had 9 of them). During and after the tournament, the amount of time each player lost to those injuries and spent with the Dr and Physios was also looked at. The mean severity of injuries was 23.6 days (forwards 21.2 and backs 26.2). Knee ligament injuries took the longest to heal and accounted for 1,113 days lost for 14 players (average 79.5 days), then posterior thigh injuries took 523 days for 20 players (26.1 days), and concussions took 152 days for 15 players (average 10.1 days). All in all, 4,020 days of training/playing time were lost to 171 injuries. The likeliness of players getting injured this time around? Well in the last World Cup, for every 1,000 hours of rugby played, there were 89.1 injuries, of which 85.0 were the forwards and 93.8 were the backs. As with any tournament, the further you progress, the higher the risk of injury. It will be interesting to see how England & Wales 2015 plays out.