Intended for healthcare professionals

Rapid response to:


The unknown risks of youth rugby

BMJ 2015; 350 doi: (Published 08 January 2015) Cite this as: BMJ 2015;350:h26

Rapid Response:

Carter’s paper on the schoolboy rugby injury crisis is both timely and helpful.

Concerns regarding rugby injury are not new. In 1954 O’Connell reported an injury incidence of 1 per 31 playing appearances. This increased to 1 per 17 playing appearances in 1992.(1) Currently it is suggested that the injury rate has increased to a level where 1 in 4 rugby players can expect a significant injury during the course of a season.

The changes in the injury rate and profile are underscored by Mr Carter`s paper. The answer to the changing profile may lie in the laws of the game. In 1995 rugby union became an “open game” and professionalism was embraced by the rugby fraternity. From that moment on the commerciality of rugby union became a primary concern. The injury rate also increased at the onset of professional standing for rugby union. Bathgate demonstrated a nearly 2 fold increase in injury incidence after the onset of professionalism with a rate change of 47 to 74 injuries p er 1000 player hours.(2)

In 2009 the Laws were changed to speeded up rugby union to make it easier to play, easier to referee and easier for the public to understand. The upshot was an exciting professional game and an explosion in injuries in both amateur and schoolboy rugby, all in an effort to promote a professional game that very few school boys would ever play.
As a result of the Law changes continuity was increased and the ball is now in play for longer periods of time during a rugby match. This was of the order of 22 minutes in 1991 in the pre professional era, and now is of the order of 36 minutes. At the 2011 Rugby World Cup the ball was in play for an average of 35 minutes 25 seconds or 44.3% of the allotted 80 minutes of the rugby game.

With a greater playing time and more continuity, professional teams placed greater emphasis on the breakdown where possession can be contested and possession maintained. Rugby players have become bigger and heavier with a great emphasis placed on size by modern coaches. This too undoubtedly affects the injury profile, particularly during high speed contact in the tackle which is the single event that accounts for the largest proportion of injury (46.6%) across all levels of play.(3)

The changes in the Laws of rugby are considered to have created a better and more exciting visual spectacle but excellence in this sport does not specifically equated to professionalism.

The overt crowd aggression that Carter`s paper highlights at school rugby matches is a relatively new phenomenon in rugby union football and often borders on tribalism. This has come from professional sport where winning is the only end point and enjoying a good match or your child’s participation for its own sake may not be enough.

This raises a question. Is school boy rugby a sport--“a competitive pursuit with an objective way to score and hinder your opponent's ability to score”--or a game "which is both entertaining to play and watch”? Schoolboy rugby football can be both with the added advantage of being an educational tool for life skills.

As Carter has clearly outlined, there is a significant need for audit to quantify the extent of the problem and grasp the nettle of underage rugby injury. However should the medical profession also recommend a change in the Laws of rugby union pertaining to schoolboy rugby?

Rugby football from its inception was a game which had room on the pitch every one: “the piano movers and piano players”. The changes in the Laws over the past number of years have created a game that suits the former only, with a significant increase in injury rate and severity. Has the time come to change the Laws for schoolboys and cadet players, and make this level of rugby a safer game? This may then address the fundamental problem that the pattern of injuries have changed since the “Laws” changed to make the professional game more attractive to a viewing audience. Perhaps the time has come for schoolboys to return to the rugby game of the 1980s and 1990s, when the rugby injury rate was less significant. This could be simply achieved by reworking the Laws for school boys.

Some simple changes in school boy rugby might have a significant impact on the danger areas of the tackle, the breakdown and scrum, as well as reducing the ”ball in play time” to the low 20 minutes by reducing the length of school boy matches.

The time has come for the medical profession to influence this important debate, and act as an advocate to ensure the safety and survival of this wonderful old game, and protect the vulnerable school boy rugby player.

1 O’ Brien C; Retrospective survey of rugby injuries in the Leinster province of Ireland 1987-1989. , Br J Sports Med. Dec 1992; 26(4): 243–244.
2. Bathgate A, Best JP, Craig G, Jamieson M. A prospective study of injuries to elite Australian rugby union players. Br J Sports Med. 2002;36(4):265-9; discussion, 9
3 McIntosh AS, Dutfield R;. Rugby Union Injury Surveillance Study. 2007 Summary Report. Sydney, Australia: School of Safety Science, University of New South Wales; 2007.

Competing interests: No competing interests

15 January 2015
Conor P O'Brien
Consultant Clinical Neurophsiologist and Sports Medicine Physician
Sports Surgery Clinic Santry Dublin
suite 3 SSC