Authored by the Women’s Rugby Injury Surveillance Project (WRISP) steering group

RFU:

  • Dr Simon Kemp (Medical Services Director)
  • Katie Wojek (Player Welfare Manager)
  • Katy Hornby (England Women’s Lead Doctor)
  • Dr Chris Bosshardt (England Women’s Lead Doctor)
  • Lewis Henderson (Rugby Systems and Data Controller)
  • Aisling Byrne (England Women’s Physiotherapist)
  • Emily Ross (England Women’s Physiotherapist)
  • Dr David Holmes (Sale Sharks)

University of Bath:

  • Sean Williams (Senior Lecturer)
  • Professor Keith Stokes

The authors would like to acknowledge with considerable gratitude, the work of the doctors, physiotherapists and strength and conditioning staff from the Premier 15s clubs and England teams who have recorded injury and training information throughout the project.


1 At-a-Glance Summary

Premier 15s Match Injuries

  • Injury incidence rate: 40.1 / 1000 h
  • Mean days missed: 40 days
  • Burden: 1604 days absence / 1000 h
  • Highest burden event: Tackled
  • Highest burden injury diagnosis: Concussion

Premier 15s Training Injuries

  • Injury incidence rate: 1.9 / 1000 h
  • Mean days missed: 63 days
  • Burden: 120 days absence / 1000 h
  • Highest burden event: Rugby skills, full contact
  • Highest burden injury diagnosis: Knee sprain/ligament

England Match Injuries

  • Injury incidence rate: 56 / 1000 h
  • Mean days missed: 40 days
  • Burden: 2240 days absence / 1000 h
  • Highest burden event: Tackling
  • Highest burden injury diagnosis: Groin other

England Training Injuries

  • Injury incidence rate: 7 / 1000 h
  • Mean days missed: 22 days
  • Burden: 154 days absence / 1000 h
  • Highest burden event: Rugby Skills - Full Contact - Game based
  • Highest burden injury diagnosis: Hamstring muscle strain/rupture/cramps

Figure 1. Summary of match injury data in the Premier 15s, England Women’s team, and Men’s Premiership (for comparison) over the past four seasons. Size of bubble represents injury burden.

2 Executive Summary

This is the fifth injury surveillance report from the women’s Premier 15s competition. The Women’s Rugby Injury Surveillance Project (WRISP) will be pivotal in both providing the baseline data needed to assess trends in injury risk, and in guiding further investigation into injuries that are common, severe, or increasing in incidence. It cannot be assumed that the injury risk profile from other rugby settings is applicable to the women’s professional game in England, and so appropriate injury prevention strategies can only be designed and evaluated through the collection of high-quality injury surveillance data.

  • The overall incidence of match injury in the Premier 15s was 40.1 per 1000 hs (15 injuries per team, or 1.6 injuries per match), which was similar to 2020-21 (48 per 1000 hours).

  • The average time missed per match injury was 40 days. This figure is similar to the men’s Premiership (44 days).

  • Concussion was again the most commonly reported match injury (13.4 per 1000 hours), making up 34% of all match injuries. The rate of concussion was above the upper control limit based on the first three seasons of WRISP data. The 2021-22 season saw the introduction of the World Rugby Head Injury Assessment (HIA) protocol, supported by access to real-time video replay, both of which have been shown to consolidate and enhance the detection and management of concussion injuries in similar settings.

  • A more detailed breakdown of all match injuries incurred during Premier 15s matches since the 2017-18 season can be found here.

  • The incidence rate for training injuries was low (1.9 per 1000 h), whilst the average number of days missed per training injury was high (63 days). This equates to approximately one time-loss training injury every 6 team-training sessions (assuming 2 h sessions involving 45 players), or 10 training injuries per team each season. These data may reflect the challenges associated with detecting and reporting injuries in this setting. For instance, medics do not see players as regularly as in the men’s Premiership, and so minor injuries are more likely to be missed in the women’s game. Developing medical resources and practitioner reporting will impact upon this.

  • Despite their low incidence rate, training injuries still accounted for 39% all injuries reported in this setting. Given the more controllable nature of the training environment, these injuries should be a priority for future preventative efforts.

  • The incidence rate in England women’s international training was high (7 per 1000 hours, respectively), and comparable to the England men’s team. These data may reflect an improved ability to report minor injuries in the England international setting. For instance, England medical practitioners will have greater contact with players during international camps, compared to the practitioners in the Premier 15s, enhancing their ability to report minor injuries.

3 Definitions

Time-loss Injury

A time-loss injury was defined as ‘any injury that prevents a player from taking a full part in all training activities typically planned for that day and/or match play for more than 24 hours from midnight at the end of the day the injury was sustained’. For example, if a player was injured during a match on Saturday and she was able to take a full part in training on Monday, the incident would not be classed as an injury. If the player’s training was restricted on Monday due to the injury received on Saturday, the incident would be classed as a time-loss injury and reported.

Days missed

The time (days) lost from competition and practice was used as a marker of injury severity and was defined as the number of days from the date of the injury to the date that the player was deemed to have regained full fitness not including the day of injury or the day of return. A player was deemed to have regained full fitness when she was ‘able to take a part in training activities (typically planned for that day) and was available for match selection.’

Confidence interval (CI)

The confidence interval shows, with 95% certainty, the likely range of the true value for a given statistic.

Injury incidence rate

The likelihood of sustaining an injury during match play or training is reported as the injury incidence rate. The injury incidence rate is the number of injuries expressed per 1,000 player-hours of match exposure (or training exposure).

Burden

The burden of injury is a measure which takes into account both the frequency and the mean number of days missed of injuries. Burden is measured as the day’s absence per 1,000 player-hours of exposure.

Statistical significance

A result is considered to be statistically significant if the probability that it has arisen by chance is less than 5% or 1 in 20. In this report, statistical analysis has been performed for the match and training injury incidence and burden.

Statistical Process Control

Statistical Process Control (SPC) charts are used to determine whether a process is consistent (in control) or is unpredictable (out of control, affected by special causes of variation). The following rules were used to test for special cause variation:

  • The 3-sigma rule, which signals if one or more data points fall outside the 3-sigma limits. The 3-sigma rule is effective in detecting larger (> 2SD) shifts in data.
  • The Anhøj rules, which test for unusually long runs of data points on one side of the centre line, and unusually few crossings.
  • Control limits were based on all previous seasons’ data, excluding the current season, unless otherwise stated.

More information on this method can be found here.

4 Premier 15s Match Injuries

4.1 Injury incidence rate

In the 2021-22 Premier 15s season there were 149 auditable match injuries that led to time-loss from training and/or match play. The analysis included 3720 total hours of match exposure, resulting in a match injury incidence rate of 40.1 injuries per 1000 match‐hours (95% CI: 34.1-47). This equates to 15 injuries per team per season, and 1.6 injuries per Premier 15s fixture. This incidence rate is within the expected range based on values observed in previous seasons (Figure 2). For comparison, the incidence rate in the men’s Premiership was 75 per 1000 match-hours during the 2021-22 season. The incidence rate of injuries resulting in greater than seven days of absence was 31.5 per 1000 match-hours (95% CI: 26.2-37.7).


\label{fig:fig2}Figure 2. Statistical Process Control (SPC) chart for Premier 15s match injury incidence rate. Green = Within expected variation | Red = Outside expected variation.

Figure 2. Statistical Process Control (SPC) chart for Premier 15s match injury incidence rate. Green = Within expected variation | Red = Outside expected variation.

4.2 Days missed

The mean number of days missed per match injury during the 2021-22 season was 40 days, while the median was 18 days. This mean days absence value is within the expected range based on values observed in previous seasons (Figure 3). For comparison, the mean and median number of days missed for match injuries in the men’s Premiership was 44 and 18 days, respectively, during the 2021-22 season. The context within which both the players and medical practitioners in the Premier 15s competition operate should be noted; the non-rugby work commitments of players will influence their injury risk and may prolong rehabilitation in some cases, whilst the reduced contact time for medical practitioners with players (compared to the men’s professional setting) may inhibit their ability to report minor injury/illness episodes. The overall burden of match injury was 1604 days absence per 1000 hours. This value equates to approximately 17 days absence per team per match. This burden value is within the expected range based on values observed in previous seasons (Figure 4). Note, estimated return-to-play dates were provided for 10 match injuries (7%), and these estimations were used to calculate the number of days missed for those injuries.


\label{fig:fig3}Figure 3. Statistical Process Control (SPC) chart for Premier 15s match injury mean days absence. Green = Within expected variation | Red = Outside expected variation.

Figure 3. Statistical Process Control (SPC) chart for Premier 15s match injury mean days absence. Green = Within expected variation | Red = Outside expected variation.


\label{fig:fig4}Figure 4. Statistical Process Control (SPC) chart for Premier 15s match injury burden. Green = Within expected variation | Red = Outside expected variation.

Figure 4. Statistical Process Control (SPC) chart for Premier 15s match injury burden. Green = Within expected variation | Red = Outside expected variation.


4.3 Injury event

Figure 5 shows the incidence, mean days missed and burden attributed to each specific match injury event for the 2021-22 Premier 15s season. Being tackled was the (known) match event most likely to result in a time-loss injury, whilst tackling was the match event associated with the highest overall injury burden. This finding aligns the men’s Professional game, where a greater proportion of injuries are also incurred by the ball carrier rather than the tackler. The characteristics of tackle events in the women’s game will be explored in more detail in future seasons. Running was the third highest burden match event. ‘Unknown’ and ‘Other’ classifications are not displayed in Figure 5 (n = 19, 13% of all match injuries).

Figure 5. Incidence and mean days missed of Premier 15s match injuries by injury event. Size of bubble represents relative injury burden. ‘Unknown’ and ‘Other’ classifications are not displayed.

4.4 Injury location

Figure 6 provides the distribution of injuries across the four body regions. Overall, 46% of match injuries occurred to the lower limb, whilst 38% occurred to the head/neck. For specific injury locations, the head, knee, and ankle were the body locations associated with the highest incidence rate and injury burden.

4.4.1 Body region

Figure 6. The distribution of Premier 15s match injuries by body region (lower limb, upper limb, trunk, head/neck). Hover over the region to see the percentage of injuries incurred in that region

4.4.2 Location

Figure 7. Incidence and mean days missed of Premier 15s match injuries by injury location. Size of bubble represents relative injury burden.

4.5 Injury diagnosis

This section provides information about the injury diagnoses. The diagnoses comprise the body site and general injury type but do not provide the details of specific diagnoses. For example, knee ligament injuries are grouped rather than displaying specific injuries such as MCL or ACL. Concussion was the most common match injury, and also carried the highest overall injury burden (Table 2). A more detailed breakdown of all match injuries incurred during Premier 15s matches since the 2017-18 season can be found here.

4.6 Concussion

From a concussion perspective, the elite women’s game in England has historically operated a ‘recognise and remove’ policy. In keeping with the game’s increasing professional status however, and to continue progressing to parity between the men’s and women’s game from a player welfare perspective, the head injury assessment (HIA) process HIA was introduced to the elite women’s game for the 2021-22 season. The HIA is a structured assessment protocol (using real-time video to support clinical assessment) that allows medical staff to manage head impact events where the initial diagnosis may be unclear, and to differentiate between possible, suspected and confirmed concussions.

As part of the roll out of the HIA system, a significant educational drive was also performed to increase concussion literacy amongst all medics, coaches, players and officials working in the league. Given the introduction of the HIA protocol and the increased awareness, and in keeping with the pattern seen in other playing settings, it was expected that the concussion incidence would be higher in the 2021-22 season relative to other seasons.

In 2021-22, there were 50 match concussions and 22 training concussions, therefore 31% of concussions occurred in training. The incidence of match concussion was 13.4 concussions per 1000 hours, which was above the upper control limit based on the first three seasons of WRISP data (Figure 8). Improving the detection of these complex injuries to ensure safe removal of concussed players remains a priority, as is developing and evaluating strategies to reduce concussion incidence and optimally managing recovery after concussion. It should be noted that there were cases of concussions in players that had not provided informed consent to take part in the WRISP project, and so the true concussion rate will be higher than described in the current report. Of the players who sustained a concussion in 2021-22, 20% returned within 6-7 days, 60% within 28 days and 8% (n=4) had not returned within 84 days (Table 3).

\label{fig:fig8}Figure 8. Statistical Process Control (SPC) chart for Premier 15s match concussion incidence rate. Green = Within expected variation | Red = Outside expected variation. Note, control limits were set based on the first three seasons of WRISP data.

Figure 8. Statistical Process Control (SPC) chart for Premier 15s match concussion incidence rate. Green = Within expected variation | Red = Outside expected variation. Note, control limits were set based on the first three seasons of WRISP data.


4.7 Artificial turf

Four teams included in the current analysis played their home fixtures on 3G artificial turf pitches, resulting in a total exposure of 1520 match hours on these surfaces, compared to 2200 hours played on natural grass/hybrid surfaces. Overall, there was no statistically significant difference in the injury burden on artificial turf (1601 days per 1000 match-hours, 95% CI: 1229-2085) compared with natural grass/hybrid (1617 days per 1000 match-hours, 95% CI: 1321-1979, Figure 9). When combining data pertaining to surface type over the past five seasons, there was no significant difference in the overall burden of injury between playing surfaces (Figure 10).

\label{fig:fig9}Figure 9. Incidence and mean days missed per injury for Premier 15s match injuries played on artificial turf and natural grass/hybrid surface during the 2020-21 season. Size of bubble represents relative injury burden.

Figure 9. Incidence and mean days missed per injury for Premier 15s match injuries played on artificial turf and natural grass/hybrid surface during the 2020-21 season. Size of bubble represents relative injury burden.

Figure 10. Burden associated with Premier 15s match injuries incurred on artificial turf and natural grass/hybrid surfaces for the 2017-18, 2018-19, 2019-20, 2020-21, 2021-21 seasons, and for all seasons combined.

5 Premier 15s Training Injuries

5.1 Injury incidence rate

In the 2021-22 Premier 15s season there were 96 auditable training injuries that led to time-loss from training and/or match play. The analysis included 50475 total hours of training exposure, resulting in a training injury incidence rate of 1.9 injury per 1000 training‐hours (95% CI: 1.6-2.3). The overall training injury incidence rate equated to approximately one time-loss training injury every 6 team-training sessions (assuming 2 h sessions involving 45 players), or 10 training injuries per team each season. This incidence rate is within the expected range based on values observed in previous seasons (Figure 11). For comparison, the incidence rate in the men’s Premiership was 2.8 per 1000 training-hours during the 2021-22 season. The incidence of training injuries resulting in more than seven days of absence was 1.6 per 1000 training-hours (95% CI: 1.3 - 2). Despite their low incidence rate, training injuries still accounted for 39% of all injuries reported in this setting. Given the more controllable nature of the training environment, these injuries should be a priority for future preventative efforts.


\label{fig:fig11}Figure 11. Statistical Process Control (SPC) chart for Premier 15s training injury incidence rate. Green = Within expected variation | Red = Outside expected variation.

Figure 11. Statistical Process Control (SPC) chart for Premier 15s training injury incidence rate. Green = Within expected variation | Red = Outside expected variation.

5.2 Days missed

The mean number of days missed for training injuries during the 2021-22 Premier 15s season was 63 days, while the median was 27 days. This mean days absence value is within the expected range based on values observed in previous seasons (Figure 12).For comparison, the mean and median severity of training injuries in the men’s Premiership was 39 and 18 days during the 2021-22 season, respectively; these findings may again reflect a reduced ability to report minor (2-7 day) injuries in the Premier 15s, due to differences in medical/administrative resources in comparison to the men’s Premiership setting (Table 4). The overall burden of training injury was 120 days absence per 1000 hours. This burden value is within the expected range based on values observed in previous seasons (Figure 13). Note, estimated return-to-play dates were provided for 10 training injuries (11%), and these estimations were used to calculate the number of days missed for those injuries.


\label{fig:fig12}Figure 12. Statistical Process Control (SPC) chart for Premier 15s training injury mean days absence. Green = Within expected variation | Red = Outside expected variation.

Figure 12. Statistical Process Control (SPC) chart for Premier 15s training injury mean days absence. Green = Within expected variation | Red = Outside expected variation.


\label{fig:fig13}Figure 13. Statistical Process Control (SPC) chart for Premier 15s training injury burden. Green = Within expected variation | Red = Outside expected variation.

Figure 13. Statistical Process Control (SPC) chart for Premier 15s training injury burden. Green = Within expected variation | Red = Outside expected variation.


5.3 Injury event

Table 5 shows the incidence, mean days missed and burden attributed to each specific training injury event for the 2021-22 season. Rugby skills training (full-contact) was the training format most likely to result in a time-loss injury and also represented the training format with the highest overall burden, alongside rugby skills training (non-contact).

5.4 Injury location

In training, 52% of injuries were to the lower limbs (Figure 14), with a large majority of these (n=13) related to the ankle (Table 6).

5.4.1 Body region

Figure 14. The distribution of Premier 15s training injuries by body region (lower limb, upper limb, trunk, head/neck). Hover over the region to see the percentage of injuries incurred in that region

5.4.2 Location

5.5 Injury diagnosis

Concussion and ankle sprains were the most common injury diagnosis in training, whilst knee sprain/ligament injuries were associated with the highest overall burden (Table 7).

6 England Match Injuries

6.1 Injury incidence rate

In the 2021-22 season there were 10 auditable match injuries during England women’s matches that led to time-loss from training and/or match play. The analysis included 180 total hours of match exposure, resulting in a match injury incidence rate of 56 injuries per 1000 match‐hours (95% CI: 30-103).This incidence rate is within the expected range based on values observed in previous seasons (Figure 15). The relatively low amount of match exposure per season for the England women’s team means that the season-to-season variation in injury rates will likely be higher in comparison to the Premier 15s. The mean injury incidence rate during the 2010-2017 women’s Rugby World Cup tournaments was 44 per 1000 match‐hours. The incidence rate of injuries resulting in greater than seven days of absence was 38.9 per 1000 match-hours (95% CI: 18.5-81.6).


\label{fig:fig15}Figure 15. Statistical Process Control (SPC) chart for England Women's match injury incidence rate. Green = Within expected variation | Red = Outside expected variation.

Figure 15. Statistical Process Control (SPC) chart for England Women’s match injury incidence rate. Green = Within expected variation | Red = Outside expected variation.

6.2 Days missed

The mean number of days missed per match injury for the 2021-22 season was 40 days, while the median was 27 days. This mean days absence value is within the expected range based on values observed in previous seasons (Figure 16). The mean days missed for injuries during the 2010-2017 women’s Rugby World Cup tournaments was 46 days. The overall burden of match injury was 2240 days absence per 1000 hours. This burden value is within the expected range based on values observed in previous seasons (Figure 17). This burden value equates to approximately 249 total days absence per match. Compared to the Premier 15s, England injuries occurred at a higher rate but resulted in the same number of days missed per injury (on average), resulting in an overall burden of injury that was similar to that of the Premier 15s (2240 vs. 1604 days/1000 match-hours).


\label{fig:fig16}Figure 16. Statistical Process Control (SPC) chart for England Women's match injury mean days absence. Green = Within expected variation | Red = Outside expected variation.

Figure 16. Statistical Process Control (SPC) chart for England Women’s match injury mean days absence. Green = Within expected variation | Red = Outside expected variation.


\label{fig:fig17}Figure 17. Statistical Process Control (SPC) chart for England Women's match injury burden. Green = Within expected variation | Red = Outside expected variation.

Figure 17. Statistical Process Control (SPC) chart for England Women’s match injury burden. Green = Within expected variation | Red = Outside expected variation.


6.3 Injury event

Figure 18 shows the incidence and mean days missed for each specific match injury event for the 2021-22 season. Tackling was the most common and highest burden match event leading to injury.

Figure 18. Incidence and mean days missed of England match injuries by injury event. Size of bubble represents relative injury burden.

6.4 Injury location

Figure 19 provides the distribution of injuries across the four body regions. Overall, 50% of match injuries occurred to the lower limbs. For specific injury locations, groin and hamstring injuries had the greatest overall burden, though this was accounted for by just three injuries in total (Table 9).

6.4.1 Body region

Figure 19. The distribution of England match injuries by body region (lower limb, upper limb, trunk, head/neck). Hover over the region to see the percentage of injuries incurred in that region

6.4.2 Location

6.5 Injury diagnosis

This section provides information about the specific match injury diagnoses relating to the England women’s team. ‘Groin other’ injuries were the most common injury diagnosis (Table 10), though all diagnoses had a low absolute number of occurrences.

7 England Training Injuries

In the 2021-22 season, the Red Roses camp planning has targeted minimal transitions between club and country, with the aim of keeping as much consistency in rugby training style (intensity/density/on-feet pattern) and gym programming and to avoid unnecessary variables that could be detrimental to fitness status. The Red Roses have also implemented a proactive and targeted approach to developing contact robustness via appropriately timed micro-dosing of contact technical development and live contact exposure. These changes may influence injury risk in the current and future seasons for the England women’s team and this will be monitored via the WRISP data.

7.1 Injury incidence rate

In the 2021-22 season there were 24 auditable training injuries that led to time-loss from training and/or match play. The analysis included 3448 total hours of training exposure, resulting in a training injury incidence rate of 7 injuries per 1000 match‐hours (95% CI: 5-10). This incidence rate is within the expected range based on values observed in previous seasons (Figure 20). The incidence of training injuries resulting in more than seven days of absence was 4.4 per 1000 training-hours (95% CI: 2.6-7.2).


\label{fig:fig20}Figure 20. Statistical Process Control (SPC) chart for England Women's training injury incidence rate. Green = Within expected variation | Red = Outside expected variation.

Figure 20. Statistical Process Control (SPC) chart for England Women’s training injury incidence rate. Green = Within expected variation | Red = Outside expected variation.

7.2 Days missed

The mean number of days missed per training injury for the 2021-22 season was 22 days, while the median was 13 days. This mean days absence value is within the expected range based on values observed in previous seasons (Figure 21). The majority of injuries resulted in 2-7 days of absence (Table 11). The overall burden of injury was 154 days absence per 1000 hours. This burden value is within the expected range based on values observed in previous seasons (Figure 22).


\label{fig:fig21}Figure 21. Statistical Process Control (SPC) chart for England Women's training injury mean days absence. Green = Within expected variation | Red = Outside expected variation.

Figure 21. Statistical Process Control (SPC) chart for England Women’s training injury mean days absence. Green = Within expected variation | Red = Outside expected variation.


\label{fig:fig22}Figure 22. Statistical Process Control (SPC) chart for England Women's training injury burden. Green = Within expected variation | Red = Outside expected variation.

Figure 22. Statistical Process Control (SPC) chart for England Women’s training injury burden. Green = Within expected variation | Red = Outside expected variation.


7.3 Injury event

Table 12 shows the incidence, mean days missed and burden attributed to each specific training injury event for the 2021-22 season. Rugby Skills (Full Contact - Game based) sessions was the training format associated with the highest injury incidence rate and burden.

7.4 Injury location

In training, a large majority (62%) of injuries were to the lower limbs (Figure 23), with hamstring injuries having the biggest burden (Table 13).

7.4.1 Body region

Figure 23. The distribution of England training injuries by body region (lower limb, upper limb, trunk, head/neck). Hover over the region to see the percentage of injuries incurred in that region

7.4.2 Location

7.5 Injury diagnosis

This section provides information about the injury diagnoses relating to England training injuries. Hamstring muscle strain/rupture/cramps had the highest incidence rate (n=4), though all diagnoses had a low absolute number of occurrences.

8 WRISP Methods

Written informed consent was obtained from 73% of registered Premier 15s squad players for the 2021-22 season. A total of 186 team games were included in the analyses for the 2021-22 season. Injuries from consented first team squad players sustained in training and in all matches in the Premier 15s competition were included. Injuries sustained while players represented England were reported and analysed separately. Match and training injury data were provided by all 10 Premier 15 teams in 2021-22. One team did not provide training exposure data in 2021-22, and so this was estimated based on the mean value provided by the other nine teams. Medical personnel at each Premier 15 club and the England women’s team reported the details of injuries and illnesses sustained by a player at their club/team that were included in the study group together with the details of the associated injury event using an online medical record keeping system. Strength and conditioning staff recorded the squad’s weekly training schedules and exposure on a password protected online system. Team match days were also recorded by strength and conditioning staff. Injury and illness diagnoses were recorded using the Orchard Sports Injury Classification System (OSICS) version 10.1. This sports specific injury classification system allows detailed diagnoses to be reported and injuries to be grouped by body part and injury pathology. The definitions and data collection methods utilised in this study are aligned with the World Rugby Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union.

A number of quality control processes are embedded within the WRISP data collection process to ensure the validity and integrity of the data being presented within this report. All match exposures are crosschecked against fixture lists for each club at the end of the season to ensure match exposure is correct. Furthermore, concussions reported in the WRISP database are crosschecked with the CSx (concussion management mobile application) data to ensure all concussions are logged correctly. Finally, before the WRISP data is analysed, all injuries are checked for duplicates and inconsistencies and final approval of the included injuries is sought from the medical lead in each club.