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

RFU:

  • Dr Simon Kemp (Medical Services Director)
  • Katie Wojek (Medical Operations Lead)
  • Dr Lewis Jones (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)
  • Kate Tyler (Bristol Bears)
  • Dr David Holmes (Sale Sharks)

University of Bath:

  • Sean Williams (Senior Lecturer)
  • Kieran Smith (PhD Candidate)
  • Professor Keith Stokes
  • Carly McKay (Reader)

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.

The elite women’s league in England has now been re-branded as Premiership Women’s Rugby (PWR). For the purpose of this report we will refer to the league as it was known for the period of the report (i.e., Premier 15s), but this will be updated to PWR for future reports.

1 At-a-Glance Summary

Premier 15s Match Injuries

  • Injury incidence rate: 45.7 / 1000 h
  • Mean days missed: 52 days
  • Burden: 2376 days absence / 1000 h
  • Highest burden event: Tackled
  • Highest burden injury diagnosis: Knee sprain/ligament

Premier 15s Training Injuries

  • Injury incidence rate: 2.19 / 1000 h
  • Mean days missed: 58 days
  • Burden: 127 days absence / 1000 h
  • Highest burden event: Rugby Skills - Controlled Contact - Drill based
  • Highest burden injury diagnosis: Knee sprain/ligament

England Match Injuries

  • Injury incidence rate: 62 / 1000 h
  • Mean days missed: 34 days
  • Burden: 2108 days absence / 1000 h
  • Highest burden event: Tackled
  • Highest burden injury diagnosis: Concussion

England Training Injuries

  • Injury incidence rate: 5 / 1000 h
  • Mean days missed: 45 days
  • Burden: 225 days absence / 1000 h
  • Highest burden event: Rugby Skills - Controlled Contact - Game based
  • Highest burden injury diagnosis: Ankle tendon injury/rupture

Figure 1. Summary of match and training injury data in the Premier 15s, England Women’s team, and Men’s Premiership (for comparison) throughout the WRISP project. Size of bubble represents injury burden.

2 Executive Summary

This is the sixth 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.

In 2023, both Wasps and Worcester Warriors were placed into administration and are subsequently no longer a part of the PWR competition. Both teams were unable to provide sufficient data for inclusion in this 2022-23 WRISP report. As such, this report only includes data pertaining to eight Premier 15s teams.

In October/November 2022, the Women’s Rugby World Cup took place in New Zealand. Allianz Cup fixtures were played alongside the latter stages of the Women’s Rugby World Cup, whilst the Premier 15s competition schedule was adapted to take place in a shortened time frame, compared with previous seasons.

  • The overall incidence of match injury in the Premier 15s was 45.7 per 1000 h (17 injuries per team, or 1.8 injuries per match), which was similar to 2021-22 (40 per 1000 hours).

  • The average time missed per match injury was 52 days. This figure is higher than the men’s Premiership average (38 days).

  • Concussion was again the most commonly reported match injury (15 per 1000 hours), making up 33% of all match injuries.

  • 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 above the expected range based on values observed in previous seasons (2.19 per 1000 h). This equates to approximately one time-loss training injury every 5 team-training sessions (assuming 2 h sessions involving 45 players), or 14 training injuries per team each season. This finding may reflect improved reporting of training injuries in comparison to earlier WRISP seasons, as well as the impact of increased training exposure and a greater consent capture for the WRISP project.

  • Despite their relatively low rate in comparison to match injuries, training injuries still accounted for 45% 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.

  • The Red Roses competed at the Women’s Rugby World Cup in October/November 2022, and these data are included in the current report. Both the match and training exposure of the Red Roses were substantially higher than typical seasons.

  • The incidence rate in England women’s international training was high (5 per 1000 hours), 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 2022-23 Premier 15s season there were 137 auditable match injuries that led to time-loss from training and/or match play. The analysis included 3000 total hours of match exposure, resulting in a match injury incidence rate of 45.7 injuries per 1000 match‐hours (95% CI: 38.6-54). This equates to 17 injuries per team per season, and 1.8 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 76 per 1000 match-hours during the 2022-23 season. The incidence rate of injuries resulting in greater than seven days of absence was 37.3 per 1000 match-hours (95% CI: 31-44.9).


\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 2022-23 season was 52 days, while the median was 19 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 38 and 17 days, respectively, during the 2022-23 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 2376 days absence per 1000 hours. This value equates to approximately 32 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 2022-23 Premier 15s season. The match event associated with the highest overall injury burden was ‘Tackled’, followed by ‘Tackling’ and ‘Ruck’. ‘Unknown’ and ‘Other’ classifications are not displayed in Figure 5 (n = 18, 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, 41% of match injuries occurred to the lower limb, whilst 36% occurred to the head/neck. The specific body locations associated with the highest injury burden were 1) Ankle, 2) Knee, and 3) Head.

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. Knee sprain/ligament was the highest burden match injury, followed by Ankle fracture and Ankle sprain/ligament (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 2022-23 season relative to the first three seasons of WRISP data.

In 2022-23, there were 45 match concussions. The incidence of match concussion was 15 concussions per 1000 hours, which was within the expected range for the last 3 seasons of WRISP data (Figure 8). The average severity of match concussions was also within the expected range for the last 3 seasons of WRISP data (Figure 9). Of the players who sustained a match concussion in 2022-23, 20% returned within 7 days, 71% within 8-28 days, 7% returned within 29-84 days and 2% had not returned within 84 days (Table 3). Compared to the previous two seasons, there were fewer concussions resulting in extended absences (Figure 10). It should be noted that a new assessment of players was included in the return-to-play process as part of the Rugby Readiness and Rehabilitation Enhanced and Personalised (RREP) study funded by World Rugby. Moreover, in comparison to the men’s professional game, the women’s game currently has a younger age profile and so is likely to have more players without a significant concussion history that can access the 7-day return.

\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, the first three seasons of WRISP data were excluded when setting the control limits.

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

\label{fig:fig9}Figure 9. Statistical Process Control (SPC) chart for Premier 15s match concussion mean days absent Green = Within expected variation | Red = Outside expected variation. Note, the first three seasons of WRISP data were excluded when setting the control limits.

Figure 9. Statistical Process Control (SPC) chart for Premier 15s match concussion mean days absent Green = Within expected variation | Red = Outside expected variation. Note, the first three seasons of WRISP data were excluded when setting the control limits.


Figure 10. Days absent for reported match concussions as a percentage for 2020-21 and 2021-22 seasons combined (red line) and 2022-23 (blue line).

4.7 Artificial turf

Three teams included in the current analysis played their home fixtures on 3G artificial turf pitches, resulting in a total exposure of 880 match hours on these surfaces, compared to 2120 hours played on natural grass/hybrid surfaces. The incidence rate on artificial turf was significantly higher than on natural grass, whilst the mean days missed per injury was significantly lower. Overall, there was no statistically significant difference in the injury burden on artificial turf (2572 days per 1000 match-hours, 95% CI: 2005-3298) compared with natural grass/hybrid (2325 days per 1000 match-hours, 95% CI: 1854-2915, Figure 11). 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 12).

\label{fig:fig11}Figure 11. Incidence and mean days missed per injury for Premier 15s match injuries played on artificial turf and natural grass/hybrid surface during the 2022-23 season. Size of bubble represents relative injury burden.

Figure 11. Incidence and mean days missed per injury for Premier 15s match injuries played on artificial turf and natural grass/hybrid surface during the 2022-23 season. Size of bubble represents relative injury burden.

Figure 12. 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, 2021-22 and 2022-23 seasons, and for all seasons combined.

5 Premier 15s Training Injuries

5.1 Injury incidence rate

In the 2022-23 Premier 15s season there were 112 auditable training injuries that led to time-loss from training and/or match play. The analysis included 51057 total hours of training exposure, resulting in a training injury incidence rate of 2.19 injuries per 1000 training‐hours (95% CI: 1.8-2.6). On average, each team had ~1300 hours more training exposure compared to last season. This is likely the result of changes to the Premier 15s league schedule made to accommodate the Women’s Rugby World Cup, which meant the Premier 15s league fixtures did not start until Mid-November and allowed more time for Premier 15s team training.

The overall training injury incidence rate equated to approximately one time-loss training injury every 5 team-training sessions (assuming 2 h sessions involving 45 players), or 14 training injuries per team each season. The training incidence rate was above the expected range based on values observed in previous seasons (Figure 13). The increased rate of training injuries may be due to several factors, including i) improved reporting of training injuries in comparison to earlier WRISP seasons, ii) the impact of increased training exposure on fatigue and recovery, and iii) a greater consent capture for the WRISP project.

For comparison, the incidence rate in the men’s Premiership was 3.2 per 1000 training-hours during the 2022-23 season. The incidence of training injuries resulting in more than seven days of absence was 1.9 per 1000 training-hours (95% CI: 1.6 - 2.3). Despite their relatively low rate, training injuries still accounted for 45% 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. Trends in training injury risk will be closely monitored in future seasons.


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

Figure 13. 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 2022-23 Premier 15s season was 58 days, while the median was 23 days. This mean days absence value is within the expected range based on values observed in previous seasons (Figure 14). For comparison, the mean and median severity of training injuries in the men’s Premiership was 39 and 19 days during the 2022-23 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 127 days absence per 1000 hours. This burden value was above the expected range based on values observed in previous seasons (Figure 15), primarily due to the increased incidence rate.


\label{fig:fig14}Figure 14. Statistical Process Control (SPC) chart for Premier 15s training injury mean days absence. Green = Within expected variation | Red = Outside expected variation.

Figure 14. Statistical Process Control (SPC) chart for Premier 15s training injury mean days absence. Green = Within expected variation | Red = Outside expected variation.


\label{fig:fig15}Figure 15. Statistical Process Control (SPC) chart for Premier 15s training injury burden. Green = Within expected variation | Red = Outside expected variation.

Figure 15. 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 2022-23 season. ‘Rugby Skills - Controlled Contact - Drill based’ was the training format associated with the highest injury burden, followed by ‘Rugby Skills - Controlled Contact - Lineout work’, and ‘Rugby Skills - Non Contact - Skill based’.

5.4 Injury location

In training, 54% of injuries were to the lower limbs (Figure 16), with the largest burden attributed to the Knee (Table 6).

5.4.1 Body region

Figure 16. 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

Knee sprain/ligament injuries were associated with the highest overall burden, followed by Concussion and Hamstring muscle strain/rupture/cramps injuries (Table 7).

5.6 Concussion

In 2022-23, there were 24 training concussions, therefore 35% of all concussions occurred in training. The incidence of training concussion was 0.5 concussions per 1000 hours, which was within the expected range for previous WRISP data (Figure 17). The average severity of match concussions was also within the expected range for the last 3 seasons of WRISP data (Figure 18). Of the players who sustained a training concussion in 2022-23, 4% returned within 7 days, 67% within 8-28 days, 21% returned within 29-84 days and 8% had not returned within 84 days (Table 8).

\label{fig:fig17}Figure 17. Statistical Process Control (SPC) chart for Premier 15s training concussion incidence rate. Green = Within expected variation | Red = Outside expected variation. Note, the first three seasons of WRISP data were excluded when setting the control limits.

Figure 17. Statistical Process Control (SPC) chart for Premier 15s training concussion incidence rate. Green = Within expected variation | Red = Outside expected variation. Note, the first three seasons of WRISP data were excluded when setting the control limits.

\label{fig:fig18}Figure 18. Statistical Process Control (SPC) chart for Premier 15s training concussion mean days absent Green = Within expected variation | Red = Outside expected variation. Note, the first three seasons of WRISP data were excluded when setting the control limits.

Figure 18. Statistical Process Control (SPC) chart for Premier 15s training concussion mean days absent Green = Within expected variation | Red = Outside expected variation. Note, the first three seasons of WRISP data were excluded when setting the control limits.


Figure 19. Days absent for reported training concussions as a percentage for 2020-21 and 2021-22 seasons combined (red line) and 2022-23 (blue line).

6 England Match Injuries

The Red Roses competed at the Women’s Rugby World Cup in October/November 2022, and these data are included in the section below. The match exposure of the Red Roses was substantially higher than typical seasons as a result of competing in the Women’s Rugby World Cup. It should be noted that, as these data relate to just a single team, the findings are based on a relatively low number of injuries and will be subject to more uncertainty than the Premier 15s league-wide results.

6.1 Injury incidence rate

In the 2022-23 season there were 16 auditable match injuries during England women’s matches that led to time-loss from training and/or match play. The analysis included 260 total hours of match exposure, resulting in a match injury incidence rate of 62 injuries per 1000 match‐hours (95% CI: 38-100). This incidence rate is within the expected range based on values observed in previous seasons (Figure 20). 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 42.3 per 1000 match-hours (95% CI: 23.4-76.4).


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

Figure 20. 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 2022-23 season was 34 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 21). 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 2108 days absence per 1000 hours. This burden value is within the expected range based on values observed in previous seasons (Figure 21). This burden value equates to approximately 162 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 (2108 vs. 2376 days/1000 match-hours).


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

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

Figure 22. 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 23 shows the incidence and mean days missed for each specific match injury event for the 2022-23 season. ‘Tackled’ was the highest burden match event leading to injury.

Figure 23. Incidence and mean days missed of England match injuries by injury event. Size of bubble represents relative injury burden.

6.4 Injury location

Figure 24 provides the distribution of injuries across the four body regions. Overall, 69% of match injuries occurred to the lower limbs. The specific body locations associated with the highest injury burden were 1) Head and 2) Knee (Table 10).

6.4.1 Body region

Figure 24. 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. ‘Concussion’ injuries were the highest burden injury diagnosis (Table 11), though all diagnoses had a low absolute number of occurrences.

7 England Training Injuries

The Red Roses competed at the Women’s Rugby World Cup in October/November 2022, and these data are included in the section below. The training exposure of the Red Roses was substantially higher than typical seasons as a result of competing in the Women’s Rugby World Cup. It should be noted that, as these data relate to just a single team, the findings are based on a relatively low number of injuries and will be subject to more uncertainty than the Premier 15s league-wide results.

7.1 Injury incidence rate

In the 2022-23 season there were 24 auditable training injuries that led to time-loss from training and/or match play. The analysis included 4933 total hours of training exposure, resulting in a training injury incidence rate of 5 injuries per 1000 match‐hours (95% CI: 3-7). This incidence rate is within the expected range based on values observed in previous seasons (Figure 25). The incidence of training injuries resulting in more than seven days of absence was 3.6 per 1000 training-hours (95% CI: 2.3-5.8).


\label{fig:fig25}Figure 25. Statistical Process Control (SPC) chart for England Women's training injury incidence rate. Green = Within expected variation | Red = Outside expected variation.

Figure 25. 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 2022-23 season was 45 days, while the median was 15 days. This mean days absence value is within the expected range based on values observed in previous seasons (Figure 26). The majority of injuries resulted in 2-7 days of absence (Table 12). The overall burden of injury was 225 days absence per 1000 hours. This burden value is within the expected range based on values observed in previous seasons (Figure 27).


\label{fig:fig26}Figure 26. Statistical Process Control (SPC) chart for England Women's training injury mean days absence. Green = Within expected variation | Red = Outside expected variation.

Figure 26. Statistical Process Control (SPC) chart for England Women’s training injury mean days absence. Green = Within expected variation | Red = Outside expected variation.


\label{fig:fig27}Figure 27. Statistical Process Control (SPC) chart for England Women's training injury burden. Green = Within expected variation | Red = Outside expected variation.

Figure 27. 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 13 shows the incidence, mean days missed and burden attributed to each specific training injury event for the 2022-23 season. ‘Rugby Skills - Controlled Contact - Game based’ sessions were the training format associated with the highest injury burden.

7.4 Injury location

In training, a large majority (83%) of injuries were to the lower limbs (Figure 28), with Ankle injuries having the biggest burden (Table 14).

7.4.1 Body region

Figure 28. 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. Ankle tendon injury/rupture injuries had the highest injury burden, though all diagnoses had a low absolute number of occurrences.

8 WRISP Methods

Written informed consent was obtained from 99% of registered Premier 15s squad players for the 2022-23 season. A total of 150 team games were included in the analyses for the 2022-23 season. Injuries from consented first team squad players sustained in training and in 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 eight Premier 15 teams in 2022-23. One team did not provide training exposure data in 2022-23, and so this was estimated based on the mean value provided by the other seven 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 PRISP database are crosschecked with SCRM, the World Rugby HIA protocol and concussion management platform, 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.