Sports Med 2004; 34 (12): 849-859

INJURY CLINIC 0112-1642/04/0012-0849/$31.00/0

© 2004 Adis Data Information BV. All rights reserved.

Incidence of Injury in Junior and

Senior Rugby League Players
Tim J. Gabbett
Queensland Academy of Sport, Sunnybank, Queensland, Australia

Contents
Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 849
1. Description of Rugby League . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 850
2. Definition of Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 851
3. Injury Exposure and Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 851
4. Incidence of Match Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 851
4.1 Incidence of Severe Match Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 852
4.2 Site, Type and Cause of Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 853
4.3 Forwards versus Backs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 854
4.4 Time of Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 854
4.5 Seasonal Variations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 855
5. Incidence of Training Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 855
5.1 Incidence of Severe Training Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 855
5.2 Site, Type and Cause of Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 855
5.3 Forwards versus Backs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 856
5.4 Time of Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 856
5.5 Seasonal Variations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 856
6. Injury Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 856
7. Directions for Future Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 857
8. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 858

Abstract Rugby league is an international collision sport played at junior, amateur,

semi-professional and professional levels. Due to the high numbers of physical
collisions and tackles, musculoskeletal injuries are common. A large percentage
of injuries result in long-term employment and study limitations, medical costs
and loss of income. Review articles addressing the applied physiology of rugby
league and common rugby league injuries have been published. However, both of
these review articles have focused on the professional rugby league player. This
review addresses the extent of the injury problem in rugby league in all levels of
competition (i.e. junior, amateur, semi-professional and professional).
The incidence of rugby league injuries typically increases as the playing level
is increased. The majority of studies have shown that the head and neck is the most
common site of match injuries in senior rugby league players, while knee injuries
are the most common site of injury in junior rugby league players. Muscular
injuries are the most common type of injury sustained by senior rugby league
players, while junior rugby league players more commonly sustain fractures.
Injuries are most commonly sustained in tackles, by the tackled player. Thigh and
850 Gabbett

calf strains are the most common injuries sustained during rugby league training,
while overexertion is the most common cause of training injuries. Player fatigue
may influence the incidence of injury, with most sub-elite (amateur and
semi-professional) rugby league injuries occurring in the second half of matches
or the latter stages of training sessions. The majority of training injuries occur in
the early stages of the season, while match injuries occur in the latter stages of the
season, suggesting that changes in training and playing intensity may influence
the incidence of injury in rugby league.
Injury prevention studies are required to reduce the incidence, severity and cost
of rugby league injuries. These injury prevention strategies could include coach-
ing on defensive skills, correct tackling technique, correct falling technique and
methods to minimise the absorption of impact forces in tackles. Game-specific
attacking and defensive drills practised before and during fatigue may also
encourage players to make appropriate decisions under fatigued conditions and
apply learnt skills during the pressure of competitive matches. Further studies
investigating risk factors for injury in junior and senior rugby league players,
injuries sustained by specific playing positions and the influence of injuries on
playing performance are warranted.

Rugby league is an international collision sport
played at junior, amateur, semi-professional and
professional levels. The game is played over two 30-
to 40-minute halves (depending on the level of com-
petition) separated by a 10-minute rest interval.
Players compete in a challenging contest involving
frequent bouts of high-intensity activity (e.g. run-
ning and passing, sprinting, tackling) separated by
short bouts of low-intensity activity (e.g. walking,
jogging). The physiological demands of rugby
league are complex, requiring players to have highly
developed speed, agility, muscular strength and
power, and maximal aerobic power.
1. Description of Rugby League
A rugby league team consists of 13 players, with
junior and amateur rugby league matches typically
played under an unlimited interchange rule, whereas
professional rugby league teams are permitted a
maximum of 12 interchange movements during the
course of a match. Each team is allowed six tackles
with the ball. The objective is to advance the ball
down the field into the opposition’s territory and
score a try (touch down).[1,2] The ball must be passed
backwards, but can be carried or kicked into the
opposition’s territory.[2] At the completion of each
set of six tackles, the ball is immediately given to the
opposition team to commence its set of six tackles.[1]
Therefore, the same players are involved in both
attack and defence.
The two major playing groups within a rugby
league team are the forwards (prop, hooker, second-
row and lock) and backs (halfback, five-eighth, cen-
tre, wing and fullback). The demands placed on
players vary according to the specific position
played.[3-5] Forwards are predominantly involved in
large numbers of physical collisions and tackles
while backs spend more time in free running. Due to
the high intensity of the game and the large number
of physical collisions and tackles, musculoskeletal
injuries are common.
Review articles addressing the applied physiolo-
gy of rugby league[6] and common rugby league
injuries[7] have been published. However, both of
these review articles have focused on the profession-
al rugby league player. To date, no attempt has been
made to address the extent of the injury problem in
all levels of competition (i.e. junior, amateur, semi-
professional and professional rugby league). Due to
differences in fitness and skill, the circumstances
surrounding injuries in junior, amateur, semi-profes-
sional and professional rugby league are quite dif-

© 2004 Adis Data Information BV. All rights reserved. Sports Med 2004; 34 (12)
Incidence of Injury in Rugby League Players
Table I. Injury exposure and the calculation of injury rates
Injuries Matches
Team A 25 40
Team B 25 20
a Injury exposure calculated based on a match duration of 80 minutes (1.33 hours). Incidence of injury expressed as the number of
injuries per 1000 player-position game hours.
ferent. With this in mind, the purpose of this review
is to summarise the site, nature, cause and severity
of training and match injuries in junior, amateur,
semi-professional and professional rugby league
players. The time of injury, seasonal variations and
position of injured players will also be discussed.
Finally, injury prevention strategies and directions
for future research will also be provided.
2. Definition of Injury
Rugby league injury surveillance studies have
used many different definitions of injury, making
comparisons amongst studies difficult. While some
studies record an injury as any pain or disability
sustained by a player during a match[8,9] or training
session[10] (i.e. all injury events), other studies have
defined injuries in terms of subsequent missed
matches.[1,11] All injuries have the potential to im-
pact on playing performance,[12] so some rugby
league researchers have recently recorded all injury
events and then classified injuries according to
matches missed as a result of injury.[13,14] Minor
injuries cause a player to miss one match, moderate
injuries cause a player to miss two to four matches,
while major injuries cause the player to miss five or
more matches.[1] For the purpose of this review,
comparisons are made between studies that defined
injuries as: (i) any pain or disability sustained by a
player during a match or training session (i.e. all
injury events); and (ii) any injury that occurred
during a match or training session that caused the
player to miss subsequent matches.
3. Injury Exposure and Incidence
The number of injuries sustained by a playing
population is often not sufficient to define the true
extent of the injury problem. In order to obtain a
valid estimate of the injury rates experienced in
© 2004 Adis Data Information BV. All rights reserved.
851
Injury exposurea Incidence of injury
691.6 36.2
345.8 72.3
rugby league, the number of hours that players are
exposed to an injury must also be considered. For
example, the number of injuries sustained by two
teams during the course of a rugby league season is
shown in table I. Team A and team B may sustain 25
injuries each during the course of the season. Simply
counting injuries would suggest that the injury rates
are identical between the two teams. However, when
exposure is considered, it can be seen that team A
played 40 matches during the season, while team B
played 20 matches. The exposure to injury is 2-fold
higher in team A, resulting in a lower calculated
injury rate.
Injuries can be expressed as the number of inju-
ries per match, the number of injuries per minutes of
play or the number of injuries per playing appear-
ances.[15,16] Injury rates (or incidence) are most com-
monly reported per 1000 player position game
hours. To calculate player position game hours, one
multiplies the number of matches, the number of
players on the field at a given time and the match
duration (in hours). For example, a season consist-
ing of 20 matches, each lasting 80 minutes in dura-
tion would provide a match injury exposure of 691.6
player position game hours (i.e. 20 matches × 13
players × 2 teams × 1.33 hours). The failure to
record exposure hours represents a weakness in
many rugby league injury surveillance studies.[15]
4. Incidence of Match Injuries
Several studies have documented the incidence
of match injuries in rugby league,[1,8,9,11,13,14,16-27]
with injury rates typically increasing as the playing
level is increased (table II). A 3-year prospective
study of all injuries sustained by amateur rugby
league players reported an overall incidence of inju-
ry of 160.6 per 1000 player-position game hours.[9]
The incidence of injury in professional rugby league
players has been reported to be as high as 214,[18]
Sports Med 2004; 34 (12)
852 Gabbett

Table II. Incidence of match injuries in senior rugby league players 4.1 Incidence of Severe Match Injuries
Study Playing level Incidence of injurya
all missed The incidence of junior rugby league injuries
injuries matches
resulting in missed matches is 1.4–28.0 per 1000
Estell et al.[18] Professional 210.7 38.5
player-position game hours (table III).[18,26] More-
Gibbs[1] Professional 44.9
Gissane et al.[2] Professional 40.3
over, the injury rates of pre-pubertal, peri-pubertal
Gissane et al.[16] Professional 174.4
and post-pubertal rugby league players have been
Gissane et al.[20] Professional 114.3 34.0 shown to progressively increase as the playing level
Gissane et al.[25] Professional 50.3 is increased.[26] The increased injury rate with in-
Hodgson Phillips et al.[13] Professional 346 52.3 creasing age has been associated with an increase in
Seward et al.[19] Professional 139 44.0 speed and body mass,[28] and greater impact forces
Stephenson et al.[8] Professional 114.3 34.0 between players.[26] The incidence of amateur rugby
Walker[21] Professional 58.4 league injuries resulting in missed matches is 26.8
Gabbett[14] Semi- 824.7 67.7 per 1000 player-position game hours.[11] Profession-
professional
Gabbett[9] Amateur 160.6
al rugby league is associated with a higher incidence
Gabbett[11] Amateur 26.8 of injury, resulting in 34–52.3 injuries per 1000
a Incidence of injury expressed as the number of injuries per player-position game hours.[1,2,13,16,18,19] The inci-
1000 player-position game hours. dence of semi-professional rugby league injuries
resulting in missed matches is reported to be as high
278[23] and 346[13] injuries per 1000 player-position as 67.7 per 1000 player-position game hours.[14] The
greater access to specialised medical staff and the
game hours. The 1.3- to 2.2-fold higher injury rates
greater pressure to return to sport following injury,
in professional rugby league players has been attrib- may explain the lower incidence of injury in profes-
uted to a higher playing intensity at the elite lev- sional players compared with semi-professional
el.[1,8,16] Despite the higher playing intensity in pro- players.[14] Approximately 15.6–30.0% of rugby
fessional rugby league players, the incidence of league injuries are major, resulting in five or more
injury in semi-professional rugby league players has Table III. Incidence of match injuries in junior rugby league players
been reported to be as high as 824.7 per 1000 player- Study Playing level Incidence of injurya
position game hours.[14] A combination of high fit- all missed
injuries matches
ness and moderate skill levels are thought to contrib-
Estell et al.[18] Elite under 19 405.6 28.0
ute to the higher match injury rates of semi-profes- Elite under 17 343.2 17.8
sional rugby league players compared with amateur Elite under 15 197.8 11.0

(low fitness/low skill) and professional (high fit- Raftery et al.[26] Sub-elite under 17 15.6
Sub-elite under 16 13.5
ness/high skill) players. Progressive increases in the Sub-elite under 15 17.1
incidence of injury have been reported over consec- Sub-elite under 14 16.3
utive seasons in amateur,[9] semi-professional[14] and Sub-elite under 13 11.4
Sub-elite under 12 13.0
professional[13] rugby league players. Hodgson Phil-
Sub-elite under 11 6.0
lips et al.[13] also reported a further increase in match Sub-elite under 10 6.2
injury rates when players were given an insufficient Sub-elite under 9 6.0

off-season to recover from injuries. These findings Sub-elite under 8 1.4

Sub-elite under 7 1.7
suggest that pre-existing injury and player fatigue Sub-elite under 6 3.4
may contribute to match injuries in rugby league a Incidence of injury expressed as the number of injuries per
1000 player-position game hours.
players.

© 2004 Adis Data Information BV. All rights reserved. Sports Med 2004; 34 (12)
Incidence of Injury in Rugby League Players 853

Table IV. Most common site, type and cause of match injuries in junior and senior rugby league players
Study Playing level Site of injury Type of injury Cause of injury
Alexander et al.[23] Professional Head and neck Haematomas and strains
Alexander et al.[24] Professional Head and neck Contusions
Gibbs[1] Professional Knee Ligament and joint
Gissane et al.[2] Professional Lower limb
Gissane et al.[16] Professional Head and neck Haematomas and strains Being tackled
Gissane et al.[20] Professional Head and neck Haematomas and strains Being tackled
Gissane et al.[25] Professional Head and neck, knee and shoulder Joint sprains Being tackled
Hodgson Phillips et al.[13] Professional Knee Haematomas and strains
Seward et al.[19] Professional Head and neck Lacerations and contusions
Stephenson et al.[8] Professional Head and neck Haematomas and strains Being tackled
Gabbett[14] Semi-professional Thigh and calf Haematomas and strains Being tackled
Gabbett[9] Amateur Head and neck Haematomas and strains
Gabbett[11] Amateur Arm and hand Joint sprains While tackling
Raftery et al.[26] Junior Knee Fractures Being tackled

missed matches.[1,11,13,14] These results demonstrate
that the incidence of match injuries in rugby league
players is alarmingly high and that a considerable
number of injuries are severe, resulting in a signifi-
cant loss of playing time.
Rugby league injuries are also associated with
significant long-term job limitations, medical costs
and loss of income.[11,29] Gabbett[11] reported that the
respective median direct (e.g. medical expenses)
and indirect (e.g. wages lost) costs associated with
amateur rugby league injuries were £28.29 and
£77.04 per playing injury (2000 values), with
55–80% of players reporting medical costs, job limi-
tations or loss of income as a result of the injury.
Meir et al.[29] reported that 4–6% of retired profes-
sional rugby league players experienced long-term
job limitations, medical costs and loss of income as
a result of injuries sustained while playing. Collec-
tively, these findings demonstrate that rugby league
injuries are associated with significant immediate
and long-term consequences and economic costs.
4.2 Site, Type and Cause of Injury
Although early rugby league studies identified
the knee as the major site of injury,[1] the majority of
recent studies have reported that head and neck
injuries are most commonly sustained by rugby
league players (table IV).[8,9,16,19,20,24] Gabbett[9] re-
ported that injuries to the head and neck accounted
for 25.3% of all amateur rugby league injuries.
Facial (13.3%), abdomen and thorax (13.3%), and
knee injuries (11.1%) were less common sites of
injury for amateur rugby league players. Alexander
et al.[24] and Stephenson et al.[8] found that 28.8%
and 33.3%, respectively, of all professional rugby
league injuries were to the head and neck. The thigh
and calf (17.9%), knee (10.2%), and thorax and
abdomen (9.2%) are less common sites of injury for
professional rugby league players.[8] Although the
majority of injuries sustained in rugby league are
head and neck injuries, the thigh and calf is the most
common site of injury in semi-professional players,
with only 10.0% of injuries reported to be to the
head and neck.[14] Raftery et al.[26] also reported that
the majority of junior rugby league injuries were to
the lower limb (knee 13.9%; ankle 13.1%), while
head and neck injuries were less common (10.7%).
Variations in playing styles, defensive strategies or
coaching philosophies may explain the different
sites of injury at the different levels of competition.
Raftery et al.[26] reported that fractures were the
most common type of injury sustained by junior
rugby league players aged 6–17 years. However, the
majority of senior rugby league studies have shown
that the most common type of injuries sustained
during rugby league matches are haematomas and
strains.[8,9,13,14,16,20-23] In a 3-year study of amateur
rugby league injuries, it was shown that 28.5% of all

© 2004 Adis Data Information BV. All rights reserved. Sports Med 2004; 34 (12)
854
injuries were muscular injuries (haematomas and
strains).[9] Haematomas and strains account for
32.9% and 32.3% of semi-professional[14] and pro-
fessional[16] rugby league injuries, respectively.
Contusions,[19,24] lacerations[19] and joint inju-
ries[11,21,22,25,26] are also common types of injuries
sustained by rugby league players, with severe joint
injuries most commonly responsible for players
missing matches.[1,11,22,25]
The majority of injury surveillance studies have
identified the tackle as the major cause of rugby
league injuries.[8,11,14,16,20,26] Indeed, 46.3–91.0% of
injuries have been shown to occur in tack-
les.[8,11,14,20,26] These findings are to be expected
given that players are involved in an average of 41
physical collisions per match.[30] In a 4-year pro-
spective study of one professional rugby league
club, it was shown that 46.3% of injuries were
sustained by the tackled player, 21.3% of injuries
were sustained by the tackling player and 32.4% of
injuries occurred in other undefined activities.[8,20]
Amateur rugby league injury studies have also iden-
tified the tackle as the major cause of injury; howev-
er, unlike professional rugby league, injuries are
most commonly sustained by the tackling player
(35.7%), with injuries to the tackled player being
less common (25.0%).[11] The finding of high tackle
injury rates in amateur and professional rugby
league has been confirmed by semi-professional
rugby league injury studies.[14] Gabbett[14] demon-
strated that 46.3% of injuries occurred in tackles,
with 19.5% sustained by tackling players and 26.8%
sustained by the tackled player. In addition, injuries
were also identified to have occurred through over-
exertion (7.8%), overuse (1.8%), collisions with op-
posing players and/or fixed objects (15.5%), falling
and stumbling (5.5%), and slipping and tripping
(0.3%). Raftery et al.[26] reported that 51.0% of
junior rugby league injuries were sustained by the
tackled player, while 40.0% were sustained by the
tackling player.
4.3 Forwards versus Backs
Forwards have higher tackling injury rates than
backs (both being tackled and while tack-
© 2004 Adis Data Information BV. All rights reserved.
Gabbett
ling),[14,16,20] which most likely reflects their greater
involvement in tackles and physical colli-
sions.[8,29,31-33] Indeed, most[8,9,14,16,20] but not all[2,25]
studies have shown higher match injury rates in
forwards than backs. In a 4-year study of profession-
al rugby league players, Gissane et al.[20] reported
that forwards sustained 56.3% and backs 43.7% of
all match injuries. Similar findings have been re-
ported for amateur (52.4% vs 47.6%) and semi-
professional (58.0% vs 42.0%) rugby league play-
ers, respectively.[9,14] These findings are to be ex-
pected given that amateur rugby league forwards
and backs average 32 and 19 physical confrontations
(tackles and being tackled) per match, respective-
ly.[32] A similar distribution of physical confronta-
tions has been reported for professional rugby
league forwards (36–55 per match) and backs
(19–29 per match).[30,33] Studies showing higher in-
jury rates in backs have attributed this phenomenon
to a greater match involvement by backs and a
reduction in the amount of physical contact by the
forwards.[25]
In addition to having overall higher injury rates,
amateur forwards have been shown to have higher
rates of head and neck, facial and knee injuries than
backs.[9] These findings have been confirmed by
professional rugby league studies that have shown
higher injury rates in forwards than backs for all
injury sites except the ankle and ‘others’ catego-
ries.[20] To date, no study has compared the injury
rates of junior rugby league forwards and backs.
4.4 Time of Injury
Over 70% of amateur rugby league injuries occur
in the second half of matches, suggesting that fa-
tigue contributes to injuries in amateur rugby league
players.[9] Conversely, comparatively fewer (38.5%)
injuries are sustained by semi-professional players
in the second half of matches.[14] These findings are
to be expected given the poor aerobic fitness of
amateur players compared with semi-professional
players.[34,35] The lower second-half injury rates of
semi-professional players highlights the importance
of aerobic fitness in preventing fatigue-related inju-
ries in rugby league. Professional rugby league inju-
Sports Med 2004; 34 (12)
Incidence of Injury in Rugby League Players
ry studies have found that second-half injuries are
similar[19] or only slightly greater than[22] first-half
injuries. No study has reported injury occurrence in
relation to the time of play (i.e. first half or second
half) in junior rugby league players.
4.5 Seasonal Variations
Recent evidence from amateur rugby league
studies has demonstrated that the majority of match
injuries occur in the latter half of the season.[9] In
addition, a progressive increase in match injuries
occurs from the beginning to the end of the season.
These findings have been attributed to fatigue and/or
accumulative microtrauma;[9] however, others have
suggested that environmental conditions and ground
hardness[36] may play a more important role in the
late season increase in injury rates. Semi-profession-
al rugby league injury studies have also demonstrat-
ed a progressive increase in injury rates during the
course of a season, with injury rates peaking in the
latter half of the season.[14] The finding of high
match injury rates towards the end of the competi-
tive season in semi-professional rugby league play-
ers has been attributed to increases in playing inten-
sity as the ‘finals’ series approaches.[14] These find-
ings have been supported by Gabbett[37] who found a
significant correlation (r = 0.74) between match
injury rates and match intensity in semi-professional
rugby league players. Hodgson Phillips et al.[13] and
Alexander et al.[24] reported that more injuries oc-
curred towards the end of the competitive season in
professional rugby league players, while Seward et
al.[19] and Gissane et al.[16] reported more injuries in
the early stages of the season in professional rugby
league players. No study has documented the sea-
sonal variations in injury rates of junior rugby
league players.
Table V. Incidence of training injuries in rugby league players
Study Playing level
Hodgson Phillips et al.[13] Professional
Gabbett[10] Semi-professional
Gabbett[14] Semi-professional
a Incidence of injury expressed as the number of injuries per 1000 training hours.
© 2004 Adis Data Information BV. All rights reserved.
855
5. Incidence of Training Injuries
Although several studies have documented the
incidence of match injuries in rugby league, few
have reported the incidence of rugby league training
injuries.[10,13,14,16] Of the studies that have been pub-
lished, training injury rates have been shown to be
considerably lower than match injury rates.[13,14]
When all injuries are considered, the incidence of
training injuries in semi-professional rugby league
players is 26.9–45.3 per 1000 training hours.[10,14]
Training injury rates have been shown to be lower in
professional rugby league players (12.2 per 1000
training hours), perhaps reflecting greater access to
specialised medical support staff (table V).[13]
5.1 Incidence of Severe Training Injuries
Training injuries resulting in missed matches are
uncommon. Over a 2-year period, the incidence of
semi-professional training injuries resulting in a
subsequent missed match was reported to be 1 injury
per 1000 training hours.[14] Professional rugby
league training injuries resulting in missed matches
has also been shown to be low (1.4 injuries per 1000
training hours).[13] No study has documented the
incidence and severity of training injuries in junior
or amateur rugby league players.
5.2 Site, Type and Cause of Injury
Of the few studies that have documented the
incidence of training injuries, the thigh and calf has
been the most common site of injury (table VI).[10,14]
Indeed, the majority (72.1%) of training injuries are
sustained to the lower limb (thigh and calf, knee, and
ankle and foot).[10] Muscular strains are the most
common type of training injury while joint injuries
and contusions are less common.[10,14] Overuse and
overexertion are the major causes of injury.[14] Rug-
Incidence of injurya
all injuries missed matches/training
12.2 1.4
26.9 9.0
45.3 1.0
Sports Med 2004; 34 (12)
856
Table VI. Most common site, type and cause of training injuries in rugby league players
Study Playing level Site of injury
Gissane et al.[16] Professional Thigh and calf
Gabbett[10] Semi-professional Thigh and calf
Gabbett[14] Semi-professional Thigh and calf
by league players require the ability to accelerate,
decelerate and change direction.[38] The higher train-
ing injury rates for joint injuries and muscular
strains, coupled with the high incidence of overexer-
tion injuries, may therefore reflect an increased em-
phasis on game-specific speed, power and agility
conditioning drills.
5.3 Forwards versus Backs
The incidence of training injuries is higher in
forwards than backs. In a 2-year study of semi-
professional rugby league injuries, it was shown that
forwards had a significantly higher incidence of
training injuries than backs (52.7 per 1000 training
hours vs 38.0 per 1000 training hours).[14] Forwards
had higher rates of head and neck, shoulder, thigh
and calf, knee, and ankle and foot injuries than
backs, and more commonly sustained muscular
strains and overuse injuries.[10,14] The higher inci-
dence of training injuries in forwards most likely
reflects a progression towards increased training
specificity to maximise training adaptations and ca-
ter for the specific skills and physiological demands
of different playing positions.
5.4 Time of Injury
The majority (55.3%) of training injuries occur in
the latter stages of the training session.[14] Rugby
league teams often integrate skills and conditioning
sessions in order to facilitate the development of
skills under fatigued conditions.[35] The finding of
higher injury rates in the latter stages of training
sessions suggests that fatigue may contribute to rug-
by league training injuries.[14]
5.5 Seasonal Variations
Recent evidence from semi-professional players
has shown that the majority of rugby league training
injuries occur in the early stages of the season.[14,37]
© 2004 Adis Data Information BV. All rights reserved.
Gabbett
Type of injury Cause of injury
Joint sprains
Muscular strains
Muscular strains Overexertion
The early season incidence of injury of 116.1 per
1000 training hours is 2.6-fold higher than the sea-
sonal average injury rate (45.3 per 1000).[14] These
findings are to be expected given that training loads
are greatest during the early stages of the season.[37]
Indeed, training injury rates have been shown to be
significantly correlated (r = 0.86) with increases in
training loads, suggesting that the harder rugby
league players train, the more injuries they will
sustain.[37] However, while training injury rates are
highest in the early stages of the season for semi-
professional rugby league players, similar injury
patterns have not been observed in professional rug-
by league players.[13,16]
6. Injury Prevention
The majority of rugby league studies have identi-
fied ‘being tackled’ as the most common cause of
rugby league match injuries.[8,14,16,20,26] In addition,
factors relating to the tackle (e.g. poor tackling
technique and player collisions) have also been
shown to contribute to rugby league injuries.[11]
These findings suggest that injury prevention strate-
gies designed to minimise tackling injuries will re-
duce the overall incidence of injury in rugby league.
Injury prevention strategies that address defensive
skills,[11] correct tackling technique,[11] correct fall-
ing technique[26] and methods to minimise the ab-
sorption of impact forces in tackles[11] may reduce
the incidence and severity of tackling injuries.
The majority of amateur rugby league injuries
have been shown to occur in the second half of
matches, suggesting that fatigue contributes to inju-
ries in amateur rugby league players.[9] The poor
aerobic fitness of amateur rugby league players may
explain, at least in part, the high occurrence of
fatigue-related injuries in these players.[34] Identifi-
cation of additional factors that contribute to fatigue
in rugby league players may prevent the onset of
Sports Med 2004; 34 (12)
Incidence of Injury in Rugby League Players
fatigue in these individuals. Additionally, it is also
likely that fatigue reduces the skill and decision-
making ability of players. If fatigue compromises
skill and decision-making ability and contributes to
injuries, it may be possible to train skill and deci-
sion-making ability under fatigued conditions to
reduce the incidence of fatigue-related injuries in
rugby league. Game-specific attacking and defen-
sive drills practised before and during fatigue may
encourage players to make appropriate decisions
under fatigued conditions and apply learnt skills
during the pressure of competitive matches.
The majority of rugby league training injuries
occur in the pre-season preparation period when
training loads are greatest.[37] Moreover, increases in
training loads are significantly correlated (r = 0.86)
with increases in training injury rates.[37] These find-
ings suggest that the harder rugby league players
train, the more injuries they will sustain. Reductions
in training loads may reduce training injury rates in
rugby league players. The obvious challenge for
rugby league conditioning coaches is to develop
training programmes that provide an adequate train-
ing stimulus to enhance physical fitness, without
unduly increasing the incidence of training inju-
ries.[37]
7. Directions for Future Research
The implementation and evaluation of effective
injury prevention strategies is dependent on the
identification of injury risk factors.[39] While player
fatigue and playing intensity have been suggested to
contribute to rugby league injuries, no study has
confirmed if physical fitness is a risk factor for
injury in rugby league players. In addition, no study
has investigated the relationship between injury and
other risk factors (e.g. players’ physique, skill
levels, attitudes towards violence and foul play, and
environmental conditions) in rugby league players.
Further studies investigating risk factors for injury
in junior and senior rugby league players are re-
quired.
Few studies have investigated the injury rates of
junior rugby league players.[18,26] In addition, the
incidence of junior rugby league training injuries
© 2004 Adis Data Information BV. All rights reserved.
857
has not been documented. Further studies docu-
menting the seasonal variations in training and
match injury rates, and the influence of fatigue on
injuries in junior rugby league players are war-
ranted. In addition, studies evaluating the success of
junior rugby league injury prevention strategies (e.g.
improved coaching techniques) are clearly required.
Most studies have shown higher match injury
rates in forwards than backs.[8,9,14,20] These findings
have been attributed to the high number of physical
collisions and tackles experienced by forwards dur-
ing a match. However, while forwards have been
shown to have higher injury rates than backs, rela-
tively little has been documented on the injury rates
of specific playing positions.[16] Given that rugby
league players are subjected to different physical
and physiological demands depending on the posi-
tion played,[4] the site, nature and cause of injuries
sustained during the course of a rugby league match
may also vary according to playing position. An
understanding of the site, nature and cause of inju-
ries sustained by specific playing positions would
facilitate the development of effective injury pre-
vention strategies.[39] In addition, the use of video
analysis to identify the mechanisms of injury may
also assist reduce the incidence of injury in rugby
league.
While the health and financial costs associated
with rugby league injuries are well document-
ed,[11,29] the influence of injuries on playing per-
formance is unclear. Transient injuries sustained
during the course of a rugby league match may
result in compromised technique and reductions in
skill. In addition, severe injury that results in lost
playing time may lead to reduced cohesion with
replacement players and subsequent reductions in
team performance. Although all injuries have the
potential to impact on sporting performance,[12] to
date, no study has determined whether injuries influ-
ence playing performance in rugby league. Studies
documenting the influence of injuries on playing
performance are clearly required.
Finally, while the injury rates of rugby league
players have been documented,
most[1,8,10,13,14,16-18,20,21,23-25] but not all[9,11,19,22] rugby
Sports Med 2004; 34 (12)
858
league studies have investigated the incidence of
injury in single teams and clubs. Gissane et al.[2]
performed a pooled data analysis of injuries sus-
tained by professional rugby league players to pro-
vide more accurate estimates of injury incidence at
the elite level. Similar studies could be performed at
junior, amateur and semi-professional levels. Alter-
natively, future rugby league injury surveillance
studies could employ larger sample sizes (i.e. all
teams in a competition) to provide more accurate
estimates of injury rates and improve the general-
isability of injury prevention strategies.[2]
8. Conclusions
This review has addressed the extent of the injury
problem in rugby league in all levels of competition
(i.e. junior, amateur, semi-professional and profes-
sional). The incidence of rugby league injuries typi-
cally increases as the playing level is increased. The
majority of studies have shown that the head and
neck is the most common site of match injuries in
senior rugby league players, while knee injuries are
the most common site of injury in junior rugby
league players. Muscular injuries are the most com-
mon type of injury sustained by senior rugby league
players, while junior rugby league players more
commonly sustain fractures. Injuries are most com-
monly sustained in tackles, by the tackled player.
Thigh and calf strains are the most common injuries
sustained during rugby league training, while over-
exertion is the most common cause of training inju-
ries. Player fatigue may influence the incidence of
injury, with most sub-elite (amateur and semi-pro-
fessional) rugby league injuries occurring in the
second half of matches or the latter stages of training
sessions. The majority of training injuries occur in
the early stages of the season, while match injuries
occur in the latter stages of the season, suggesting
that changes in training and playing intensity may
influence the incidence of injury in rugby league.
Further research is required to identify risk factors
for injury in rugby league and to determine the
influence of injuries on the playing performance of
rugby league players.
© 2004 Adis Data Information BV. All rights reserved.
Gabbett
Acknowledgements
No sources of funding were used to assist in the prepara-
tion of this review. The author has no conflicts of interest that
are directly relevant to the content of this review.
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Correspondence and offprints: Dr Tim J. Gabbett, Queen-
sland Academy of Sport, PO Box 956, Sunnybank, QLD
4109, Australia.
E-mail: tim.gabbett@qld.gov.au
Sports Med 2004; 34 (12)