Promoting players’ safety and welfare through the sharing of scientific knowledge with sports agents: the new reality of Portuguese rugby sevens

As the authors of the recently published article ‘Epidemiology of injuries in senior male rugby union sevens: a systematic review’ [1], we would like to share with you its impact on the Portuguese rugby community and our achievements since then. As we stated in the article, we believe that the medical staff and all other agents (athletes, coaches, and researchers) must work together aiming at creating a safer environment in a sport with such a high injury incidence rate. We also reported that few data were available regarding injuries in non-elite rugby sevens and that more studies were needed in order to broad current knowledge. Following the publication of our article, we were granted the support from the board and the medical department of the Portuguese Rugby Union to hold a Medical Conference to present our research on rugby sports medicine, which took place in Portugal on the 10th of June 2017 [2. ] In this scientific event, we were able to sit in the same stage athletes, coaches, directors, physiotherapists, doctors, and researchers from different parts of the country with the single purpose of debating the need to focus on the epidemiology of sevens injuries and the pathways to a deeper knowledge and mitigation of the problem. During the meeting two relevant pieces of data were presented, followed by a rich discussion: the systematic review that we have published in The Physician and Sports Medicine; a set of data collected in the 2015/16 season of the Portuguese National Rugby Sevens Championship by the same authors that we expect to publish in detail soon. Although data from the systematic review had already been published, it still made a significant impact on the delegates, especially on the members of the Rugby Union that agreed on the need of further studies and research. The data from the study conducted during the national championship, which revealed an overall injury incidence rate of 133.9 injuries per 1000 player match-hours caused a significant concern and long discussion. These figures are much higher than those reported by López et al. [3] for amateur rugby competitions, but more surprising, are higher than those reported for international elite sevens [1]. A deeper analysis of the data allowed the authors to present the ‘Portuguese paradox,’ where the injury incidence rate for the group of athletes playing in the lower division was higher (197) than of those in the top division (118 injuries per 1000 player match-hours), unlike what was previously reported for sevens and fifteens Rugby. However, injury severity was inversely related, with top-tier athlete’s average severity being similar to those at elite level (28 days per injury) unlike the injuries of bottomtier athletes (8.63 days). No other relevant differences were found in our data compared to the literature. We tried to deepen our analysis by collecting data regarding competition formats, athlete’s experience, age, height, weight, training load, and warm-up and to relate it to the occurrence of injuries in those athletes. The bottom-tier was contested by seven teams playing in a single 1-day event, 6 weeks after the end of the fifteens season. A direct association between the occurrence of injuries and the decrease in the volume of training (especially resistance training) was identified, as well as an inverse relation between the number of training hours during the sevens season and the severity of injuries. In the top-tier, contested by eight teams in three consecutive weekly 1-day tournaments (four games played in a day), the opposite relation regarding training loads and injuries was identified: a higher training volume during the sevens season was associated with a higher occurrence of injuries. Players who trained sevens and fifteens simultaneously during the year presented a significant increase in the risk of injury. Based on our findings, we presented a number of suggestions of changes to the competition formats and relevance of rugby sevens season in the Portuguese setting, which included: 1 – avoid the decrease of training volume during the sevens season, and increase the focus on individual preparation of athletes; 2 – highlight the relevance of rugby sevens to the sport and its promotion by increasing the duration of the season and the number of tournaments; 3 – implement bye weeks during the season to allow players’ recovery; 4 – increase the duration of the tournaments from 1–2 days, as