Aims and objectives: To investigate the epidemiology, risk factors, and preventive strategies for serious head and spinal injuries related to rugby league and union football in New South Wales (NSW). Methods: The three main components of this study included. 1. A retrospective analysis of clinical and compensation case file records during the 16-year period, 1984-1999. 2. A review of game rules, weights and heights of players, over the past 100 years. 3. A review of film and video footage of rugby football games spanning most of the 20th century. A method was developed to allow valid comparisons in style of play over a 70-year period. Results: The estimated annual incidence rate of SCI for rugby league players was 1.9 (95%CI 1.3 - 2.8) per 100,000 estimated players per year, and 3.3 (95%CI 2.2 - 4.8) per 100,000 estimated rugby union players per year over the study period 1984 to 1999. There was no significant change in the incidence of rugby league related serious spinal cord injuries (1984-1999), fatalities (1984-1999) or serious head injuries (1984-1999). There was a small but significant decline in rugby union related serious spinal cord injuries (1984-1999, P<0.05). However, the relative risk of spinal cord injury was 1.34 times greater for rugby union compared to rugby league over the entire study period (95%CI 1.01 - 1.67, P<0.05). For rugby football, the evidence suggested that the force of impact between participants was a key causal risk factor for serious injury. Elite rugby league and union players from 1999-2000 teams were significantly heavier (P<0.05) and taller (P<0.05) than players pre 1950. Players in modern elite games post 1989 were more likely to be tackled by multiple opponents (P = 0.000), tackled head on (P<0.05), at chest level (P<0.05) and at greater speeds than their earlier counterparts pre 1958. However, modern players appear to be no more aggressive or perpetrate greater foul play than their predecessors. Conclusions: There was a continued annual occurrence of catastrophically serious injuries leading to permanent brain damage and quadriplegia associated with rugby league and union in NSW. The critical risk factors found to be associated with serious injury in rugby football suggest relatively novel approaches to the development of preventive strategies.

Aims and objectives: To investigate the epidemiology, risk factors, and preventive strategies for serious head and spinal injuries related to rugby league and union football in New South Wales (NSW). Methods: The three main components of this study included. 1. A retrospective analysis of clinical and compensation case file records during the 16-year period, 1984-1999. 2. A review of game rules, weights and heights of players, over the past 100 years. 3. A review of film and video footage of rugby football games spanning most of the 20th century. A method was developed to allow valid comparisons in style of play over a 70-year period. Results: The estimated annual incidence rate of SCI for rugby league players was 1.9 (95%CI 1.3 - 2.8) per 100,000 estimated players per year, and 3.3 (95%CI 2.2 - 4.8) per 100,000 estimated rugby union players per year over the study period 1984 to 1999. There was no significant change in the incidence of rugby league related serious spinal cord injuries (1984-1999), fatalities (1984-1999) or serious head injuries (1984-1999). There was a small but significant decline in rugby union related serious spinal cord injuries (1984-1999, P<0.05). However, the relative risk of spinal cord injury was 1.34 times greater for rugby union compared to rugby league over the entire study period (95%CI 1.01 - 1.67, P<0.05). For rugby football, the evidence suggested that the force of impact between participants was a key causal risk factor for serious injury. Elite rugby league and union players from 1999-2000 teams were significantly heavier (P<0.05) and taller (P<0.05) than players pre 1950. Players in modern elite games post 1989 were more likely to be tackled by multiple opponents (P = 0.000), tackled head on (P<0.05), at chest level (P<0.05) and at greater speeds than their earlier counterparts pre 1958. However, modern players appear to be no more aggressive or perpetrate greater foul play than their predecessors. Conclusions: There was a continued annual occurrence of catastrophically serious injuries leading to permanent brain damage and quadriplegia associated with rugby league and union in NSW. The critical risk factors found to be associated with serious injury in rugby football suggest relatively novel approaches to the development of preventive strategies.