Sports Medicine: Just the Facts

CHAPTER 88 • RUNNING 519

coaches with techniques to provide proper instruction

on some of the more complex skills and techniques of

the game.

SIDELINE PREPAREDNESS

• Since the spectrum of injury in rugby union is wide,
  the physician covering this sport must be well
  rounded and prepared to handle the variety of acute
  injuries.


• The nature of the substitution rules of rugby place
  more pressure on a sideline physician to make a timely
  decision on fitness to play. Prompt and accurate evalu-
  ation is therefore critical. The game continues without
  a substitution while the physician is evaluating the
  injured athlete. If another player replaces the injured
  rugger, he or she cannot return to the match, even if
  physically capable. Therefore, the coach is anxiously
  waiting for the physician to tell whether to play one
  man down till the injured person’s return or whether a
  permanent substitution should be made.


• There is a delicate balance between not prematurely
  removing an athlete from play versus minimizing the
  time the team competes one man short while the
  physician is performing the evaluation.


• Lacerations deserve special mention as the team physi-
  cian’s proficiency in attending to a bleeding wound
  within the allotted “blood sub” time of 15 min will
  determine whether an athlete is able to return to play.


• Although rare, catastrophic injury has been reported
  in rugby union play. An emergency response plan
  should be preestablished in case of such a situation.

REFERENCES

Bird YN et al: The New Zealand Rugby injury and performance
project: V. Epidemiology of a season of rugby injury. Br J
Sports Med 32:319–325, 1998.
Chalmers, DJ, New Zealand’s: Injury prevention research unit:
Reducing sport and recreational injury. Br J Sports Med
28(4):221–222, 1994.
Dexter WW: Rugby, in Mellion MM, Putukian M, Madden CC
(eds.): Sports Medicine Secrets, 3rd ed.Philadelphia, PA,
Hanley & Belfus, 2003, pp 579–583.
Dietzen CJ, Topping BR, Rugby Football: Phys Med Rehabil
Clin N Am10(1):159–175, 1999.
Garraway M, Macleod D: Epidemiology of rugby football
injuries. Lancet North Am Ed(345):1485–1487, 1995.
Gerrard DF, Waller AE, Bird YN: The New Zealand Rugby
injury and performance project: II. Previous injury experience
of a rugby-playing cohort. Br J Sports Med 28(4):229–233,
1994.

Marshall SW, Spencer RJ: Concussion and rugby: The hidden

epidemic. J Athl Train36(3):3334–3338, 2001.

Milburn PD: Biomechanics of Rugby union scrummaging, tech-

nical and safety issues. Sports Med16(3):168–179, 1993.

Quarrie KL, Cantu RC, Chalmers DJ: Rugby union injuries to the

cervical spine and spinal cord. Sports Med32(10):633–653,

2002.

Quarrie KL et al: The New Zealand rugby injury and performance

project: III. Anthropometric and physical performance charac-

teristics of players. Br J Sports Med29(4):263–270, 1995.

Quarrie KL, Handcock P, Toomey MJ et al: The New Zealand

rugby injury and performance project. IV. Anthopometric and

physical performance comparisons between positional cate-

gories of senior A rugby players. Br J Sports Med 30:53–56,

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Quarrie KL, et al: The New Zealand rugby injury and perform-

ance project: VI. A prospective cohort study of risk factors for

injury in rugby union football. Br J Sports Med35:157–166,

2001.

Scher AT: Rugby injuries to the cervical spine and spinal cord: A

10-year review. Neurol Athl Head Neck Injuries17(1):195–206,

1998.

USA Rugby Football Union: USA Rugby Handbook, 2002–2003.

USA Rugby website. History: An American Tradition. http://www.

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88 RUNNING

Robert Wilder, MD, FACSM

EPIDEMIOLOGY OF RUNNING

INJURIES

INTRODUCTION

• There are over 30 million runners of which more than
  10 million run on more than 100 days per year.


• One million enter competitive races per year (Epperly,
  2001; Van Mechelen, 1992; Jacobs and Berson, 1986).
  •Yearly injury incidence rate ranges from 37 to 56%
  (Epperly, 2001; Van Mechelen, 1992; Jacobs and
  Berson, 1986; Walter et al, 1989; Lysholm and
  Wiklander, 1987).


• Injury rate ranges from 2.5 to 5.8 injuries per 1000 h
  of running (Epperly, 2001; Van Mechelen, 1992;