AOSSM Members Support Major League Rugby, America’s Newest Professional Sports League

Rugby, or rugby union, is the fastest growing team sport in the United States – further documented with the launch of Major League Rugby (MLR) in 2018. The sport has a wide range of participants from youth to the professional elite. Due to the collision nature of the sport, injuries are relatively frequent, making team physicians a critical part of the game.

Common Injury Types
Common injuries include abrasions and cuts, contusions, sprains/strains, fractures, dislocations, and concussions. Soft tissue injuries are most common and generally account for over half of all rugby injuries. Most injuries are contact-related, particularly from tackling situations. Injuries occur more frequently in competition than in practice. Multiple studies have found injury rates vary by position, but have reached conflicting results as to which positions are at greatest risk.

The lower extremity – particularly the knee and thigh – is most commonly injured. “Minor” injuries include ankle sprains, contusions, hematomas, and other low-grade sprains and strains. Common “major” injuries resulting in significant loss of play include anterior cruciate ligament tears, meniscus tears, and hamstring strains.

Upper extremity injuries are less common in rugby but can be equally severe. Shoulder dislocations, capsulo-labral injuries and clavicle fractures are among the most severe injuries encountered, along with fractures in the hand, wrist, and fingers. AC separations, sprains, lacerations, and contusions are also relatively common. Elbow injuries account for only a small portion of injuries but can include biceps or triceps ruptures.

As with other collision sports, ruby presents a concussion risk for athletes. World Rugby, the governing body of the sport, provides in depth resources on concussion evaluation and management, which are available online (6Rs: recognize, remove, refer, rest, recover, return). It is important to note that athletes with suspected or diagnosed concussion should be immediately and permanently removed from play.

Injury Treatment and Prevention
Sports medicine personnel covering rugby matches have a unique consideration – play does not stop, except for the most severe injuries, when the match officials will generally whistle to stop play. The sports medicine team must be prepared to enter open play to evaluate injured athletes, so it is critical to monitor the run of play.

A growing body of literature describing injury risks and attempting to develop evidence-based injury prevention practices in rugby. For example, US Rugby Football Foundation sponsored the Reporting Information Online (RIO) initiative to better characterize injury risks in high school rugby in the USA and identify opportunities for injury prevention and reduction. World Rugby offers training and educational resources online as well as certifications for pitch-side training. As the sport continues to grow, orthopedic sports medicine specialists will need to educate themselves about the sport, common injuries, and foster efforts to optimize the care and safety of these athletes.

Theodore B. Shybut MD is Associate Professor and an orthopedic sports medicine specialist at Baylor College of Medicine, Houston, Texas, and a member of the AOSSM Public Relations Committee. He is head team physician for the MLR Houston SaberCats. He can be reached at