Associations Between Diagnosed Concussion And Upper Extremity Injury In Community Rugby Players

Rugby is the most popular team collision sport and may have the highest incidence rate of concussion per athletic exposure. Concussion in rugby has been associated with increased odds of lower-extremity injury, with rates similar by sex. Recently, it has been shown that concussion was associated with subsequent upper extremity injury in collegiate athletes, however, this relationship in rugby remains unknown. PURPOSE: To determine 1) the association between lifetime diagnosed concussion and lifetime upper extremity musculoskeletal injury (UE-MSI) among community rugby union players and 2) the sex specific risk of UE-MSI given concussion history among these rugby players. METHODS: 1,037 (31.0% female, 31.6 + 11.3 years) rugby players completed an online survey to determine lifetime history of diagnosed concussion and acute UE-MSIs. A chi-squared test of association was performed between concussion (yes; no) and UE-MSI (yes; no). Odds ratio were calculated for risk of UE-MSI given history of concussion. Analyses were repeated by sex (male; female). RESULTS: There was a significant association between concussion and UE-MSI for this cohort (χ(1) = 10.802, p = 0.001, OR = 1.70 [95%CI: 1.23-2.32]). There was a significant association between concussion and UE-MSI among males for (χ(1) = 13.612, p < 0.001, OR = 2.20 [95%CI: 1.4-3.3]) but not among females (χ(1) = 0.735, p = 0.391, OR = 1.20 [95%CI: 0.8-2.0]). CONCLUSION: Community rugby players with a history of diagnosed concussion are at a 1.7x increased odds for history of UE-MSI compared to rugby players who are concussion naïve; however, sex specific analyses revealed only increased risk among males. Sports medicine professionals and rugby stakeholders should view concussions as a risk factor and utilize established injury prevention programs (i.e., Activate) which has been shown to reduce UE-MSI in addition to other musculoskeletal injuries in rugby players. Future research should aim to verify this finding in more diverse samples, establishing an order effect of concussion and UE-MSI, and employ injury prevention programs to reduce injury risk over time.