A Million-Dollar Healthcare Anomaly: The Hidden Costs of Rugby Injuries

Have you ever wondered why the sports world is so obsessed with injury prevention? In the literal sense, sports injuries limit an athlete’s performance level; if you are injured, you just can’t perform at your best or at all. Imagine scaling a mountain with a chain supporting the entirety of your weight. How would you feel if the first few links holding you up were corroded? What about throwing in some rusty pieces in the middle? That horror usually gnaws at coaches when pondering the off-chance of injury—after all, a team’s strength is only as great as their weakest player. However, it would be naïve to think the cost of injury lies in the glory or medals alone, as the modern world of sport has a lot more money at stake.

Rugby’s high-impact nature demands that players exert extreme force to gain and maintain possession of the ball. As such, it seems obvious that injuries would occur more frequently or as much as 90% in a season. However, what doesn’t meet the eye at first glance? As the rate of injuries slowly decreases, the cost of their treatment skyrockets.

Age ISN’T Just a Number: A Case Study

Meet Bobby, a 16 year old elite baseball pitcher who presented to a sports chiropractor with a busted right (throwing arm) shoulder, right elbow, left hip and lower back pain. Taken all together, the summation of these injuries impaired Bobby’s performance and led to significant time away from playing. Let’s examine his circumstances: growing up in the Dominican Republic, he began his career playing baseball at the tender age of five. Playing baseball year round, at a frequency of 2–3 times per week, he became the top pitcher on the team and assumed a significant role.

Keep in mind that this league had no pitch counts or limitations like local little leagues in the U.S.

At age 10, he moved to Canada, joined a local city baseball league (AAA) and became a dominant pitcher; his baseball volume dramatically decreased to playing only during the summer months. In turn, Bobby began to notice some intermittent, low-intensity lower back and left hip pain. It did not impair his ability to play, so he just ignored the symptoms. At age 14, an elite travel team within the city recognized his talent as well.

While Bobby developed into a teenager, he engaged in several high-intensity, off-season throwing programs to improve his arm strength. At this stage, Bobby participated in baseball training 10+ months a year and played for two teams (local AAA and the travel team; 3–7 games and 2–3 practices per week). During this time, he began to notice a gradual onset of right medial elbow pain--ruled as low priority.  Leading into the next baseball season, he reported “not feeling 100%” regarding his right elbow, low back or left hip. Near the end of the season, his pitching volume increased into the playoffs, and the medial elbow pain intensified to the point that he could no longer throw.

Too soon? Sports Specialization in Early childhood

Bobby fell victim to a concealed pandemic: early sports specialization or ESS in adolescent athletes, especially common in Olympic sports. In 2016, the Olympics included Rugby-7s and, in turn, attracted an estimated 30 million fans globally; of those millions invested, many of them include parents and coaches that hastily push their middle-aged children (6-12) athletes to the edge--but at what cost?

In 2018, the cost of rugby-related injuries reached an all-time high with the ACC (Accident Compensation Corporation) forking over $110M to help heal players’ aches and pains. Of said players, the 20-40 age bracket cost the ACC the most, but the 10-14 age bracket experienced the majority of injuries.

Even Isaac Carlson, head of injury prevention for the ACC agrees that “A lot more young people have significant injuries that are more typical of elite level players.

In other words, of the over $7 million that the ACC spent treating ACL (anterior cruciate ligament) related injuries in 2018, they likely allocated a huge chunk to the under 18 population. Unsurprisingly, the ACL injury made headlines as the ACC’s most expensive injury for four years in a row.

In this context, Bobby could have easily played rugby from age 5 to 20 with excessive frequency and singled focus; his targeted lifestyle could have simply resulted in recurrent concussion(s) contributing to CTE, and then suicide. In reality, when Bobby's sports physician diagnosed him with a severe UCL or ulnar collateral ligament sprain, he rehabilitated for 3-4 weeks and returned with a limited role. Several weeks after, he presented to his local chiropractor with the list of ailments described above.

The cause of these serious injuries may lie in sports specialization in early to middle childhood; as most experts agree that a child needs a certain level of specialization to reach elite heights, some debate as to whether such strenuous practice time must begin during early childhood. As these junior athletes grow, so does the amount of training and competition.

The combination of frequent, recurrent, and overuse rugby injuries in adolescence and youth potentially can bleed into adulthood--not to mention a myriad of other issues such as mental health. Overall, these long-term issues generate more and more expense every year, despite rugby injury prevention efforts contributing to somewhat of a decline in injury rate. In truth, the junior athlete population truly pays for their elite aspirations.