Life after the game: quantitative and qualitative analyses of long-term effects of injuries in Rugby Union players


Evert Verhagen

James Brown


The project team is composed of Marelise Badenhurst (Physiotherapist / PhD candidate), James Brown (Post-Doc), Evert Verhagen (Associate Professor), Mike Lambert (Professor) and Willem van Mechelen (professor). This project is funded through the Desmond Tutu Programme; an academic programme of VU University Amsterdam and the National Research Foundation (NRF), South Africa, which aims to strengthen the cooperation between VU University Amsterdam and South African Higher Education Institutions. This project is a joined project between VUmc and the University of Capetown.


Background: Rugby union (henceforth “rugby”) is one of the most popular team sports globally. It is particularly popular in South Africa with an estimated 600,000 participants. The South African national team is ranked 2nd in the world. The sport is also growing in the Netherlands. Rugby is a sport characterised by short duration, high intensity bouts of exercise during which collisions occur between players. These demands are associated with both general and catastrophic injuries to players. SARU has a corporate societal responsibility to look after the well being of all the players, including those who become seriously injured while playing the sport. This is a significant challenge with such a large participant base, particularly since the players are from diverse socioeconomic backgrounds, with a large proportion not having any medical insurance. In response, in 2009 SARU implemented the “BokSmart programme” in South Africa based on the success of the New Zealand injury prevention programme, RugbySmart. This injury prevention programme attempts to educate coaches and referees about “safe and effective” practices for rugby with the aim to reduce as many injuries as possible.

Objectives: Recent evaluations of the BokSmart programme indicate the programme is achieving some of it’s goals – the most important of which is the prevention of catastrophic injuries, there are some areas where the programme is less successful. These shortfalls could be ascribed, in part, to the enormous socioeconomic diversity that still exists in South Africa. Furthermore, some injury risk factors, specific to South Africa, have been identified during the evaluation of the BokSmart programme, particularly in youth populations. The South African Rugby Union has requested for on-going assistance from the existing ESSM/VUmc relationship to further improve the programme and to help ameliorate injury risk factors specific to the players of South Africa. Therefore, this research project aims to develop intervention strategies to reduce identified barriers and injury risk factors to a minimum. As with any intervention, this would need to be formally evaluated, as per the “sequence of prevention” model for Sports Medicine. The overall success of the BokSmart programme would also need to continue to be evaluated, in parallel with this evaluation. These evaluations would require a “pragmatic research design” which includes both qualitative and quantitative research methods.