Healthy Wealthy & Smart 518: Dr. Steffan Griffin: Rugby - More than Big Hits and Concussions!
In this episode, Dr. Steffan Griffin talks about his research into ‘Rugby Union, and Health and Wellbeing.’
Dr. Steffan Griffin is a junior doctor based in London, pursuing a career in Sport and Exercise Medicine. He is a Sports Medicine Training Fellow at the Rugby Football Union, deputy editor at the BJSM, and a part-time Ph.D. student at the University of Edinburgh, where he is researching the topic of ‘rugby union, and health and wellbeing’. Steffan also works clinically with a range of elite sports teams including Chelsea Football Club, and London Irish Rugby Football Club.
Today, we learn about the different forms of rugby, and Steffan elaborates on the findings of his research regarding the health and wellbeing benefits associated with playing rugby. What does the review mean to those who are interested in gaining the health benefits from rugby? How does this review affect policymakers? What does the review mean for researchers?
Steffan tells us about the common misconceptions surrounding rugby, and how his research aims to change that, and he gives his younger self some advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Key Takeaways- “There are 10 million people playing the game rugby, and they don’t play this blind to the fact that there are risks associated with ”
- The different forms of rugby:
Contact Rugby: It’s the “collision game” that you typically see when tuning in on a Saturday afternoon.
Touch Rugby: It’s a glorified version of “tag” with a ball.
Tag Rugby: Players wear a belt with Velcro strips, and a tackle is when players manage to grab one of those Velcro tags.
Wheelchair Rugby: Nicknamed “Murderball”.
- “Our research found that all forms of rugby can provide health-enhancing moderate- to-vigorous intensity physical ”
- “Symptoms of common mental disorders were higher in professional players compared to general ”
- “People are well aware; rugby compared to other sports has a higher injury ”
- “What the review isn’t doing is saying that everybody in the world should play rugby… It provides an objective piece of work that can help people make a decision based on evidence and not on emotion and ”
- “We need to try and move away from just looking at studies where all the participants are white middle class ”
- “One of the potential conclusions that a reader could get from this study is that non- contact rugby is the holy grail of rugby, but actually there aren’t any level 1 studies looking at the injury risk of ”
Dr Steffan Griffin is a junior doctor based in London, pursuing a career in Sport and Exercise Medicine. He is a Sports Medicine Training Fellow at the Rugby Football Union, deputy editor at the BJSM, and also a part-time PhD student at the University of Edinburgh, where he is researching the topic of ‘rugby union, and health and wellbeing’.
Steffan also works clinically with a range of elite sports teams including Chelsea Football Club, and London Irish Rugby Football Club.
Suggested KeywordsRugby, Health, Wellbeing, Injury, Research, Review, Benefits, Risks, Sport, Policies, Union, Activity,
To learn more, follow Dr. Griffin at:Website: Rugby, Health and Wellbeing
Twitter: @SteffanGriffin
Review: https://bjsm.bmj.com/content/early/2020/11/23/bjsports-2020-102085
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Read the Transcript here:
Speaker 1 (00:00):
Hey, Steffan, welcome to the podcast. I'm happy to have you on
Speaker 2 (00:04):
Thank you very much for the invitation, Karen. So it's a real privilege to have been asked to come on and to have a good chat with you.
Speaker 1 (00:11):
Yes. And for those of you who may think to yourself, God, this voice sounds familiar it's because Stephan is the host of many, many podcasts for BJSM. So if you have the chance definitely, and you haven't listened to BJSM podcast, definitely go over and listen to all of them because they're all really wonderful. So but this is your first time on the other side, which I find hard to believe
Speaker 2 (00:36):
It is. Yeah, absolutely. As you said, it's something I've been doing for a few years for the journal now and yeah, it's the, it's very strange to be on the other side of the podcast. So I'm a different set of nerves. I'm really looking forward to it.
Speaker 1 (00:49):
Great. Well, thank you so much. And today we're going to talk about a recent review that was published in the British journal of sports medicine, the relationship between rugby union and health and wellbeing, which was a scoping review with you and also our good friend Nim but amongst other wonderful authors, but let's start out with the basic why behind this review.
Speaker 2 (01:19):
Yeah, sure. And I think that the main, why about this is that it was just, it's just a completely unexplored area. So I'm sure that, you know, for people in America, maybe their perception of room B probably comes from our friends at absurd with Ross, where I think he comes out pretty battered and bruised. And actually that's actually not too dissimilar to a lot of the perceptions in the, in the kind of the health and the sports science, sports medicine research landscape. We know about rugby's relationships with injuries and concussions. They're highly publicized and probably rugby is a victim of its own success in that because it's leading on player welfare and it's, you know, really pushing the boundaries in terms of trying to make it as safe a game as possible. Everyone's very aware of of the injury injurious nature of forgetting.
Speaker 2 (02:12):
But what I think for me personally, I've, I'm, I'm Welsh by birth. So I brought up on rugby and, you know, there are 10 million people playing the game of rugby and they don't play this blind to the fact that there are risks associated with it. So we know people know there are benefits to it, but looking at the actual scientific literature, there's nothing really providing a big picture overview of some of that, the health and wellbeing benefits associated with the sport. And really as we know, to make an informed decision about anything in life, be that sport, be that buying a car, for instance, people need to know the, the data surrounding the risks and the benefits, and, you know, we had a lot of the former so what we, what this really has been as aimed to do is provide, you know, some, some evidence not just emotion around some of the benefits associated with the sport. So really is a piece that hopefully prides balance to that, to the wider picture now.
Speaker 1 (03:17):
And what did, what did the review find? So what were those benefits to health and wellbeing?
Speaker 2 (03:23):
Yeah, sure. And before we jumped on the call, we kind of discussed the different types of members. So I'll probably just spend a tiny bit of time just covering and providing a tiny bit of context. So what we wanted to do is rugby, as we've mentioned, the friends app. So there is the contact form of rugby union, which is, you know, this collision gamers, if you're tuning in on a Saturday afternoon, typically here, especially in well-established rugby countries like England, like New Zealand, and it is growing in the U S and over in Canada as well, you know, that's the contact forms of the game, and there are other forms of rugby. So there's, non-contact rugby such as touch rugby, which is basically a glorified version of, of the game tag with a ball involved. And there's also something called tag rugby, which generally people wear a belt with the Velcro strips and tackle is where you manage to grab one of those Velcro type tags off.
Speaker 2 (04:17):
The other form of rugby then that we looked at was wheelchair rugby, which is I think given the lovely nickname of Murderball. But actually we want to, so you may have some of the listeners may have heard admirable being referenced and there are some wonderful documentaries on Netflix, you know, that really provide a good insight into the game. So basically by breaking it down to the type of rugby, we then wanted to break it down further. So people who read the review could really look to see exactly where the benefits lay. So if we kind of look at it from and I'll split it into, into some themes that some listeners might be might be familiar with. So as we know a big, I mean the world health organization, physical activity guidelines came out yesterday. So if we look at physical activity, so we know this is a huge global health priority at the moment, and our research found that all forms of rugby be that contact be that non-contact and wheelchair rugby can provide health enhancing, moderate to vigorous intensity physical activity, which, which really wasn't well known before.
Speaker 2 (05:27):
And then now it puts, it allows people like governing bodies and policy makers to align the sport of rugby with some of those global health priorities. As, as we all know, as practitioners, as practitioners, that muscle strengthening balance coordination and huge parts of these physical activity guidelines. And although we didn't find any studies that really look, look at that, per se, we found that lots of national population surveys, which are really based on expert consensus, consider rugby and all sports such as rugby to provide some of these benefits as well. So again, that was a kind of a landmark finding of this study in terms of the, we then looked at different kinds of health benefits. So we, first of all, wanted to look at physical health and we stratified by that by different domains. So for instance, cardiovascular health, respiratory health, musculoskeletal health, probably the best way to summarize this is non-contact rugby and wheelchair rugby have very supportive research kind of around that, you know, that rugby can provide quite significant physical health benefits into the contact drug B, which is kind of the traditional form of the game.
Speaker 2 (06:43):
There's a real mix there, lots of mixed studies and also just a lot of conflicting findings as well. Although a lot of the studies that look at that, you know, look to control for things like age you know, some of the demographic variables did show some supportive data that is conflicted by some other studies. And you know, what we couldn't do as part of this scoping review was really delve into the pros and cons of each of those individual studies. So in terms of, in terms of contact rugby, slightly more mixed findings in terms of physical health mental health and kind of wellbeing. So psychosocial measures such as quality of life and things, again, non-contact rugby or wheelchair rugby, rugby can provide a real wide raft of of mental health and wellbeing benefits. And most of the research in the contact game was, was, was focused on professional athletes and that fans that have symptoms of common mental disorders were higher and in professional players compared to general population though that is, you know, similar actually to professional athletes in other sports, such as football and things.
Speaker 2 (07:58):
And then the last thing is, as we've discussed right at the very top was the injuries associated with the game because we were very aware of is that it wouldn't be all well and good. That's just providing the health benefits, but also, you know, we didn't, we, although we didn't have the capacity to look at every single injury study to do with rugby relate to all the systematic reviews and Metro analyses around this. And as people are very, Oh, well aware, rugby compared to other sports has the higher injury profile and especially around concussion and things. So, so yeah, so sorry, that answer probably a bit tiny bit longer, but just to kind of try and break it down a little bit you know, in terms of the different types of rugby and then the various kind of health domains.
Speaker 1 (08:38):
Yeah. No, that was great. So let's break it down even further now. So let's say I am a player, or I'm a parent of a child who we want them to have these benefits of physical activity. And if rugby is something that maybe we're looking at to accomplish that what does this review mean to that parent or to that player?
Speaker 2 (09:08):
Yeah, sure. So, I mean, six months ago, if you, I mean, if I was a, if I was a, if I was a parent, you know, I was thinking about, you know, do I want my kids to play rugby, then I probably would have done, you know, Google search health and wellbeing rugby. And the vast majority would have been around purely to do with, you know, concussion injuries and not letting my kids anywhere near this kind of sport. Although, you know, rugby unions and, and people know there are loads of testimonials. As I said, at the top of the podcast, there are 10 million people playing rugby. They ha there has to be a benefit. It's just probably the scientists a bit slow to catch up. People can, kids players can reach all their physical activity guidelines and tick that box by playing any form of rugby.
Speaker 2 (09:51):
And then it's about individual perception of risks and benefit as to what kinds of rugby they want to play. So for instance, you might have, I might have, I might have a child for me. I don't know that, you know, the research says that participants in contact rugby, they say they, they there's Reese qualitative research really supporting the fact that it could provide a lot of psychosocial benefits that instills lots of confidence in people that builds teamwork. And people will say that they feel stronger by doing it and that's across across women, across youth players, across adult players. But also at the same time, you know, I think what there isn't doing is saying that everybody in the world should play rugby. It's providing people with the, with kind of a, some objective data so that, you know, someone else might come along and say, okay, we want our kids to be getting know taking all the physical activity boxes.
Speaker 2 (10:43):
Cause we know that it reduces the incidence of diabetes, heart disease. We know it provides X amount of benefits, but for me, the injurious side of it means that I don't want my kids or I don't want to expose myself to that risk. So what I'm going to do is look for a non-contact form. And I'll, I'll try and get and get, you know, reap the benefits by, by going down that route. So yeah, we hope that it provides an objective piece of work that can just help people make a decision based on, on evidence and not just pure kind of emotion and headlines,
Speaker 1 (11:19):
How novel, especially in this day and age now let's go, let's move on to what does this mean for the researcher?
Speaker 2 (11:29):
Yeah, she also, I mean, we, we found offset strategy. We found six Oh six and a half thousand studies of which we included 200 studies. And, you know, as, as I can, as I kind of said, like having broken it down into different forms of rugby in different healthcare domains there are some huge research gaps. So for the research right there, you know, we've identified we've identified a lot of research gaps that really, you know, there are some real low hanging fruit there that could really help them inform, help inform decisions further and provide more evidence in these areas. So for instance, I think there's a real pressing need to, first of all, look at populations outside of just the white, 70 kg male playing player. So we know that I think women's rugby had a growth from 2018 to 19.
Speaker 2 (12:24):
Excuse me, if the, if the exact percentage is off, I think it was that 28% increase in participation and it's growing in, in areas such as Asia, especially. And, you know, we, we, we need to try and move away from just looking at looking at participants and looking at studies that look at the benefits or look at, you know, studies where all the participants are, as I said, kind of white middle-class males, that's one big thing. And looking then at, you know, we do need to do more research. We need to, we need to try and quantify how rugby integrates with the physical activity guidelines even further. We need to be looking at more you know, how rugby interacts with various health and wellbeing outcomes you know, across more diverse populations, as I said. But also then I think, you know, I think one of the potential conclusions that really could get from this study is that non-contact rugby is, you know, the Holy grail now with rugby, but actually no, there aren't any kind of level one studies looking at the injury risk of that. So, you know, there are a ton of research areas that we've identified that that are going to be really important moving forward to allow people to make fully informed decisions.
Speaker 1 (13:39):
Excellent. And then moving on, how does this review then affect policymakers? You touched on it a little bit earlier and also international federations.
Speaker 2 (13:53):
Yeah, sure. So again, I've been very fortunate to have to work NAFA 18 months with the rugby football union, which is the essential England's national governing body for rugby. And two of the medical services director and the head of medical research that Simon Kemp and Keith Stokes to, to they for part of the scientific committee of the, of the PhD and their co-authors of the study. So we what's been great at doing this research and doing this PhD is that we're trying to answer questions that we know are relevant to governing bodies and to policy makers. So for governing bodies, for instance, you know, we're now able to provide the English from BMC, the RFU the likes of world rugby. Who've been really receptive to this kind of research with again, objective health objective scientific data that allows them to align the game with some of the current global health priorities, you know, be that physical activity or be that, you know, that we know physical activity levels are down because of COVID and because of lockdowns and you're could the sports such as rugby, such as football, tennis play a role in actually getting, you know, increasing health globally and then says as a policy makers, again, it's it provides because, you know, we know that sports such as rope in your needs, look at football or soccer.
Speaker 2 (15:12):
Now, you know, there's such a huge debater on head injuries and things, and these are, there's a sense that sensationalized to a certain degree, but they're also brought up in pretty in high places, you know, and government level. And, you know, what I'm hoping that this kind of research does is it provides, you know, a big picture for them to see and to look at it and say, well, actually, you know, we can promote rugby before. You know, whether it be that to kids, we can, you know, we need to make sure that rugby is a it's the welcoming environment for all types of all types of people and, you know, across society, because we know that it could provide people with lots of benefits and yes, we know that it might be more injurious relative, but, you know, as long as we put pressure on rugby to keep on making it as safe as possible, and that's where it's great, you know, that we're dropping all these governing bodies have player welfare as they're kind of strap by the number one priority, but it just provides a, you know, a broad picture that people government bodies and policy makers, like you said, can start to actually, you know, start promote things and to provide you filter that down to individuals and groups.
Speaker 1 (16:22):
Yeah. I think that's wonderful. And I love the thing that I really liked about this review. And we sort of spoke about it before we went on the air is I love that you included wheelchair rugby. I did not know that was murder ball, but now that I, now I'm like, Oh, okay. Yes, I get that. But I thought that was really important to include that because there are a lot of people in, across all countries who are wheelchair bound or who maybe cannot participate fully in, you know non-contact or contact rugby. And to include this, I thought was, was really, really great. And it, even in the wheelchair, rugby still had all of these physical, it's still taking the physical activity boxes, right. And still increasing muscle mass and improving cardiovascular and mental health and that feeling of a team. And so I thought that was really great. And to me, the non-contact rugby seems like a much much more forgiving game for people who are like, I would never do rugby. Cause I would like literally be in, you know, laid out for days or something like that because it looks so intimidating.
Speaker 2 (17:38):
Yeah, absolutely. And actually that's a lot of what you just mentioned, actually, it's pretty much going to be our next steps in terms of what we, what we do, because what we don't want to do is we don't want to set up in awards in like a research ivory tower and say, this is our research now go forth and do what you want to there. We really now want to see how people perceive our research. And I think rugby and rugby also wants to know what, so there's no point us, one of the, you know, one of the main points of the resets being, you know, playing rugby, which is your contact, rugby is good for you. Therefore everybody should do it because we need, what isn't known at the moment is how different population groups might perceive those risks. So for instance, if, for instance, you know, if someone's never played the game before, you know, is the fact that there are only really contact versions of the game available locally, is that a huge barrier to them then getting involved?
Speaker 2 (18:36):
So, so I think, yeah, you've touched nicely upon, you know, some of the real practical key issues there. And that's really what we want to be going into next is kind of being able to now piece together and also pretty much providing a toolkit to not just participants, but to governing bodies that says, you know, if you want more people involved, this is what matters at the, at the coalface and this is what you need to be providing. So no, you're, yeah, you're completely right. Because, you know, look watching, you know, watching 20 stone, you know, 250 pound blokes run into each other on a Saturday sometimes quite hard to think, how am I going to get from the sofa to that? Yeah.
Speaker 1 (19:13):
You can't even, you can't even picture it. You can't even imagine. Imagine it because it looks so scary. You know, and even as let's say, as a woman, if I were interested in playing, I wouldn't even know where to start. Right. So this research eVic, and I'm sure there's places I'm in New York city, there's gotta be rugby clubs and things like that, but I wouldn't even know where to start. And so I feel like this might spark some curiosity among people to say, Hey, listen, I can't do the contact. I just can't do it nor do I want to do it, but Oh, I didn't even realize there was a non-contact option. Or if you're wheelchair bound, gosh, I didn't even realize that this is something that I can do so great parts of the research.
Speaker 2 (19:59):
Oh, thank you. Yeah. and yeah. And just to kinda touch on you at the wheelchair, every point. Yeah. We were, we wanted to make this as big picture, as inclusive as possible. And that was one of the real, almost surprising things that the, that the evidence of, you know, of benefits associated with wheelchair rugby were so significant and so wide ranging. It was yeah. A really pleasant surprise. And the population group that isn't as well studied, you know, as we know.
Speaker 1 (20:25):
Excellent. All right. So before we start to wrap things up here, what do you want the listeners to take away from this discussion and also from this, from this research article, from this broad scoping research?
Speaker 2 (20:38):
Yeah, sure. I mean, I think some of it is, is probably a bit broad in that, you know, trying to, you know, we, so, so for when, so for instance, in my role with in revenue, we're looking at how to reduce concussion. We're looking at exactly, you know, nailing down what the incidence is kind of across various playing groups. You know, and that is the kind of thing that generates headlines in terms of you know, cause it, well, it's actually, as soon as something's published, it's now concussion rates up down the same for X consecutive year. That it's, it's, it's a, it's a common thing. Whereas hopefully what this does, it just provides the people. If people are aware that this now exists and there's this research going on, that they can touch base with either the paper with the website kind of with with any of our kinds of sites, social media platforms as well.
Speaker 2 (21:32):
I can just see what that, you know, if I do know someone, if I know a parent's a play, who's looking into it, this is actually, you know, this is where I'd go to make to be able to make a fully informed decision. So yeah, we're not, you know, the, the point of the research wasn't to show that rugby, you know, is this all singing, all dancing, wonderful sport you know, we're, it's always sunshine and rainbows just by the fact that for some people, it, it really is. But you know, it's just, it's just something that can provide, you know, as you, as you said, what sometimes feels like a bit of a novelty at the moment, just an objective overview, so people can make fully informed decisions.
Speaker 1 (22:11):
Excellent. And before we end, I'm going to ask you the question I ask everyone, sorry, I didn't bring this up to you earlier, but surprise now. So knowing where you are now in your life and in your career, what advice would you give to your younger self?
Speaker 2 (22:27):
I think just, just keep going, just keep doing what you're doing head down and hopefully everything so far, it all ends up working out. Yeah, just work hard and keep going.
Speaker 1 (22:40):
Excellent. Excellent advice. And now where can people find you social media websites, et cetera?
Speaker 2 (22:49):
Yeah, sure. So I'm probably I'm most active, especially from a kind of a professional research point of view on Twitter. So is that Stefan Griffin with Welsh spelling? So it's too, otherwise I'm not would kill me. Yeah. And then there's a website www.rugby, health and wellbeing dot com and, and yeah, and, and as, as you, as you've mentioned at the start, we publish the scope review and the question was sports medicine. So it's very easy to find to find the scrap from view on there as well. So, yeah. And if anyone has any questions and you, you know, once access to the PDF or anything, so unfortunately it is behind a paywall, then I'm obviously more than happy to provide all of that.
Speaker 1 (23:30):
Awesome. And we will have all of this information at podcast dot healthy, wealthy, smart.com under the show notes. Thank you so much stuff for coming on. This was great. Lovely to catch up, lovely to see you and congratulations on a great article.
Speaker 2 (23:45):
Thank you very much, Karen. It's lovely to know to chat to you and that's here. Everything's going well.
Speaker 1 (23:49):
And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.