Changing playing surfaces is associated with increased injury incidence and burden rates in men's elite rugby union.

This study examined the association between playing surface changes and match injury risk in professional men's rugby in England. Nine seasons of injury data (2013/14-2021/22) were collected from 15 clubs. Incidence, severity and burden of injury were compared between conditions involving surface changes in matches from 1 week to the next ('change') and consistent surface use ('no change'). Injury burden was significantly higher under 'change' conditions ('change' 2,739 d/1,000 h, [2,571-2,917] vs. 'no change' 2,210 d/1,000 h, [2,131-2,292], p < 0.001, RR = 1.24 [1.15-1.33]), primarily due to higher injury incidence. Changing to artificial surfaces resulted in greater injury incidence ('change to artificial': 92.6/1,000 h, [85.19-100.8] vs. 'change to hybrid/natural': 74.1/1,000 h, [67.4-81.5], RR = 1.24 [1.10-1.42]), severity ('change to artificial': 35 days, [32-38] vs. 'change to hybrid/natural': 31 d/1,000 h, [28-34], p < 0.001) and burden of injury ('change to artificial': 3,206 /1,000 h, [2,946-3,489] vs. 'change to hybrid/natural': 2,265 d/1000 h, [2,060-2,491], p < 0.001, RR = 1.42 [1.25-1.61]) compared to changing to hybrid/natural surfaces. Surface transitions, particularly to artificial surfaces, are associated with significantly higher injury incidence and burden. These data can inform player preparation strategies and interventions to mitigate injury risk during surface transitions.