Published in PLOS One on 2026-04-29, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Mordicai Atinga, Jasmit Shah, Sarah Karanja, Mark Lutomia Lumbasi, Miriam Wambui Ndungu, Sarah Kiburi, James Ondiege, Njalalle Baraza
Source: PLOS One • DOI 10.1371/journal.pone.0343140
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Musculoskeletal injuries are common among athletes and can negatively affect both physical and psychological wellbeing. Beyond physical disability, injuries have been linked to poor mental health, loss of athletic identity, and increased substance use. In low- and middle-income countries (LMICs), where awareness and management of mental health remain limited, the psychological burden of sports injuries may be underrecognized. Rugby, a physically demanding contact sport, has one of the highest rates of injury, but little is known about how such injuries influence mental health and related outcomes in African contexts. This study explored the relationship between musculoskeletal injuries and health outcomes—including mental health, physical functioning, identity, and substance use—among rugby players in Kenya.
We conducted a cross-sectional survey between October 2024 and November 2024 among rugby players from ten clubs across Kenya. Eligible participants were adults aged 18 years and above, recruited using convenience sampling. Data were collected through electronic questionnaires that captured demographics and included various psychological and health assessment tools. Summary statistics were presented as medians and interquartile ranges for continuous data and frequencies and percentages for categorical data. The non-parametric Kruskal–Wallis test was used to compare the continuous variables and Fisher’s exact test was used to compare the categorical variables between group associations.
A total of 400 players were recruited and included in the analysis. The median age was 24.0 years (IQR 21.0–27.0) and majority were males (89.8%). Over half (52.5%) reported a significant injury in the past two years, most commonly affecting the knee (41.0%), ankle (32.4%), and shoulder (21.0%). The mean GHQ-12 score was 22.4 (SD = 5.6), indicating some burden of mental health symptoms, and injured players had significantly higher GHQ-12 scores (p = 0.001). On the SF-12, the mean physical and mental component scores were 84.5 (SD = 12.6) and 60.5 (Sd = 8.6), with injured players reporting lower physical scores (p < 0.001). The AIMS shower strong athletic identity overall with injured players demonstrating significantly higher social identity scores (p = 0.007). The ASSIST revealed that 72.8% had ever used substances, with alcohol (71.8%), cannabis (19.5%), and tobacco (13.3%) being the most common; cannabis use was significantly higher among injured players (p = 0.002).
Musculoskeletal injuries among rugby players were associated with poorer mental health, reduced physical functioning, and greater cannabis use. These findings underscore the need for integrated injury management approaches that address both physical rehabilitation and psychological wellbeing, including mental health screening, counselling, and substance use surveillance.
Introduction
Sport and physical activity are increasingly recognized as powerful determinants of both physical and mental health, contributing not only to disease prevention but also to social and personal development. Regular participation improves cardiovascular health, stamina, and bone strength, while also reducing the risk of chronic diseases later in life [1]. Beyond these psychological benefits, sports-particularly organized and team-based sports, also contributes to social cohesion, discipline, teamwork and a sense of belonging across the life course. Participation in team sports, in particular, offers additional advantages by fostering a strong sense of community, enhanced social integration, and personal growth. These benefits are especially evident among youth, where engagement in sports has been linked to improved social skills [2,3], enhanced personal development [4], and a reduction in substance use [5,6]. Collectively, these factors have also contributed to a higher quality of life [7] and encourage continued participation and long-term commitment to sports [8].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Mordicai Atinga, Jasmit Shah, Sarah Karanja, Mark Lutomia Lumbasi, Miriam Wambui Ndungu, Sarah Kiburi, James Ondiege, Njalalle Baraza. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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