Ten-season epidemiological study of match injuries in men's international rugby sevens

How are female rugby players affected by contact breast injuries and exercise-induced breast pain - an international survey

Female Rugby Union players were affected by contact breast injuries (CBI) and exercise-induced breast pain (EIBP). Hundred and eighty-two female Rugby players from 25 different countries reported incurring a CBI or EIBP which affected sport performance. A higher percentage of 7s players (7s: 64.3%, 15s: 51.9%) reported at least one CBI over a 12-month period. EIBP frequency, during the same period, was notably low for 7s and 15s. Sprinting, jumping and running were the most frequent activities precipitating the severest EIBP. Being tackled or tackling most frequently caused a CBI. Respondents affected by either CBI (57.3%) or EIPB (51.3%) reported always playing-on during matches despite their pain or injury. Between 19.4% and 32.1% of the respondents did not have a CBI or EIBP prevention strategy. A paucity of player knowledge on prevention strategies was noted, indicating a need for education addressing breast pain and injury among players.

Paving the path for injury prevention in rugby-7s: A systematic review and meta-analysis

This review and meta-analysis aimed to describe the current rugby-7s injury epidemiological literature by examining injury data from both sexes, all levels of play, and their associated risk factors. Studies published up until March 2024 were included. These studies were retrieved from six databases using search terms related to rugby-7s or sevens, tackle, collision, collision sport, injury, athlete, incidence rate, mechanism, and risk factor. Only peer-reviewed original studies using prospective or retrospective cohort designs with a clearly defined rugby-7s sample were considered. Included studies needed to report one injury outcome variable. Non-English and qualitative studies; reviews, conference papers, and abstracts were excluded. Twenty studies were included. The meta-analysis used the DerSimonian-Laird continuous random-effects method to calculate the pooled estimated means and 95% confidence interval. The estimated mean injury incidence rate for men was 108.5/1000 player-hours (95% CI: 85.9-131.0) and 76.1/1000 player-hours (95% CI: 48.7-103.5) for women. The estimated mean severity for men was 33.9 days (95% CI: 20.7-47.0) and 44.2 days (95% CI: 32.1-56.3) for women. Significantly more match injuries occurred in the second half of matches, were acute, located at the lower limb, diagnosed as joint/ligament, and resulted from being tackled. Fatigue, player fitness, and previous injuries were associated with an increased risk of injury. There were no statistically significant differences between women's and men's injury profiles. However, the inherent cultural and gendered factors which divide the two sports should not be ignored. The findings from this review will help pave the way forward beyond the foundational stages of injury prevention research in rugby-7s.

Non-contact Anterior Cruciate Ligament Injury Epidemiology in Team-Ball Sports: A Systematic Review with Meta-analysis by Sex, Age, Sport, Participation Level, and Exposure Type

BACKGROUND

Not all anterior cruciate ligament (ACL) injuries are preventable. While some ACL injuries are unavoidable such as those resulting from a tackle, others that occur in non-contact situations like twisting and turning in the absence of external contact might be more preventable. Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts.

OBJECTIVE

To synthesize the evidence on the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level and exposure type in team ball-sports.

METHODS

Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and SPORTDiscus) were searched from inception to July 2021. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included.

RESULTS

Forty-five studies covering 13 team ball-sports were included. The overall proportion of non-contact to total ACL injuries was 55% (95% CI 48-62, I2 = 82%; females: 63%, 95% CI 53-71, I2 = 84%; males: 50%, 95% CI 42-58, I2 = 86%). The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.05-0.10, I2 = 77%), and 0.05 per 1000 player-exposures (95% CI 0.03-0.07, I2 = 97%). Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.10-0.19, I2 = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.03-0.07, I2 = 48%), and this difference was significant. Injury incidence during competition was higher (0.48 per 1000 player-hours, 95% CI 0.32-0.72, I2 = 77%; 0.32 per 1000 player-exposures, 95% CI 0.15-0.70, I2 = 96%) than during training (0.04 per 1000 player-hours, 95% CI 0.02-0.07, I2 = 63%; 0.02 per 1000 player-exposures, 95% CI 0.01-0.05, I2 = 86%) and these differences were significant. Heterogeneity across studies was generally high.

CONCLUSION

This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes. Injuries mostly occurred in competition settings.

Poor isometric neck extension strength as a risk factor for concussion in male professional Rugby Union players

BACKGROUND

Concussion is one of the highest burden injuries within professional Rugby Union ('rugby') and comes with a high health and financial cost to players and teams. Limited evidence exists as to the existence of modifiable intrinsic risk factors for concussion, leaving athletes and clinicians with few options when developing prevention strategies.

OBJECTIVE

To investigate whether neck strength is significantly associated with concussion incidence in professional male rugby players.

METHODS

225 rugby players were assessed for neck strength at three time points throughout the 2018/2019 season using a method of isometric contraction. Associations with clinically diagnosed concussion injuries are presented as incidence rate ratios (IRRs) with 95% CIs.

RESULTS

Thirty concussions occurred in 29 players during the study period; a rate of 13.7 concussions per 1000 hours played. Greater neck strength was observed at mid and end of season time points versus preseason across the study population. There was a significant association between extension strength and concussion; a 10% increase for extension strength was associated with a 13% reduction in concussion rate (adjusted IRR (95% CI) 0.87 (0.78 to 0.98). No other significant associations were observed between concussion incidence and any other unique neck strength range or composite score.

CONCLUSION

Higher neck extension strength is associated with lower concussion rates in male rugby players. Neck strength is a modifiable intrinsic risk factor for concussion and may be an important component of a strength and conditioning regime.

Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021

This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.

Eight-season epidemiological study of match injuries in women's international rugby sevens

This study aimed to describe anthropometry and incidence, nature and causes of match injuries in women's international rugby sevens and to compare these with results reported previously for men's international rugby sevens. The study comprised an 8-season, prospective study of World Rugby's women's Sevens World Series. Over the eight seasons, the overall incidence of injury was 105.6 (95% CI: 96.0 to 116.3) injuries/1000 player-match-hours with a mean injury severity of 53.4 (95% CI: 46.9 to 59.9) days-absence. There were no statistically significant trends for backs or forwards in the incidence (backs: p = 0.470; forwards: p = 0.242) or mean severity (backs: p = 0.098; forwards: p = 0.544) of injuries sustained over the 8-season period. Head/face (20.8%), knee (19.7%), ankle (11.3%) and shoulder/clavicle (8.4%) were the most common injury locations while ligament sprain (31.7%), concussion (15.6%), haematoma/bruise (11.5%) and fracture (11.5%) were the most common types of injury sustained. Being-tackled (35.4%), tackling (26.3%), collisions (13.8%) and rucks (8.8%) were the match events responsible for most injuries. The study indicates that injury burden in women's international rugby sevens (5,640 days-absence/1000 player-match-hours; 95% CI: 5,123 to 6,209) is similar to that reported previously for men's international rugby sevens (5,263 days-absence/1000 player-match-hours; 95% CI: 5,000 to 5,540).