A prospective study of injuries to elite Australian rugby union players

The 50 Most Cited Papers on Rugby since 2000 Reveal a Focus Primarily on Strength and Conditioning in Elite Male Players

We sought to conduct a bibliometric analysis and review of the most cited publications relating to rugby since 2000 in order to identify topics of interest and those that warrant further investigations. Clarivate Web of Science database was used to perform a literature search using the search term "rugby." The top 200 papers by citation count were extracted and reviewed for the inclusion criteria: all subjects were rugby players. The top 50 manuscripts were included for analysis of author, publication year, country of lead authors, institution, journal name and impact factor, topic, participant sex, and level of rugby. The total number of citations was 9,071 (average of 181.4 citations/article), with an average journal impact factor of 7.21; the top article was cited 407 times at the time of analysis. The most frequent publication was the Journal of Strength and Conditioning Research (26%), followed by the British Journal of Sports Medicine (20%) and the Journal of Sports Sciences (18%). Forty-eight (96%) of the manuscripts contained only male subjects, with 1 manuscript including females only and 1 manuscript containing mixed sexes. Thirty-three (66%) of the manuscripts focused on professional rugby players, with the next highest player group being mixed levels (10%). Twenty-eight (56%) concentrated on topics regarding strength and conditioning, 11 (22%) on injury, and 4 (8%) on physiology. Despite rugby being one of the most injurious sports and community players representing the largest component of the player pool, most of the top-cited rugby articles are cohort studies of professional male athletes focused on performance and strength and conditioning, noting the bias in research towards socially relevant topics that may not impact the majority of stakeholders and long-term health of rugby athletes. These findings highlight the need for further research among women and community athletes and on topics in injury prevention.

Noncontact Injury Distribution and Relationship With Preseason Training Load and Nonmodifiable Risk Factors in Rugby Union Players Across Multiple Seasons

ABSTRACT

Evans, SL, Whittaker, G, Elphinstone Davis, E, Jones, ES, Hardy, J, and Owen, JA. Noncontact injury distribution and relationship with preseason training load and non-modifiable risk factors in Rugby Union players across multiple seasons. J Strength Cond Res 37(7): 1456-1462, 2023-This study examined the distribution of noncontact injury during phases of the competitive season and the association between preseason training load (TL) and nonmodifiable risk factors on injury risk during these phases. Injury data were recorded from 1 senior academy team over 3 seasons (2017-2020) and analyzed across early-season, midseason, and late-season phases. A generalized estimating equation was used to model risk factors with noncontact injury for selected phases. The highest noncontact injury incidence occurred in the late-season phase (22.2 per 1,000 hours) compared with early (13.7 per 1,000 hours, p < 0.001) and midseason phases (15.5 per 1,000 hours, p = 0.001). Low preseason TL (8,949-12,589 arbitrary units; odds ratio [OR], 95% confidence interval [CI] = 4.7, 1.0-21.6; p = 0.04) and low preseason TL combined with high early-season TL and injury in the early-season phase (OR, 95% CI = 6.5, 1.1-35.5; p = 0.03) were associated with greater midseason noncontact injury risk. In addition, low preseason TL combined with previous injury was associated with increased risk of noncontact injury risk in the late season (OR, 95% CI = 12.2, 0.9-15.6, p = 0.05). Our results suggest players are at a greater injury risk during the late-season phase, with low preseason cumulative loads combined with a history of previous injury associated with increased in-season injury risk. Strength and conditioning coaches should therefore monitor cumulative preseason TL alongside screening for previous injury history to identify athletes at greater risk of noncontact injury risk during the competitive season.

Epidemiology of the Injuries Sustained by Elite Spanish under-18 and under-20 Rugby Players

This study examines the injuries suffered by players (n=166) of the Spanish national men's under-18 and under-20 rugby teams between 2015 and 2017, and identifies the actions involved in their occurrence. All injuries (total n=78) sustained during matches and training were recorded as recommended by World Rugby, and injury incidence rates per 1000 player-hours (ph) calculated for both types of activity. Injuries occurred more commonly during matches than during training (incidence 105.3 [95% CI: 78.7-131.9] per 1000 [ph] of match play, vs 1.16 [95% CI: 0.69-1.62] per 1000 ph of training), and most days absent per 1000 ph during matches with<3 days rest since the previous match (4209.2 [95% CI: 3516.2-4902.1] per 1000 ph of match play, vs 1947.4 [95% CI: 1511.8-2382.9] per 1000 ph of match play in matches with>3 days rest). These results provide information that may be useful in the development of strategies aimed at reducing the incidence of injuries.

A cross-sectional retrospective survey of injury situation and prevalence in female recreational netball players with a focus on knee injuries

OBJECTIVES

To examine situations of injury and injury prevalence in female adult recreational netball players with a focus on knee injuries.

DESIGN

Cross sectional retrospective online survey.

PARTICIPANTS

193 female adult recreational netball players.

MAIN OUTCOME MEASURES

Any injury sustained in the previous 12 months, situation of injury, any knee injuries sustained in the previous five years, the length of time unable to play netball, and knee injury management.

RESULTS

In the previous 12 months, 61% of respondents sustained injury to the lower limb, and 27% to the upper limb. Lower limb injury situations were mostly landings (46%). Upper limb injury situations were mostly collisions with an opponent (27%). 46% reported sustaining a knee injury in the previous five years. Following knee injury, players were unable to play netball for 6.8 ± 7.0 months (training); and 8.2 ± 7.4 months (matches) respectively.

CONCLUSIONS

Lower limb injury is more common than upper limb injury in recreational adult female adult netball players. Landing was the most common situation of injury for the lower limb including knee injuries. In the previous five years, nearly half of the players had sustained a knee injury resulting in more than six months out of the game.

Match Injuries in the Spanish Rugby Union Division de Honor

OBJECTIVE

To describe the injury rate, severity, cause, anatomical location (tissue damaged), recurrence, place and time during matches throughout a season in the Spanish Rugby Union Division de Honor.

METHODS

Observational, prospective and descriptive study conducted in the competition of the Spanish División de Honor de Rugby with 258 players. The data were reported by the medical services of the previously formed clubs.

RESULTS

Total exposure was 4100 h, during which 220 injuries occurred. The average number of sick days was 36.8. The total injury rate was 53.6 injuries/1000 h of exposure. Three quarters suffered 93 injuries and the forwards sustained a total of 127 injuries, with a total of 48.6 and 58.1 injuries/1000 h of exposure, respectively. Moderate injuries were the most frequent. Specifically, ligament injury was the most frequent, and dislocation was the injury that caused the most sick days. The most injuries occurred in the third quarter of the match, and the most serious injuries occurred in the second quarter.

CONCLUSIONS

The injury rate of Spanish rugby competitors is 53.6 injuries/1000 match hours, with an average of 36.8 sick days. Contact injuries are the most frequent, taking place especially when tackling or being tackled.

The Epidemiology of Injuries in Spanish Rugby Union División de Honor

BACKGROUND

We describe and analyze injury incidence, severity, cause of injury, anatomical location, damaged tissue, injury recurrence, and the time and place at which injuries occur over the course of a season.

METHODS

An observational, descriptive, prospective, nomothetic, and multidimensional study was conducted during the 2018-2019 season with 258 players of the top semiprofessional rugby league in Spain (División de Honor de Rugby). Data were reported by the clubs' medical services. Reported time-loss injuries were collected.

RESULTS

Overall exposure was 4100 h (137 matches), over 35 weeks of competition. A total of 288 injuries were reported, with three of these leading to withdrawal from the sport. A total average of 35.63 days was lost to injury. Overall time-loss injury incidence was 3.41 injuries/1000 h of exposure. Backs suffered 119 injuries corresponding to 3.80 injuries/1000 h of exposure, whilst forwards suffered 169 injuries with 4.27 injuries/1000 h of exposure. Severe injuries were the most frequent injury type.

CONCLUSIONS

Outcomes confirm that more injuries take place during competition, with these also being more severe in nature. Contact injuries were most frequently suffered, above all, due to tackling or being tackled.

Knee function after a mean of 19 years Post-retirement in 65 Italian semi-professional rugby veterans

Background and aim sport activity has been largely correlated to the development of knee osteoarthritis, but only few papers have investigated the long-term impact of a rugby career on the knee joint. The aim of this retrospective study was to evaluate the incidence and epidemiology of knee osteoarthritis and general health in a population of 65 retired semi-professional rugby players. Methods demographic and anamnestic analysis was recorded and Oxford Knee score, SF-12 and VAS were submitted to all veterans in order to assess current knee function, general health condition and level of pain. Parametric analysis of Spearman was used to evaluate the statistical significance on these results and the Kruskal-Wallis test was used to assess the significant differences between the questionnaire results and the demographic and anamnestic records. Results we found that players who sustained a knee injury during their career have a current reduction of the knee function compared to veterans who did not suffer any injury and who showed values comparable with those of the health population. In terms of general and mental health, athletes who retired later have now a better condition than those who retired from the sport  earlier. Conclusions: we concluded that knee injury prevention should be an unequivocal priority because although rugby is a high energy sport, it does not increase the risk of knee osteoarthritis in absence of serious knee injuries.

Spinal cord and brain tissue impairments as long-term effects of rugby practice? An exploratory study based on T1 and ihMTsat measures

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Diffuse degeneration of spinal cord (higher T₁) is observed in retired rugby players.

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Demyelination of brain WM tracts (higher T₁ / lower ihMTsat values) is present in rugby players.

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Early aging in both brain and spinal cord tissues may be linked to the rugby practice.

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The aforementioned effects may suggest cumulative effects of long-term impacts on the tissues.

Rugby players are subject to multiple impacts to their head and neck that could have adverse neurological effects and put them at increased risk of neurodegeneration.

Previous studies demonstrated altered default mode network and diffusion metrics on brain, as well as more foraminal stenosis, disc protrusion and neck pain among players of contact sports as compared to healthy controls. However, the long-term effects of practice and repetitive impacts on brain and cervical spinal cord (cSC) of the rugby players have never been systematically investigated.

In this study, 15 retired professional and amateur rugby players (R) and 15 age-matched healthy controls (HC) (all males; mean age R: 46.8 ± 7.6; and HC: 48.6 ± 9.5) were recruited both to investigate cord impairments and further characterize brain structure damage. Medical questionnaires including modified Japanese Orthopedic Association scale (mJOA) and Neck Disability Index (NDI) were filled by all participants. A 3 T multi-parametric MR protocol including conventional qualitative techniques such as T₁-, T₂-, and T₂*-weighted sequences, as well as state-of-the art quantitative techniques including MP2RAGE T₁ mapping and 3D ihMTRAGE, was used on both brain and cSC. Normalized brain WM and GM volumes, spine Overall Stenosis Score, cord cross-sectional area and regional T₁ and ihMT metrics were derived from these acquisitions.

Rugby players showed significantly higher NDI scores, as well as a faster decline of normalized brain GM volume with age as compared to HC. Moreover, higher T₁ values on cSC suggestive of structural degeneration, together with higher T₁ and lower ihMTsat on brain WM suggestive of demyelination, were observed in retired rugby players as compared to age-matched controls, which may suggest cumulative effects of long-term impacts on the tissues. Metrics also suggest early aging and different aging processes on brain tissue in the players.

These preliminary observations provide new insights in the domain, which should now be further investigated on larger cohorts and multicentric longitudinal studies, and further correlated to the likelihood of neurodegenerative diseases and risk factors.

Five-Year Trends in Reported National Football League Injuries

OBJECTIVE

To determine the incidence of all-cause injury and concussion in the National Football League (NFL) over a 5-season time span (2012-2016).

DESIGN

Prospective descriptive epidemiological study.

SETTING

National Football League Injury Report data from 2012 to 2016.

PARTICIPANTS

National Football League players.

INTERVENTIONS

None (descriptive study).

MAIN OUTCOME MEASURES

Injury report data were collected prospectively for all NFL injuries from 5 seasons (2012-2016). The incidences of reported concussions, knee injuries, and all-cause injury were compared across the 5 seasons using the Kruskal-Wallis rank-sum test.

RESULTS

A total of 10 927 injuries were identified across the 5 seasons, including 752 (6.9%) concussions. The top 3 most injured areas included the knee (17.2%), ankle (13.6%), and shoulder (8.8%). Defensive backs consistently had the highest number of all-cause injuries per season. When comparing across years, there was a significant decrease in all-cause injury in 2016 compared with 2015, a significant decrease in knee injuries in 2016 compared with 2015, and a significant increase in concussion in 2015 compared with 2014 (P < 0.05).

CONCLUSIONS

Reported all-cause injury incidence and knee injury incidence is currently on the decline. However, reported concussion incidence has recently increased, perhaps due to increased awareness and rule changes implemented to aid in the detection and treatment of concussion. Strategies to reduce injury and improve injury awareness should continue to be explored.

Effect of Acupuncture on Muscle Endurance in the Female Shoulder Joint: A Pilot Study

Shoulder joint dysfunction is the leading cause of decreased athletic ability in athletes. Shoulder joint sports injuries affect the athletic performance of athletes. Improvements in the muscle endurance of the shoulder joint can reduce the incidence of shoulder joint dysfunction. Acupuncture has been an important part of Asian culture for a long time. In acupuncture, nerves are stimulated, inducing postactivation potentiation (PAP) in the body's motor units and enhancing muscle strength. In this research, 20 female participants with full flexion/extension and adduction/abduction ranges of motion in the shoulder joint during isokinetic exercises underwent stimulation of the following acupuncture points in the shoulder joint: Binao (LI14), Jianyu (LI15), Jianliao (SJ14), Naohui (SJ13), Yuzhong (KI26), Zhongfu (LU1), Yunmen (LU2), Xiabai (LU4), Chize (LU5), Tianfu (LU3), and Xiaoluo (SJ12). In the study, there were significant increases after acupuncture in the average maximum torque in flexion, extension, and adduction; the average work in flexion/extension and adduction/abduction; the average power in flexion/extension and adduction/abduction; the total work in flexion/extension and adduction/abduction; the total net sagittal-plane work (flexion + extension); and the total net frontal-plane work (adduction + abduction) (P < 0.05). The average maximum abduction torque did not increase significantly, potentially due to antagonistic forces of muscles. Therefore, acupuncture at acupoints around the shoulder joint can increase muscle excitability, thereby delaying muscle fatigue and increasing muscle endurance.

Training Load, Injury Burden, and Team Success in Professional Rugby Union: Risk Versus Reward

CONTEXT

Individual and team injury burden and performance are 2 key considerations facing practitioners in the daily prescription of an athlete's training load. Whereas a considerable number of researchers have examined univariate relationships between training load and performance, training load and injury, or injury and performance, few investigators have examined all 3 concurrently.

OBJECTIVE

To assess the association among training load, injury burden, and performance in professional rugby union.

DESIGN

Descriptive epidemiology study.

SETTING

The English Premiership competition.

PATIENTS OR OTHER PARTICIPANTS

Individual injury and training load data, as well as team performance data, were captured during the 2015-2016 (n = 433 players) and 2016-2017 (n = 569 players) seasons.

MAIN OUTCOME MEASURE(S)

Data were aggregated into team average scores for each week, including weekly (acute) load, smoothed chronic load, changes in load, injury burden, and weekly performance. Linear mixed modelling techniques were used to assess the association among measures.

RESULTS

Injury burden was negatively associated with performance, with a high weekly burden associated with a likely harmful (P = .01) decrease in performance. Training load measures displayed only trivial associations with performance. Only the acute:chronic workload ratio measure was clearly associated with injury burden, with a possibly harmful effect (P = .02). Both squad size and player availability were associated with only trivial changes in performance.

CONCLUSIONS

Whereas no association between average training load and performance existed, associations between training load and injury burden and between injury burden and performance were clear. Further investigation using more sensitive and individualized measures of load, performance, and injury may elicit a clearer relationship and should be considered for future work.

Ankle osteoarthritis and its association with severe ankle injuries, ankle surgeries and health-related quality of life in recently retired professional male football and rugby players: a cross-sectional observational study

OBJECTIVES

To determine (1) the prevalence of ankle osteoarthritis (OA) among former professional football and rugby players, (2) assess the association between ankle injuries or ankle surgeries with ankle OA, and (3) compare the mental and physical quality of life (QoL) between former professional football and rugby players with and without OA.

METHODS

We conducted a questionnaire-based observational study with a cross-sectional design. Former professional football and rugby players were recruited by the Football Players Worldwide and the International Rugby Players. Information concerning ankle OA, sustained ankle injuries and ankle surgeries was gathered (medical record or most recent medical professional). Health-related QoL was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) physical and mental health scores.

RESULTS

Overall, 553 former professional football (n=401) and rugby (n=152) players were enrolled in the study (response rate of 56%). Ankle OA prevalence among former professional football and rugby players was 9.2% and 4.6%, respectively. Football players were more likely to suffer from ankle OA following every ankle injury and/or surgery. Football and rugby players with ankle OA had similar PROMIS physical and mental health scores to the norm for the general population.

CONCLUSION

Former professional football and rugby players had higher ankle OA prevalence than the general population (3.4%). Football players are more likely to suffer from ankle OA following every ankle injury and/or surgery. No clinically relevant difference was seen for physical or mental health-related QoL among football and rugby players. Preventive measures for ankle injuries are recommended.

Match and Training Injuries in Women's Rugby Union: A Systematic Review of Published Studies

BACKGROUND

There is a paucity of studies reporting on women's injuries in rugby union.

OBJECTIVE

The aim of this systematic review was to describe the injury epidemiology for women's rugby-15s and rugby-7s match and training environments.

METHODS

Systematic searches of PubMed, SPORTDiscus, Web of Science Core Collection, Scopus, CINAHL(EBSCO) and ScienceDirect databases using keywords.

RESULTS

Ten articles addressing the incidence of injury in women's rugby union players were retrieved and included. The pooled incidence of injuries in women's rugby-15s was 19.6 (95% CI 17.7-21.7) per 1000 match-hours (h). Injuries in women's rugby-15s varied from 3.6 (95% CI 2.5-5.3) per 1000 playing-h (including training and games) to 37.5 (95% CI 26.5-48.5) per 1000 match-h. Women's rugby-7s had a pooled injury incidence of 62.5 (95% CI 54.7-70.4) per 1000 player-h and the injury incidence varied from 46.3 (95% CI 38.7-55.4) per 1000 match-h to 95.4 (95% CI 79.9-113.9) per 1000 match-h. The tackle was the most commonly reported injury cause with the ball carrier recording more injuries at the collegiate [5.5 (95% CI 4.5-6.8) vs. 3.5 (95% CI 2.7-4.6) per 1000 player-game-h; χ²₍₁₎ = 6.7; p = 0.0095], and Women's Rugby World Cup (WRWC) [2006: 14.5 (95% CI 8.9-23.7) vs. 10.9 (95% CI 6.2-19.2) per 1000 match-h; χ²₍₁₎ = 0.6; p = 0.4497; 2010: 11.8 (95% CI 6.9-20.4) vs. 1.8 (95% CI 0.5-7.3) per 1000 match-h; χ²₍₁₎ = 8.1; p = 0.0045] levels of participation. Concussions and sprains/strains were the most commonly reported injuries at the collegiate level of participation.

DISCUSSION

Women's rugby-7s had a higher un-pooled injury incidence than women's rugby-15s players based on rugby-specific surveys and hospitalisation data. The incidence of injury in women's rugby-15s and rugby-7s was lower than men's professional rugby-15s and rugby-7s competitions but similar to male youth rugby-15s players. Differences in reporting methodologies limited comparison of results.

CONCLUSION

Women's rugby-7s resulted in a higher injury incidence than women's rugby-15s. The head/face was the most commonly reported injury site. The tackle was the most common cause of injury in both rugby-7s and rugby-15s at all levels. Future studies are warranted on injuries in women's rugby-15s and rugby-7s.

PROSPERO REGISTRATION NUMBER

CRD42018109054 (last updated on 17 January 2019).

The epidemiology of kicking injuries in professional Rugby Union: A 15-season prospective study

PURPOSE

While kicking in Rugby Union can be influential to match outcome, the epidemiology of kicking injuries remains unknown. This study therefore aimed to investigate the epidemiology of injuries attributed to kicking in professional rugby, including playing position-specific effects and differences in kicking volumes and kick types.

METHODS

Fifteen seasons of injury surveillance data and two seasons of match kicking characteristics from professional rugby players were analyzed. Incidence, propensity, and severity of kicking-related injuries were calculated together with the locations and types of these injuries. Position-related differences in match kicking types and volumes were also established.

RESULTS

Seventy-seven match and 55 training acute-onset kicking injuries were identified. The match kicking injury incidence for backs was 1.4/1000 player-match-hours. Across all playing positions, the propensity for match kicking injury was 0.57 injuries/1000 kicks. Fly-halves sustained the greatest proportion of match kicking injuries (47%) and performed the greatest proportion of match kicks (46%); an average propensity for match kicking injury (0.58/1000 kicks). Scrum-halves executed 27% of match-related kicks but had a very low propensity for match kicking injury (0.17/1000 kicks). All other positional groups executed a small proportion of match-related kicks but a high propensity for match kicking injury. Ninety-two percent of match kicking injuries occurred in the pelvis or lower limb, with the majority sustained by the kicking limb. 21% of all match kicking injuries were associated with the rectus femoris muscle.

CONCLUSION

Match kicking profiles and kicking injuries sustained are position-dependent, which provides valuable insight for developing player-specific conditioning and rehabilitation protocols.

Acute subdural hematoma in an elite-level rugby union player

Acute subdural hematoma is a rare but potentially fatal medical condition in athletes. This condition has been reported in both contact and non-contact sports. Patients who survive an acute subdural hematoma typically have lifelong deficits and require extensive rehabilitation. Prompt recognition of this condition and access to a hospital with an available neurosurgeon is critical. To our knowledge, this is the first report of a subdural hematoma in an elite-level rugby player.

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Prompt recognition of head injuries is vital to prevent devastating outcomes.

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History and subjective symptoms should be carefully assessed after a head injury.

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Medical staff should remain vigilant, symptoms may develop over days or weeks.

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Expedient transport to a facility with neurosurgical support should be available.

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Transport should be considered, even in the absence of concerning exam findings.

Video Analysis of Shoulder Dislocations in Rugby: Insights Into the Dislocating Mechanisms

BACKGROUND

Mechanisms previously described for traumatic shoulder injuries in rugby may not adequately describe all the mechanisms that result in shoulder dislocations.

PURPOSE

To investigate the mechanism of shoulder dislocation events in professional rugby players through use of systematic video analysis.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

In our series, 39 cases of shoulder dislocations from games played in top professional leagues and international matches across a 2-year period were available for video analysis. All cases were independently assessed by 2 analysts to identify the sequence of events occurring during shoulder dislocation. This included injury circumstance such as contact with another player or the ground, game scenario, injury timing, and the movements and force vectors involved in the dislocation mechanism.

RESULTS

We identified 4 distinct injury mechanisms. The previously described mechanisms "try scorer,""tackler," and "direct impact" were identified in 67% of cases. We describe a new injury mechanism occurring in the "poach position," accounting for 18% of all shoulder dislocations studied. The remaining 15% could not be categorized. Shoulder dislocations occurred to a ball carrier in 15% of cases (n = 6) and a non-ball carrier in 85% of cases (n = 33). The injury most commonly occurred during a tackle (49%; n = 19) followed by ruck/maul (26%; n = 10). Time of injury showed that 36% (n = 14) of cases occurred in the last quarter of the game.

CONCLUSION

Shoulder dislocations have now been shown to occur predominantly as a result of 1 of 4 distinct mechanisms, most frequently in the second half of the game. A new mechanism for shoulder dislocation has been described in this series, termed the poach position.

Epidemiology of Injuries Sustained by Elite Under-18 Rugby Players

CONTEXT

The physical nature of rugby is responsible for the high incidence of injuries, but no researchers have examined the epidemiology of injuries sustained by elite under-18 rugby players.

OBJECTIVE

To investigate the incidence of injuries sustained by players on the Spanish national under-18 rugby team during their participation in 4 European championships (2014-2017) and the types of play in which they occurred.

DESIGN

Cohort study.

SETTING

European rugby championships.

PATIENTS OR OTHER PARTICIPANTS

Ninety-eight under-18 rugby players.

MAIN OUTCOME MEASURE(S)

All injuries sustained during the championship periods were recorded per the World Rugby protocol.

RESULTS

A total of 40 injuries were logged over the 4 championships. The incidence of injury was higher during matches than during training (P < .05), with 138.0 (95% confidence interval [CI] = 136.5, 139.6) injuries per 1000 hours of play compared with 1.2 (95% CI = 1.2, 1.3) per 1000 hours of training. With only 2 days of rest between games, the injury rate was higher than with 3 days of rest (P < .05). More injuries were sustained during the third quarter of the game: 13 (44.8%) versus 6 (20.6%) in the last quarter, 5 (17.3%) in the second quarter, and 5 (17.3%) in the first quarter.

CONCLUSIONS

The most common injuries during matches were sprains and concussions, and these injuries were more likely to occur during matches than during training. Most injuries were caused by tackles and occurred during the third quarter of the game. These findings indicate that teams should focus on teaching players skills to reduce injuries caused by tackles and warming up properly before returning to the field after halftime. The injury rate was higher with only 2 versus 3 days' rest between games. These results suggest that young players' matches should be at least 72 hours apart.

Seasonal changes in glenohumeral joint isokinetic strength in professional rugby league players

OBJECTIVE

To assess glenohumeral joint (GHJ) rotation strength across a rugby league season, since strength of rotator cuff musculature may protect against contact injuries to the shoulder.

DESIGN

A prospective cohort study was used to compare GHJ rotation pre-, in-, and post-season.

SETTING

Laboratory.

PARTICIPANTS

Twenty-nine players from a professional European Super League club.

MAIN OUTCOME MEASURES

Isokinetic dynamometry for concentric and eccentric muscle actions for shoulder internal and external rotation at 240°/s. Peak torque, traditional strength ratios, and dynamic control ratios were compared.

RESULTS

There were no significant differences between peak torque strength parameters at any time point. Similarly, differences in strength ratios failed to reach statistical significance across the season. Ipsilateral strength ratios were indicative of selective strengthening of internal rotators for concentric and eccentric muscle actions.

CONCLUSIONS

The findings suggest that rugby league players are no more likely to sustain a shoulder injury in the latter stages of the season as a result of decreased GHJ rotation strength. Players were able to maintain strength across the season which is valuable to practitioners developing conditioning programmes to optimise performance and minimise the risk of injury. This may afford protection, particularly during forced external rotation following physical contact.

Tendon and Ligament Injuries in Elite Rugby: The Potential Genetic Influence

This article reviews tendon and ligament injury incidence and severity within elite rugby union and rugby league. Furthermore, it discusses the biological makeup of tendons and ligaments and how genetic variation may influence this and predisposition to injury. Elite rugby has one of the highest reported injury incidences of any professional sport. This is likely due to a combination of well-established injury surveillance systems and the characteristics of the game, whereby high-impact body contact frequently occurs, in addition to the high intensity, multispeed and multidirectional nature of play. Some of the most severe of all these injuries are tendon and ligament/joint (non-bone), and therefore, potentially the most debilitating to a player and playing squad across a season or World Cup competition. The aetiology of these injuries is highly multi-factorial, with a growing body of evidence suggesting that some of the inter-individual variability in injury susceptibility may be due to genetic variation. However, little effort has been devoted to the study of genetic injury traits within rugby athletes. Due to a growing understanding of the molecular characteristics underpinning the aetiology of injury, investigating genetic variation within elite rugby is a viable and worthy proposition. Therefore, we propose several single nucleotide polymorphisms within candidate genes of interest; COL1A1, COL3A1, COL5A1, MIR608, MMP3, TIMP2, VEGFA, NID1 and COLGALT1 warrant further study within elite rugby and other invasion sports.

Do orbital floor plates adequately protect against serious secondary injury?

Reconstruction of the orbital floor is common in cases of trauma and a variety of alloplastic materials, including titanium, can be used. However, we know of no reports about what happens to these materials if there is a second injury to the surgical site. This pilot study on six human cadavers (12 orbits) was therefore designed to investigate the possible outcomes should this occur. A "blowout fracture" was created in each orbit, which was then repaired using a preformed titanium implant. In two orbits, two implants were placed without fixation. The remaining implants were secured to the anterior orbital floor with a single screw, which was placed laterally or medially. A second impact sufficient to fracture the zygomaticomaxillary complex was then applied and its effect on the implants noted.

Can a short neuromuscular warmup before tackling improve shoulder joint position sense in rugby players?

BACKGROUND

In rugby the tackle is a complex task requiring joint position sense (JPS). Injuries commonly occur during the tackle and these account for significant time lost from training and play. Simulated tackling tasks have previously shown a reduction in shoulder joint position sense and it is possible that this may contribute to injury. There is growing evidence in support of injury prevention programs, but none so far are dedicated specifically to tackling. We postulate that a brief neuromuscular warmup could alter the negative effects of fatigue on shoulder JPS.

METHODS

In this field based, repeated measures design study, 25 semi-professional Rugby players participated. JPS was measured at criterion angles of 45° and 80° of right arm shoulder external rotation. Reproduction accuracy prior to and following a neuromuscular warmup and simulated tackling task was then assessed.

RESULTS

In pre-warmup JPS measures, the spread of angle errors were larger at the 80° positions. Adding the warmup, the spread of the angle errors at the 80° positions decreased compared to pre-intervention measures. Two one-sided tests (TOST) analysis comparing pre- and post-testing angle errors, with the addition of the warmup, indicated no difference in JPS.

CONCLUSIONS

The neuromuscular warmup resulted in a decrease in JPS error variance meaning fewer individuals made extreme errors. The TOST analysis results also suggest the neuromuscular warmup used in this study could mitigate the negative effects of tackling on JPS that has been seen in prior research. This neuromuscular warmup could play a role in preventing shoulder injuries. It can easily be added to existing successful injury prevention programs.

Changes in northern hemisphere male international rugby union players' body mass and height between 1955 and 2015

Objectives

We sought to establish the effects of professionalism, which officially began in 1995, on the body mass and height of northern hemisphere male international rugby union (RU) players. We hypothesised that mass would significantly increase following professionalism. We also investigated the changes in size of players according to their playing position, and we compared changes to rugby league (RL) players and the public.

Methods

The body mass and height of players representing their international team for that country’s first game of the Five Nations in 1955, 1965, 1975, 1985 and 1995 and, for 2005 and 2015, the Six Nations, were collected from matchday programmes. RL players’ data were collected from the Challenge Cup final games played in the same years.

Results

International RU player body mass has significantly increased since 1995. In 1955 mean (±SD) player body mass was 84.8  kg (±8.2); in 2015, it was 105.4  kg (±12.1), an increase of 24.3%. Between 1955 and 2015, the body mass of forwards increased steadily, whereas that of backs has mostly gone up since 1995. RU player body mass gain has exceeded that of RL, but the age-matched difference between RU players and the public has remained relatively constant.

Conclusions

The factors influencing the gain in body mass of rugby players are legion; however, we believe that the interpretation of the law relating to the scrum put-in and changes allowing substitutions have, at least in part, contributed to the observed changes. Injury severity is increasing, and this may be linked to greater forces (caused by greater body mass) occurring in contact. RU law makers should adjust the rules to encourage speed and skill at the expense of mass.

Prevalence of Shoulder Labral Injury in Collegiate Football Players at the National Football League Scouting Combine

Background

Labral tears confirmed by magnetic resonance imaging (MRI) are a relatively common injury among collegiate athletes and can influence a player's ability to compete at the professional level.

Purpose

To determine the prevalence of MRI-confirmed shoulder labral injuries in collegiate football players entering the National Football League (NFL) Combine and to further describe these injuries by tear location, player position, history of surgical intervention, and associated concomitant shoulder injuries.

Study Design

Descriptive epidemiology study.

Methods

Data from 2009 to 2015 were retrospectively collected through review of the injury data registry available to the medical and training staff of all NFL teams following the completion of the NFL Combine. After players with potential labral tears were identified through history and examination, their MRIs were reviewed by 2 fellowship-trained orthopaedic sports medicine surgeons. Players diagnosed with a labral tear confirmed by MRI were separated for further analysis.

Results

A total of 2285 players were analyzed for the presence of labral tears at the NFL Combine. Overall, 377 shoulders (in 340/2285 players; 14.9%) demonstrated MRI evidence of labral tear; whereas linebackers had the highest rate of labral tear (19.2%), linemen had significantly higher risk for labral injury in at least 1 shoulder (odds ratio, 1.31; 95% CI, 1.02-1.67; P = .029) compared with nonlinemen. Of the 377 shoulders analyzed, 115 (30.5%) exhibited an anterior labral tear, 131 (34.7%) had a posterior labral tear, and 131 (34.7%) had combined anterior and posterior tears. One hundred twenty (31.8%) shoulders had superior labral anterior-posterior (SLAP) tears. A total of 203 (53.8%) shoulders demonstrated evidence of previous surgical intervention on imaging.

Conclusion

Injury involving the labrum is relatively common among participants at the NFL Combine, especially linebackers and linemen. Further investigation is necessary to determine the impact these injuries have on player draft position and NFL performance.

Epidemiology of Time-Loss Injuries in Senior and under-18 Portuguese Male Rugby Players

Rugby union has one of the highest injury incidence rates in team sports, however, most of the available data focus on the epidemiology of injuries in countries where rugby is popular. We aimed to report the incidence rate and relevant epidemiological aspects of injuries occurred in a group of Portuguese male rugby players. A prospective cohort study was conducted with a group of 45 senior and 32 under-18 male players (total of 77 players). Outcome measures included injury incidence, position, type, location and severity of injuries. The match injury incidence for all players was 55.84 per 1000 player match-hours (66.66 for seniors, 42.85 for under-18), while mean time-loss for injury was 20.79 days. No statistical differences were found between groups. Lower limb injuries accounted for 60.5% of all injuries, while joint/ligament injuries were the most prevalent type. Contact events were responsible for 65.1% of injuries. Despite the limitations, the obtained data are consistent with the literature. Time-loss injuries seem highly prevalent in rugby union and the incidence rates found in this Portuguese-based study were lower than the reported for international and senior men’s professional rugby union, but higher than those occurring in community rugby in tier-1 countries. The authors believe these data reinforce the need to develop and implement effective injury surveillance and prevention programs.

Epidemiology of Injury in Elite English Schoolboy Rugby Union: A 3-Year Study Comparing Different Competitions

CONTEXT

  Injury risks in professional and community rugby union have been extensively described; however, less is known about injury epidemiology at the schoolboy level.

OBJECTIVE

  To investigate the injury risk in English schoolboy rugby union matches, comparing an elite competition (Achieving Academic and Sporting Excellence [AASE]) with subelite matches (non-AASE).

DESIGN

  Retrospective cohort study.

SETTING

  Rugby union academy, consisting of 16- to 19-year-old males, based at an elite sports college in England.

PATIENTS OR OTHER PARTICIPANTS

  A total of 132 participants (mean age = 17.5 years) were included in the study; 64 athletes experienced a total of 103 time-loss injuries over a 3-season period (2012-2015). All injuries were assessed and recorded by the team therapist using consensus statement definitions.

MAIN OUTCOME MEASURE(S)

  Injury characteristics were recorded and compared between groups. Primary outcome measures were injury incidence (per 1000 h match exposure) and injury burden (days absent/1000 h), and rate ratios and 95% confidence intervals are presented throughout.

RESULTS

  A total of 131 matches were played (34 AASE, 97 non-AASE) and a total of 103 injuries were recorded (47 AASE, 56 non-AASE). The injury incidence in AASE matches (77/1000 h) was greater than in non-AASE matches (34/1000 h). The concussion incidence in AASE matches (20/1000 h) was 5 times that of non-AASE matches (4/1000 h). The head/face had the highest injury incidence for a specific location, followed by the shoulder region (AASE = 19/1000 h, non-AASE = 5/1000 h), which had the greatest injury burden (553/1000 h and 105/1000 h, respectively) for any specific body location. More than 50% of all injuries were associated with tackles.

CONCLUSIONS

  A much greater incidence of all injuries occurred at the highest level of competition, and the concussion incidence was greater than that reported in any previously published study of youth rugby. Given the high incidence and burden of concussions and shoulder injuries, prevention and management deserve specific focus.

Tackler's head position relative to the ball carrier is highly correlated with head and neck injuries in rugby

Objectives

To characterise the tackler’s head position during one-on-one tackling in rugby and to determine the incidence of head, neck and shoulder injuries through analysis of game videos, injury records and a questionnaire completed by the tacklers themselves.

Methods

We randomly selected 28 game videos featuring two university teams in competitions held in 2015 and 2016. Tackles were categorised according to tackler’s head position. The ‘pre-contact phase’ was defined; its duration and the number of steps taken by the ball carrier prior to a tackle were evaluated.

Results

In total, 3970 tackles, including 317 (8.0%) with the tackler’s head incorrectly positioned (ie, in front of the ball carrier) were examined. Thirty-two head, neck or shoulder injuries occurred for an injury incidence of 0.8% (32/3970). The incidence of injury in tackles with incorrect head positioning was 69.4/1000 tackles; the injury incidence with correct head positioning (ie, behind or to one side of the ball carrier) was 2.7/1000 tackles. Concussions, neck injuries, ‘stingers’ and nasal fractures occurred significantly more often during tackles with incorrect head positioning than during tackles with correct head positioning. Significantly fewer steps were taken before tackles with incorrect head positioning that resulted in injury than before tackles that did not result in injury.

Conclusion

Tackling with incorrect head position relative to the ball carrier resulted in a significantly higher incidence of concussions, neck injuries, stingers and nasal fractures than tackling with correct head position. Tackles with shorter duration and distance before contact resulted in more injuries.

Prolonged running increases knee moments in sidestepping and cutting manoeuvres in sport

OBJECTIVES

To investigate how knee kinematics, kinetics and loading changes during sidestepping tasks following a prolonged running protocol performed in a laboratory setting.

DESIGN

All participants performed sidestepping, and crossover cutting tasks in a randomised order before and after a 60min running protocol on a non-motorised treadmill that simulated an AF game.

METHODS

Eight healthy male participants who partook in semi-professional and amateur Australian Football undertook a series of straight line runs, sidestepping (SS), and crossover cutting (XO) tasks before and after a simulated game of Australian football. Kinematic data were analysed at initial foot contact of the SS and XO manoeuvres and kinetic data were analysed during the weight acceptance phase of the stance.

RESULTS

The knee was significantly more flexed at foot contact following fatigue compared to pre-fatigue states. Fatigue was also a factor contributing to significant increases in internal knee extension moments. Significant differences were also observed between SS and XO trials with flexion/extension moments, with notable differences in varus/valgus and internal/external rotation moments.

CONCLUSIONS

Acute angles of knee flexion at foot strike in a fatigued state may place the joint at an increased risk of injury. Increases in knee extension moments in the fatigued state suggests the knee joint must withstand significantly high stresses once fatigued.

Subsequent Injuries Are More Common Than Injury Recurrences: An Analysis of 1 Season of Prospectively Collected Injuries in Professional Australian Football

BACKGROUND

It is known that some people can, and do, sustain >1 injury over a playing season. However, there is currently little high-quality epidemiological evidence about the risk of, and relationships between, multiple and subsequent injuries.

PURPOSE

To describe the subsequent injuries sustained by Australian Football League (AFL) players over 1 season, including their most common injury diagnoses.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Within-player linked injury data on all date-ordered match-loss injuries sustained by AFL players during 1 full season were obtained. The total number of injuries per player was determined, and in those with >1 injury, the Subsequent Injury Classification (SIC) model was used to code all subsequent injuries based on their Orchard Sports Injury Classification System (OSICS) codes and the dates of injury.

RESULTS

There were 860 newly recorded injuries in 543 players; 247 players (45.5%) sustained ≥1 subsequent injuries after an earlier injury, with 317 subsequent injuries (36.9% of all injuries) recorded overall. A subsequent injury generally occurred to a different body region and was therefore superficially unrelated to an index injury. However, 32.2% of all subsequent injuries were related to a previous injury in the same season. Hamstring injuries were the most common subsequent injury. The mean time between injuries decreased with an increasing number of subsequent injuries.

CONCLUSION

When relationships between injuries are taken into account, there is a high level of subsequent (and multiple) injuries leading to missed games in an elite athlete group.

Kinetic and kinematic analysis of stamping impacts during simulated rucking in rugby union

Laceration injuries account for up to 23% of injuries in rugby union. They are frequently caused by studded footwear as a result of a player stamping onto another player during the ruck. Little is known about the kinetics and kinematics of rugby stamping impacts; current test methods assessing laceration injury risk of stud designs therefore lack informed test parameters. In this study, twelve participants stamped on an anthropomorphic test device in a one-on-one simulated ruck setting. Velocity and inclination angle of the foot prior to impact was determined from high-speed video footage. Total stamping force and individual stud force were measured using pressure sensors. Mean foot inbound velocity was 4.3 m ∙ s^-1 (range 2.1-6.3 m ∙ s^-1). Mean peak total force was 1246 N and mean peak stud force was 214 N. The total mean effective mass during stamping was 6.6 kg (range: 1.6-13.5 kg) and stud effective mass was 1.2 kg (range: 0.5-2.9 kg). These results provide representative test parameters for mechanical test devices designed to assess laceration injury risk of studded footwear for rugby union.

Risk factors for head injury events in professional rugby union: a video analysis of 464 head injury events to inform proposed injury prevention strategies

OBJECTIVES

The tackle is responsible for the majority of head injuries during rugby union. In order to address head injury risk, risk factors during the tackle must first be identified. This study analysed tackle characteristics in the professional game in order to inform potential interventions.

METHODS

464 tackles resulting in a head injury assessment (HIA) were analysed in detail, with tackle type, direction, speed, acceleration, nature of head contact and player body position the characteristics of interest.

RESULTS

Propensity to cause an HIA was significantly greater for active shoulder tackles, front-on tackles, high speeder tackles and an accelerating tackler. Head contact between a tackler's head and ball carrier's head or shoulder was significantly more likely to cause an HIA than contact below the level of the shoulder (incident rate ratio (IRR) 4.25, 95%-CI 3.38 to 5.35). The tackler experiences the majority (78%) of HIAs when head-to-head contact occurs. An upright tackler was 1.5 times more likely to experience an HIA than a bent at the waist tackler (IRR 1.44, 95% CI 1.18 to 1.76).

CONCLUSIONS

This study confirms that energy transfer in the tackle is a risk factor for head injury, since direction, type and speed all influence HIA propensity. The study provides evidence that body position and the height of tackles should be a focus for interventions, since lowering height and adopting a bent at the waist body position is associated with reduced risk for both tacklers and ball carriers. To this end, World Rugby has implemented law change based on the present data.

A Review of the Anthropometric Characteristics, Grading and Dispensation of Junior and Youth Rugby Union Players in Australia

The grading of Australian junior and youth rugby union players has received substantial media attention in recent years. Media reports have focussed on size mismatches observed between players, especially players with Polynesian heritage, and the concerned parents who fear for the safety of their child owing to perceived mismatches. Although such concerns are well meaning, few media reports recognise the need for substantial evidence to determine the best grading system for junior and youth rugby union players. The current study reviewed relevant literature pertinent to the grading and dispensation of junior and youth rugby union players. Using primary and secondary search strategies, a total of 33 articles reporting the anthropometric characteristics of junior and youth rugby players were identified. Anthropometric data from the literature were compared with normative population data and currently used dispensation criteria. Junior and youth rugby players were found to be taller and heavier than normative population data. Current dispensation criteria, in terms of body mass, were found to vary and it is suggested that criteria be revised and standardised across rugby unions throughout Australia. Although it is acknowledged that other factors are important for grading players, anthropometric characteristics should be considered as potential dispensation criteria to supplement current age-based grading for junior and youth rugby union players. Measuring the body mass and stature of each junior player upon pre-season registration is suggested, which would provide data to establish valid dispensation criteria for the following season.

Differences in the kinetics and kinematics of supported and un-supported landings of the rugby union lineout

The aim of the current investigation was to comparatively examine the kinetics and kinematics of supported and un-supported landings during the rugby union lineout. Eleven male lineout jumpers were tested under two conditions, ‘supported’ in which the lifters maintained supportive contact with the jumper until the jumpers’ feet touched the floor and ‘un-supported’ in which the lifters released the jumper once they had caught the ball. Kinematics were examined using an eight camera motion capture system and kinetics using a force platform. Differences between conditions were examined using paired t-tests. The findings showed the instantaneous loading rate (supported = 212.9±102.5 body weight (BW)/s and un-supported = 449.0±142.4 BW/s) and vertical velocity (supported = 2.7±0.4 m/s and un-supported = 4.0±0.4 m/s) at foot contact were significantly larger in the un-supported condition. The findings from the current investigation indicate that if the lineout jumper is un-supported by the lifters in returning to the ground then their risk from injury is likely to be greater. Therefore, given the number of lineouts that are conducted per game it is recommended that this law be clarified to also specify supported lowering of the jumper at all levels of play.

A 1-Year Prospective Analysis of Ice Climbing Injuries

OBJECTIVE

To describe rates, patterns, and causes of acute injuries in an increasingly popular outdoor sport.

DESIGN

Prospective cohort study.

SETTING

One winter season ranging from November 2011 to March 2011.

PARTICIPANTS

Seventy ice climbers from 13 different countries and various performance levels.

MAIN OUTCOME MEASURES

Participants were asked to complete a monthly Internet-based survey regarding their completed hours of training and competitions and eventual sustained injuries.

RESULTS

During 4275 hours of ice climbing, 42 injuries occurred, of which 81.0% were defined as mild, 16.6% as moderate, and 2.4% as severe. The calculated injury rate was 9.8 injuries per 1000 hours of sports exposure. Intermediate ice climbers had a significantly higher injury risk compared with advanced ice climbers (odds ratio, 2.55; 95% confidence intervals, 1.17-5.54; P = 0.018). About 73.8% of all injuries occurred on a frozen waterfall, icicles, or icefalls, whereas 4.8% occurred on artificial ice walls. The head was the most injured body part (47.6%), followed by the knee (14.3%) and the shoulder (11.9%). The most common types of injuries were abrasions (38.1%), contusions (35.7%), and joint sprains (7.1%). Falling ice was the main circumstance leading to injury (59.5%). All athletes with a head injury wore a helmet; however, only 35.0% mentioned they used protective goggles.

CONCLUSION

Ice climbing is a sport with moderate risk for injury with most of the reported injuries being of minor severity. However, severe and fatal injuries, although less common, also occur. Advanced ice climbers with greater experience and skill level have a lower overall injury risk.

Concussions and Head Injuries in English Community Rugby Union Match Play

BACKGROUND

Previous research has described general injury patterns in community-level rugby union, but specific information on time-loss head injuries has not been reported.

PURPOSE

To establish the incidence and nature of significant time-loss head injuries in English community rugby match play, and to identify the injury risk for specific contact events.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Over 6 seasons, injury information was collected from 46 (2009-2010), 67 (2010-2011), 76 (2011-2012), 50 (2012-2013), 67 (2013-2014), and 58 (2014-2015) English community rugby clubs (Rugby Football Union levels 3-9) over a total of 175,940 hours of player match exposure. Club injury management staff reported information for all head injuries sustained during match play whereby the player was absent for 8 days or greater. Clubs were subdivided into semiprofessional (mean player age, 24.6 ± 4.7 years), amateur (24.9 ± 5.1 years), and recreational (25.6 ± 6.1 years) playing levels. Contact events from a sample of 30 matches filmed over seasons 2009-2010, 2010-2011, and 2011-2012 provided mean values for the frequency of contact events.

RESULTS

The overall incidence for time-loss head injuries was 2.43 injuries per 1000 player match hours, with a higher incidence for the amateur (2.78; 95% CI, 2.37-3.20) compared with recreational (2.20; 95% CI, 1.86-2.53) ( P = .032) playing level but not different to the semiprofessional (2.31; 95% CI, 1.83-2.79) playing level. Concussion was the most common time-loss head injury, with 1.46 per 1000 player match hours. The tackle event was associated with 64% of all head injuries and 74% of all concussions. There was also a higher risk of injuries per tackle (0.33 per 1000 events; 95% CI, 0.30-0.37) compared with all other contact events.

CONCLUSION

Concussion was the most common head injury diagnosis, although it is likely that this injury was underreported. Continuing education programs for medical staff and players are essential for the improved identification and management of these injuries. With the majority of head injuries occurring during a tackle, an improved technique in this contact event through coach and player education may be effective in reducing these injuries.

Mechanisms of ACL injury in professional rugby union: a systematic video analysis of 36 cases

Background

The mechanisms of ACL injury in rugby are not well defined.

Aim

To describe the mechanisms of ACL injury in male professional rugby players using systematic video analysis.

Methods

36 cases from games played in top professional leagues and international matches were analysed. 5 analysts independently assessed all videos to record the estimated frame/time of initial ground contact, frame/time of ACL tear and a range of play specific variables. This included contact versus non-contact ACL injuries, injury timing, joint flexion angles and foot contact with the ground. 37 side-stepping manoeuvres from a control game were analysed to allow comparison of non-injury versus injury situations.

Results

57% of ACL injuries occurred in a contact manner. 2 main scenarios were identified: (1) offensive running and (2) being tackled, indicating that the ball carrier might be at higher risk of ACL injury. The majority of non-contact ACL injuries resulted from a side-stepping manoeuvre. In most non-contact cases, initial ground contact was through heel strike. Statistical assessment of heel strike at initial ground contact versus non-heel strike cases showed a significant difference in injury versus non-injury outcomes, with heel strike associated with higher injury risk. Non-contact ACL injuries had lower median knee flexion angles and a more dorsiflexed ankle when compared with a control group (10° vs 20°, p≤0.001 and 10° vs 0°, p=0.033 respectively).

Conclusions

Over half of ACL injuries in rugby in our analysis resulted from a contact mechanism. For non-contact injuries, lower knee flexion angles and heel-first ground contact in a side-stepping manoeuvre were associated with ACL injury.

Injuries in Australian school-level rugby union

There is a high incidence of injuries in rugby union due to the physical nature of the game. In youth rugby union, there are large variations in injury rates reported. Our study investigated the rates of injuries in school-level rugby union players in Australia using the consensus statement for rugby union injuries. Injury surveillance was conducted on 480 rugby players from 1 school in Queensland, Australia. Injury data were collected using paper-based injury recording forms during the 8-week rugby season using a "medical-attention" injury definition. In total, 76 players sustained one or more injuries, with a total of 80 injuries recorded. The overall injury rate was 31.8 injuries/1000 match player hours (95% CI, 25.4-39.4). Concussion had an incidence rate of 6.0/1000 match player hours (95% CI, 3.5-9.6). The incidence of upper limb and lower limb injuries were 9.1 and 9.9/1000 match player hours, respectively (95% CI, 5.9-13.5 and 6.6-14.5). The older age divisions had higher injury rates and most injuries occurred while tackling or being tackled. The injury rates observed in this sample of Australian school rugby union players provides direction for future studies to enable informed decisions relating to development of injury prevention programmes at this level of rugby.

Catastrophic Cervical Spine Injuries in Contact Sports

Study Design Systematic review. Objectives To determine the incidence of catastrophic cervical spine injuries (CCSIs) among elite athletes participating in contact team sports and whether the incidence varies depending on the use of protective gear or by player position. Methods Electronic databases and reference lists of key articles published from January 1, 2000, to January 29, 2016, were searched. Results Fourteen studies were included that reported CCSI in rugby (n = 10), American football (n = 3), and Irish hurling (n = 1). Among Rugby Union players, incidence of CCSI was 4.1 per 100,000 player-hours. Among National Football League players, the CCSI rate was 0.6 per 100,000 player-exposures. At the collegiate level, the CCSI rate ranged from 1.1 to 4.7 per 100,000 player-years. Mixed populations of elite and recreational rugby players in four studies report a CCSI rate of 1.4 to 7.2 per 100,000 player-years. In this same population, the scrum accounted for 30 to 51% of total reported CCSIs in Rugby Union versus 0 to 4% in Rugby League. The tackle accounted for 29 to 39% of injuries in Rugby Union and 78 to 100% of injuries in Rugby League. Making a tackle was responsible for 29 to 80% of injuries in American football. Conclusion CCSIs are infrequent among elite athletes. There is insufficient evidence to determine the effect of protective gear (e.g., helmets, padding) on CCSI incidence. Scrum and tackle in rugby and tackling in American football account for the majority of CCSIs in each respective sport.

Return to sport following clavicle fractures: a systematic review

INTRODUCTION

This review aims to provide information on the return rates and return times to sport following clavicle fractures.

SOURCES OF DATA

A systematic search of Medline, EMBASE, CINAHAL, Cochrane, Web of Science, PEDro, SPORTDiscus, Scopus and Google Scholar was performed using the keywords 'clavicle', 'clavicular', 'fractures', 'athletes', 'sports', 'non-operative', 'conservative', 'operative', 'return to sport'.

AREAS OF AGREEMENT

Twenty-three studies were included: 10 reported on mid-shaft fractures, 14 on lateral fractures. The management principles for athletic patients were to attempt non-operative management for undisplaced fractures to undertake operative intervention for displaced lateral fractures and to recommend operative intervention for displaced mid-shaft fractures.

AREAS OF CONTROVERSY

The optimal surgical modality for mid-shaft and lateral clavicle fractures.

GROWING POINTS

Operative management of displaced mid-shaft fractures offers improved return rates and times to sport compared to non-operative management. Suture fixation and non-acromio-clavicular joint (ACJ)-spanning plate fixation of displaced lateral fractures show promising results.

AREAS TIMELY FOR DEVELOPING RESEARCH

Future prospective studies should aim to establish the optimal treatment modalities for clavicle fractures.

Incidence and Factors Associated With Concussion Injuries at the 2011 to 2014 South African Rugby Union Youth Week Tournaments

OBJECTIVE

To determine the concussion incidence and to identify factors associated with concussion in South African youth rugby union players.

DESIGN

Prospective cohort study.

SETTING

Injury surveillance was completed at the South African Rugby Union Youth Week tournaments (under-13, under-16, and under-18 age groups).

PARTICIPANTS

South African youth rugby union players. A total of 7216 players participated in 531 matches between 2011 and 2014.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Concussion incidence was calculated per 1000 player-match-hours with 95% CIs. Poisson regression was used to calculate the incidence rate ratio (IRR) between factors (age, time period, playing position, and activity at the time of concussion) potentially associated with concussions.

RESULTS

The concussion incidence was 6.8/1000 player-match-hours (95% CI, 5.5-8.1) across all age groups. Under-13s (IRR, 1.5; P = 0.09) and under-16s (IRR, 1.7; P = 0.03) had higher concussion incidence rates than the under-18 age group. The incidence was higher in the third (IRR, 2.1; P = 0.04) and fourth (IRR, 2.5; P = 0.01) quarters of matches compared with the first quarter. Sixty-two percent of concussions occurred in the tackle situation. The tackler had a 4-fold greater concussion rate (IRR, 4.3; P < 0.001) compared with the ball carrier. The hooker and loose forwards had higher incidence rates than several other player positions (P < 0.05).

CONCLUSIONS

The reported concussion incidence falls within the broad range previously reported in youth rugby. The evidence highlighted in this study may contribute to targeted concussion prevention strategies and provide a baseline against which the effectiveness of future interventions can be measured.

Risks associated with significant head impact events in elite rugby union

PRIMARY OBJECTIVES

To conduct video and statistical analysis on Rugby Union play, focusing mainly on the tackle, to establish the player to player configurations for significant direct head impacts and non-direct head impacts.

RESEARCH DESIGN

Quantitative, observational cohort study.

METHODS AND PROCEDURES

Video analysis of 52 significant direct head impacts (31 Tackle, 10 Ruck, 7 Dive and 4 Ground) and 40 non-direct head impact tackles from 2014/15 International Rugby Union matches. Relative risk, 95% CI and p-values were calculated for a range of tackle variables.

MAIN OUTCOME AND RESULTS

Upper body tackles and lower body tackles accounted for 37% (19) and 23% (12) of cases, respectively, with the tackler as the head impacted player for 97% (30) of cases. The majority (81%) of tackle-related significant direct head impacts occurred in the second half of the game, with 63% of upper body tackle significant direct head impacts occurring in the final quarter. Tackler head placement and high speed tackles had statistical significance for causing tackle related significant direct head impacts as well as foot planting and difference in tackler and ball carrier mass for upper body tackles and ball carrier change in direction for lower body tackles.

CONCLUSION

Tackle variables that statistically increased the risk of significant direct head impact were identified, which can aid player protection strategies.

A systematic review of education programmes to prevent concussion in rugby union

BACKGROUND

There is a high incidence of concussion sustained by athletes participating in rugby union, many of which go unreported. A lack of sufficient knowledge about concussion injuries may explain athletes' failure to report. Several rugby union-playing countries have developed injury education and prevention programmes to address this issue.

OBJECTIVE

The aim of the current review was to systematically assess the content and level of evidence on concussion education/prevention programmes in rugby union and to make recommendations for the quality, strength, and consistency of this evidence.

METHODS

We searched PubMed, PsycInfo, MEDLINE, SPORTDiscuss, Webofscience, and conducted a manual search for articles.

RESULTS

Ten articles were included for review. Of these, six focused on the BokSmart injury prevention programme in South Africa, two focused on the RugbySmart injury prevention programme in New Zealand, one was an analysis of prevention programmes, and one was a systematic review of rugby injury prevention strategies.

CONCLUSIONS

Despite the initiative to develop concussion education and prevention programmes, there is little evidence to support the effectiveness of such programmes. There is evidence to support education of coaches and referees. In addition, there is scant evidence to suggest that education and rule changes may have the benefit of changing athlete behaviours resulting in a reduction in catastrophic injury.