Differences in injury and concussion rates in a cohort of Canadian female and male youth Rugby Union: a step towards targeted prevention strategies

The Incidence of Sports-Related Concussion in Children and Adolescents: A Systematic Review and Meta-Analysis

BACKGROUND

Sport-related concussions (SRC) are a concern for young athletes due to the potential for long-term health problems. This systematic review and meta-analysis aimed to provide a comprehensive overview of the literature exploring SRC incidence in youth sports to understand the associated risks.

METHODS

Medline, Embase, SPORTDiscus, PsycINFO, and Web of Science databases were searched without language restrictions up to September 2024. Studies were included if they (i) reported data for calculation of SRC incidence, (ii) were a prospective cohort study, and (iii) included a sample aged ≤ 18 years. Studies that reported Athlete Exposure (AE) or Player Hours (PH) as SRC incidence data measures were included in a multi-level random-effects meta-analysis. Additional analysis explored SRC incidence based on age, sex, country, year of data collection, setting, and level of contact.

RESULTS

Of the 6474 studies reviewed for eligibility, 116 studies were accepted for a systematic review and 99 in the meta-analysis. A total of 3,025,911 participants were included in the review (59% male, 41% female); however, 41% of studies did not report sample size. The pooled incidence rate of SRC per 1000 AE was found to be 1.41 across 21 sports, and 4.36 per 1000 PH across 7 sports. The highest incidence per 1000 AE were in taekwondo, rugby union, and ice hockey, and the highest incidence per 1000 PH were in rugby 7s, rugby league, and rugby union.

CONCLUSIONS

This systematic review and meta-analysis can serve as an updated baseline for risk of concussion among youth athletes across various sports.

TRIAL REGISTRATION

This systematic review was registered on OSF Registries ( https://osf.io/v298s ).

A Comparison of Suspected Injuries, Suspected Concussions, and Match Events in Male and Female Canadian High School 15s and 7s Rugby

OBJECTIVE

To compare match event rates and suspected injury and concussion rates between 7-a-side (7s) and 15-a-side (15s) female and male high school rugby union players using video analysis (VA).

DESIGN

Cross-sectional video analysis study.

SETTING

Alberta high school rugby competitions.

PARTICIPANTS

Senior high school rugby players (ages 14-18 years) in Calgary, Alberta, participating in the March to June 2022 season.

ASSESSMENT OF RISK FACTORS

Video analysis of high school rugby matches in 7s and 15s.

MAIN OUTCOME MEASURES

Univariate Poisson regression analyses were used to determine rates of match events, video-identified suspected injuries, and suspected concussions per 1000-player-hours. Incidence rates and incidence rate ratios (IRR) were used to compare between 7s and 15s (15s referent group) and females and males (male referent group).

RESULTS

Suspected injury rates ranged from 115.0 to 223.6/1000 match hours, while suspected concussion rates ranged from 61.5 to 93.2/1000 hours. The male 7s cohort reported the highest suspected injury and suspected concussion rate, with no significant differences between male or female cohorts across formats. The tackle accounted for 84.6% of all injuries. Despite 30% more tackles in female compared with male 15s, tackle-related injury rates were similar between sexes [IRR = 1.1 (95% CIs: 0.7-1.6)].

CONCLUSIONS

This study did not find any differences in suspected injury or suspected concussion rates between sexes or formats of the game. The proportion of injuries recorded in the tackle and the high reported suspected injury rates does suggest the need for further investigation into tackle proficiency, injury prevention intervention evaluation, and potential law changes.

Assessing Head Acceleration Events in Female Community Rugby Union Players: A Cohort Study Using Instrumented Mouthguards

BACKGROUND

The rapid growth of women's rugby union has underscored the need for female-specific player welfare protocols, particularly regarding the risk of head injuries. Instrumented mouthguards (iMGs) play a vital role in gathering comprehensive data on head acceleration events (HAEs), including their frequency, magnitude, and spatial distribution during games and training. By doing so, iMGs offer valuable context for circumstances in women's matches that may increase player risk.

OBJECTIVES

The study aimed to contextualize HAEs in female community rugby players using instrumented mouthguards and video review.

METHODS

This prospective, observational cohort study involved 332 female rugby players across 38 matches and 80 training sessions during the 2021/2022 seasons. Players were representative of four playing grades: U13 (N = 9), U15 (N = 111), U19 (N = 95) and Premier women (N = 115). HAEs were recorded using boil-and-bite iMGs, with a single-axis recording threshold of 5 g. The incidence and prevalence of HAEs was expressed by grade, years of experience, playing positions, and session types (match or training). The effect of playing grade and previous playing experience on HAE propensity during tackles and rucks was also examined.

RESULTS

Throughout the study, 9151 iMG events over 5 g were recorded, with 80% verified for analysis. Overall, the incidence rate (IR) was highest for HAEs between 10 and 29 g, 12-18 times higher than the IR for > 30-g events. Premier grade players had the highest weekly HAE load (26.2 per player per week) and the highest prevalence of players (49%) exposed to events over 30 g. An inverse relationship was found between years of rugby experience and peak angular acceleration (PAA) in U13-U19 players (p = 0.002, 95% CI [47,177 rads/s2]), showing that more experienced school-age players had lower rotational acceleration during HAEs. However, propensity for HAEs in tackle events was highest in Premier players with > 9 years of experience compared with U13-U19 grade players with similar years of experience (RR = 1.21, 95% CI 1.06-1.37; p = 0.004). Ball carries consistently resulted in the highest propensity of events over 30 g, regardless of playing grade or experience.

CONCLUSIONS

This research presents unique information regarding head accelerations that occur during women's community rugby matches and practices. The results have significant implications for recognising populations that are at the highest risk of experiencing high cumulative and acute head accelerations. The findings may assist in managing training loads and instructing skill execution in high-risk activities, particularly for younger players who are new to the sport. Consideration of playing grade, experience, and contact phases is crucial for understanding head acceleration exposure and injury risk in female rugby players. These insights can inform injury prevention strategies.

Incidence and Risk Factors for Sport-Related Concussion in Female Youth Athletes Participating in Contact and Collision Invasion Sports: A Systematic Review

BACKGROUND

The incidence and risk factors for sport-related concussion (SRC) associated with contact and collision invasion sports (CCIS) in female youth are unclear.

OBJECTIVES

This systematic review aimed to identify (i) the incidence of and (ii) risk factors for SRC in female youth athletes playing CCIS.

METHODS

A systematic search of PubMed, CINAHL, Embase, SPORTDiscus and ProQuest to 8 May, 2024 was conducted. Two reviewers independently screened articles against eligibility criteria and assessed risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Aetiological or intervention studies reporting on SRC incidence or risk factors in female youth athletes (aged 13-19 years and under) participating in CCIS were included. Meta-analyses were conducted to explore SRC incidence and risk factors. For each meta-analysis of SRC incidence rate, sub-group analyses were conducted by sport. Where heterogeneity was above 60% for the meta-analysis of SRC risk/protective factors, sensitivity analyses were conducted.

RESULTS

The search yielded 4509 articles; 66 were included. Sport-related concussion incidence or risk factor data for nine CCIS were extracted. Pooled estimates revealed SRC incidence for female youth athletes in CCIS combined was 0.50/1000 match and practice hours (95% confidence interval [CI] 0.34-0.66). When examined by sport classification, SRC incidence in contact invasion sports was 0.12/1000 match and practice hours (95% CI 0.03-0.21), and in collision invasion sports was 2.08/1000 match and practice hours (95% CI 0.90-3.25). Sub-group analysis by individual sport revealed female youth soccer players had the highest overall SRC incidence rate (0.89/1000 match and practice hours, 95% CI - 0.19 to 1.97) amongst contact sports, and rugby union players had the highest overall SRC incidence rate (4.04/1000 match and practice hours, 95% CI 3.03-5.05) among collision sports. Forty-five studies (68%) reported SRC risk factor data, investigating 12 different potential risk factors. Female youth sustained over 7.5 times the rate of SRC in matches compared with practice (incidence rate ratio 7.52, 95% CI 6.32-8.95, p < 0.01) when competing in CCIS; however, considerable heterogeneity existed (I2 = 84.98%). When exploring potential risk factors, no significant difference was found in SRC rate between female youth lacrosse players wearing versus not wearing headgear (p = 0.07). No significant difference was found in SRC rates between female youth athletes competing in younger versus older age groups (incidence rate ratio 0.91, 95% CI 0.52-1.61, p = 0.48, I2 = 0.00%). Insufficient evidence was available to examine remaining risk factors.

CONCLUSIONS

This meta-analysis revealed SRC in female youth playing CCIS was higher than previously reported, with SRC rates higher in matches than practice. Soccer had the highest SRC incidence rate for female youth athletes competing in contact invasion sports, whilst rugby union demonstrated the highest SRC incidence rates for collision invasion sports. The results of this review should be interpreted with caution given the lack of representation from some common CCIS codes. Further research is required to examine SRC risk factors in female youth athletes participating in CCIS.

CLINICAL TRIAL REGISTRATION

OSF Registration: osf.io/s573v.

Practitioners preference in using electrotherapy to treat paediatric lower limb conditions: an online survey

PURPOSE

Electrotherapies are commonly used to treat adult musculoskeletal pathologies. However, there is insufficient evidence supporting the use of electrotherapies for lower limb conditions in children. Currently, it is unknown how electrotherapies are used in paediatric clinical practice. This study aimed to investigate if practitioners use electrotherapy to treat children's lower limb conditions, frequency and why.

MATERIALS AND METHODS

A custom-built online survey was disseminated via social media targeting international medical and healthcare practitioners who treat children with lower limb conditions using electrotherapy. Practitioners were asked if they did or did not use electrotherapies, and their reasons. Responses were described in frequencies and with thematic analysis.

RESULTS

There were 445 practitioners who responded. From these, 301(68%) indicated they used electrotherapy, with the most frequently used being Transcutaneous Electrical Nerve Stimulation (n = 110). The most common reason cited for using electrotherapy was practitioner preference due to the alleged effectiveness of the chosen modality. The remaining 144 (32%) practitioners reported not using electrotherapy, the most common reason being lack of evidence.

CONCLUSIONS

We found that a majority of practitioners used electrotherapies on children. The reasons for using or not using electrotherapy were practitioner centred.

An examination of social relations and concussion management via the blue card

Introduction

Initially developed by New Zealand Rugby in 2014, the Blue Card initiative in rugby enables match officials to remove athletes from play if they are suspected to have sustained a concussion. Considerable attention has been paid by sport and health advocates to the possibilities and limitations of this initiative in safeguarding athlete health. However, little if any attention has been paid to the well-being of those responsible for administering the Blue Card (i.e., match officials). The aim of this paper was to examine match officials' experiences with and perspectives on implementing the Blue Card initiative in Ontario, Canada, with focused attention on the tensions around their ability to manage games and participants (e.g., athletes, coaches) while attempting to safeguard athlete well-being.

Methods

Using Relational Coordination Theory (RCT) as a guiding framework and qualitative research method, we highlight the rich accounts of 19 match officials' perspectives and experiences regarding sport-related concussion (SRC) management and the Blue Card protocol.

Results

Four themes were derived from the data, reflecting latent assumptions embedded within the concussion management process, which include: assumptions of trust, respect, and cooperation; assumptions of shared responsibility; assumptions of shared understanding; and assumptions of harassment-free sport.

Discussion

Our findings emphasize the need to attend to social relations in concussion management and provide insight into match officials' fraught experiences on the frontlines of concussion management. We identify factors affecting match official well-being and provide considerations for concussion management initiatives designed to improve athlete safety, such as the Blue Card.