Injury Risk in International Rugby Union: Three-Year Injury Surveillance of the Welsh National Team

Characterizing Longitudinal Alterations in Postural Control Following Lower Limb Injury in Professional Rugby Union Players

Assessment of player's postural control following a lower limb injury is of interest to sports medicine practitioners due to its fundamental role in daily tasks and sporting activities. The aim was to longitudinally monitor professional rugby union players' postural control during each phase of the rehabilitation program (acute, middle, and late) following a lower limb injury. Seven male rugby union players (height 1.80 [0.02] m; mass 100.3 [11.4] kg; age 24 [4] y) sustained a time loss, noncontact lower limb injury. Static postural control was assessed via sway path (in meters), and dynamic postural control was assessed via vertical postural stability index. Group differences (P < .05) were reported across the acute, middle, and late phase. Smaller magnitudes of sway path were observed for eyes-open sway path, and for the middle and late phase smaller magnitudes of vertical postural stability index (P < .05) at the end session compared with first session. Whereas larger magnitudes of vertical postural stability index were found between baseline and the last session (P < .05). Large interindividual and intraindividual variation was apparent across the 3 phases of rehabilitation. Postural control improvements were identified during rehabilitation. However, postural control did not return to baseline, with altered kinetics throughout each rehabilitation phase.

Epidemiology of International Match Injuries in Scottish Rugby: A Prospective Cohort Study

Fifteen-a-side rugby union ("rugby") is a full-contact sport played separately by men and women, with large injury incidences reported previously. Context specific injury surveillance fulfils governing bodies' duty of care to understand risks to player welfare, yet no contemporary match injury epidemiology studies exist for international players in Scotland. The current study therefore aimed to describe the incidence, severity, burden and nature of match injuries sustained by Scotland's men's and women's national teams. A prospective cohort study of injuries recorded in matches across the 2017/18 and 2018/19 seasons was undertaken, with injury and exposure definitions in line with the international consensus for injury surveillance in rugby. Injury incidence was 120.0 (men) and 166.7/1,000 player match hours (women), injury severity was 12.0 (median) and 31.2 days (mean) for men, and 11.0 (median) and 30.2 days (mean) for women. Injury burden was 3,745 (men) and 5,040 days absence/1,000 player match hours (women). Concussion was the most common specific injury for men (22.5/1,000 hours) and women (26.7/1,000 hours). No statistical differences were found for incidence or severity measures between sexes. Injury incidence was greater than recent Rugby World Cup studies. High incidences of concussion reinforces the need for prevention strategies targeting this injury.

FIFA football nurse - A task sharing approach in sports and exercise medicine practice in grassroots women's football in low- and middle- income settings. A study protocol for a cluster randomised controlled trial

Football (soccer) is a very popular team sport among African women and girls, with player numbers continuing to rise at all levels of the sport. Whereas the participation in football and associated injuries are on the rise, there are not enough sports and exercise medicine (SEM) personnel to attend to these women football players. While Africa may not currently have enough SEM trained medical doctors and/or physiotherapists, it has relatively higher numbers of other healthcare workers; for example, nurses, who lead healthcare services provision from community to tertiary levels. The primary objective of this study will be to compare sports medicine practices; injury prevention behaviours; injury risk parameters; incidence and prevalence of injuries and illnesses in teams with and without a Football Nurse during one competitive season in Malawi's Women's football league. This study will be a cluster randomised control trial will recruit 24 teams from the Women's Football League in Malawi, which will be randomised to either the intervention group or the control group. A cohort of 12 nurses will receive training in basic football medicine; after which they will be attached to a total of 12 women's football teams (intervention group) during one competitive season. The Football Nurses will be directly report to a physiotherapist or doctor in their district to whom they will refer serious injuries for investigations, or further management. The teams with Football Nurses will be compared to other teams that will not have Football Nurses. We expect to develop a low cost, sustainable and context relevant solution to manage the treatment gap of football injuries/illnesses in underserved communities such as women's football. Trial registration number: Pan African Clinical Trial Registry (PACTR202205481965514).

Intrinsic variables associated with low back pain and lumbar spine injury in fast bowlers in cricket: a systematic review

BACKGROUND

Lumbar spine injuries in fast bowlers account for the greatest missed playing time in cricket. A range of extrinsic and intrinsic variables are hypothesised to be associated with low back pain and lumbar spine injury in fast bowlers, and an improved understanding of intrinsic variables is necessary as these may alter load tolerance and injury risk associated with fast bowling. This review critically evaluated studies reporting intrinsic variables associated with low back pain and lumbar spine injury in fast bowlers and identified areas for future investigation.

METHODS

OVID Medline, EMBASE, SPORTDiscus, CINAHL, Web of Science and SCOPUS databases were last searched on 3 June 2022 to identify studies investigating intrinsic variables associated with low back pain and lumbar spine injury in cricket fast bowlers. Terms relevant to cricket fast bowling, and intrinsic variables associated with lumbar spine injury and low back pain in fast bowlers were searched. 1,503 abstracts were screened, and 118 full-text articles were appraised to determine whether they met inclusion criteria. Two authors independently screened search results and assessed risk of bias using a modified version of the Quality in Prognostic Studies tool.

RESULTS

Twenty-five studies met the inclusion criteria. Overall, no included studies demonstrated a low risk of bias, two studies were identified as moderate risk, and twenty-three studies were identified as high risk. Conflicting results were reported amongst studies investigating associations of fast bowling kinematics and kinetics, trunk and lumbar anatomical features, anthropometric traits, age, and neuromuscular characteristics with low back pain and lumbar spine injury.

CONCLUSION

Inconsistencies in results may be related to differences in study design, injury definitions, participant characteristics, measurement parameters, and statistical analyses. Low back pain and lumbar spine injury occurrence in fast bowlers remain high, and this may be due to an absence of low bias studies that have informed recommendations for their prevention. Future research should employ clearly defined injury outcomes, analyse continuous datasets, utilise models that better represent lumbar kinematics and kinetics during fast bowling, and better quantify previous injury, lumbar anatomical features and lumbar maturation.

TRIAL REGISTRATION

Open Science Framework https://doi.org/10.17605/OSF.IO/ERKZ2 .

Movement retraining programme in young soccer and rugby football players: A feasibility and proof of concept study

INTRODUCTION

Movement screening to identify abnormal movement patterns can inform development of effective interventions. The primary objective of this study was to evaluate the feasibility of using a movement screening tool in combination with a tailored movement control retraining programme in young soccer and rugby football players. A secondary objective was to investigate changes in movement control patterns post-intervention, to provide proof of concept (PoC) for movement retraining.

METHODS

52 male amateur players, including 34 soccer players (mean age 15 ± 2 years) and 18 rugby players (mean age 15 ± 1 years) participated. They were screened for movement control ability using a shortened version of the Hip and Lower Limb Movement Screening (Short-HLLMS) and completed an eight-week movement control retraining programme. Evaluation of feasibility included consent from players invited, adherence, attendance at the exercise sessions, drop-out and adverse events. Short-HLLMS total score and The Copenhagen Hip and Groin Outcome Score (HAGOS) were analysed to provide PoC for retraining movement control.

RESULTS

feasibility outcomes were favourable. Significant statistical changes occurred post-intervention in the Short-HLLMS total score (paired-samples t-test) and in three HAGOS subscales (symptoms, physical function in daily living and in sport and recreation) (Wilcoxon-Signed Rank Test) in both groups.

CONCLUSIONS

Feasibility of using the Short-HLLMS in combination with a movement control retraining programme in soccer and rugby players was promising. The data provided PoC for the potential application of a shortened version of the HLLMS to evaluate changes in movement control and to inform targeted motor control programmes.

Drop Test Kinematics Using Varied Impact Surfaces and Head/Neck Configurations for Rugby Headgear Testing

World Rugby employs a specific drop test method to evaluate headgear performance, but almost all researchers use a different variation of this method. The aim of this study was, therefore, to quantify the differences between variations of the drop testing method using a Hybrid III headform and neck in the following impact setups: (1) headform only, with a flat steel impact surface, approximating the World Rugby method, (2 and 3) headform with and without a neck, respectively, onto a flat MEP pad impact surface, and (4) headform and neck, dropped onto an angled MEP pad impact surface. Each variation was subject to drop heights of 75-600 mm across three orientations (forehead, side, and rear boss). Comparisons were limited to the linear and rotational acceleration and rotational velocity for simplicity. Substantial differences in kinematic profile shape manifested between all drop test variations. Peak accelerations varied highly between variations, but the peak rotational velocities did not. Drop test variation also significantly changed the ratios of the peak kinematics to each other. This information can be compared to kinematic data from field head impacts and could inform more realistic impact testing methods for assessing headgear.

Genetics and Sport Injuries: New Perspectives for Athletic Excellence in an Italian Court of Rugby Union Players

Several genes are involved in sport performance, especially in injuries incidence. The aim of this study was to investigate the association of ACE, ACTN3, COL1A1, and MCT1 genotypes and injuries in rugby players in order to find a genotype/phenotype correlation and provide useful information improving athletic performance. One-hundred male professional and semiprofessional rugby players were selected. Analysis was performed genotyping the genes ACE, ACTN3, COL1A1, and MCT1 as candidate gene of interest involved in athletic performance. A control group of non-athletic Italian male participants was analyzed to compare the results. We found statistical significance of MCT1 rs1049434 AA for total injuries (χ2 = 0.115; p = 0.003) and bone injuries (χ2 = 0.603; p = 0.007) in the rugby athlete population. No statistical significance was found between injury incidence and ACE, ACTN3, COL1A1 genotypes. The MCT1 AA genotype is associated with the incidence of total and bone injuries in the rugby player population. Although environmental factors such as lifestyle, diet, training, and stress can influence athletic performance, our data demonstrated the importance of genetic study in sport aimed at developing personalized training and achieving the best possible athletic excellence.

Impact, incidence and prevalence of musculoskeletal injuries in senior amateur male rugby: epidemiological study

OBJECTIVES

Exposure to different types of injuries in rugby union is common. It is important to know about the injury epidemiology for medical teams care in order to optimize players´ performance and the treatment of common injuries, but there is limited specific information related to amateur rugby union. The purpose of this study is to determine the incidence, prevalence, injury burden, severity, nature of injuries sustained by senior amateur male rugby players from three clubs in Argentina during a given season.

METHODS

An observational, analytical, prospective, multicenter study was developed. Data collection was conducted from 15 March 2019 to 2 November 2019, during a complete season under the applicable standards of the Rugby Injury Consensus Group according to the Orchard Sports Injury and Illness Classification System.Incidence (injuries/1000 player-match-hours), prevalence (%), severity (time loss), injury burden (days lost/1000 player-match-hours), injured location and type of injury (%) were estimated.

RESULTS

250 players and 180 injuries were assessed. Injury prevalence was 52.4%. Incidence rate per match and training was 30.9/1000 player-match-hours, and 0.77/1000 player-training-hours, respectively.The median injury severity score was 23 (IQR 12.7-52) days lost accounting for an injury burden of 97.3/1000 player-hours. Of the total, 113 (62.8%) injuries were contact injuries. The lower limbs were the most commonly affected (58.9%). Hamstring strain injury had the highest incidence and anterior cruciate ligament tear was the most severe injury.

CONCLUSION

The prevalence, incidence, and injury burden reported in this study are unprecedented and would add knowledge for the amateur rugby union community. Trainers, physicians, and physical therapists, should consider it to improve their clinical practice.

Potential of Soft-Shell Rugby Headgear to Mitigate Linear and Rotational Peak Accelerations

Rugby union is a popular sport played across the world. The physical contact inherent in the game means that players are at increased risk of concussive injury. In 2019, World Rugby created a new category of permitted headgear under Law 4 as a medical device. This established a pathway for headgear designed to reduce peak accelerations to be worn in matches. Investigations of the potential of soft-shelled protective headgear to reduce head impact accelerations have been mostly limited to the analysis of linear kinematics. However rotational head impact accelerations have long been implicated as far more injurious. The aim of this study, therefore, was to assess the linear and rotational acceleration reduction brought about by soft-shelled rugby headgear. A Hybrid III headform and neck were dropped onto a modular elastomer programmer impact surface, impacting at four different velocities (1.7–3.4 m/s) in five different impact orientations. Impact surface angles were 0°, 30°, and 45°. Peak linear and rotational accelerations, PLA and PRA respectively, were recorded. All headgear significantly reduced PLAs and PRAs when compared to a no headgear scenario. The new generation, headgear reduced all measures significantly more than the older generation of headgear. Impact locations offset from the center of mass of the headform resulted in the highest PRAs measured. As the impact surface angle increased, both PLAs and PRAs decreased. The study demonstrated that headgear tested lowered PLAs by up to 50%, and PRAs by up to 60% compared to the bare headform. Our data suggest that new generation headgear could make a difference on the field in reducing injurious impact accelerations in a collision.

Injuries in Elite Men's Rugby Union: An Updated (2012-2020) Meta-Analysis of 11,620 Match and Training Injuries

Background

The most recent meta-analytic review of injuries in elite senior men’s Rugby Union was published in 2013. The demands of the game at the elite level are continually changing alongside law amendments and developments in player preparation. As such, an updated meta-analysis of injury data in this setting is necessary.

Objective

To meta-analyse time-loss injury data in elite senior men’s Rugby Union between 2012 and 2020.

Methods

Electronic databases were searched using the keywords ‘rugby’ and ‘inj*’. Nineteen studies met the inclusion criteria. Injury incidence rate data were modelled using a mixed-effects Poisson regression model. Days missed data were modelled using a general linear mixed model.

Results

The included data encompassed a total of 8819 match injuries and 2801 training injuries. The overall incidence rate of injuries in matches was 91 per 1000 h (95% confidence interval (CI) 77–106). The estimated mean days missed per match injury was 27 days (95% CI 23–32). The overall incidence rate of match concussions was 12 per 1000 h (95% CI 9–15). The overall incidence rate of training injuries was 2.8 per 1000 h (95% CI 1.9–4.0). Playing level was not a significant effect modifier for any outcome.

Conclusions

The injury incidence rate and mean days missed per injury in the present meta-analysis were higher, but statistically equivalent to, the 2013 meta-analysis (81 per 1000 h and 20 days, respectively). The injury incidence rate for match injuries in elite senior men’s Rugby Union is high in comparison to most team sports, though the training injury incidence rate compares favourably. The tackle event and concussion injuries should continue to be the focus of future preventative efforts.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01603-w.

Trends in match concussion incidence and return-to-play time in male professional Rugby Union: A 16-season prospective cohort study

AIM

To describe trends in the incidence of match concussions and time to return-to-play in professional rugby union.

METHODS

Match concussion incidence (injuries per 1000 player-match-hours) and time to return-to-play (mean and median days absence) were recorded in 3006 male professional rugby union players over 16 seasons (2002/03 - 2018/19).

RESULTS

From 2002/03 to 2009/10, incidence of concussions was stable at 4.3/1000 player-match-hours. From 2009/10 to 2018/19, there was an increase in concussion incidence, with the highest incidence in 2016/17 at 20.9/1000 player-match-hours (95% CI: 17.9-24.3). Annual prevalence of concussion also increased, suggesting more players were concussed rather than the same players sustaining more concussions. Before the introduction of standardized graduated return-to-play (GRTP) guidelines in 2011, 27% of players returned to play in <6 days. After the introduction of the GRTP, this decreased to 7%, with no players returning in <6 days after 2014/15. Between 2002/03 and 2018/19, incidence of all other injuries remained stable.

CONCLUSIONS

From 2009/10 onwards, the incidence of diagnosed concussions increased. Since the introduction of the GRTP, there has been a dramatic reduction in the number of players returning in <6 days.

A descriptive prospective study of sports medicine practices for athletes in Uganda

BACKGROUND

Many international sporting organizations have recommended practices to reduce the risk of injury. These practices include screening for injury, having appropriate emergency medical care, and protocols for managing injury before return-to-play. The extent of the uptake of these practices in a developing country such as Uganda, is unknown.

METHODOLOGY

Using a descriptive case study approach, this investigation focused on a sample of injured athletes (n = 75) in Uganda from four main sports associations (football, athletics, basketball and rugby). The data were collected through observations and interviews after the injury. Using a best medical practice framework the phases of emergency, intermediate, rehabilitative, and return-to-sports participation were described.

RESULT

Nine conditions/types of injury were included. The results revealed a lack of specific pre-season screening or return-to-play readiness for all the injured athletes. Further, there was a lack of application of best practice principles for most of the injury types. For athletes who received medical care, the results show inconsistencies and inadequacies from the acute stage of the injury to return-to-sports participation.

CONCLUSION

This study identified barriers such as up-to-date knowledge among the sports resource providers; the gaps for appropriate and adequate specific facilities for managing injured athletes, and policies to mandate care of injured athletes. These barriers detract from applying best medical practices.

A qualitative investigation into the individual injury burden of amateur rugby players

OBJECTIVE

To examine the individual experiences of injury burden in amateur Rugby players across the onset of injury, rehabilitation, and return to play.

DESIGN

Qualitative.

SETTING

Irish amateur Rugby clubs.

PARTICIPANTS

Three male and two female Rugby players who sustained a severe injury that resulted in a time loss of at least 28 days.

MAIN OUTCOME MEASURES

Semi-structured interviews were used to explore the injury burden experienced during the three phases of injury.

RESULTS

Hierarchical content analysis revealed 36 codes representing individual injury burden, which were clustered into seven themes across personal (emotional reaction; impact on performance or involvement; lack of knowledge; severity of injury and incapacitation) and situational (exposure to others playing; negative experiences with treatment or rehabilitation; societal burden) dimensions.

CONCLUSIONS

The findings indicate that individual injury experiences can affect a player's recovery and rehabilitation outcome, potentially extending the injury process and affecting player availability for the team. As such, injury management should focus on alleviating any injury-related burden experienced by players, as well as burden placed on the team, to maximise rehabilitation outcomes.

Potential of Soft-Shelled Rugby Headgear to Reduce Linear Impact Accelerations

The purpose of this study was to examine the potential of soft-shelled rugby headgear to reduce linear impact accelerations. A hybrid III head form instrumented with a 3-axis accelerometer was used to assess headgear performance on a drop test rig. Six headgear units were examined in this study: Canterbury Clothing Company (CCC) Ventilator, Kukri, 2nd Skull, N-Pro, and two Gamebreaker headgear units of different sizes (headgears 1-6, respectively). Drop heights were 238, 300, 610, and 912 mm with 5 orientations at each height (forehead, front boss, rear, rear boss, and side). Impact severity was quantified using peak linear acceleration (PLA) and head injury criterion (HIC). All headgear was tested in comparison to a no headgear condition (for all heights). Compared to the no headgear condition, all headgear significantly reduced PLA and HIC at 238 mm (16.2-45.3% PLA and 29.2-62.7% HIC reduction; P < 0.0005, η p 2 = 0.987-0.991). Headgear impact attenuation lowered significantly as the drop height increased (32.4-5.6% PLA and 50.9-11.7% HIC reduction at 912 mm). There were no significant differences in PLA or HIC reduction between headgear units 1-3. Post hoc testing indicated that headgear units 4-6 significantly outperformed headgear units 1-3 and additionally headgear units 5 and 6 significantly outperformed headgear 4 (P < 0.05). The lowest reduction PLA and HIC was for impacts rear orientation for headgear units 1-4 (3.3 ± 3.6%-11 ± 5.8%). In contrast, headgear units 5 and 6 significantly outperformed all other headgear in this orientation (P < 0.0005, η p 2 = 0.982-0.990). Side impacts showed the greatest reduction in PLA and HIC for all headgear. All headgear units tested demonstrated some degree of reduction in PLA and HIC from a linear impact; however, units 4-6 performed significantly better than headgear units 1-3.

Recurrent and Subsequent Injuries in Professional and Elite Sport: a Systematic Review

BACKGROUND

Injury surveillance in professional sport categorises injuries as either "new" or "recurrent". In an attempt to make categorisation more specific, subsequent injury categorisation models have been developed, but it is not known how often these models are used. The aim was to assess how recurrent and subsequent injuries are reported within professional and elite sport.

METHODS

Online databases were searched using a search strategy. Studies needed to prospectively report injury rates within professional or elite sports that have published consensus statements for injury surveillance.

RESULTS

A total of 1322 titles and abstract were identified and screened. One hundred and ninety-nine studies were screened at full text resulting in 81 eligible studies. Thirty studies did not report recurrent injuries and were excluded from data extraction. Within the studies that reported recurrent injuries, 21 reported the number and percentage; 13 reported only the proportion within all injuries; three reported only the number; five reported the number, percentage and incidence; and two only reported the incidence. Seven studies used subsequent injury terminology, with three reporting subsequent injury following concussion, one using an amended subsequent injury model and three using specific subsequent injury categorisation models. The majority of subsequent injuries (ranging from 51 to 80%) were categorised as different and unrelated to the index injury. The proportion of recurrent injuries (exact same body area and nature related to index injury) ranged from 5 to 21%.

CONCLUSIONS

Reporting recurrent or subsequent injuries remains inconsistent, and few studies have utilised subsequent injury models. There is limited understanding of subsequent injury risk, which may affect the development of injury prevention strategies.

TRIAL REGISTRATION

CRD42019119264.

Influence of Weekly Workload on Physical, Biochemical and Psychological Characteristics in Professional Rugby Union Players Over a Competitive Season

Dubois, R, Lyons, M, Paillard, T, Maurelli, O, and Prioux, J. Influence of weekly workload on physical, biochemical and psychological characteristics in professional rugby union players over a competitive season. J Strength Cond Res 34(2): 527-545, 2020-This study aimed to (a) quantify the physical workload (P-WL) during training and games throughout the professional rugby season and (b) analyze the influence of the season period and weekly-WL, at short (acute) and moderate (chronic) terms, on physical, biochemical, and psychological responses during the season. Physiological (physical and biochemical) responses to P-WL were analyzed by examining changes in the individual Z score of the Yo-Yo intermittent recovery test (YYIRT), submaximal aerobic tests (5'/5'-test), strength tests, countermovement jump tests, blood sampling, and "recovery-stress" scores (RESTq) in 14 professional players (26.9 ± 1.9 years). Changes throughout the season were analyzed using a linear mixed model to identify changes in P-WL, whereas repeated-measures analysis of variance was used to analyze changes in physiological responses across the season. The relationship between P-WL and physiological responses was analyzed using Pearson's correlation coefficient (r). The results showed that the preseason period comprised the highest level of P-WL compared with all other blocks across the season (p < 0.001). The acute P-WL, acute competitive-WL, and number of impacts seemed to be the WL parameters, which most influenced the physiological responses (changes in testosterone [T], cortisol [C], T/C ratio, IGF-1/C ratio, strength, and RESTq index). The chronic P-WL, particularly conditioning-WL, induced positive changes in fitness characteristics (YYIRT and 5'/5'-test). Finally, this study provides information to players and coaches alike as to the influence of P-WL on as well as adaptations in physiological and psychological indices throughout a playing season. This information can greatly inform the training and preparation of future players in different levels.

Implementation of Injury and Illness Surveillance Protocols in Varsity Athletes

OBJECTIVE

To develop and implement a prospective varsity athlete surveillance system to identify injury and illness trends in a multisport varsity-level university setting.

DESIGN

Longitudinal prospective surveillance study.

SETTING

Varsity-level sport program at the University of Guelph, Guelph, ON, Canada.

PARTICIPANTS

Athletic therapists (ATs) (n = 35) from 17 varsity sports provided injury and illness information on 624 varsity-level athletes (381 men and 243 women) during the 2016/2017 competitive season.

INTERVENTIONS

Team ATs reported athlete health complaints weekly. Athletes reported additional details on the injury or illness that was reported.

MAIN OUTCOME MEASURES

The outcome measurements included when the injury or illness occurred, anatomical location, diagnosis, cause, perceived severity, treatment, estimated athlete exposure (AE) to training and competition, and time loss from sport. Measures were recorded from the teams' first competition through to the end the season and/or playoffs.

RESULTS

Twenty-nine of 30 varsity sports teams participated in this injury and illness surveillance protocol. The compliance of team ATs and varsity athletes was 89% (men: 94%, women: 82%). The overall injury and illness rates were 5.5 injuries and 1.7 illnesses per 1000 AEs, respectively. Men's injury rates were greater than women's, and injury rates of contact sports were greater than noncontact sports.

CONCLUSIONS

The utilization of a prospective injury and illness surveillance protocol in the Canadian University sport system is feasible with good athlete, AT, and coach acceptance. The surveillance data should inform future injury and illness prevention strategies.

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.

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.

Injury Prevention Strategies for Adolescent Cricket Pace Bowlers

Adolescent cricket pace bowlers are prone to non-contact shoulder, low back and lower-limb injuries. Exercise-based injury prevention programmes (IPPs) are effective for reducing non-contact injuries in athletes; however, a specific programme for adolescent pace bowlers has not been published. This paper therefore seeks to provide a rationale for the development of an exercise-based IPP specific for adolescent pace bowlers. It also outlines design principles and provides an example exercise programme that can be implemented at the community level. In addition, the paper addresses other injury prevention techniques concerned with the prescription of appropriate bowling loads and the modification of poor bowling biomechanics. Performing an exercise-based IPP before cricket training could reduce injury rates in adolescent pace bowlers. Eccentric strengthening exercises can be employed to target injuries to the posterior shoulder muscles, hip adductors and hamstring muscles. The risk of low back, knee and ankle injury could also be reduced with the inclusion of dynamic neuromuscular control exercises and trunk extensor endurance exercises. Other prevention strategies that need to be considered include the modification of poor bowling biomechanics, such as shoulder counter-rotation and lateral trunk flexion. Coaches and players should also aim to quantify bowling load accurately and coaches should use this information to prescribe appropriate individualised bowling loads. Specifically, players would benefit from avoiding both long periods of low load and acute periods when load is excessively high. Future evidence is needed to determine the effectiveness of the example programme outlined in this paper. It would also be beneficial to investigate whether the modification of bowling biomechanics is achievable at the non-elite level and if bowling load can be accurately measured and manipulated within a community-level population.

Validity of a Microsensor-Based Algorithm for Detecting Scrum Events in Rugby Union

PURPOSE

Commercially available microtechnology devices containing accelerometers, gyroscopes, magnetometers, and global positioning technology have been widely used to quantify the demands of rugby union. This study investigated whether data derived from wearable microsensors can be used to develop an algorithm that automatically detects scrum events in rugby union training and match play.

METHODS

Data were collected from 30 elite rugby players wearing a Catapult OptimEye S5 (Catapult Sports, Melbourne, Australia) microtechnology device during a series of competitive matches (n = 46) and training sessions (n = 51). A total of 97 files were required to "train" an algorithm to automatically detect scrum events using random forest machine learning. A further 310 files from training (n = 167) and match-play (n = 143) sessions were used to validate the algorithm's performance.

RESULTS

Across all positions (front row, second row, and back row), the algorithm demonstrated good sensitivity (91%) and specificity (91%) for training and match-play events when the confidence level of the random forest was set to 50%. Generally, the algorithm had better accuracy for match-play events (93.6%) than for training events (87.6%).

CONCLUSIONS

The scrum algorithm was able to accurately detect scrum events for front-row, second-row, and back-row positions. However, for optimal results, practitioners are advised to use the recommended confidence level for each position to limit false positives. Scrum algorithm detection was better with scrums involving ≥5 players and is therefore unlikely to be suitable for scrums involving 3 players (eg, rugby sevens). Additional contact- and collision-detection algorithms are required to fully quantify rugby union demands.

Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review

BACKGROUND

Although injuries to the head represent a small proportion of all sport injuries, they are of great concern due to their potential long-term consequences, which are even suspected in mild traumatic brain injuries.

OBJECTIVE

The aim of this review was to compare the incidence of concussions and other head injuries in elite level football, rugby, ice hockey and American Football.

METHODS

Four electronic databases (CINAHL, PsycINFO, Web of Science, PubMed) were searched. Prospective cohort studies on the incidence of concussion in elite athletes aged 17 years or older that were published in an English-language peer-reviewed journal since 2000 were included. Two authors independently evaluated study eligibility and quality. The extracted data on concussions were pooled in a meta-analysis using an inverse-variance fixed-effects model. The extracted data on head injuries were reported in a narrative and tabular summary.

RESULTS

The search yielded 7673 results of which 70 articles were included in the qualitative and 47 in the quantitative analysis. In our meta-analysis, we found the highest concussion incidences in rugby match play (3.89 and 3.00 concussions per 1000 h and athletic exposures (AEs), respectively), and the lowest in men's football training (0.01 and 0.08 per 1000 h and AEs, respectively). Overall, concussions and all head injuries were rare in training when compared to match play. Female players had an increased concussion risk in football and ice hockey when compared to male players.

CONCLUSION

Future research should focus on concussion in women's contact sports, as there is little evidence available in this area. Methodological deficits are frequent in the current literature, especially regarding sample size and study power, and should be avoided.

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.

Risk Factors for Non-Contact Injury in Adolescent Cricket Pace Bowlers: A Systematic Review

BACKGROUND

Adolescent cricket pace bowlers are prone to injury. Recognising the risk factors for non-contact injury in this population will aid future injury prevention strategies.

OBJECTIVE

To identify the risk factors for non-contact injury in adolescent cricket pace bowlers.

METHODS

We systematically searched PubMed, Cochrane Library, PEDro, SPORTDiscus, Embase, and the South African Journal of Sports Medicine to identify all experimental and observational studies reporting risk factors for non-contact injuries in pace bowlers (aged 12-19 years). The search syntax included terms relevant to cricket bowling, injury, and known risk factors for injury. The Newcastle-Ottawa Quality Assessment Scale and a modified Newcastle-Ottawa Quality Assessment Scale were used to assess the risk of bias in the cohort and cross-sectional studies, respectively.

RESULTS

Sixteen studies (five cross-sectional studies, 11 cohort studies) comprising 687 participants (96% male, 75% playing cricket in Australia) met the selection criteria and were included for qualitative synthesis. Three cross-sectional studies were rated as high risk of bias and two as very high risk of bias. For the cohort studies, three were rated as low risk of bias, and eight as high risk of bias. Injury was associated with bowling biomechanics (excessive lateral trunk flexion and pelvis/hip kinematics), reduced trunk endurance, poor lumbo-pelvic-hip movement control, and early signs of lumbar bone stress. Conflicting results were found by studies examining the mixed technique, bowling workload and quadratus lumborum asymmetry.

CONCLUSIONS

The current systematic review identified a number bowling biomechanics and various neuromuscular deficiencies as risk factors for non-contact injury in adolescent pace bowlers. These factors may provide a useful target for future interventional research aiming to prevent injury in this population. Future studies should utilise prospective cohort designs, and ensure that participants are injury-free at baseline, confounding factors are well controlled and attrition rates are reported.

REGISTRATION

This systematic review was registered a priori (PROSPERO, CRD42016043956).

Does the Reliability of Reporting in Injury Surveillance Studies Depend on Injury Definition?

Background:

Choosing an appropriate definition for injury in injury surveillance studies is essential to ensure a balance among reporting reliability, providing an accurate representation of injury risk, and describing the nature of the clinical demand.

Purpose:

To provide guidance on the choice of injury definition for injury surveillance studies by comparing within- and between-team variability in injury incidence with >24-hour and >7-day time-loss injury definitions in a large multiteam injury surveillance study.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

Injury data were reported for 2248 professional rugby union players from 15 Premiership Rugby clubs over 12 seasons. Within-team percentage coefficient of variation and mean between-team standard deviation (expressed as a percentage coefficient of variation) in injury incidence rates (injuries per 1000 player match hours) were calculated. For both variables, a comparison was made between >24-hour and >7-day injury incidence rates in terms of the magnitude of the observed effects.

Results:

The overall mean incidence across the population with a >24-hour time-loss injury definition was approximately double the reported incidence with the >7-day definition. There was a 10% higher between-team variation in match injury incidence rates with the >24-hour time-loss definition versus the >7-day definition.

Conclusion:

There was a likely higher degree of between-team variation in match injury incidence rates with a >24-hour time-loss definition than with a >7-day definition of injury. However, in professional sports settings, it is likely that the benefits of using a more inclusive definition of injury (improved understanding of clinical demand and the appropriate and accurate reporting of injury risk) outweigh the small increase in variation in reporting consistency.

On average, a professional rugby union player is more likely than not to sustain a concussion after 25 matches

Objectives

To investigate concussion injury rates, the likelihood of sustaining concussion relative to the number of rugby union matches and the risk of subsequent injury following concussion.

Methods

A four-season (2012/2013–2015/2016) prospective cohort study of injuries in professional level (club and international) rugby union. Incidence (injuries/1000 player-match-hours), severity (days lost per injury) and number of professional matches conferring a large risk of concussion were determined. The risk of injury following concussion was assessed using a survival model.

Results

Concussion incidence increased from 7.9 (95% CI 5.1 to 11.7) to 21.5 injuries/1000 player-match-hours (95% CI 16.4 to 27.6) over the four seasons for combined club and international rugby union. Concussion severity was unchanged over time (median: 9 days). Players were at a greater risk of sustaining a concussion than not after an exposure of 25 matches (95% CI 19 to 32). Injury risk (any injury) was 38% greater (HR 1.38; 95% CI 1.21 to 1.56) following concussion than after a non-concussive injury. Injuries to the head and neck (HR 1.34; 95% CI 1.06 to 1.70), upper limb (HR 1.59; 95% CI 1.19 to 2.12), pelvic region (HR 2.07; 95% CI 1.18 to 3.65) and the lower limb (HR 1.60; 95% CI 1.21 to 2.10) were more likely following concussion than after a non-concussive injury.

Conclusion

Concussion incidence increased, while severity remained unchanged, during the 4 years of this study. Playing more than 25 matches in the 2015/2016 season meant that sustaining concussion was more likely than not sustaining concussion. The 38% greater injury risk after concussive injury (compared with non-concussive injury) suggests return to play protocols warrant investigation.

A Review of a Decade of Rugby Union Injury Epidemiology: 2007-2017

Context:

Rugby union is the most widely played team collision sport globally. As with other contact sports, there is substantial risk of injury. To date, the majority of studies on injury epidemiology have focused on elite male cohorts, which inherently prevents extrapolation of research findings to other groups within the player continuum. This review aims to describe emerging injury trends across the spectrum of various rugby union subpopulations and to highlight gaps that may influence future injury prevention tactics.

Evidence Acquisition:

Relevant articles published from 2007 to 2017 were obtained by searching MEDLINE, PubMed, and SPORT Discus. Studies on 15-a-side rugby union, implemented according to the 2007 consensus statement on injury definitions and data collection procedures for injuries in rugby union, were used.

Study Design:

Clinical review.

Level of Evidence:

Level 3.

Results:

Match injuries occur more frequently than training injuries. Injury rates increase consistently according to age and level of play. Severity of injury often is greater among lower levels of the game, and sex-specific differences relating to injury patterns and incidence rates exist.

Conclusion:

To date, a paucity of injury surveillance data exists for women and players of both sexes at all levels of community rugby union. Furthermore, the incidence of injuries and illnesses are poorly reported in epidemiological studies. Despite methodological differences, injury trends remain consistent throughout all levels of play.

Concussion knowledge and experience among Welsh amateur rugby union coaches and referees

Background

Rugby union is a collision sport where participants are at high risk of sustaining a concussion. In settings where there is little qualified medical supervision, certain stakeholders (eg, coaches and officials) should possess sufficient knowledge in regard to the recognition and management of concussion.

Aim

The aim of this study was to assess the knowledge and experience of various aspects of concussion among coaches and referees involved in Welsh amateur rugby union.

Methods

A questionnaire was distributed to 1843 coaches and 420 referees.

Results

A total of 333 coaches and 283 referees completed the questionnaire (18% and 68% response rates, respectively). Participants exhibited greater knowledge of concussion symptom recognition relative to knowledge of both the consequences of concussion and associated return-to-play protocols, both of which could be considered poor. There were no differences in knowledge levels between coaches and referees or between participants with or without a history of concussion. Two-thirds of participants incorrectly believed that headgear could prevent concussion, and nearly 30% of coaches reported having witnessed other coaches allowing a potentially concussed player to continue playing.

Conclusions

Identification of several misconceptions indicates that concussion management within Welsh amateur rugby union needs to be improved, warranting a multi-faceted educational intervention.

Reduced severity of lumbo-pelvic-hip injuries in professional Rugby Union players following tailored preventative programmes

OBJECTIVES

The aim of this study was to tailor lumbo-pelvic-hip (LPH) injury reduction programmes in professional rugby union players based on screening data and examine its effectiveness.

DESIGN

Prospective case controlled study.

METHODS

Twenty-eight professional rugby union players were screened pre- and immediately post- the YO-YO intermittent recovery level 1 test using six hip and groin strength tests (adductor squeeze at 0°, 60° and 90°, prone hip extension, abductor, adductor hand held dynamometry). The changes in hip and groin measures, were analysed using hierarchical cluster analysis. Three clusters emerged and a tailored LPH injury reduction programme was administered for each cluster. In addition, 22 players who were not involved in the initial testing received a generic LPH injury reduction programme and were used as the control. Seasonal information for LPH injury incidence, severity and prevalence were compared to the previous season.

RESULTS

The same number of injuries were observed when the prospective injury surveillance data was compared to the previous season, however a reduced injury severity (936days vs 468days), average severity (78±126days vs 42±37days) and prevalence (21% vs 19%) were found. Moreover, LPH injury severity for players who were prescribed a tailored injury reduction programme (209days) were 50days less than players given a generic LPH injury reduction programme (259days).

CONCLUSIONS

Our preliminary observations support the effectiveness of grouping players and tailoring intervention based on common group characteristics in reducing the severity of LPH injuries in professional Rugby Union.

ACL Injury Prevention: What Does Research Tell Us?

PURPOSE OF REVIEW

Mechanisms leading to anterior cruciate ligament (ACL) injury have been identified, yet re-injury or a secondary injury persists in the athletic population. The purpose of this review is to identify risk factors associated with ACL injury and investigate programs to prevent injury.

RECENT FINDINGS

Faulty mechanics during dynamic movement that cause excessive valgus force at the knee increases the risk of ACL injury. Faulty mechanics may be a result of lateral displacement of the trunk, unequal limb loading, and lack of control to avoid the valgus knee position. Altered movements that place the ACL at risk are best identified in a fatigued state; however, could be recognized in a standard dynamic assessment. The faulty movement patterns are modifiable and should be addressed in an injury prevention program. Prevention programs include various modes of exercise such as plyometrics, neuromuscular training, and strength training. This review concludes that those programs which utilize neuromuscular training and strength training at a young age show the most promise in reducing ACL injuries. An ongoing thorough dynamic examination is necessary for all athletes while adjusting the intervention program in order to decrease the risk of ACL injury.

Application of the subsequent injury categorisation model for longitudinal injury surveillance in elite rugby and cricket: intersport comparisons and inter-rater reliability of coding

BACKGROUND

When an athlete has more than one injury over a time period, it is important to determine if these are related to each other or not. The subsequent injury categorisation (SIC) model is a method designed to consider the relationship between an index injury and subsequent injury(ies).

OBJECTIVE

The primary aim was to apply SIC to longitudinal injury data from two team sports: rugby union and cricket. The secondary aim was to determine SIC inter-rater reliability.

METHODS

Rugby union (time-loss; TL) and cricket (TL and non-time-loss; NTL) injuries sustained between 2011 and 2014 within one international team, respectively, were recorded using international consensus methods. SIC was applied by multiple raters, team clinicians, non-team clinicians, and a sports scientist. Weighted kappa and Cohen's kappa scores were calculated for inter-rater reliability of the rugby union TL injuries and cricket NTL and TL injuries.

RESULTS

67% and 51% of the subsequent injuries in rugby union and cricket respectively were categorised as injuries to a different body part not related to an index injury (SIC code 10). At least moderate agreement (weighted and Cohen kappa ≥0.60) was observed for team clinicians and the non-team clinician for both sports. Including NTL and TL injuries increased agreement between team clinician and non-team clinician, but not between clinician and sports scientist.

CONCLUSION

The most common subsequent injury in both sports was an injury to a different body part that was not related to an index injury. The SIC model was generally reliable, with the highest agreement between clinicians working within the same team. Recommendations for future use of SIC are provided based on the proximity of the rater to the team and the raters' level of clinical knowledge.

Hamstring injuries in elite Gaelic football: an 8-year investigation to identify injury rates, time-loss patterns and players at increased risk

Background

Hamstring injuries occur frequently in field sports, yet longitudinal information to guide prevention programmes is missing.

Aim

Investigate longitudinal hamstring injury rates and associated time loss in elite Gaelic football, while identifying subgroups of players at increased risk.

Methods

38 data sets from 15 elite male Gaelic football teams were received by the National Gaelic Athletic Association (GAA) Injury Surveillance Database between 2008 and 2015. Injury and exposure data were provided by the team's medical staff via an online platform.

Results

391 hamstring injuries were sustained accounting for 21% (95% CI 20.0% to 21.7%) of all injuries. Prevalence was 21% (95% CI 19.2% to 23.4%). Incidences were 2.2 (95% CI 1.9 to 2.4) per 1000 exposure hours, and 7.0 (95% CI 6.5 to 7.1) times greater in match play than in training. Typically each team sustained 9.0 (95% CI 7.0 to 11.0) hamstring injuries per season affecting the: bicep femoris belly (44%; 95% CI 39.4% to 48.7%); proximal musculotendinous junction (13%; 95% CI 9.8% to 16.3%); distal musculotendinous junction (12%; 95% CI 8.6% to 14.9%) and semimembranosis/semitendinosis belly (9%; 95% CI 6.3% to 11.7%). ∼36% (95% CI 31.5% to 41.0%) were recurrent injuries. Mean time loss was 26.0 (95% CI 21.1 to 33.0) days, which varied with age, injury type and seasonal cycle. Hamstring injuries accounted for 31% (95% CI 25.8% to 38.2%) of injury-related time loss. Previously injured players (rate ratio (RR)=3.3), players aged 18–20 years (IRR=2.3) or >30 years (RR=2.3), as well as defensive (IRR=2.0) and midfield players (RR=1.5), were most at risk of sustaining a hamstring injury. Comparisons of 2008–2011 with 2012–2015 seasons revealed a 2-fold increase in hamstring injury incidences. Between 2008 and 2015 training incidence increased 2.3-fold and match-play incidences increased 1.3-fold.

Conclusions

Hamstring injuries are the most frequent injury in elite Gaelic football, with incidences increasing from 2008–2011 to 2012–2015. Tailoring risk management strategies to injury history, age and playing position may reduce the burden of hamstring injuries.

Training volume and soft tissue injury in professional and non-professional rugby union players: a systematic review

AIM

To investigate the relationship between training volume and soft tissue injury incidence, and characterise soft tissue injury in rugby union players.

DESIGN

A systematic search of electronic databases was performed. The search strategy combined terms covering: training volume and injury, and rugby union, and players of all levels.

DATA SOURCES

Medline, SPORTDiscus, Web of Science, Embase, PubMed.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included if they reported: male rugby union players, a clear definition of a rugby union injury, the amount of training volume undertaken by participants, and epidemiological data for soft-tissue injuries including the number or incidence.

RESULTS

15 studies were eligible for inclusion. Overall match and training injury incidence ranged from 3.3 to 218.0 injuries/1000 player match hours and 0.1-6.1 injuries/1000 player training hours, respectively. Muscle and tendon as well as joint (non-bone) and ligament injuries were the most frequently occurring injuries. The lower limb was the most prevalent injury location. Injury incidence was higher in professional rugby union players than non-professional players. Contact events were responsible for the greatest injury incidence. For non-contact mechanisms, running was responsible for the highest injury incidence. Inconsistent injury definitions hindered reliable comparison of injury data. The lack of reporting training volumes in hours per player per week limited the ability to investigate associations between training volume and injury incidence.

CONCLUSIONS

A higher level of play may result in higher match injury incidence. Muscle and tendon injuries were the most common type of soft tissue injury, while the lower limb was the most common location of injury in rugby union players, and running was responsible for the highest injury incidence during non-contact events.