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

Injury Profile in Youth Female Athletes: A Systematic Review and Meta-Analysis

BACKGROUND

An increasing number of epidemiological studies assessing the incidence, prevalence and severity of injury in youth female sport are available. However, no study has sought to synthesise the current evidence base across all youth female sport. As such, a systematic review and meta-analysis of injury in this cohort is necessary to understand the diversity of injury and its associated burden between sports in addition to identifying the density of research available.

OBJECTIVE

To conduct a systematic review and meta-analysis of epidemiological data of injuries in youth female athletes with particular attention to injury incidence, mean days lost and injury burden.

METHODS

Searches were performed in PubMed, EBSCO (SPORTDiscus with Full Text MEDLINE, APA PsycINFO, CINAHL, Academic Search Complete) and Cochrane databases. Studies were considered if they reported time-loss injury incidence or prevalence in youth female (≤ 19 years old) athletes. Study quality and risk of bias were assessed using STROBE-SIIS extension, Newcastle-Ottawa Scale, and funnel plots, respectively. Injury incidence and burden rate data were modelled using a mixed-effect Poisson regression model. Days lost data were modelled using a generalised linear mixed model.

RESULTS

Thirty-two studies were included. The overall incidence rate, mean days lost per injury, and burden rate were 4.4 injuries per 1000 h (95% CI 3.3-5.9), 10 days (95% CI 6-15), and 46 days per 1000 h (95% CI 23-92), respectively. Forty percent of athletes sustained at least one time-loss injury. Competitive level was a significant moderator of match and training injury incidence, with elite youth athletes presenting greater pooled injury incidence estimates than non-elite athletes (p = 0.0315 and p = 0.0047, respectively). The influence of moderators on days lost and injury burden could not be determined due to an insufficient number of studies for analysis.

CONCLUSION

Despite a broad inclusion criterion, there is limited injury surveillance research available across youth female sport. Outside of soccer, little research density is evidenced with single studies available in popular team sports such as Australian football and rugby union. Insufficient study numbers reporting mean days lost and injury burden data were available for analysis, and pooled days lost data could only be estimated for soccer. This highlights a need for future research to report days lost data alongside injury number and exposure so burden can be calculated and the full risk of injury to youth female athletes can be identified.

'Body on the line': experiences of tackle injury in women's rugby union - a grounded theory study

OBJECTIVES

Tackle-related injuries account for up to 67% of all match injuries in women's rugby union. The perspective of women players on tackle injury can help key stakeholders understand psychosocial determinants of tackle injury risk and prevention. We aimed to capture psychosocial processes that explain tackle injury experiences and behaviours in women's rugby union.

METHODS

We conducted a qualitative study using a grounded theory approach. Adult women players, with at least 1-year senior level experience, were recruited from Europe, South Africa and Canada between December 2021 and March 2022. Data were collected through semistructured interviews and analysed in line with grounded theory coding procedures.

RESULTS

Twenty-one players, aged 20-48 years with a mean 10.6 years of rugby playing experience, participated. In our analysis, we identified three categories central to participants' experiences of tackle injury: (1) embodied understandings of tackle injury, (2) gender and tackle injury risk and (3) influences on tackle injury behaviours. Participants reported a sense of fear in their experience of tackling but felt that tackle injuries were an inevitable part of the game. Tackle injury was described based on performance limitations. Tackle injury risks and behaviours were influenced by gendered factors perpetuated by relations, practices and structures within the playing context of women's rugby union.

CONCLUSION

Women's tackle injury experiences were intertwined with the day-to-day realities of marginalisation and under preparedness. Grounded in the voices of women, we have provided recommendations for key stakeholders to support tackle injury prevention in women's rugby.

Traumatic muscle injury

Traumatic muscle injury represents a collection of skeletal muscle pathologies caused by trauma to the muscle tissue and is defined as damage to the muscle tissue that can result in a functional deficit. Traumatic muscle injury can affect people across the lifespan and can result from high stresses and strains to skeletal muscle tissue, often due to muscle activation while the muscle is lengthening, resulting in indirect and non-contact muscle injuries (strains or ruptures), or from external impact, resulting in direct muscle injuries (contusion or laceration). At a microscopic level, muscle fibres can repair focal damage but must be completely regenerated after full myofibre necrosis. The diagnosis of muscle injury is based on patient history and physical examination. Imaging may be indicated to eliminate differential diagnoses. The management of muscle injury has changed within the past 5 years from initial rest, immobilization and (over)protection to early activation and progressive loading using an active approach. One challenge of muscle injury management is that numerous medical treatment options, such as medications and injections, are often used or proposed to try to accelerate muscle recovery despite very limited efficacy evidence. Another challenge is the prevention of muscle injury owing to the multifactorial and complex nature of this injury.

How to harness and improve on video analysis for youth rugby player safety: a narrative review

Video analysis is a useful tool for injury surveillance in rugby union. There are few video analysis studies in the professional female game, with most studies published in the male elite/professional settings. Moreover, there is a sparsity of literature in youth rugby settings. The following narrative review outlines the strengths and limitations of the current video analysis literature for injury surveillance in youth rugby union, highlights the importance of video analysis for youth rugby player safety and welfare, and discusses recommendations for using video analysis to inform player safety in youth rugby.

A Global Women's Rugby Union Web-Based Survey

Rugby Union (rugby) is a full-contact team sport characterised by frequent collision events. Over one third (2.7 million) of global rugby participants are women and girls. Yet, most rugby research, laws, and regulations are derived from the men's game with limited transferability to the women's game. This includes research focused on injury and concussion management. Greater insights are urgently required to enable appropriate adaptations and support for all rugby participants. Therefore, this paper presents the protocol for a project that sought to gather insights into the understanding, experiences, and attitudes of players and coaches in women's rugby regarding key issues of concussion, injury, and training for injury prevention, as well as the implications of the menstrual cycle for training and performance. From August 2020 to November 2020, online, open, cross-sectional surveys for players and coaches were distributed globally through rugby governing bodies and women's rugby social media platforms using snowball sampling. Survey responses were recorded anonymously via a GDPR-compliant online survey platform, JISC (jisc.ac.uk, Bristol, England). Participant eligibility included being ≥18 years and either actively playing or coaching women's rugby 15s and/or sevens, or having done so in the past decade, at any level, in any country. To enhance the number and accuracy of responses, the survey was professionally translated into eight additional languages. A total of 1596 participants from 62 countries (27 ± 6 years; 7.5 ± 5.1 years of playing experience) and 296 participants from 37 countries (mean age = 36.64, SD = 9.09, mean experience = 6.53 years, SD = 3.31) completed the players' and coaches' surveys, respectively. Understanding women's participation in and experiences of rugby is important to enable lifelong engagement and enjoyment of the sport and health during and following participation.

Injuries and Concussions in Female High School Rugby: Prevention is Worth a Try

OBJECTIVES

To describe injury and concussion rates and mechanisms in female high school rugby players.

DESIGN

Two-year prospective cohort study.

SETTING

High school rugby.

PARTICIPANTS

Participants included 214 female High school rugby players (year 1) and 207 female High school players (year 2) from the Calgary Senior High School Athletics Association 2018 and 2019 rugby competition.

INTERVENTION

None.

MAIN OUTCOME MEASURES

Match and training injury and concussion. Injury definition included any injury resulting in time loss, inability to complete a session, and/or requiring medical attention. Details of reported injuries were collected on injury report forms and validated by a certified athletic therapist on a validated online injury surveillance platform. Exposure hours for players were tracked using paper or virtual weekly exposure forms by team designates.

RESULTS

A match incidence rate (IR) = 93.7 injuries/1000 match hours (95% confidence intervals (CI): 78.6-11.7) and training IR = 5.3 injuries/1000 training hours (95% CI: 4.0-6.9) were estimated. The tackle accounted for 109 (70%) match and 37 (44%) training injuries. Tackling was the most frequent mechanism of injury (IR = 37.5 injuries/1000 match hours, 95% CI: 27.5-51.8 and 1.2 injuries/1000 training hours, 95% CI: 0.7-2.4). Sixty-two match concussions (IR = 37.5 concussions/1000 match hours, 95% CI: 26.8-52.3) and 16 training concussions (IR = 1.0 concussions/1000 training hours, 95% CI: 0.7-1.4) occurred. Of 78 reported concussions, 78% for match and 56% for training were physician diagnosed. Tackling was the most frequent mechanism of concussion in matches (IR = 18.1 concussions/1000 match hours, 95% CI:11.4-28.6).

CONCLUSIONS

Injury and concussion rates in female high school rugby are high. The tackle accounted for the highest proportion of injuries. Prevention strategies (eg, tackle policy change, tackle-training programs, and neuromuscular training) should be explored to increase sport safety.

International survey of injury surveillance practices in competitive swimming

OBJECTIVE

The purpose of this study was to identify the injury surveillance practices being used in competitive swimming environments. It explored the nature of the data collected, the injury definitions used and the perceived effectiveness of injury surveillance. Finally, this study also examined barriers to injury surveillance.

DESIGN

Online cross-sectional.

PARTICIPANTS

Twenty-two responders working in competitive swimming.

OUTCOME MEASURES

Injury surveillance methods, data collected, perceived level of effectiveness and barriers associated with injury surveillance.

RESULTS

Fifteen responders participated in injury surveillance, with 13 responders using a recognised definition for injury. Ten responders did not use any sports injury classification system. Ten responders found injury surveillance to be very effective at identifying injury trends, while previous injury history and training load data were perceived to be most influential in preventing injury. Limited time, funding and compliance were common obstacles, while poor staff communication and engagement were barriers to the effective implementation of injury surveillance.

CONCLUSIONS

The implementation of injury surveillance is related to the system objectives, competitive level of those under surveillance and the resources available. This implementation requires the balance of adhering to the principles outlined in prominent consensus statements and overcoming the barriers associated with implementing a system effectively.

Multisensory perception is not influenced by previous concussion history in retired rugby union players

BACKGROUND

To assess whether concussion history adversely affects multisensory integration, we compared susceptibility to the Sound-Induced Flash Illusion (SIFI) in retired professional rugby players compared to controls.

METHODS

Retired professional rugby players ((N = 58) and retired international rowers (N = 26) completed a self-report concussion history questionnaire and the SIFI task. Susceptibility to the SIFI (i.e., perceiving two flashes in response to one flash paired with two beeps) was assessed at three stimulus onset asynchronies (70 ms, 150 ms or 230 ms).Logistic mixed-effects regression modeling was implemented to evaluate how athlete grouping, previous concussion history and total number of years playing sport, impacted the susceptibility to the SIFI task. The statistical significance of a fixed effect of interest was determined by a likelihood ratio test.

RESULTS

Former rugby players had significantly more self-reported concussions than the rower group (p < 0.001). There was no impact of athlete grouping (i.e., retired professional rugby players and retired international rowers), years participation in elite sport or concussion history on performance in the SIFI.

CONCLUSION

A career in professional rugby, concussion history or number of years participating in professional rugby was not found to be predictive of performance on the SIFI task.

Caught on camera: a video assessment of suspected concussion and other injury events in women's rugby union

OBJECTIVES

The objective of this study was to identify and report the incidence and mechanisms of suspected injury and concussion in women's rugby union.

DESIGN

A cross-sectional video analysis study.

METHODS

Using video analysis of non-professional, single-angle footage, cases of suspected injury and concussion were identified and reported, based on content validation and consensus by eight rugby-specific researchers, therapists, and sport medicine physicians.

RESULTS

There were 225 suspected injuries recorded in 48 games [Suspected injury rate (IR) = 117.5/1000 h (95 % CI;102.6-133.9) or 4.7 suspected injuries per match]. The on-field medical attention IR was 95.0/1000 h (95 % CI;81.7-109.9: 3.8 per game). Suspected concussions accounted for 26 % of injuries (30.8/1000 h: 95 % CI;23.5-39.7: 1.2 per game). The attacking team sustained 64 % of suspected injuries. Permanent removal from play was observed for 29 % of suspected injuries. The most common suspected injury locations were head/neck (28.4 %) and lower extremity (27.6 %). The tackle accounted for 67.1 % of all suspected injuries, with a propensity of 11.2/1000 tackle events (95 % CI;9.5-13.2) or 3.1 tackle-related injuries/game. Of tackle-related injuries, 63.6 % were to the ball carrier while 52.2 % of tackle-related concussions were to the ball carrier.

CONCLUSION

This study adds to the growing body of literature examining women's rugby. The rate of suspected injury is high compared with other studies. It is acknowledged that these are suspected injuries not supported by prospective injury surveillance. The high proportion of suspected injuries that are tackle-related warrants specific attention to identify tackle characteristics associated with injury and concussion.

Applied sports science and sports medicine in women’s rugby: systematic scoping review and Delphi study to establish future research priorities

Objectives

In part 1, the objective was to undertake a systematic scoping review of applied sports science and sports medicine in women’s rugby, and in part 2 to develop a consensus statement on future research priorities.

Design

In part 1, a systematic search of PubMed (MEDLINE), Scopus and SPORTDiscus (EBSCOhost) was undertaken from the earliest records to January 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, the PRISMA extension for Scoping Reviews, and the PRISMA extension protocols were followed. In part 2, 31 international experts in women’s rugby (ie, elite players, sports scientists, medical clinicians, sports administrators) participated in a three-round Delphi consensus method. These experts reviewed the findings from part 1 and subsequently provided a list of priority research topics in women’s rugby. Research topics were grouped into expert-based themes and expert-based subthemes via content analysis. Expert-based themes and expert-based subthemes were ranked from very low to very high research priority on a 1–5 Likert scale. Consensus was defined by ≥70% agreement. The median research priority agreement and IQR were calculated for each expert-based theme and subtheme.

Data sources

PubMed (MEDLINE), Scopus and SPORTDiscus (EBSCOhost).

Eligibility criteria for selecting studies

Studies were eligible for inclusion if they investigated applied sports science or sports medicine in women’s rugby.

Results

In part 1, the systematic scoping review identified 123 studies, which were categorised into six sports science and sports medicine evidence-based themes: injury (n=48), physical performance (n=32), match characteristics (n=26), fatigue and recovery (n=6), nutrition (n=6), and psychology (n=5). In part 2, the Delphi method resulted in three expert-based themes achieving consensus on future research priority in women’s rugby: injury (5.0 (1.0)), female health (4.0 (1.0)) and physical performance (4.0 (1.0)).

Summary/Conclusion

This two-part systematic scoping review and Delphi consensus is the first study to summarise the applied sports science and sports medicine evidence base in women’s rugby and establish future research priorities. The summary tables from part 1 provide valuable reference information for researchers and practitioners. The three expert-based themes that achieved consensus in part 2 (injury, female health and physical performance) provide clear direction and guidance on future research priorities in women’s rugby. The findings of this two-part study facilitate efficient and coordinated use of scientific resources towards high-priority research themes relevant to a wide range of stakeholders in women’s rugby.

Physical and Technical Demands and Preparatory Strategies in Female Field Collision Sports: A Scoping Review

Women's participation in field collision sports is growing worldwide. Scoping reviews provide an overview of scientific literature in a developing area to support practitioners, policy, and research priorities. Our aim is to explore published research and synthesise information on the physical and technical demands and preparation strategies of female field collision sports. We searched four databases and identified relevant published studies. Data were extracted to form (1) a numerical analysis and (2) thematic summary. Of 2318 records identified, 43 studies met the inclusion criteria. Physical demands were the most highly investigated (n+=+24), followed by technical demands (n+= 18), tactical considerations (n+=+8) and preparatory strategies (n=1). The key themes embody a holistic model contributing to both performance and injury prevention outcomes in the context of female field collision sports. Findings suggest a gender data gap across all themes and a low evidence base to inform those preparing female athletes for match demands. Given the physical and technical differences in match-demands the review findings do not support the generalisation of male-derived training data to female athletes. To support key stakeholders working within female field collision sports there is a need to increase the visibility of female athletes in the literature.

Guidelines for performing systematic reviews in sports science

Most of the reviews carried out in sports science have used the general items suggested by Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Due to the specific requirements of each knowledge area, several modifications of the PRISMA are necessary to optimize the process of the systematic reviews and, in consequence, the quality of the conclusions provided in this type of study. Therefore, this work aimed to adapt PRISMA to provide specific guidelines to carry out systematic reviews in sports science. The methodology criteria (search strategy, databases, and eligibility) and the results section (flow diagrams and study contents) were adapted based on previous studies, and several new considerations were added to design the new guidelines. We compiled 28 items suggested by sports science researchers and included two new items: (i) population/problem (i.e., age, level, and country) and (ii) the entire training process, which is monitored and compared between groups (e.g., total training load). To maximize the benefit of this document, we encourage people to read it in conjunction with the PRISMA statement. The main differences between PRISMA and the PRISMA adapted to sports science were related to registration, search strategy, flow diagrams, and results. Application of the new guidelines could improve the information provided to readers and make it easier to generalize and compare the results in sports science.

Match and training injury incidence in rugby league: A systematic review, pooled analysis, and update on published studies

In studies reporting rugby league injuries, match injuries varied depending upon participation level. To review and update pooled data estimates for rugby league injury epidemiology and add information for participation levels in match and training environments. A systematic review and pooled analysis for published studies reporting rugby league match and training injuries. Searches were performed in the PubMed, CINHAL, ScienceDirect, Scopus, SPORTDiscus, SpringerLink, and Wiley Online databases. Studies were considered if they reported on rugby league match or training injuries between Jan 1990 to June 2021. Two authors (DK, TC) extracted the study characteristics, numerical data and assessed the article quality, by adhering to the protocol for systematic review of observational studies (MOOSE) and the STrengthening and Reporting of OBservational studies in Epidemiology (STROBE) statement. The 46 studies included a combined exposure of 419,037 h and 18,783 injuries incorporating 158,003 match-hr and 15,706 match injuries (99.4 [95%CI: 97.9–101.0] per 1000 match-hr) and 264,033 training-hr and 3077 training injuries (11.8 [95%CI: 11.4–12.2] per 1000 training-hr). Of included studies, 47.9% utilised a medical attention/treatment injury definition. There was a five-fold difference in injuries for the semi-professional participation level (431.6 per 1000 match-hr) compared with professional (RR: 4.92; p < 0.001) and elite (RR: 3.77; p < 0.001) participation levels. The hooker recorded the highest pooled injury incidence (93.1 per 1000 match-hr). Compared to the 2014 analysis there was a 10-fold increase for head-neck region (RR: 10.7; p < 0.001) injury incidence, and more injuries for the ball carrier (RR: 1.1; p = 0.008) and tackler (RR: 1.2; p = 0.001). There was a three-fold decrease in injury incidence in the first half (RR: 2.9; p < 0.001) and a two-fold decrease in the second half (RR: 2.3; p < 0.001) of matches. While rugby league match and training injury incidence had decreased since 2014, the increase in head injuries, and greater injury rate at the semi-professional level, mean further injury prevention interventions are needed.

•

Based on 46 studies, updated estimates of injury incidence for rugby league-related activities ranged from 14.6 per 1000 match-hr (Junior) to 431.6 per 1000 match-hr (Semi-Professional) participation levels for match activities and 5.3 per 1000 training-hr (Professional) to 97.1 per 1000 training-hr (Elite) participation levels for training activities.

Compared with the pooled analysis in 2014, the current analysis showed:•

The hooker playing position continues to have the highest match injury risk (93.1 per 1000 match-hr).

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The lower limb (64.5 per 1000 match-hr) continues to be the body region with the highest injury risk.

•

The quadriceps was the most reported injury site (28.5 per 1000 match-hr).

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The incidence of concussion in studies reporting on rugby league match injuries increased (7.7 vs. 11.6 per 1000 match-hr); and

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Most concussions took 28 days to recover, which conflicts with the Concussion in Sport Consensus Statement that reported 80%–90% of all concussions recover in seven to ten days.

A systematic video analysis of 21 anterior cruciate ligament injuries in elite netball players during games

This systematic video analysis of 21 anterior cruciate ligament (ACL) injuries sustained by elite-level netball players during televised games, describes the situation, movement pattern and player behaviour, providing insight regarding the injury mechanism. Seventeen of the ACL injuries occurred from jump-landing actions and only two from cutting manoeuvres. A common scenario was identified for 11 players. In this scenario, players were decelerating rapidly after jumping to receive a high pass, utilising a double-footed landing with a wide base of support (WBOS). Deceleration appeared to be applied predominantly via the injured leg with the knee extended and foot planted. Often the players appeared unbalanced on landing leaning too far back. ACL injury risk was possibly exacerbated by the players head turning away from the injured side. A further compressive knee moment may have been placed on the lateral aspect of the knee by bringing the ball from a high position to a low position at the estimated time of injury. Players may benefit from landing technique training programmes that encourage shoulder-width foot landings, with ≥30° knee flexion, a small amount of plantar-flexion and good balance. Incorporating challenges to players balance and ability to cope with perturbations may also be beneficial. Training programmes should include instruction on securing the ball in a stable above pelvis-level position after receiving a pass and bringing their whole body around during landing into the direction of their next pass, rather than simply turning their head to look.

The Incidence, Cost, and Burden of Concussion in Women's Rugby League and Rugby Union: A Systematic Review and Pooled Analysis

Background

The extent of concussion injury in the rugby codes for women is unclear.

Objective

Our aim was to review all published studies reporting concussion injuries from match and training participation in rugby codes and report the pooled data estimates for rugby league and union concussion injury epidemiology.

Methods

We conducted a systematic literature analysis of concussion in rugby league and rugby union for published studies from January 1990 to July 2021. Data from 16 studies meeting the inclusion criteria were extracted for women’s concussion injuries and were subsequently pooled. Costs from Accident Compensation Corporation (ACC) data were attributed to the results to provide cost estimates.

Results

The pooled analysis match injury incidence of women’s concussion was higher for rugby league (10.3 per 1000 match hours) than rugby 15 s (2.8 per 1000 match hours) or rugby 7 s (8.9 per 1000 match hours). There was a fourfold difference in the pooled incidence of concussion in women’s rugby league (risk ratio [RR] 4.53, 95% confidence interval [CI] 1.8–11.3]; p = 0.0001) when compared with rugby 15 s. There was also a ninefold higher risk of a concussion during match participation compared with training participation for women’s rugby 15 s (RR 9.3, 95% CI 1.29–66.78; p = 0.0070). The total estimated costs for the concussions reported were NZ$1,235,101. For rugby 7 s, the pooled concussive injury burden was 33.2 days.

Conclusions

Our pooled analysis clarified the extent of concussion injury and the possible associated costs at several levels of the game for women’s rugby codes. The pooled mean days lost because of concussions was 33 days. As this was considerably longer than the 7- to 10-day expected timeframe outlined in the Concussion in Sport Consensus statement, these guidelines need to be updated to include sex-specific differences.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-022-01645-8.

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.

Differences in Adiposity Profile and Body Fat Distribution between Forwards and Backs in Sub-Elite Spanish Female Rugby Union Players

The purpose of this study was to analyze the adiposity profile and the body fat distribution in 56 sub-elite female rugby union players involved in the Spanish National Women's Rugby Union Championships. The participants included in this study, which was the first to analyze sub-elite players, show thinner skinfolds, lower fat mass, and lesser fat percentage than previously reported for elite female rugby union players. Forwards were heavier and had higher body mass index (BMI) and fat mass, thicker skinfolds, and higher fat percentage than back players. Forwards also possessed significantly greater total fat-free mass than backs. All these differences were applicable only to players under 25 years of age. A negative correlation between age and both abdominal and lower extremity fat was found in forward players but not in the backs. Both Yuhasz and Faulkner equations tended to underestimate fat percentage in comparison to Reilly equation. Although Yuhasz equation provided higher systematic error, random error was lower in comparison to Faulkner equation. This study shows the relevance of analyzing and monitoring adiposity in female rugby union players to optimize adaptation to the sports requirements of different playing positions and age.

Laboratory Validation of Instrumented Mouthguard for Use in Sport

Concussion is an inherent risk of participating in contact, combat, or collision sports, within which head impacts are numerous. Kinematic parameters such as peak linear and rotational acceleration represent primary measures of concussive head impacts. The ability to accurately measure and categorise such impact parameters in real time is important in health and sports performance contexts. The purpose of this study was to assess the accuracy of the latest HitIQ Nexus A9 instrumented mouthguard (HitIQ Pty. Ltd. Melbourne Australia) against reference sensors in an aluminium headform. The headform underwent drop testing at various impact intensities across the NOCSAE-defined impact locations, comparing the peak linear and rotational acceleration (PLA and PRA) as well as the shapes of the acceleration time-series traces for each impact. Mouthguard PLA and PRA measurements strongly correlated with (R² = 0.996 and 0.994 respectively), and strongly agreed with (LCCC = 0.997) the reference sensors. The root mean square error between the measurement devices was 1 ± 0.6g for linear acceleration and 47.4 ± 35 rad/s² for rotational acceleration. A Bland-Altman analysis found a systematic bias of 1% for PRA, with no significant bias for PLA. The instrumented mouthguard displayed high accuracy when measuring head impact kinematics in a laboratory setting.

Applied sport science and medicine of women's rugby codes: a systematic-scoping review and consensus on future research priorities protocol

Women's rugby (rugby league, rugby union and rugby sevens) has recently grown in participation and professionalisation. There is under-representation of women-only cohorts within applied sport science and medicine research and within the women's rugby evidence base. The aims of this article are: Part 1: to undertake a systematic-scoping review of the applied sport science and medicine of women's rugby, and Part 2: to develop a consensus statement on future research priorities. This article will be designed in two parts: Part 1: a systematic-scoping review, and Part 2: a three-round Delphi consensus method. For Part 1, systematic searches of three electronic databases (PubMed (MEDLINE), Scopus, SPORTDiscus (EBSCOhost)) will be performed from the earliest record. These databases will be searched to identify any sport science and medicine themed studies within women's rugby. The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews will be adhered to. Part 2 involves a three-round Delphi consensus method to identify future research priorities. Identified experts in women's rugby will be provided with overall findings from Part 1 to inform decision-making. Participants will then be asked to provide a list of research priority areas. Over the three rounds, priority areas achieving consensus (≥70% agreement) will be identified. This study has received institutional ethical approval. When complete, the manuscript will be submitted for publication in a peer-reviewed journal. The findings of this article will have relevance for a wide range of stakeholders in women's rugby, including policymakers and governing bodies.

3D Biomechanics of Rugby Tackle Techniques to Inform Future Rugby Research Practice: a Systematic Review

BACKGROUND

The tackle is the most common in-play event in rugby union and rugby league (the rugby codes). It is also associated with the greatest propensity for injury and thus accounts for the most injuries in the sport. It is therefore of critical importance to accurately quantify how tackle technique alters injury risk using gold-standard methodology of three-dimensional motion (3D) capture.

OBJECTIVE

To examine the 3D motion capture methodology of rugby-style tackle techniques to provide recommendations to inform practice for future rugby code research and advance the knowledge of this field.

STUDY DESIGN

Systematic review.

METHODS

Articles published in English language, up to May 2020, were retrieved via nine online databases. All cross-sectional, correlational, observational, and cohort study designs using 3D motion capture of tackle techniques in rugby code players met inclusion criteria for this review. A qualitative synthesis using thematic analysis was pre-specified to identify five key themes.

RESULTS

Seven articles met eligibility criteria. Participant demographic information (theme one) involved a total of 92 rugby union players, ranging in skill level and playing experience. Experimental task design information (theme two) included one-on-one, front-on (n=5) or side-on (n=1) contact between a tackler and a ball carrier, or a tackler impacting a tackle bag or bump pad (n=3). 3D data collection (theme three) reported differing sampling frequencies and marker sets. 3D data reduction and analysis (theme four) procedures could be mostly replicated, but the definitions of temporal events, joint modelling and filtering varied between studies. Findings of the studies (theme five) showed that the one-on-one tackle technique can be altered (n=5) when tackle height, leg drive and/or tackle speed is modified. A study reported tackle coaching intervention.

CONCLUSIONS

This is the first review to evaluate 3D motion capture of rugby-style tackle technique research. A research framework was identified: (i) participant demographic information, (ii) experimental task design information, (iii) 3D motion capture data specifications, and (iv) 3D data reduction and analysis. Adherence of future 3D tackling research to these framework principles will provide critical scientific evidence to better inform injury reduction and performance practices in the rugby codes.

TRIAL REGISTRATION

The review was registered with PROSPERO (registration number CRD42018092312 ).

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.

Assessing Technical Skills in Talented Youth Athletes: A Systematic Review

Background

Talent identification and development (TID) programs aim to identify players with the greatest potential for long-term success. Previous research suggests that the assessment of sport-specific technical skills is valuable for discriminating between more and less skilled individuals and/or for predicting future performance.

Objective

This review aims to provide an overview on both the instruments used to assess sport-specific technical skills and their discriminatory, explanatory and/or predictive findings in the context of TID.

Methods

Electronic searches were conducted in PubMed, Web of Knowledge, SPORTDiscus, SURF and Scopus (January 1990–October 2019). Search terms covered the areas of sport, technical skills assessment, performance, skill level and youth. In the end, 59 relevant studies were identified and evaluated.

Results

The results highlight the widespread and important role of technical skills in TID; almost all studies (93%) reported discriminatory, explanatory and/or predictive benefits for the assessment of sport-specific technical skills. Analyzing and categorizing the number of assessment methods applied in the studies (n = 69) according to their method type (‘technique-related’ or ‘outcome-related’ variables) and method set-up (‘experimental’ or ‘competition’ data acquisition environment) indicated a clear tendency towards ‘outcome-related’ (73%) and ‘experimental’ (75%) assessment methods. We also found a strong overrepresentation of studies assessing cross-sectional data (75%) in soccer (53%) in male samples (74% of studies reporting subjects’ sex) from European countries (64%).

Conclusions

On the one hand, our findings demonstrate the great capability of sport-specific technical skills assessments to discriminate different performance levels and predict future performance in TID activities. On the other hand, this review highlights the focus on ‘outcome-related’ and ‘experimental’ methods in specific populations and, consequently, the limited knowledge in other areas. Here, the application of ‘technique-related’ and ‘competition’ methods appears promising for adding new knowledge, especially in the light of technological advances.

Training Design, Performance Analysis, and Talent Identification-A Systematic Review about the Most Relevant Variables through the Principal Component Analysis in Soccer, Basketball, and Rugby

Since the accelerating development of technology applied to team sports and its subsequent high amount of information available, the need for data mining leads to the use of data reduction techniques such as Principal Component Analysis (PCA). This systematic review aims to identify determinant variables in soccer, basketball and rugby using exploratory factor analysis for, training design, performance analysis and talent identification. Three electronic databases (PubMed, Web of Science, SPORTDiscus) were systematically searched and 34 studies were finally included in the qualitative synthesis. Through PCA, data sets were reduced by 75.07%, and 3.9 ± 2.53 factors were retained that explained 80 ± 0.14% of the total variance. All team sports should be analyzed or trained based on the high level of aerobic capacity combined with adequate levels of power and strength to perform repeated high-intensity actions in a very short time, which differ between team sports. Accelerations and decelerations are mainly significant in soccer, jumps and landings are crucial in basketball, and impacts are primarily identified in rugby. Besides, from these team sports, primary information about different technical/tactical variables was extracted such as (a) soccer: occupied space, ball controls, passes, and shots; (b) basketball: throws, rebounds, and turnovers; or (c) rugby: possession game pace and team formation. Regarding talent identification, both anthropometrics and some physical capacity measures are relevant in soccer and basketball. Although overall, since these variables have been identified in different investigations, further studies should perform PCA on data sets that involve variables from different dimensions (technical, tactical, conditional).

Injury Trends in Irish Amateur Rugby: An Epidemiological Comparison of Men and Women

Background:

Rugby union is a physically demanding sport that carries an inherent risk of injury. Despite being a popular and widely played team sport, little is known about injuries occurring across the male and female amateur game.

Purpose:

To establish and compare injury incidence, nature, and severity in male and female Irish amateur rugby union.

Study Design:

Prospective cohort study.

Level of Evidence:

Level 3.

Methods:

Data were collected prospectively from 25 male teams (959 players) and 8 female teams (234 players) over 2 full seasons. Both time-loss (24-hour time-loss injury definition) and non-time-loss match injury reports were collected, alongside match exposure data.

Results:

Time-loss match injury incidence rates were 49.1/1000 and 35.6/1000 player-hours for male and female players, respectively. Concussion and ankle ligament sprains were the most common diagnoses for male (5.6/1000 and 4.4/1000 player-hours, respectively) and female players (5.5/1000 and 3.9/1000 player-hours, respectively). Anterior cruciate ligament injuries presented the highest injury burden for male and female players with 200.3 and 307.2 days of absence per 1000 player-hours, respectively. In female players, 83% of noncontact injuries occurred in the fourth quarter of match play.

Conclusion:

While female players had a lower overall injury incidence rate compared with male players, concussion and ankle ligament injuries were the most common injuries in both cohorts. In female players, a high rate of noncontact injuries in the second half points to the need for strength and conditioning training programs to reduce fatigue-related injuries.

Clinical Relevance:

Establishing the incidence and burden of rugby-related injuries is an essential step in minimizing injury risk. This epidemiological information will aid the development of future reduction strategies, including education and coaching strategies and strength and conditioning programs, informed by the most common injuries observed and the mechanism of injury.

Rugby Health and Well-Being Study: protocol for a UK-wide survey with health data cross-validation

INTRODUCTION

Rugby football (Union and League) provides physical activity (PA) with related physical and mental health benefits. However, as a collision sport, rugby research and media coverage predominantly focus on injuries in elite players while the overall impact on health and well-being remains unclear. This study aims to provide a greater understanding of the risks and benefits of rugby participation in a diverse sample of men and women, current and former rugby Union and League players from recreational to the elite level of play. We will explore: (1) joint-specific injuries and concussion; (2) joint pain and osteoarthritis (OA); (3) medical and mental health conditions; (4) PA and sedentary behaviour and (5) well-being (quality of life, flourishing and resilience).

METHODS AND ANALYSIS

The Rugby Health and Well-being Study is designed in two phases: (1) a UK-wide cross-sectional survey and (2) cross-validation using health register data from Scotland. Participants will be at least 16 years old, current or former rugby players who have played rugby for at least one season. We will report standardised, level of play-, sex- and age-stratified prevalence of joint injury, concussion, medical conditions and PA. We will describe injury/concussion prevention expectations and protective equipment use. Rugby-related factors associated with injury, pain, OA, PA, health and well-being will be explored in regression models. We will compare joint pain intensity and duration, elements of pain perception and well-being between recreational and elite players and further investigate these associations in regression models while controlling for confounding variables. In the second phase, we will validate self-reported with health register data, and provide further information on healthcare use.

ETHICS AND DISSEMINATION

The Yorkshire and the Humber-Leeds East Research Ethics Committee (REC reference: 19/HY/0377) has approved this study (IRAS project ID 269424). The results will be disseminated through scientific publications, conferences and social media.

Employing Standardised Methods to Compare Injury Risk Across Seven Youth Team Sports

Injury surveillance systems seek to describe injury risk for a given sport, in order to inform preventative strategies. This often leads to comparisons between studies, although these inferences may be inappropriate, considering the range of methods adopted. This study aimed to describe the injury epidemiology of seven youth sports, enabling valid comparisons of injury risk. Consistent methods were employed across seven sports [male American football, basketball, soccer, rugby league, rugby union; female soccer and rugby union] at a high school in England. A 24-hour time-loss injury definition was adopted. Descriptive statistics and injury incidence (/1000 match-hours) are reported. In total, 322 injuries were sustained by 240 athletes (mean age=17.7±1.0) in 10 273 player-match hours. American football had a significantly greater injury incidence (86/1000 h; 95% CI 61-120) than all sports except female rugby union (54/1000 h; 95% CI 37-76). Concussion was the most common injury (incidence range 0.0-26.7/1000 h), while 59% of injuries occurred via player contact. This study employed standardized data collection methods, allowing valid and reliable comparisons of injury risk between youth sports. This is the first known study to provide epidemiological data for female rugby union, male basketball and American football in an English youth population, enabling the development of preventative strategies.

Injury Profile in Women's Football: A Systematic Review and Meta-Analysis

BACKGROUND

Football is the most popular sport among women; however, little is known about the injury profile in this population. This information would help design tailored injury risk mitigation strategies that may make football safer for women.

OBJECTIVE

The aim of this study was to perform a systematic review and meta-analysis of epidemiological data of injuries in women´s football.

METHODS

A systematic review following PRISMA guidelines was performed up to January 2020 in PubMed, Web of Science, Sportdiscus and the Cochrane Library databases. Twenty-two studies reporting the incidence of injuries in women football were analysed. Two reviewers independently extracted data (intraclass correlation coefficient [ICC] for inter-reviewer reliability = 0.87) and assessed study quality using the STROBE statement, GRADE approach, Newcastle Ottawa Scale and Downs and Black assessment tools. Studies were combined in pooled analyses (injury incidence and injury proportion) using a Poisson random effects regression model.

RESULTS

The overall incidence of injuries in female football players was 6.1 injuries/1000 h of exposure. Match injury incidence (19.2 injuries/1000 h of exposure) was almost six times higher than training injury incidence rate (3.5 injuries/1000 h of exposure). Lower extremity injuries had the highest incidence rates (4.8 injuries/1000 h of exposure). The most common types of injuries were muscle/tendon (1.8 injuries/1000 h of exposure) and joint (non-bone) and ligament (1.5 injuries/1000 h of exposure), which were frequently associated with traumatic incidents. Slight/minimal injuries (1-3 days of time loss) were the most common. The incidence rate of injuries during matches in the top five world ranking leagues was higher than the rest of the leagues (19.3 vs 10.7 injuries/1000 h of exposure, respectively). The weighted injury proportion was 1.1 (95% confidence interval = 0.6-1.7) whereby on average players sustained more than one injury per season.

CONCLUSIONS

Female football players are exposed to a substantial risk of sustaining injuries, especially during matches that require the highest level of performance. To markedly reduce overall injury burden, efforts should focus on introducing and evaluating preventative measures that target match specific dynamics to make football players more capable of responding to the challenges that they have to deal with during match play.

REGISTRATION

This systematic review was registered in the PROSPERO international prospective register of systematic reviews (ID = CRD42019118152).

Injuries in Netball-A Systematic Review

BACKGROUND

Netball is estimated to be played by more than 20 million people worldwide, but there is evidence of high injury incidence. A thorough understanding of the types and rates of netball injuries is essential for effective injury management and prevention strategies to be developed and implemented. This systematic review summarises the published findings with respect to injury types, participant characteristics and any identified risk factors for netball injuries.

METHODS

A librarian-assisted computer search of seven scientific databases was conducted for studies reporting on netball injuries. Inclusion criteria were studies published in English, in peer-reviewed journals, which reported data on injuries and variables (e.g. age and competition level) that have been proposed as possibly associated with netball injury risk.

RESULTS

Forty-six studies (43.5% prospective, 37% hospital/insurance records, 19.5% retrospective) from 45 articles were included after screening. The majority of studies (74%) were conducted in Australia or New Zealand. There was little consistency in the definition of 'injury'. Elite or sub-elite level players were included in 69% of studies where the level of competition was reported. The duration of injury surveillance was generally related to the format of competition from which data were collected. Self-report questionnaires were used in 48% of studies and only 26% of studies used qualified health professionals to collect data courtside. Injuries to the ankle and knee were the most common (in 19 studies) although the incidence varied considerably across the studies (ankle 13-84% and knee 8-50% of injuries). Prevention of ankle and knee injuries should be a priority. Children sustained more upper limb injuries (e.g. fractures) compared with adults who sustained more lower limb injuries (e.g. ankle and knee sprains/strains). A large number of potential risk factors for injury in netball have been investigated in small numbers of studies. The main circumstances of injury are landings, collisions and falls.

CONCLUSION

Further studies should be directed towards recreational netball, reporting on injury incidence in players by age and utilising high-quality, standardised methods and criteria. Specific injury diagnosis and a better understanding of the circumstances and mechanisms of injury would provide more meaningful data for developing prevention strategies.

Athlete concussion history recall is underestimated: a validation study of self-reported concussion history among current professional rugby union players

Objective: To assess the concurrent validity and test re-test reliability of the Michigan Traumatic Brain Injury Identification Method (MTBIIM). The psychometric properties of this concussion index were investigated by comparing the agreement between player self-reported diagnosed concussions and medical record diagnosed concussions among professional rugby union players.Study Design: Cross-sectional study i) validation and ii) test re-test reliability.Methods: The MTBIIM was administered via a structured interview to obtain the number and nature of player self-reported concussion histories from players, while contracted to the host club. Self-reported concussion history information was compared to medically recorded data captured between 2008 and 2017. A mixed-effects logistic regression model explored predictors of player self-report accuracy.Results: Data from 62 players (25.39[4.36] years) included 99 unique rugby related concussions. Medically documented concussions (n = 92) per player (1.48 [1.96]) were 30% more than the mean number of self-reported diagnosed (n = 63) concussions per player (1.02 [1.21] events). Overall, self-reported diagnosed concussions and medical record diagnosed concussion histories had a 'fair' level of agreement (k=0.274; SE [0.076]), p=.001). Self-reported lifetime concussion history was signicantly negatively correlated with recall of concussions.Conclusions: Initial concurrent validity of the MTBIIM was found to be fair with the average athlete under-reporting the number of clinically diagnosed concussions.

A Survey on Dietary Supplement Consumption in Amateur and Professional Rugby Players

Purpose: the aim of the present study was to analyse the pattern of dietary supplements (DS) consumption on federated rugby players, including the analysis of differences based on the sex and competitive level (professional vs. amateurs). Material and methods: 144 rugby players (83 male and 61 female), of whom 69 were professionals and 75 amateurs, were recruited for the study. All the participants filled out a specific questionnaire about DS consumption including questions related to the consumption of DS and their effects on sport performance and health status. Results: 65.3% of participants declared consuming at least one DS, with a higher prevalence in males than females (77.1% vs. 49.2%) and in professionals thanin amateur players (79.7% vs. 52.0%). The main reason for consumption was to enhance sport performance (62.3%) with differences only based on sex (74.3% males vs. 43.2% females). The most common purchase sites were the Internet (45.6%) and specialised stores (39.8%). As to the moment of ingestion, professionals did this most frequently during competition and training (56.4% vs. 28.2%), whereas amateur players did so only during competition (20.5% vs. 3.6%). Moreover, professional player intake most frequently in post-exercise (65.5% vs. 35.9%), whereas amateur during pre-exercise (30.8% vs. 5.5%). The DS most consumed included whey protein (44%), caffeine (42%), sports drinks (38%), energy bars (34%) and creatine monohydrate (31%), with a higher prevalence in male and professional players of whey protein and creatine monohydrate. Conclusions: The main reason for DS consumption is for enhancing sports performance). Professional players more frequently purchase them on the Internet and consume DS during training and competition period and in the post-exercise, whereas amateur players consume during competition and pre-exercise. Related to the main form of DS consumption, it is observed that a moderate consumption of DS could be considered ergogenic, such as whey protein, sport bar and creatine, while an absence of other DS could be considered ergogenic.

Training injury incidence in an amateur women's rugby union team in New Zealand over two consecutive seasons

OBJECTIVES

To describe the training injury incidence in amateur women's rugby union in New Zealand over two consecutive seasons.

DESIGN

A prospective cohort observational study METHODS: A total of 69 amateur women's rugby 15s team playerswere observed. Training exposure and training injury incidence were calculated.

RESULTS

The 38 training injuries resulted in a total injury incidence of 11.4 (8.3-15.6) per 1,000 training-hours. There were 12 injuries that resulted in a time-loss injury incidence of 3.6 (95% CI: 2.0-6.3) per 1,000 training-hours. Forwards recorded more total (RR: 1.8 [95% CI: 0.9-3.5]; p=0.0516) and time-loss (RR: 2.0 [95% CI: 0.6-6.6]; p=0.2482) injuries than Backs. The tackle was the most common injury cause for total (3.0 [95% CI: 1.6-5.6] per 1,000 training-hours.) injuries, but collisions (1.5 [95% CI: 0.6-3.6] per 1,000 training-hours.) with the ground or another person were the most common cause for time-loss injuries.The training injuries occurred most often to the lower limb and during the latter part of training sessions. These injuries were mostly minor in nature resulting in minimal time-loss away from training.

DISCUSSION

The time-loss injury incidence (3.6 per 1,000 training-hours.) for the amateur women's rugby 15s team players was higher than that reported for National (1.2 per 1,000 training-hours.) and Rugby World Cup for women (0.2 to 3.0 per 1,000 training-hours.) competitions.

CONCLUSION

The training injury incidence in amateur women's rugby union in New Zealand was higher than that reported for national and international rugby union injury incidences.

The Physical Characteristics of Elite Female Rugby Union Players

This study explored the anthropometric and body composition characteristics of elite female rugby union players, comparing between and within different playing positions. Thirty elite female rugby union players (25.6 ± 4.3 y, 171.3 ± 7.7 cm, 83.5 ± 13.9 kg) from New Zealand participated in this study. Physical characteristics were assessed using anthropometric (height, body mass, skinfolds) and body composition (dual-energy X-ray absorptiometry) measures. Forwards were significantly taller (p < 0.01; d = 1.34), heavier (p < 0.01; d = 2.19), and possessed greater skinfolds (p < 0.01; d = 1.02) than backs. Forwards also possessed significantly greater total (p < 0.01; d = 1.83–2.25) and regional (p < 0.01; d = 1.50–2.50) body composition measures compared to backs. Healthy bone mineral density values were observed in both forwards and backs, with significantly greater values observed at the arm (p < 0.01; d = 0.92) and femoral neck (p = 0.04; d = 0.77) sites for forwards. Tight-five players were significantly heavier (p = 0.02; d = 1.41) and possessed significantly greater skinfolds (p < 0.01; d = 0.97) than loose-forwards. Tight-five also possessed significantly greater total body composition measures (p < 0.05; d = 0.97–1.77) and significantly greater trunk lean mass (p = 0.04; d = 1.14), trunk fat mass (p < 0.01; d = 1.84), and arm fat mass (p = 0.02; d = 1.35) compared to loose-forwards. Specific programming and monitoring for forwards and backs, particularly within forward positional groups, appear important due to such physical characteristic differences.

Injury Profile of Male and Female Senior and Youth Handball Players: A Systematic Review

Handball is a team sport in which players are exposed to high physical conditioning requirements and several contacts and collisions, so they must face various musculoskeletal injuries throughout their career. The aim of this study was to summarize the characteristics of handball injuries both in training and in competition contexts, differentiating by gender and age. A systematic review was conducted and a total of 15 studies (33 cohorts) met the inclusion criteria. Higher injury incidence was reported during matches compared to training sessions in all groups (i.e., male and female senior and youth players), with male senior players presenting the greatest values. Lower extremities were more frequently injured, being contusions and sprains the most common type of injuries. Females reported more serious injuries than males, who presented a higher percentage of acute injuries caused by direct contact, while in female players these injuries were not caused by direct contact actions. Wings and backs presented the highest injury incidence; additionally, players registered higher match incidence during international championships compared to national leagues. Due to the differences in the injury profile of handball players, specific preventive strategies should be implemented for each group to optimize the injury prevention process.