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Lang MA, Tucker R, Edwards S, Iverson GL, Gardner AJ. Tackle Risk Factors for Head Injury Assessments (HIAs) in Sub-Elite Rugby League and Recommendations for Prevention: Head Contacts from Upright Tackles Increase the HIA Risk to Both Ball Carrier and Tackler. SPORTS MEDICINE - OPEN 2024; 10:43. [PMID: 38630171 PMCID: PMC11024065 DOI: 10.1186/s40798-024-00696-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 03/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The rugby league tackle has been identified as the game event with the greatest propensity for a clinically diagnosed concussion. This study aims to replicate the work conducted in professional rugby league and rugby union by examining Head Injury Assessment (HIA) events to determine the associated tackle characteristics that increase concussion risk in sub-elite rugby league players. This comparison between competition levels is important due to the less developed physiological and tackle proficiency characteristics of sub-elite rugby league players and the fewer resources available for an on-field diagnosis, compared to the elite level of the sport. RESULTS Tackles resulting in Head Injury Assessments (HIAs, n = 131) and 2,088 tackles that did not result in a head injury were identified and coded from one season of the 2019 Queensland Cup. The body position of both ball carrier and tackler, tackle height, and body contact areas were evaluated. The propensity for tacklers to undergo a head injury assessment was 1.49 HIAs per 1,000 tackles, equating to a 2.5-fold higher risk than that of the ball carrier (0.59 HIAs per 1,000 tackles). The risk for an HIA was 2.75-fold greater when the tackler was upright (2.89 HIAs per 1,000 tackles) compared to a bent-at-the-waist tackler (1.05 HIAs per 1,000 tackles). The greatest risk for the tackler and ball carrier sustaining an HIA occurred when the tackle height was high, with head-to-head contact having the greatest propensity for an HIA (44.37 HIAs per 1,000 tackles). HIA risk was also greater for both players when the ball carrier did not employ an evasion strategy (3.73 HIAs per 1,000 tackles). CONCLUSIONS The study replicates results from research in elite rugby league and rugby union. A combination of higher head contact/proximity and upright body position significantly increase an HIA risk. Tackler head position and ball carrier evasion behaviours also affect risk, suggesting that injury prevention strategies designed to reduce tackle height and improve tackle technique by focusing on head position, body position, and in a novel finding, ball carrier evasion, may reduce head injury risk in sub-elite rugby league players.
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Affiliation(s)
- Martin A Lang
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Ross Tucker
- Institute of Sport and Exercise Medicine, Department of Sport Science, University of Stellenbosch, Stellenbosch, South Africa
| | - Suzi Edwards
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Mass General for Children Sports Concussion Program, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
| | - Andrew J Gardner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
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van Tonder R, Starling L, Surmon S, Viviers P, Kraak W, Boer PH, Jordaan E, Hendricks S, Stokes KA, Derman W, Brown JC. Tackling sport-related concussion: effectiveness of lowering the maximum legal height of the tackle in amateur male rugby - a cross-sectional analytical study. Inj Prev 2023; 29:56-61. [PMID: 36600566 PMCID: PMC9887377 DOI: 10.1136/ip-2022-044714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Rugby union ('rugby') is popular globally, with most of its participants being amateur. Concern regarding sport-related concussion (SRC) sustained during rugby is increasing. SRC occurs most frequently in the tackle, yet few interventions have aimed to mitigate this risk factor. This study investigated the influence of a lowered legal tackle height on SRC incidence in amateur rugby. DESIGN Cross-sectional analytical study: 2018 (control-standard tackle height) and 2019 (intervention-lowered legal tackle height) seasons. SETTING South African collegiate student rugby competition. PARTICIPANTS Between 800 and 900 male amateur student players (age: 20±1.6 years) in each year. INTERVENTION Maximum legal tackle height lowered from line of the shoulder on the ball carrier to the line of the armpit. OUTCOME MEASURES Number of overall (medical attention) and time-loss (≥1 day lost) injuries, head injuries and SRCs in 2018 and 2019 (dependent variables); events associated with injury incidents (independent variables). RESULTS There was no statistically significant difference in incidences of time-loss injuries (IRR: 0.79; 95% CI: 0.6 to 1.1; p=0.13), head injuries (IRR: 0.83; 95% CI: 0.5 to 1.3; p=0.42) and SRC (IRR: 0.69; 95% CI: 0.4 to 1.2; p=0.20). In 2018 and 2019, most time-loss head injuries (57%, n=43) and SRCs (55%, n=26) occurred during the tackle. CONCLUSIONS Despite a trend towards reducing injuries, head injuries and SRC, lowering maximum legal tackle height to armpit level did not change SRC incidence in this amateur male rugby cohort. Most time-loss head injuries and SRCs occurred during the tackle. Further tackle-related interventions to reduce SRC incidence require investigation.
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Affiliation(s)
- Riaan van Tonder
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa .,IOC Research Centre, Cape Town, South Africa
| | | | - Sean Surmon
- Maties Sport, Stellenbosch University, Stellenbosch, South Africa
| | - Pierre Viviers
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,Campus Health Service, Stellenbosch University, Stellenbosch, South Africa
| | - Wilbur Kraak
- Division of Sport Science, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Pieter-Henk Boer
- Department of Human Movement Science, Cape Peninsula University of Technology, Wellington, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa,Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
| | - Sharief Hendricks
- Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa,Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Keith A Stokes
- Department for Health, University of Bath, Bath, UK,Medical Services, Rugby Football Union, London, UK
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,IOC Research Centre, Cape Town, South Africa
| | - James Craig Brown
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,IOC Research Centre, Cape Town, South Africa
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Suzuki K, Nagai S, Iwai K, Furukawa T, Takemura M. How does the situation before a tackle influence a tackler's head placement in rugby union?: application of the decision tree analysis. BMJ Open Sport Exerc Med 2021; 7:e000949. [PMID: 33791104 PMCID: PMC7978105 DOI: 10.1136/bmjsem-2020-000949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives Tacklers need to decide where to place their head based on the evasive manoeuvres of the ball-carrier and positional relationship with the ball-carrier before tackle. Therefore, it is difficult for tacklers to improve incorrect head placement at the moment of contact. Moreover, the characteristics prior to tackle have a relationship with the tackler's head placement. However, how situations lead to incorrect head placement remains unknown. The aim of this study was to identify pre-contact situations that lead to incorrect head placement by using decision tree analysis. Methods Tackles leading to concussions were used to identify events that provoked injury using the video recordings of matches. Injury-free tackle was used as a control. All tackles were classified according to head placements and coded from seven pre-contact factors configured aspect of both tacklers and ball-carriers. Results Three situations that led to incorrect head placement were identified. Evasive manoeuvres implemented by the ball-carrier significantly contributed to the head placement at the time of contact. Conclusion Our findings suggest that tacklers should keep their heads up to identify the movements of the ball-carrier, which might lead to tackling the head on the correct side at the moment of tackling and decrease the risk of tackler-related concussions.
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Affiliation(s)
- Keita Suzuki
- Sports Research and Development Core, University of Tsukuba, Tsukuba, Japan
| | - Satoshi Nagai
- Department of Physical Therapy, Faculty of Health Sciences, Tsukuba International University, Tsuchiura, Ibaraki, Japan
| | - Koichi Iwai
- Center of Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Inashiki-gun, Ibaraki, Japan
| | - Takuo Furukawa
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masahiro Takemura
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
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The Effect of Sub-Concussive Impacts during a Rugby Tackling Drill on Brain Function. Brain Sci 2020; 10:brainsci10120960. [PMID: 33321843 PMCID: PMC7764819 DOI: 10.3390/brainsci10120960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022] Open
Abstract
Concussion is known to detrimentally affect brain health. Rugby tackles commonly occur with high collision force between tackler and ball carrier, and low impact head contact is not uncommon. Cognitive deficits following a bout of soccer ball heading has been attributed to the impact and termed sub-concussion. Although soccer ball heading studies provide evidence for acute effects of sub-concussion, it is unknown whether this phenomenon occurs following rugby tackles. This study investigates the acute effects of rugby tackles on brain function and balance in rugby players. Twenty-six volunteers were assigned to either the ball carrier (9), tackler (9) or control (8) group. Controls performed running without the tackle. Outcome measures included corticomotor function using transcranial magnetic brain stimulation (TMS) and balance was assessed by a series of tasks performed on a NeuroCom Balance Master before and immediately after a tackle training drill. Following the tackling bout, the cortical silent period (cSP) increased for the tacklers with no change for ball carrier and control groups, and no differences between groups for balance measures were observed. Lengthening of cSP observed in the tacklers following the bout has been reported in studies of concussion and may indicate long term detrimental effects.
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