Incidence of injury in semi-professional rugby league players

Assessment of Fatigue and Recovery in Sport: Narrative Review

Fatigue is a phenomenon associated with decreases in both physical and cognitive performances and increases in injury occurrence. Competitive athletes are required to complete demanding training programs with high workloads to elicit the physiological and musculoskeletal adaptations plus skill acquisition necessary for performance. High workloads, especially sudden rapid increases in training loads, are associated with the occurrence of fatigue. At present, there is limited evidence elucidating the underlying mechanisms associating the fatigue generated by higher workloads and with an increase in injury risk. The multidimensional nature and manifestation of fatigue have led to differing definitions and dichotomies of the term. Consequently, a plethora of physiological, biochemical, psychological and performance markers have been proposed to measure fatigue and recovery. Those include self-reported scales, countermovement jump performance, heart rate variability, and saliva and serum biomarker analyses. The purpose of this review is to provide an overview of fatigue and recovery plus methods of assessments.

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.

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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.

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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.

Epidemiology of Injuries in Olympic Sports

Injuries effect the performance of athletes. Severity of injuries is determined by time loss and sporting performance reduction. To treat injuries adequately, it is necessary to get an overview of varied injuries types in different sports disciplines. In a retrospective study 7.809 athletes from Germany, Switzerland and Austria competing in competitive or recreational levels of sports were included. Injury prevalence was highest in team sports (75%), followed by combat (64%), racquet (54%) and track and field (51%). Knee (28%) and shoulder (14%) were the most at risk joints. Time loss in sporting activity after injury was longest in the region of knee (26 weeks). Of all reported injuries, 48% were accompanied by a reduced level of performance. The highest injury prevalence occurred in the year 2016 (45%). More injuries occurred during training (58%) compared to competition (42%). Across Olympic disciplines, a large number of injuries occurred during training sessions. Injury frequency increased as the Olympic games drew closer. Knee and shoulder injuries were the most severe injuries with respect to time loss and reduction sporting performance.

TRANSLATION AND TRANSCULTURAL ADAPTATION OF THE INJURY REPORT FORM FOR RUGBY UNION

OBJECTIVE

To translate into Brazilian Portuguese and conduct the cross-cultural adaptation of the "Injury Report Form for Rugby Union" questionnaire.

METHODS

This is a cross-sectional study, level of evidence II, with following the steps: translation; synthesis; back-translation; review by a committee of experts and pre-final version; pre-test to verify comprehension; elaboration of the final version of the instrument and clinical application.

RESULTS

The two versions resulting from the translation and adaptation process did not show great differences. The pre-final version was filled by 23 male rugby players; three questions were not understood by 40%, 27% and 82.5% of the players, respectively, which required a new meeting with a multidisciplinary committee of experts. The modifications were made, requiring then a new application. The new version was filled by 25 male rugby players, aged 29.44 ± 5.90 years; of which 56% had complete higher education; finalizing the process of cross-cultural adaptation.

CONCLUSION

The questionnaire "Formulário para Notificação/Avaliação de Lesão em Jogadores de Rugby" was translated and transculturally adapted into Brazilian Portuguese. Level of Evidence II, Diagnostic Studies - Investigating a Diagnostic Test.

Seasonal Changes in Lumbar Multifidus Muscle in University Rugby Players

PURPOSE

Although smaller lumbar multifidus muscle (LMM) was reported to be a strong predictor of lower limb injury (LLI) in Australian Football League players, LMM morphology has not been investigated in rugby athletes. This study examined seasonal changes in LMM in rugby players and whether LMM characteristics were associated with low back pain (LBP) and LLI.

METHODS

Ultrasound examinations of the LMM were acquired in 21 university-level rugby players (12 women, 9 men) at preseason and end-season. LMM cross-sectional area (CSA), thickness at rest, and thickness during submaximal contraction (e.g., contralateral arm lift) measurements in prone and standing were obtained bilaterally at the L5-S1 level. The percent change in LMM thickness during contraction was calculated as follows: [(thicknesscontracted - thicknessrest)/thicknessrest × 100]. Self-reported questionnaires were used to acquire data on LBP and LLI.

RESULTS

There was no significant difference in LMM characteristics between preseason and end-season measurements (P > 0.05). Preseason LMM CSA, side-to-side CSA asymmetry, and thickness at rest or during contraction were not associated with LBP or LLI. However, a lower percent thickness change in the standing position was significantly associated with having LBP during the preseason (P = 0.01) and playing season (P = 0.001), as well as LLI during the preseason (P = 0.03).

CONCLUSIONS

This study provides preliminary evidence that LMM contractile ability and behavior during functional movement, such as standing, may have important implications for the susceptibility to injury among rugby athletes.

Tackle injury epidemiology and performance in rugby league - narrative synthesis

Background

In rugby league (RL), the ability to repeatedly engage in the tackle, whether as a ball carrier or tackler, is essential for team success and player performance. It is also the leading cause of injury, with over 90% of total injuries occurring during the tackle in professional and amateur cohorts. To effectively reduce the risk of injury and optimise performance, establishing the extent of the 'problem', through injury surveillance or descriptive performance studies is required.

Objective

The purpose of this narrative synthesis was to systematically search and synthesise tackle injury epidemiology and tackle performance frequency in RL. To achieve this objective, a systematic review was conducted.

Methods

The search was limited to English-only articles published between January 1995 and October 2018. Based on the search criteria, a total of 53 studies were found: 32 focused on tackle injury epidemiology (nine cases studies) and 21 focused on tackle frequency.

Results

In general, over 600 tackles may occur during an RL match. Tackle injury frequencies (both overall and time-loss injuries) ranged between 47%-94% at the professional level, and between 38%-96% for the lower levels of play. A greater proportion of injuries occurring in professional RL are severe time-loss injuries when compared to lower levels of play. Most time-loss and overall injuries occur to players who are tackled, i.e., ball carriers, across all levels of play.

Conclusion

This narrative synthesis will facilitate tackle injury prevention and performance research in RL, and act as a reference document for coaches and practitioners.

Rugby-related adult maxillofacial trauma injuries: a NEISS database study

PURPOSE

The primary objective of this study is to delineate the data on maxillofacial trauma in rugby utilizing the National Electronic Injury Surveillance System (NEISS) database. Specifically, we want to establish the prevalence of facial rugby injuries in terms of age, mechanism of injury, and degree of injury in order to develop ways to limit facial trauma in the future.

METHODS

The NEISS database was accessed in February 2020 in order to identify adult patients (> 19 years of age) presenting to the emergence department (ED) for rugby-related head and facial injuries from the previous 10 years (2009-2018). Descriptive statistics were organized and presented. Chi-squared testing (χ²) was performed to compare categorical variables, and ANOVA was performed to compare continuous variables.

RESULTS

A total of 507 patients (national estimate = 18,952) from 2009 to 2018 were identified as appropriate for study inclusion. The most common injuries were those to the facial region including the eyelid, eye area, and nose (59.4%). The most frequently encountered facial fracture while playing rugby was the nasal bone (58.6%). Overall, 98.4% of patients who presented to the ED with rugby injuries were treated and released, 1.2% were admitted or observed, and 0.4% left against medical advice.

CONCLUSIONS

When evaluating a patient with a rugby-related injury, one should expect injuries to the eyelid, eye area, or nose. The most common fracture pattern will most likely be nasal bone. Despite these injuries, the vast majority of patients will be treated and released.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

DISCUSSION

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

CONCLUSION

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

PROSPERO REGISTRATION NUMBER

CRD42018109054 (last updated on 17 January 2019).

Posture of rugby league players and its relationship to non-contact lower limb injury: A prospective cohort study

OBJECTIVE

This study aimed to identify posture deviations in rugby league players, and to observe relationships between posture and the incidence of non-contact lower limb injury.

DESIGN

Prospective cohort.

SETTING

Laboratory and on-field.

PARTICIPANTS

Junior representative, semi-professional and professional rugby league players (n = 207).

MAIN OUTCOME MEASURES

Static posture scores from photographs (Watson and MacDonncha tool) in pre-season; non-contact lower limb injury surveillance and exposure data.

METHODS

Chi-square and logistic regression analyses were used to observe relationships between postural components and the incidence of non-contact lower limb injury.

RESULTS

8.7% of players sustained a quadriceps injury; 7.2% sustained a calf injury. Semi-professional and professional players had the highest injury rates. The most common posture deviations were having a forward shoulder position (46.9%), a forward head position (33.3%), a varus knee interspace (32.9%) or a lumbar lordosis (30.9%). A moderate C-scoliosis deviation was associated with a decrease in injury risk (OR 1.57 95% CI 1.00-2.46 p = 0.052). Included in the model was player weight, which was associated with an increased risk of injury (OR 1.04 95% CI 1.01-1.07 p = 0.010).

CONCLUSIONS

Although postural deviations are common in rugby league players, given the lack of association with injury, they may not warrant intervention.

Pectoralis major ruptures during rugby league tackling - Case series with implications for tackling technique instruction

OBJECTIVES

Document the mechanism and incidence of pectoralis major ruptures in a professional rugby league cohort, and compare to any existing data.

DESIGN

Retrospective case series.

METHODS

Case series which documents 3 such injuries incurred while effecting a tackle in 3 rugby league players from the same squad (of 36) in the same season.

RESULTS

At the initial point of contact, all three players were in a similar shoulder position of outer-range abduction and horizontal abduction and subsequently it appeared their pectoralis major was torn while attempting to effect the tackle.

CONCLUSIONS

Complete tears of the pectoralis major muscle are rare but significant injuries often requiring surgical intervention to restore full function in collision sport athletes. In this same season, the organisation changed their defensive approach which may have contributed to these injuries. Each player was managed with acute surgical repair and returned to play at the same level. Suggestions are made to consider the possible training injury implications of changing tackle technique.

The Incidence and Occurrence of Injuries To Junior Rugby League Players in a Tropical Environment

This study investigated the effect of the environment, jersey color and ground conditions on injury rates in junior rugby-league players in a tropical environment. Injury, environment and ground condition data were collected during each game, over one season (n = 12 rounds). The study investigated three teams (n = 64): one under-16 team in striped jerseys and two under-14 teams in black and orange jerseys. The injury rates for the under-16 team (83.3/1000 hrs) were higher than for the under-14 teams in black (69.9/1000 hrs) and orange (59.9/1000 hrs) jerseys. In the under-16 team, a negative correlation (r = -0.66, p < 0.05) was found between players' injuries and heat index, while in the under-14 team in black jerseys, a positive correlation was observed (r = 0.90, p < 0.01), although in the under-14 team in orange, no significant correlation was found (r = 0.140, p > 0.05). In the under-14 team in black, a significant correlation (r = 0.80, p < 0.01) between players' injuries and the temperature was observed. However, no correlations were found with any other variables per group (p > 0.05) and injury rates were not different between the teams (p > 0.05). While ground conditions had no effect on injury rates, it appears that the heat acted as a protection against injury for teams with striped and orange jerseys. However, black jerseys may put players at an increased risk of injury during hot and humid day games.

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

OBJECTIVE

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

DESIGN

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

SETTING

Laboratory.

PARTICIPANTS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

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

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

The Incidence of Injury in Amateur Male Rugby Union: A Systematic Review and Meta-Analysis

Background

Rugby union is a physically demanding, full-contact team sport that has gained worldwide popularity. The incidence of injury in rugby union has been widely reported in the literature. While comprehensive injury surveillance and prevention programmes have been implemented within the professional game, there is a need for similar strategies in the amateur game. Despite recent increases in the volume of research in rugby, there is little consensus regarding the true incidence rate of match and training injuries in senior amateur male rugby union players.

Objective

The aim of the current review was to systematically review the available evidence on the epidemiology of time-loss injuries in senior amateur male rugby union players and to subsequently conduct a meta-analysis of the findings.

Methods

A comprehensive search of the PubMed, Scopus, SportDiscus and Google Scholar electronic databases was performed using the following keywords; (‘rugby’ OR ‘rugby union’) AND (‘amateur’ OR ‘community’) AND (‘injur*’ OR ‘pain*’). Six articles regarding the incidence of injury in senior amateur male rugby union players, in both matches and training, were retrieved and included in the meta-analysis to determine the overall incidence rate of match injury, with descriptive analyses also provided for other reported variables.

Results

The overall incidence rate of match injuries within senior amateur rugby union players was 46.8/1000 player hours [95% confidence interval (CI) 34.4–59.2]. Contact events accounted for the majority of injuries, with the tackler more at risk than the player being tackled, and with respective incidence rates of 15.9/1000 player hours (95% CI 12.4–19.5) and 12.2/1000 player hours (95% CI 9.3–15.1).

Conclusion

This meta-analysis found that the incidence rate of injury in amateur rugby union players was lower than that in professional players, but higher than the incidences reported in adolescent and youth rugby players. By understanding the true incidence and nature of injuries in rugby, injury prevention strategies can best be implemented. Future prevention strategies may best be aimed towards the tackle area, specifically to the tackler, in order to minimize injury risk.

Incidence and characteristics of injury in under-19 academy level rugby league match play: A single season prospective cohort study

Academy rugby league competition is an important step along the pathway to professional status, but little is known about injury at this level of the game. The aim of this research was to establish the nature, incidence and burden of injury in English academy rugby league. Using an observational prospective cohort study design, and a time-loss injury definition, the injury outcomes of three professional rugby league academies were recorded during the 2017 season. A total of 87 injuries occurred in 59 matches for an overall injury incidence of 85 (95%CI 67-103) injuries per 1000 hours played. The mean severity of injury was 22 ± 19 days resulting in an overall injury burden of 1898 (95%CI 1813-1983) days lost per 1000 hours. The tackle event was the most common cause of injury (77% of all injuries). Forwards sustained a greater proportion of injuries than backs (forwards 67% vs. backs 33% of injuries). Concussion (13 (6-20) per 1000 hours) and ankle sprains (11 (4-17) per 1000 hours) were the most commonly diagnosed injuries. The shoulder joint was the most commonly injured site (17 (9-25) per 1000 hours). The incidence of injury for academy rugby league is similar to senior professional rugby league.

The Effect of Training Loads on Performance Measures and Injury Characteristics in Rugby League Players: A Systematic Review

PURPOSE

To conduct a systematic review into the effect of training load (TL) on both performance measures and injury characteristics in rugby league players.

METHODS

Based on PRISMA guidelines, a systematic search of electronic databases was performed from the earliest record to December 2016. Five electronic databases (MEDLINE, SPORTDiscus, CINAHL, Web of Science, and AusSportMed) were searched using keywords within the subcategories of population (rugby league players), intervention (training quantification), and outcomes (performance or injury). Original peer-reviewed published manuscripts were considered if they had a clear quantification of TL (eg, session rating of perceived exertion), clear measures of performance (tests of physiological parameters relative to rugby league players [eg, agility]), and/or injury characteristics (eg, injury incidence).

RESULTS

Twelve studies met the inclusion criteria. The highest TL was observed in preseason training phases. Higher TL elicited greater improvements in maximal aerobic power, vertical jump (in cm), and agility scores (in s). Higher TL was associated with higher incidence of muscular strains and joint sprains, lower-limb injuries, and overexertion and overuse injuries.

CONCLUSIONS

Findings suggest a dose-response relationship between TL, physical performance, and injury characteristics. However, due to study and methodological limitations, the precise nature of this relationship is, as yet, inconclusive. Therefore, the development of uniform TL definition and quantification and further research is warranted.

Semi-Professional Rugby League Players have Higher Concussion Risk than Professional or Amateur Participants: A Pooled Analysis

A combined estimate of injuries within a specific sport through pooled analysis provides more precise evidence and meaningful information about the sport, whilst controlling for between-study variation due to individual sub-cohort characteristics. The objective of this analysis was to review all published rugby league studies reporting injuries from match and training participation and report the pooled data estimates for rugby league concussion injury epidemiology. A systematic literature analysis of concussion in rugby league was performed on published studies from January 1990 to October 2015. Data were extracted and pooled from 25 studies that reported the number and incidence of concussions in rugby league match and training activities. Amateur rugby league players had the highest incidence of concussive injuries in match activities (19.1 per 1000 match hours) while semi-professional players had the highest incidence of concussive injuries in training activities (3.1 per 1000 training hours). This pooled analysis showed that, during match participation activities, amateur rugby league participants had a higher reported concussion injury rate than professional and semi-professional participants. Semi-professional participants had nearly a threefold greater concussion injury risk than amateur rugby league participants during match participation. They also had nearly a 600-fold greater concussion injury risk than professional rugby league participants during training participation.

Reporting Multiple Individual Injuries in Studies of Team Ball Sports: A Systematic Review of Current Practice

Background

To identify and prioritise targets for injury prevention efforts, injury incidence studies are widely reported. The accuracy and consistency in calculation and reporting of injury incidence is crucial. Many individuals experience more than one injury but multiple injuries are not consistently reported in sport injury incidence studies.

Objective

The aim of this systematic review was to evaluate current practice of how multiple injuries within individuals have been defined and reported in prospective, long-term, injury studies in team ball sports.

Data Sources

A systematic search of three online databases for articles published before 2016.

Study Selection

Publications were included if (1) they collected prospective data on musculoskeletal injuries in individual participants; (2) the study duration was >1 consecutive calendar year/season; and (3) individuals were the unit of analysis.

Data Extraction

Key study features were summarised, including definitions of injury, how multiple individual injuries were reported and results relating to multiple injuries.

Results

Of the 71 publications included, half did not specifically indicate multiple individual injuries; those that did were largely limited to reporting recurrent injuries. Eight studies reported the number/proportion of athletes with more than one injury, and 11 studies presented the mean/number of injuries per athlete.

Conclusions

Despite it being relatively common to collect data on individuals across more than one season, the reporting of multiple injuries within individuals is much more limited. Ultimately, better addressing of multiple injuries will improve the accuracy of injury incidence studies and enable more precise targeting and monitoring of the effectiveness of preventive interventions.

Electronic supplementary material

The online version of this article (doi:10.1007/s40279-016-0637-3) contains supplementary material, which is available to authorized users.

Guidance for sports injury surveillance: the 20-year influence of the Australian Sports Injury Data Dictionary

Background

Injury prevention requires information about how, why, where and when injuries occur. The Australian Sports Injury Data Dictionary (ASIDD) was developed to guide sports injury data collection and reporting. Sports Medicine Australia (SMA) disseminated associated data collection forms and an online tool to practitioners and the sports community. This paper assesses the long-term value, usefulness and relevance of the ASIDD and SMA tools.

Methods

A systematic search strategy identified both peer-reviewed and grey literature that used the ASIDD and/or the SMA tools, during 1997–2016. A text-based search was conducted within 10 electronic databases, as well as a Google Image search for the SMA tools. Documents were categorised according to ASIDD use as: (1) collected injury data; (2) informed data coding; (3) developed an injury data collection tool and/or (4) reference only.

Results

Of the 36 peer-reviewed articles, 83% directly referred to ASIDD and 17% mentioned SMA tools. ASIDD was mainly used for data coding (42%), reference (36%), data collection (17%) or resource development (14%). In contrast, 86% of 66 grey literature sources referenced, used or modified the SMA data collection forms.

Conclusions

The ASIDD boasts a long history of use and relevance. Its ongoing use by practitioners has been facilitated by the ready availability of specific data collection forms by SMA for them to apply to directly their settings. Injury prevention practitioners can be strongly engaged in injury surveillance activities when formal guidance is supported by user-friendly tools directly relevant to their settings and practice.

The effect of generalised joint hypermobility on rate, risk and frequency of injury in male university-level rugby league players: a prospective cohort study

Background

Rugby league is a collision sport where musculoskeletal injuries are common. There has been little research on generalised joint hypermobility (GJH) as a risk factor for injury in rugby league. The aim of this study was to investigate the role of GJH on the incidence of injuries in first and second team rugby league players from one British university.

Methods

We conducted a prospective cohort study of 45 student players from one British university first and second team rugby league squads (mean age 20.93±1.57 years). At the beginning of the season, GJH was determined using a 9-point Beighton scale, and injury and exposure data were collected on a weekly basis throughout the 2013–2014 season.

Results

The prevalence of GJH was 20%. There was no statistically significant difference in the frequency of injuries between GJH and non-GJH participants (p=0.938, Mann-Whitney U test).Participants categorised as having GJH did not experience a higher fequency of injury (p=0.722, Fisher's exact test) and there was no tendency to demonstrate a higher risk of injury for participants categorised as GJH (OR=0.64, 95% CI 0.15 to 2.78; relative risk (RR)=1.188, 95% CI 0.537 to 2.625). The most common site of injury was the ankle, but this was not statistically significant (OR=0.152, 95% CI 0.008 to 2.876; RR=0.195, CI 0.012 to 3.066).

Conclusion

British university rugby league players with GJH did not demonstrate a greater risk of injury than those without GJH.

Physical Exam Risk Factors for Lower Extremity Injury in High School Athletes: A Systematic Review

OBJECTIVE

A stated goal of the preparticipation physical evaluation (PPE) is to reduce musculoskeletal injury, yet the musculoskeletal portion of the PPE is reportedly of questionable use in assessing lower extremity injury risk in high school-aged athletes. The objectives of this study are: (1) identify clinical assessment tools demonstrated to effectively determine lower extremity injury risk in a prospective setting, and (2) critically assess the methodological quality of prospective lower extremity risk assessment studies that use these tools.

DATA SOURCES

A systematic search was performed in PubMed, CINAHL, UptoDate, Google Scholar, Cochrane Reviews, and SportDiscus. Inclusion criteria were prospective injury risk assessment studies involving athletes primarily ages 13 to 19 that used screening methods that did not require highly specialized equipment. Methodological quality was evaluated with a modified physiotherapy evidence database (PEDro) scale.

MAIN RESULTS

Nine studies were included. The mean modified PEDro score was 6.0/10 (SD, 1.5). Multidirectional balance (odds ratio [OR], 3.0; CI, 1.5-6.1; P < 0.05) and physical maturation status (P < 0.05) were predictive of overall injury risk, knee hyperextension was predictive of anterior cruciate ligament injury (OR, 5.0; CI, 1.2-18.4; P < 0.05), hip external:internal rotator strength ratio of patellofemoral pain syndrome (P = 0.02), and foot posture index of ankle sprain (r = -0.339, P = 0.008).

CONCLUSIONS

Minimal prospective evidence supports or refutes the use of the functional musculoskeletal exam portion of the current PPE to assess lower extremity injury risk in high school athletes. Limited evidence does support inclusion of multidirectional balance assessment and physical maturation status in a musculoskeletal exam as both are generalizable risk factors for lower extremity injury.

How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury

Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.

Shoulder injuries in adolescent rugby players

BACKGROUND

Rugby is a high-intensity contact sport, frequently causing shoulder injuries. Between the ages of 12 years to 18 years, academy and county level players are being selected for professional contracts, making this is a critical stage of their career. The present study aimed to describe the patterns of injury in adolescent rugby players with shoulder injuries.

METHODS

Academy and county level rugby players in the target age group, over a 7-year period, were included in the present study. Data collected included the mechanism of injury, position and level of play, radiology and surgical findings, and recurrence rate at a minimum of 2 years post-surgery.

RESULTS

One hundred and sixty-nine cases adhered to the inclusion criteria, with most cases involving two or more pathologies in the shoulder (54%). Forwards sustained more shoulder injuries than backs, incurring more labral injuries. By contrast, backs had a higher incidence of bony pathology. The mechanism of injury frequently correlated with player positions. There was a 21% injury recurrence rate, with forwards (7%) and higher level academy players (11%) most likely to suffer a recurrence.

CONCLUSIONS

Shoulder injury patterns in this important group of adolescent contact athletes are complex, with recurrence rates being higher than those in older rugby players.

The Epidemiology of Injuries in Australian Professional Rugby Union 2014 Super Rugby Competition

Background:

Rugby union is a collision-based ball sport played at the professional level internationally. Rugby union has one of the highest reported incidences of injury of all team sports.

Purpose:

To identify the characteristics, incidence, and severity of injuries occurring in Australian professional Super Rugby Union.

Design:

Descriptive epidemiology study.

Methods:

The present study was a prospective epidemiology study on a cohort of 180 professional players from 5 Australian Super Rugby teams during the 2014 Super Rugby Union Tournament. Team medical staff collected and submitted daily training and match-play injury data through a secure, web-based electronic platform. The injury data included the main anatomic location of the injury, specific anatomic structure of the injury, injury diagnosis, training or match injury occurrence, main player position, mechanism of injury, and the severity of the injury quantified based on the number of days lost from training and/or competition due to injury.

Results:

The total combined incidence rate for injury during training and match-play across all Australian Super Rugby Union teams was 6.96 per 1000 hours, with a mean injury severity of 37.45 days lost from training and competition. The match-play injury incidence rate was 66.07 per 1000 hours, with a mean severity of 39.80 days lost from training and competition. No significant differences were observed between forward- and back-playing positions for match or training injury incidence rate or severity.

Conclusion:

The incidence of injury for the present study was lower during match-play than has previously been reported in professional rugby union; however, the overall time loss was higher compared with previous studies in professional rugby union. The high overall time loss was due fundamentally to a high incidence of injuries with greater than 28 days’ severity.

The acute:chronic workload ratio predicts injury: high chronic workload may decrease injury risk in elite rugby league players

AIM

Investigate whether acute workload (1 week total distance) and chronic workload (4-week average acute workload) predict injury in elite rugby league players.

METHODS

Data were collected from 53 elite players over two rugby league seasons. The 'acute:chronic workload ratio' was calculated by dividing acute workload by chronic workload. A value of greater than 1 represented an acute workload greater than chronic workload. All workload data were classified into discrete ranges by z-scores.

RESULTS

Compared with all other ratios, a very-high acute:chronic workload ratio (≥2.11) demonstrated the greatest risk of injury in the current week (16.7% injury risk) and subsequent week (11.8% injury risk). High chronic workload (>16 095 m) combined with a very-high 2-week average acute:chronic workload ratio (≥1.54) was associated with the greatest risk of injury (28.6% injury risk). High chronic workload combined with a moderate workload ratio (1.02-1.18) had a smaller risk of injury than low chronic workload combined with several workload ratios (relative risk range from 0.3 to 0.7×/÷1.4 to 4.4; likelihood range=88-94%, likely). Considering acute and chronic workloads in isolation (ie, not as ratios) did not consistently predict injury risk.

CONCLUSIONS

Higher workloads can have either positive or negative influences on injury risk in elite rugby league players. Specifically, compared with players who have a low chronic workload, players with a high chronic workload are more resistant to injury with moderate-low through moderate-high (0.85-1.35) acute:chronic workload ratios and less resistant to injury when subjected to 'spikes' in acute workload, that is, very-high acute:chronic workload ratios ∼1.5.

Incidência, tipo e natureza das lesões dos atletas do Rúgbi São José na temporada de 2014

INTRODUÇÃO: O rúgbi será incluído novamente como esporte olímpico nos Jogos Olímpicos Rio 2016 e seus atletas apresentam alta incidência de lesões em virtude das características do esporte. OBJETIVO: Reportar a incidência, local, natureza, tratamento das lesões e o tempo de afastamento de atletas do Rúgbi São José na temporada de 2014 em função das lesões. MÉTODOS: Foi realizado um estudo transversal com 62 atletas do rúgbi, sendo identificados como principais fatores de risco para lesões na temporada de 2014 a existência de lesões prévias, idade, tempo de prática do rúgbi, IMC elevado, posição de jogo, horas de treino semanal e frequência de treinamento em academia. RESULTADOS: As principais lesões encontradas foram lesões articulares nos membros inferiores. CONCLUSÃO: Encontramos alta incidência de lesões nos atletas do Rúgbi São José, com predomínio das lesões articulares dos membros inferiores, sendo os principais fatores de risco a idade mais avançada, maior tempo de prática do rúgbi, IMC elevado, maior tempo de treino semanal e hábito de frequentar academia de musculação, além de presença de lesões prévias e a posição de jogo na "linha".

Applied sport science of rugby league

Rugby league is a team sport in which players engage in repeated high-intensity exercise involving frequent collisions. Recent research, much of which has involved global positioning system (GPS) technology, has provided coaches and sport scientists with a deeper understanding of match demands, particularly at the elite level. This has allowed for the development of training programmes that prepare players for the most intense contact and running demands likely to be experienced in competition. At the elite level, rugby league players have well-developed aerobic and anaerobic endurance, muscular strength and power, reactive agility, and speed. Upper- and lower-body strength and aerobic power are associated with a broad range of technical and sport-specific skills, in addition to a lower risk of injury. Significant muscle damage (as estimated from creatine kinase concentrations) and fatigue occurs as a result of match-play; while muscle function and perceptual fatigue generally return to baseline 48 h following competition, increases in plasma concentrations of creatine kinase can last for up to 5 days post-match. Well-developed physical qualities may minimise post-match fatigue and facilitate recovery. Ultimately, the literature highlights that players require a broad range of physical and technical skills developed through specific training. This review evaluates the demands of the modern game, drawing on research that has used GPS technology. These findings highlight that preparing players based on the average demands of competition is likely to leave them underprepared for the most demanding passages of play. As such, coaches should incorporate drills that replicate the most intense repeated high-intensity demands of competition in order to prepare players for the worst-case scenarios expected during match-play.

More than 50% of players sustained a time-loss injury (>1 day of lost training or playing time) during the 2012 Super Rugby Union Tournament: a prospective cohort study of 17,340 player-hours

BACKGROUND

Professional Rugby Union is a contact sport with a high risk of injury.

OBJECTIVE

To document the incidence and nature of time-loss injuries during the 2012 Super Rugby tournament.

DESIGN

Prospective cohort study.

SETTING

2012 Super Rugby tournament (Australia, New Zealand, South Africa).

PARTICIPANTS

152 players from 5 South African teams.

METHODS

Team physicians collected daily injury data through a secure, web-based electronic platform. Data included size of the squad, type of day, main player position, training or match injury, hours of play (training and matches), time of the match injury, mechanism of injury, main anatomical location of the injury, specific anatomical structure of the injury, the type of injury, the severity of the injury (days lost).

RESULTS

The proportion (%) of players sustaining a time-loss injury during the tournament was 55%, and 25% of all players sustained >1 injury. The overall incidence rate (IR/1000 player-hours) of injuries was 9.2. The IR for matches (83.3) was significantly higher than for training (2.1) and the IR was similar for forwards and backs. Muscle/tendon (50%) and joint/ligament (32.7%) injuries accounted for >80% of injuries. Most injuries occurred in the lower (48.1%) and upper limb (25.6%). 42% of all injuries were moderate (27.5%) or severe (14.8%), and tackling (26.3%) and being tackled (23.1%) were the most common mechanisms of injury. The IR of injuries was unrelated to playing at home compared with away (locations ≥6 h time difference).

CONCLUSIONS

55% of all players were injured during the 4-month Super Rugby tournament (1.67 injuries/match). Most injuries occurred in the lower (knee, thigh) or upper limb (shoulder, clavicle). 42% of injuries were severe enough for players to not play for >1 week.

Small Multifidus Muscle Size Predicts Football Injuries

Background:

In Australian football, lower limb injuries have had the highest incidence and prevalence rates. Previous studies have shown that football players with relatively more severe preseason and playing season hip, groin, and thigh injuries had a significantly smaller multifidus muscle compared with players with no lower limb injuries. Rehabilitation of the multifidus muscle, with restoration of its size and function, has been associated with decreased recurrence rates of episodic low back pain and decreased numbers of lower limb injuries in football players. Assessment of multifidus muscle size and function could potentially be incorporated into a model that could be used to predict injuries in football players.

Purpose:

To examine the robustness of multifidus muscle measurements as a predictor of lower limb injuries incurred by professional football players.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Ultrasound examinations were carried out on 259 male elite football players at the start of the preseason and 261 players at the start of the playing season. Injury data were obtained from records collected by the Australian Football League (AFL) club staff during the preseason and the playing season.

Results:

Decreased size of the multifidus muscle at L5 consistently predicted injury in the preseason and playing season. Asymmetry of the multifidus muscle and low back pain were significantly related to lower limb injuries in the preseason, and having no preferred kicking leg was related to season injuries. Seasonal change in the size of the multifidus muscle indicating a decrease in muscle mass was linked to injury. Sensitivity and specificity of the model were 60.6% and 84.9% for the preseason and 91.8% and 45.8% for the playing season, respectively.

Conclusion:

A model was developed for prediction of lower limb injuries in football players with potential utility for club medical staff. Of particular note is the finding that changes in muscle size from the preseason to the playing season predicted injury.

Clinical Relevance:

As size of the multifidus muscle has been shown to be modifiable with training and has been associated with reduced pain and occurrence of injuries, this information could be incorporated in current programs of injury prevention.

A systematic review of concussion in rugby league

OBJECTIVES

Concussion remains one of the inherent risks of participation in rugby league. While other injuries incurred by rugby league players have been well studied, less focus and attention has been directed towards concussion.

REVIEW METHOD

The current review examined all articles published in English from 1900 up to June 2013 pertaining to concussion in rugby league players.

DATA SOURCES

Publications were retrieved via six databases using the key search terms: rugby league, league, football; in combination with injury terms: athletic injuries, concussion, sports concussion, sports-related concussion, brain concussion, brain injury, brain injuries, mild traumatic brain injury, mTBI, traumatic brain injury, TBI, craniocerebral trauma, head injury and brain damage. Observational, cohort, correlational, cross-sectional and longitudinal studies were all included.

RESULTS

199 rugby league injury publications were identified. 39 (20%) were related in some way to concussion. Of the 39 identified articles, 6 (15%) had the main aim of evaluating concussion, while the other 33 reported on concussion incidence as part of overall injury data analyses. Rugby league concussion incidence rates vary widely from 0.0 to 40.0/1000 playing hours, depending on the definition of injury (time loss vs no time loss). The incidence rates vary across match play versus training session, seasons (winter vs summer) and playing position (forwards vs backs). The ball carrier has been found to be at greater risk for injury than tacklers. Concussion accounts for 29% of all injuries associated with illegal play, but only 9% of injuries sustained in legal play.

CONCLUSIONS

In comparison with other collision sports, research evaluating concussion in rugby league is limited. With such limited published rugby league data, there are many aspects of concussion that require attention, and future research may be directed towards these unanswered questions.

A termografia no apoio ao diagnostico de lesao muscular no esporte

INTRODUÇÃO: O rúgbi é um dos esportes que mais ocasionam lesões. A lesão muscular apresenta uma variação térmica localizada, provocando um acréscimo da temperatura local que supostamente pode ser avaliado por meio da mensuração da temperatura. OBJETIVO: O objetivo deste estudo foi analisar a correlação entre a variação de temperatura da pele em diversos sítios corporais e a variação da CK, em dois momentos do ciclo de atividades dos atletas profissionais de rúgbi, para, dessa forma, avaliar a utilização da termografia como método de apoio ao diagnóstico de lesões musculares. MÉTODOS: Participaram deste estudo, 21 atletas de rúgbi do sexo masculino com idade entre 19 e 31 anos, de um clube profissional de nível nacional. Foram realizadas coletas de sangue para avaliar a concentração sérica de CK e a aquisição da imagem infravermelha dos atletas (48 h pós-treino e 48 h pós-jogo) para avaliação da temperatura da pele nos músculos de interesse. Foram realizadas imagens do tronco e das coxas, nas incidências anterior e posterior. A análise dos termogramas foi realizada de forma sistemática. RESULTADOS: Não houve correlação entre a variação da CK e a variação de temperatura média das áreas dos músculos selecionados. Entretanto, no grupo de atletas que apresentaram elevação da CK superior a 50% entre o primeiro e o segundo momento de avaliação, os músculos peitoral esquerdo e semitendíneo esquerdo apresentaram diferenças significativas com valor de p de 0,037 e 0,045, respectivamente. CONCLUSÕES: Pode-se concluir que a termografia pode ser utilizada como método de apoio ao diagnóstico de lesão muscular em atletas.

The Incidence of Concussion in a Professional Australian Rugby League Team, 1998-2012

Background. Rugby league is a physically demanding team sport and the National Rugby League is the highest-level competition of rugby league in Australia. Frequent tackles and collisions between players result in a high incidence of injury to players. Concussion injuries have been the source of much debate, with reporting varying greatly depending on the definition used. Method. Injury records of 239 players from one professional National Rugby League were analysed during a continuous period of 15 years, with particular interest in the incidence and recurrence of concussions and the change in incidence over time. Result. A total of 191 concussions were recorded, affecting 90 players. The incidence of concussion injuries was found to be 28.33 per 1000 player match hours, with an increase over time (P = 0.0217). Multiple concussions were recorded for 51 players. Conclusion. A statistically significant increase in the incidence of concussion injuries was found, without a concurrent increase in the number of head injuries or total injuries. New rules which mandate removal of players from the field may be beneficial for protection of players on the long term, although they risk being counterproductive, if they make players less likely to report their symptoms during matches.

Shoulder injuries in professional rugby: a retrospective analysis

BACKGROUND

In the literature, little is known about the level and pattern of rugby injuries. Of the shoulder injuries reported, 51% of these are caused during a tackle, and 65% of all match injuries affected the shoulder.

OBJECTIVE

The study aims to describe a sport-specific unique intra-articular shoulder pathology of professional rugby players, who presented with persistent pain and dysfunction despite physiotherapeutic treatment and rest.

METHOD

This study is a retrospective analysis set at a university sports medicine clinic. Eighty-seven professional rugby players, referred by their professional medical team since they could no longer play, underwent shoulder arthroscopy between June 2001 and October 2007 due to persistent shoulder pain and dysfunction. All were full-time professional male rugby union and rugby league players. They all had failed conservative treatment for their complaint, and the diagnosis was unclear. Arthroscopic findings were used as a measure of main outcome.

RESULTS

The primary mechanism of injury was reported as direct tackling (56%; n = 49) followed in succession by falling onto the arm (10%; n = 8). However, in 30% of the cases, no definite injury could be recalled. The main operative finding was that most patients exhibited multiple shoulder pathologies, with 75% of cases presenting with two or more pathologies. A superior labrum anterior to posterior (SLAP) lesion was evident at arthroscopy in 72 of the 87 cases (83%), while rotator cuff tears were evident in 43% of cases (n = 37). One-third of all cases had a Bankart tear (n = 29), despite none of them reporting previous dislocations, while other labral tears, excluding SLAP tears, to the inferior or posterior labrum were present in 34% (n = 30) of the cohort.

CONCLUSIONS

Repeated tackling, which is clearly rugby specific, is most likely to be responsible for most of these shoulder injuries, which upon arthroscopic examination, showed signs of mixed pathology. We suggest that an early arthroscopic investigation is valuable in this population in order to confirm treatable diagnosis on the painful shoulder and expedite a safe return to play.

Practice injury rates in collegiate sports

OBJECTIVE

The objective of this article was to explore the differences in practice injury rates for select National Collegiate Athletic Association (NCAA) sports within and across sport by preseason, in-season, and postseason. This article will explore the relationship of practice injury rates by fall, winter, and spring sports as well as by Divisions I, II, and III.

DESIGN

Descriptive epidemiology study.

SETTING

NCAA schools.

PATIENTS

NCAA athletes.

MAIN OUTCOME MEASURES

Injury.

RESULTS

In all sports across all seasons, preseason practice injury rates [6.3 per 1000 athletic exposure (A-E)] were higher than in-season (2.3 per 1000 A-E). Fall sports had an overall preseason practice injury rate of 7.4 (per 1000 A-E) compared with 7.0 (per 1000 A-E) for winter and 3.5 (per 1000 A-E) for spring sports. Women's soccer had the highest preseason injury rate of 9.5 (per 1000 A-E). Men's football had the highest increased risk of injury comparing preseason with in-season practice injury (3.47 per 1000 A-E).

CONCLUSIONS

The recognition that preseason practice injury rates are higher compared with in-season and postseason practice injury rates can create an opportunity for athletes, coaches, and medical personnel to identify prevention strategies to reduce preseason injury risk.

Relationship between running loads and soft-tissue injury in elite team sport athletes

Although the potential link between running loads and soft-tissue injury is appealing, the evidence supporting or refuting this relationship in high-performance team sport athletes is nonexistent, with all published studies using subjective measures (e.g., ratings of perceived exertion) to quantify training loads. The purpose of this study was to investigate the risk of low-intensity (e.g., walking, jogging, total distances) and high-intensity (e.g., high acceleration and velocity efforts, repeated high-intensity exercise bouts) movement activities on lower body soft-tissue injury in elite team sport athletes. Thirty-four elite rugby league players participated in this study. Global positioning system data and the incidence of lower body soft-tissue injuries were monitored in 117 skill training sessions during the preseason and in-season periods. The frailty model (an extension of the Cox proportional regression model for recurrent events) was applied to calculate the relative risk of injury after controlling for all other training data. The risk of injury was 2.7 (95% confidence interval 1.2-6.5) times higher when very high-velocity running (i.e., sprinting) exceeded 9 m per session. Greater distances covered in mild, moderate, and maximum accelerations and low- and very low-intensity movement velocities were associated with a reduced risk of injury. These results demonstrate that greater amounts of very high-velocity running (i.e., sprinting) are associated with an increased risk of lower body soft-tissue injury, whereas distances covered at low and moderate speeds offer a protective effect against soft-tissue injury. From an injury prevention perspective, these findings provide empirical support for restricting the amount of sprinting performed in preparation for elite team sport competition. However, coaches should also consider the consequences of reducing training loads on the development of physical qualities and playing performance.

Exploração de fatores de risco para lesões desportivas em atletas de tênis de mesa

A prática do tênis de mesa requer inúmeras ações dinâmicas que podem conduzir a lesões desportivas, por isso é de importância conhecer fatores inerentes ao traumatismo nos atletas para posterior formulação dos modelos preventivos. Objetivou-se explorar os fatores de risco para lesões desportivas em mesa-tenistas. Para isso, foram entrevistados 111 atletas participantes do Campeonato Paulista de Tênis de Mesa, com média de idade de 22,39±8,88 anos de ambos os gêneros, recrutados ao acaso, classificados em dois níveis competitivos: regional/estadual e nacional/internacional. Utilizou-se o Inquérito de Morbidade Referida adaptado com as características do tênis de mesa com a finalidade de reunir dados pessoais, de treinamento e da lesão desportiva. Foram observadas 0,51 lesões por atleta, e os atletas de nível nacional/internacional apresentaram maiores índices de lesão (52,94%) do que os de nível estadual/regional (48,84%). No gesto específico, notou-se que os membros superiores (93,62%) e o tronco (87,5%) são os locais mais acometidos. Para ambos os níveis, o treinamento foi o momento mais relatado de ocorrência dos agravos. Conclui-se que atletas de nível nacional/internacional possuem maiores índices de lesão e que o gesto específico é a principal causa das lesões, acometendo principalmente os membros superiores e o tronco e ocorrendo com maior frequência durante o treinamento.

Profile of an American amateur rugby union sevens series

BACKGROUND

Rugby union will enter the Olympic arena as Rugby Sevens in 2016.

PURPOSE

To investigate the injury rate, injury type, and nature of injuries sustained in an amateur American rugby union sevens tournament series.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The rate, demographics, and characteristics of injury were evaluated in 1536 rugby union sevens players, from 128 sides, competing in 4 amateur 1-day tournaments in a USA Rugby local area rugby union.

RESULTS

Forty-eight injuries occurred over 4 tournaments, for an injury rate of 55.4 injuries per 1000 playing hours. Head and neck injuries were most common (33.3% of injuries), followed by upper extremity (31.3%), trunk (18.8%), lower extremity (14.6%), and physiologic injuries (2.1%). The most common type of injury was ligament sprain (25.0%); followed by concussion (14.6%), hematoma/contusion (12.5%), muscle strain (10.4%), and abrasion (8.3%). Tackling was the most common mechanism of injury (74.5%). Males were injured at a significantly higher rate than females (RR, 7.5, P < .01), but no significant difference was observed based on player position (P = .08).

CONCLUSION

Injuries are common among American amateur rugby athletes, with a substantial proportion involving the head and neck region.

CLINICAL RELEVANCE

Understanding injury patterns in an American rugby union will be important for formulating future injury prevention, assessment, and treatment protocols.

Seasonal change in bone, muscle and fat in professional rugby league players and its relationship to injury: a cohort study

OBJECTIVES

To examine the anthropometric characteristics of an Australian National Rugby League team and identify the relationship to type and incidence of injuries sustained during a professional season. It was hypothesised that body composition would not change discernibly across a season and that injury would be negatively related to preseason bone and muscle mass.

DESIGN

A repeated measure, prospective, observational, cohort study.

SETTING

Griffith University, Gold Coast, Australia.

PARTICIPANTS

37 professional male Australian National Rugby League players, 24.3 (3.8) years of age were recruited for preseason 1 testing, of whom 25 were retested preseason 2.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measures included biometrics; body composition (bone, muscle and fat mass; dual-energy x-ray absorptiometry; XR800, Norland Medical Systems, Inc); bone geometry and strength (peripheral quantitative CT; XCT 3000, Stratec); calcaneal broadband ultrasound attenuation (BUA; QUS-2, Quidel); diet and physical activity history. Secondary outcome measures included player injuries across a single playing season.

RESULTS

Lean mass decreased progressively throughout the season (pre=81.45(7.76) kg; post=79.89(6.72) kg; p≤0.05), while whole body (WB) bone mineral density (BMD) increased until mid-season (pre=1.235(0.087) g/cm(2); mid=1.296(0.093) g/cm(2); p≤0.001) then decreased thereafter (post=1.256(0.100); p≤0.001). Start-of-season WB BMD, fat and lean mass, weight and tibial mass measured at the 38% site predicted bone injury incidence, but no other relationship was observed between body composition and injury.

CONCLUSIONS

Significant anthropometric changes were observed in players across a professional rugby league season, including an overall loss of muscle and an initial increase, followed by a decrease in bone mass. Strong relationships between anthropometry and incidence of injury were not observed. Long-term tracking of large rugby league cohorts is indicated to obtain more injury data in order to examine anthropometric relationships with greater statistical power.

Screening the lumbopelvic muscles for a relationship to injury of the quadriceps, hamstrings, and adductor muscles among elite Australian Football League players

STUDY DESIGN

Longitudinal observational study.

OBJECTIVES

To examine the relationship between severity of preseason hip, groin, and thigh (HGT) muscle injuries, and lumbopelvic muscle size, asymmetry, and function at the start and end of the preseason.

BACKGROUND

In Australian Rules Football, HGT muscle injuries have the highest prevalence and incidence. Deficits within the lumbopelvic region, such as impaired muscle function and muscle asymmetry, could contribute to injuries in the preseason, and injury could, in turn, affect muscle size and function.

METHODS

MRI examinations were performed on 47 male elite Australian Rules Football players at the start and at the end of the football preseason. The cross-sectional area (CSA) of multifidus, psoas major, and quadratus lumborum muscles was measured, as well as change in trunk CSA due to the function of voluntarily contracting the transversus abdominis muscle. Injuries occurring during each preseason training session were routinely recorded by the club's performance staff.

RESULTS

Analysis of variance indicated that players with more severe preseason HGT injuries (more training sessions missed) had significantly smaller multifidus muscle CSA compared to players with no HGT injury (P = .006). No relationship was found for size or asymmetry of the quadratus lumborum or psoas major muscles, or ability to contract the transversus abdominis muscle through drawing in of the abdominal wall (P>.05). Small multifidus muscle size at L5 predicted 5 of 6 players who incurred a more severe HGT injury.

CONCLUSIONS

An association between multifidus muscle size (relative to age, height, and weight) and preseason injury suggests a way to identify players at risk of severe HGT injuries. This result needs to be replicated in a larger sample before resources are committed to intervention efforts.

Tackling in a professional rugby league

During the course of a rugby league match, players are involved in multiple physical collisions, predominantly in the form of tackles. The purpose of this study was to describe the nature of, and circumstances relating to the various types of tackles completed by various playing positions in professional rugby league competition. Time-motion analysis was used during 5 competition matches; 1 player from 3 positional groups (hit-up forwards, adjustables, and outside backs) was analyzed in each match. Tackles were assessed by recording the sequence of involvement (e.g., whether a player was the first, second, or third player to engage in the tackle), the area of initial body contact on the player being tackled (e.g., high-above waist or low-below waist) and the type of tackle (e.g., front-on tackle, side-on tackle, and tackle from behind). The hit-up forwards, adjustables and outside backs averaged 166, 89, and 41 tackles, respectively, a game; the majority (46%) involved the observed defender being the first physical contact in the tackle. The present data show that the first defender generally makes a front-on tackle, either low or high, whereas the second player performs a front-on high tackle. If a third player is involved in a tackle, he or she makes contact with the player from the side and above the waist. The most frequent activity immediately before tackling is striding, followed by sprinting. The development of strength-based wrestling for individual playing positions should be an integral part of physical conditioning for rugby league players. The development of tackling skills at various movement intensities should also be considered.

The development and application of an injury prediction model for noncontact, soft-tissue injuries in elite collision sport athletes

Limited information exists on the training dose-response relationship in elite collision sport athletes. In addition, no study has developed an injury prediction model for collision sport athletes. The purpose of this study was to develop an injury prediction model for noncontact, soft-tissue injuries in elite collision sport athletes. Ninety-one professional rugby league players participated in this 4-year prospective study. This study was conducted in 2 phases. Firstly, training load and injury data were prospectively recorded over 2 competitive seasons in elite collision sport athletes. Training load and injury data were modeled using a logistic regression model with a binomial distribution (injury vs. no injury) and logit link function. Secondly, training load and injury data were prospectively recorded over a further 2 competitive seasons in the same cohort of elite collision sport athletes. An injury prediction model based on planned and actual training loads was developed and implemented to determine if noncontact, soft-tissue injuries could be predicted and therefore prevented in elite collision sport athletes. Players were 50-80% likely to sustain a preseason injury within the training load range of 3,000-5,000 units. These training load 'thresholds' were considerably reduced (1,700-3,000 units) in the late-competition phase of the season. A total of 159 noncontact, soft-tissue injuries were sustained over the latter 2 seasons. The percentage of true positive predictions was 62.3% (n = 121), whereas the total number of false positive and false negative predictions was 20 and 18, respectively. Players that exceeded the training load threshold were 70 times more likely to test positive for noncontact, soft-tissue injury, whereas players that did not exceed the training load threshold were injured 1/10 as often. These findings provide information on the training dose-response relationship and a scientific method of monitoring and regulating training load in elite collision sport athletes.