Facts and values: on the acceptability of risks in children's sport using the example of rugby - a narrative review

An empirical study of the flag rugby game programme to promote gross motor skills and physical fitness in 5-6 year old preschool children

In order to investigate the effects of a flag rugby game programs on the development of gross motor skills and physical fitness in 5-6 year old preschool children. An overall random sampling method was adopted to select 56 preschoolers aged 5-6 years from class A and class B,class A was the ExG (28) implemented a flag rugby games intervention program,and class B was the ConG (28) implemented a regular physical education program,with a 12-week intervention period.The content and requirements of the experimental intervention program were determined through a systematic analysis method, and the subjects' gross motor skills level was tested using the TGMD-3, and their physical fitness level was measured using China's fifth national physical fitness monitoring of early childhood (3-6 years) component.Experimental data were statistically analyzed using independent samples t-test, paired samples t-test, and repeated measures ANOVA test.After 12 weeks of practice, 1）We found that the ExG outperformed the ConG in Skip,One hand stationary dribble, Overhand throw, Underhand throw, Forehand strike of self-bounced,Kick a stationary ball, Total object control subject score, Total gross motor score test results with significant differences (p < 0.05).The ExG differed significantly (p < 0.01) in Grip strength, Stand long jump,Sit forward bend, Continuous jump on both feet,15 m obstacle run,Walk the balance beam, while the ConG differed significantly (p < 0.05) only in Continuous jump on both feet,15 m obstacle run and Stand long jump.2）We also found gender differences in gross motor skills and Physical fitness test results, this difference is manifested in boys outperformed girls in Total object control subject Score, Grip strength and 15 m obstacle run with significant difference (p < 0.05), girls outperformed boys in Sit forward bend with significant difference (p < 0.05).The 12-week flag rugby game programs improved gross motor skills and physical fitness levels of 5-6 year old preschoolers more comprehensively than the regular program, and we recommend the purposeful and organized promotion of a flag rugby game programs in the physical activity curriculum for 5-6 year old preschoolers.

Community perspectives on spinal cord injury in rugby union: facts and fears

INTRODUCTION

The sport of rugby union, henceforth rugby, is associated with a risk of spinal cord injury (SCI). Perceived risks can impact participation. Understanding community perspectives on rugby-related SCI may provide insight for addressing concerns around risk. The aim of this study was to explore community perspectives through social media discussion about SCI in rugby union.

METHODS

Posts about SCI in rugby union were identified using the advanced search function on Twitter. Data (content as original post, retweet, quote tweet and comments) were included if focused on Rugby Union and written in English. Inclusion dates (July 2018 to June 2019) were chosen to capture a period when several SCI (n = 4) occurred in community rugby in Australia. Data were analysed using a thematic approach.

RESULTS

Four themes were derived from the collected data. The 'pendulum swing' relates to the disparate views of rugby, from being overly cautious to too dangerous to play. The 'role of rugby culture' described engrained behaviours and attitudes on and off-field toward safety. 'Media influence' describes the emotive narrative used when reporting rugby-related SCI. 'After the injury' looks at expressions of sympathy and inspiration. These findings showed how individuals' views of SCI were influenced through rugby culture, trust in governing bodies and the news media.

CONCLUSION

By 'listening in' to community views, their most pertinent safety concerns can be addressed. Both facts and fears on rugby-related SCI were evident, and these extreme views can be balanced with evidence-based education and sensible risk management.

Players' and parents' perceptions of injury in elite Northern Irish schools' rugby - A qualitative study

OBJECTIVES

To explore schools' rugby players' and their parents' perceptions of injury.

DESIGN

A qualitative study using focus groups.

SETTING

Schools who compete in the Ulster Schools' Cup competition.

PARTICIPANTS

13 players and 9 parents.

OUTCOME MEASURES

A thematic analysis approach was used to examine players' and parents' beliefs and attitudes towards injury, return to play and injury risk.

RESULTS

Findings suggest schools' rugby players and their parents are aware of injury risk in the schoolboy game. They are aware of concussion injury but are less aware of musculoskeletal injury. Parents' perceptions of injury are based on their experience of their sons' injuries. Parents are unaware of return to play strategies for musculoskeletal injury.

CONCLUSIONS

Schools' rugby players and their parents are aware of injury to some extent, however players' and parents' knowledge and understanding of injury is based on and informed by personal experience, not the evidence base. Whist they are aware of injury, many players will seek to push their fears to the back of their mind. However, for those players who have suffered severe injury, they are concerned about the risk of reinjury.

A global perspective on collision and non-collision match characteristics in male rugby union: Comparisons by age and playing standard

This study quantified and compared the collision and non-collision match characteristics across age categories (i.e. U12, U14, U16, U18, Senior) for both amateur and elite playing standards from Tier 1 rugby union nations (i.e. England, South Africa, New Zealand). Two-hundred and one male matches (5911 min ball-in-play) were coded using computerised notational analysis, including 193,708 match characteristics (e.g. 83,688 collisions, 33,052 tackles, 13,299 rucks, 1006 mauls, 2681 scrums, 2923 lineouts, 44,879 passes, 5568 kicks). Generalised linear mixed models with post-hoc comparisons and cluster analysis compared the match characteristics by age category and playing standard. Overall significant differences (p < 0.001) between age category and playing standard were found for the frequency of match characteristics, and tackle and ruck activity. The frequency of characteristics increased with age category and playing standard except for scrums and tries that were the lowest at the senior level. For the tackle, the percentage of successful tackles, frequency of active shoulder, sequential and simultaneous tackles increased with age and playing standard. For ruck activity, the number of attackers and defenders were lower in U18 and senior than younger age categories. Cluster analysis demonstrated clear differences in all and collision match characteristics and activity by age category and playing standard. These findings provide the most comprehensive quantification and comparison of collision and non-collision activity in rugby union demonstrating increased frequency and type of collision activity with increasing age and playing standard. These findings have implications for policy to ensure the safe development of rugby union players throughout the world.

Compulsory collisions and corporate interests in school rugby: challenging distortions in the framing of childhood injury

This article examines how 'framing' is used to resist a proposal to remove rugby tackling from UK schools. It focuses on rugby tackling for UK school children, which is often a compulsory part of many schools' curricula. Specifically, we explore the importance of framing in how the problem is described in various academic publications, how ideas about risk are articulated and how advocates themselves are represented. We show how the corporate interests of rugby governing bodies can become entangled with distortions about injury prevention. These distortions (or framing practices) include omitting arguments, conflating arguments, changing the argument, misrepresenting advocacy positions and skewing advocate identities. Next, the article demonstrates how a combination of recent advocacy, political interventions, research and cultural shifts appears to be changing perceptions about the risks associated with rugby tackling for children in school settings. In conclusion, we argue that while framing can be a useful strategy for policy advocates, there is value in paying attention to how framing is used by different stakeholder groups.

A Qualitative Exploration of Parents' Perceptions of Risk in Youth Contact Rugby

The purpose of this study was to explore the understandings and perceptions of risk related to brain trauma amongst parents of children that play contact rugby. A qualitative approach was taken, using semi-structured interviews with 7 mothers and 27 fathers of children that participate in contact rugby. A thematic analysis of data suggests that parents used two primary cognitive strategies to process the risk they consented to with their children's participation in rugby; (1) minimalizing rugby risk to be equivalent to less injurious sports; and (2) elevating physical and social advantages above what they think other sports are capable of providing. From the findings it is suggested that parents who permit their children to play contact rugby are both aware of the high risks of injury in the sport, but simultaneously utilize two cognitive distortion techniques to rectify the dissonance caused between their choice to have their children play, and the salient number of concussions they observe. These results suggest that it will take properly informed consent, inclusive of concussion rates compared to other sports, in order to reduce cognitive distortion and effectively communicate risks associated with participation in contact rugby.

Imposing Compulsory Rugby Union on Schoolchildren: An Analysis of English State-Funded Secondary Schools

Objective

To establish the extent to which Rugby Union was a compulsory physical education activity in state-funded secondary schools in England and to understand the views of Subject Leaders for Physical Education with respect to injury risk.

Method

A cross-sectional research study using data obtained under the Freedom of Information Act (2000) from 288 state-funded secondary schools.

Results

Rugby Union was delivered in 81% (n = 234 of 288) of state-funded secondary school physical education curricula, including 83% (n = 229 of 275) of state-funded secondary school boys' and 54% (n = 151 of 282) of girls' physical education curricular. Rugby Union was compulsory in 91% (n = 208 of 229) of state-funded secondary schools that delivered it as part of the boys' physical education curriculum and 54% (n = 82 of 151) of state-funded secondary schools that delivered contact Rugby Union as part of the girls' physical education curriculum. Subject Leaders for Physical Education also perceived Rugby Union to have the highest risk of harm of the activities they delivered in their school physical education curriculum.

Conclusion

Notwithstanding discussions of appropriate measures (i.e., mandatory concussion training, Rugby Union specific qualifications and CPD) to reduce injury risk, it is recommended that Rugby Union should not be a compulsory activity given that it has a perceived high risk of injury and is an unnecessary risk for children in physical education.

Lower limb MSK injuries among school-aged rugby and football players: a systematic review

Objective

The objective of this systematic review was to explore the incidence of lower limb musculoskeletal (MSK) injuries sustained by rugby union, rugby league, soccer, Australian Rules and Gaelic football players under 18 years. The review sought to identify the mechanisms and types of injury sustained and to compare between sports.

Design

This systematic review focused on the incidence of lower limb injury in adolescent team sports that involved running and kicking a ball. A literature search of studies published prior to January 2020 was conducted using SportDiscus, Medline and PubMed databases. The Standard Quality Assessment Criteria appraisal tool was used to assess the quality of each article included in the review. Two or more authors independently reviewed all papers.

Results

Sixteen papers met the inclusion criteria; prospective cohort (N=14), retrospective (n=1) and longitudinal (n=1). These studies investigated injuries in rugby union and rugby league (n=10), football (soccer) (n=3), Australian Rules (n=2) and Gaelic football (n=1). There were a total of 55 882 participants, aged 7–19 years old, who reported 6525 injuries. The type, site and mechanisms of injury differed across sports.

Summary

Lower limb injuries were common in adolescent rugby, soccer, Gaelic football and Australian Rules football players, however these studies may not fully reflect the true injury burden where recurrent and overuse injuries have not been considered. There were differences between sports in the mechanisms, types and severity of injury.

United States Under-19 Rugby-7s: Incidence and Nature of Match Injuries During a 5-year Epidemiological Study

Background

There is a lack of injury data for the new Olympic sport of Rugby-7s, particularly for involved youth.

Objective

To determine injury rates and characteristics for players participating in U.S. Rugby-7s U19 (under 19 years of age) tournaments.

Methods

Injury data were collected, using the Rugby Injury Survey & Evaluation report methodology, at 24 U.S. Rugby-7 s U19 tournaments over 30 tournament days (2010–2014). Tournament medical-attention injuries and time-loss injuries (days absent before return to training/competition including post tournament) were recorded.

Results

During the 2101 playing hours (3072 males, aged 17.2 ± 1.5 years; 732 females, 16.6 ± 1.3 years of age), there were 173 tournament injuries with an overall injury incidence of 82.4/1000 player-match-hours (ph) (CI 70.5–95.6). Acute injuries (79.5/1000 ph) occurred during tackling (56.2/1000 ph) and involved joints/ligaments (32.8/1000 ph) of lower extremities (31.9/1000 ph). Head and neck injuries, including concussions, were common (males 21.9/1000 ph; females 22.0/1000 ph). Medical-attention injury incidences (49.5/1000 ph; n = 104; 95% CI 40.5–60.0) were higher than time loss (32.8/1000 ph; n = 69; 95% CI 25.5–41.6). Overall, injury incidences found no difference between sex (RR 0.78; p = 0.369). Time-loss injuries resulted in an average of 35.5 d to return to sport.

Discussion

This study is the first to report match injury incidences for U19 participants in Rugby-7s. Overall, match injury incidence among U.S. U19 Rugby-7s tournaments was similar compared to adult U.S. community Rugby-7s. Recurrent injury risk was notable in this population. Community injury surveillance studies are essential to understand risk from participation in amateur sports. Knowledge of these injury patterns in U19 Rugby-7s will help identify areas to direct resources to enable growth of Rugby-7s in youths and emerging countries being exposed to Rugby-7 s. Age-based injury frequency and patterns in rugby and its various formats are needed for the development of evidence-based, sport-specific, and population-specific injury prevention initiatives.

Conclusions

The match injury incidence of U19 participants in U.S. Rugby-7s was similar to the incidence among adult participants. Recurrent match injury risk was high at 23%. There were no significant differences in injury incidences between males and females. The first three matches of a tournament day result in the most injuries.

Injury Risk in New Zealand Rugby Union: A Nationwide Study of Injury Insurance Claims from 2005 to 2017

Objectives

The Accident Compensation Corporation is a compulsory, 24-h, no-fault personal injury insurance scheme in New Zealand. The purpose of this large-scale retrospective cohort study was to use Accident Compensation Corporation records to provide information about rugby injury epidemiology in New Zealand, with a focus on describing differences in risk by age and gender.

Methods

A total of 635,657 rugby injury claims were made to the Accident Compensation Corporation for players aged 5–40 years over the period 2005–2017. Information about player numbers and estimates of player exposure was obtained from New Zealand Rugby, the administrative organisation for rugby in New Zealand.

Results

Over three quarters of claims (76%) were for soft-tissue injuries, with 11% resulting from fractures or dislocations, 6.7% from lacerations, 3.1% from concussions and 2.0% from dental injuries. Body regions injured included shoulder (14%), knee (14%), wrist/hand (13%), neck/spine (13%), head/face (12%), leg (11%) and ankle (10%). The probability of a player making at least one injury claim in a season (expressed as a percentage) was calculated under the assumption that the incidence of claims follows a Poisson distribution. Players aged 5–6 years had a probability of making at least one claim per season of 1.0%, compared to 8.3% for players aged 7–12 years, 35% for age 13–17 years, 53% for age 18–20 years, 57% for age 21–30 years and 47% for age 31–40 years. The overall probability of making at least one claim per season across all age groups was 29%. The relative claim rate for adults (players aged 18 years and over) was 3.92 (90% confidence interval 3.90–3.94) times that of children. Ten percent of players were female, and they sustained 6% of the injuries. Overall, the relative claim rate for female players was 0.57 times that of male players (90% confidence interval 0.56–0.58). The relative claim rate of female to male players tended to increase with age. There were very few female players aged over 30 years; however, those who did play had higher claim rates than male players of the same age group (1.49; 90% confidence interval 1.45–1.53).

Conclusions

Injuries resulting from rugby are distributed across the body, and most of the claims are for soft-tissue injuries. Rates of injury increase rapidly through the teenage years until the early 20 s; for male players they then decrease until the mid-30 s. For female players, the injury rate does not decrease as players move into their 30 s. Combining Accident Compensation Corporation injury claim data with national player registration data provides useful information about the risks faced by New Zealand’s community rugby players, and the insights derived are used in the development of rugby injury prevention programme content.

Electronic supplementary material

The online version of this article (10.1007/s40279-019-01176-9) contains supplementary material, which is available to authorized users.

Evaluating the Implementation of Injury Prevention Strategies in Rugby Union and League: A Systematic Review using the RE-AIM Framework

Rugby (union and league) has come under intense scrutiny due to its injury risk. Various interventions have been introduced to protect players from injury, with many deemed efficacious and advocated for use across various worldwide contexts. However, their implementation is less clear. The objective of this systematic review was to determine whether injury prevention interventions in rugby have evaluated their 'reach', 'effectiveness', 'adoption', 'implementation' and 'maintenance' as per the RE-AIM Multi-Dimension Item Checklist. Six electronic databases were searched in November 2019. Inclusion criteria included: English language, peer-reviewed journal article, original research, field-based rugby code, prospective intervention. Of the 4253 studies identified, 74 met the full inclusion criteria. Protective equipment, predominately mouthguards, was the intervention of interest in 44 studies. Other interventions included multimodal national injury prevention programmes, law changes and neuromuscular training programmes. 'Effectiveness' was the highest scoring RE-AIM dimension (55%), followed by 'reach' (26%). All other RE-AIM dimensions scored below 20%. Research currently focuses on determining intervention 'effectiveness'. For injury prevention strategies to have their desired impact, there must be a shift to address all determinants associated with implementation. Consideration should be given to how this can be achieved by adopting specific reporting checklists, research frameworks and study designs.

Cross-Sectional Investigation of Self-Reported Concussions and Reporting Behaviors in 866 Adolescent Rugby Union Players: Implications for Educational Strategies

OBJECTIVE

To examine the self-recalled concussion and bell ringer (BR) prevalence, reporting rates, and reporting behaviors in adolescent rugby players.

DESIGN

Cross-sectional survey.

SETTING

School classroom.

PARTICIPANTS

Adolescent male rugby players aged 12 to 18 years (n = 866).

MAIN OUTCOME MEASURES

Concussion and BR prevalence, reporting rates, and reporting behaviors.

RESULTS

The sample reported a concussion and BR prevalence rate of 40% and 69.9%, respectively. Of these athletes with a history, 38.4% and 86.4% suffered recurrent concussions and BRs, respectively. The total reporting rates per 1000 suspected concussions and BRs were 474.8 [95% confidence interval (CI), 415.4-534.3] and 238.7 (95% CI, 217.8-259.5), respectively. The athletes highlighted several barriers which hindered their truthful reporting of concussion, including "not thinking the injury is serious enough to report" (70%), "wanting to win the game" (38%), and "not wanting to miss future games or training" (48%).

CONCLUSIONS

Educational interventions are an invaluable component within a socioecological framework aimed at improving the concussion reporting rates of adolescent athletes. The self-recalled prevalence, underreporting rates, and behaviors of the sample are alarming, which prompts the need to further explore their motivational beliefs behind their decision to underreport a potential concussion. The information obtained can be used to tailor personalized interventions for specific athlete samples.

When This Happens, You Want the Best Care: Players' Experiences of Barriers and Facilitators of the Immediate Management of Rugby-Related Acute Spinal Cord Injury

Most contact sports, including rugby union, carry a risk of injury. Although acute spinal cord injuries (ASCIs) in rugby are rare, the consequences of such injuries are far-reaching. Optimal management of these injuries is challenging, and a detailed understanding of the different barriers and facilitators to optimal care is needed. In this study, we aimed to describe the perception of players, regarding factors related to the optimal immediate management of a catastrophic injury in a developing country with socioeconomic and health care inequities. The most frequently reported barriers were transportation delays after injury and admission to appropriate medical facilities. Other barriers included inadequate equipment, the quality of first aid care, and barriers within the acute hospital setting. Barriers were more prevalent in rural and lower socioeconomic areas. These findings are relevant for all rugby stakeholders and may help shape education, awareness, and future policy around the immediate management of ASCIs.

Training and match volume and injury in adolescents playing multiple contact team sports: A prospective cohort study

Training and competition loads have emerged as valuable injury risk factors but very few studies have explored injury outcomes in adolescent athletes. The aims of this study were to describe injuries and to explore the relationship between training and match load volumes and injury in adolescent athletes participating in multiple contact team sports. One hundred and three male youth rugby athletes aged 14-16 years from 8 rugby union teams were prospectively monitored during a season for weekly training and match volumes and injuries. The relationship between volume and injury was explored by comparing the weekly volume in the week prior to an injury vs weeks without injury. There were 83 time-loss injuries in 58 athletes (62%). Overall injury incidence was 18.5 per 1000 player-hours. Mean weekly injury prevalence was 27% (95% CI 25-30). Average weekly volume was 5.4 (2.2) hours comprising 1.4 (1) match hours and 4 (2.6) training hours. Compared with weeks without injury, weeks prior to an injury had higher match volumes (110 [57] min vs 83 [59] min, P < 0.001). Poisson regression demonstrated that match volume was a predictor of injury with an odds ratio of 1.41 (P = 0.001). The contribution of match volumes to injury risk and the relatively high injury burden in these athletes may be profound. Very high match volumes are unlikely to be in the best interests of young athletes and could be avoided with a systematic approach to load management and athlete development.

Time to get our four priorities right: an 8-year prospective investigation of 1326 player-seasons to identify the frequency, nature, and burden of time-loss injuries in elite Gaelic football

Managing injury risk requires an understanding of how and when athletes sustain certain injuries. Such information guides organisations in establishing evidence-based priorities and expectations for managing injury risk. In order to minimise the impact of sports injuries, attention should be directed towards injuries that occur frequently, induce substantial time-loss, and elevate future risk. Thus, the current study aimed to investigate the rate at which elite Gaelic football players sustain different time-loss injuries during match-play and training activities. Datasets (n = 38) from elite Gaelic football teams (n = 17) were received by the National Gaelic Athletic Association Injury Surveillance Database from 2008 to 2016. A total of 1,614 time-loss injuries were analysed. Each season teams sustained 24.0 (interquartile ranges) (IQR 16.0–32.0) and 15.0 (IQR 10.0–19.0) match-play and training injuries, respectively. When exposure was standardised to 1,000 h, greater rates of injury (12.9, 95% CI [11.7–14.3]) and time-loss days (13.4, 95% CI [12.3–14.9]) were sustained in match-play than in training. Acute injury rates were 3.1-times (95% CI [2.7–3.4]) greater than chronic/overuse injuries. Similarly, non-contact injury rates were 2.8-times (95% CI [2.5–3.2]) greater than contact injuries. A total of 71% of injuries in elite Gaelic football affected five lower limb sites. Four lower limb-related clinical entities accounted for 40% of all time-loss injuries (hamstring, 23%; ankle sprain, 7%; adductor-related, 6%; quadriceps strain, 5%). Thus, most risk management and rehabilitation strategies need to be centred around five lower limb sites—and just four clinical entities. Beyond these, it may be highly unlikely that reductions in injury susceptibility can be attributed to specific team interventions. Thus, compliance with national databases is necessary to monitor injury-related metrics and future endeavours to minimise injury risk.

Association between community socioeconomic characteristics and access to youth flag football

BACKGROUND

The American Academy of Pediatrics has recommended that opportunities for non-tackling American football (e.g., flag football) be expanded, given concerns about the risks of brain trauma from tackle football. This study tested the hypothesis that flag football would be more accessible in communities characterised by higher socioeconomic status residents.

METHODS

In July 2017, the locations of community-based organisations offering youth flag and tackle football for youth between the ages of 6 and 13 in two US states (Georgia and Washington) were aggregated (n=440). Organisations were coded in terms of the availability of tackle and/or flag football teams for youth at each year of age between 6 and 13. Multivariate logistic regression analyses were used to assess the odds of a community-based football organisation offering flag football, by community socioeconomic and demographic characteristics.

RESULTS

In both states, communities with more educated residents were more likely to offer flag football for youth aged 6-12. For example, among 6 year-olds every 10% increase in the number of adult residents with a college education was associated with 1.51 times the odds of flag football availability (95% CI 1.22 to 1.86, P<0.001).

CONCLUSION

These results suggest that youth living in communities characterised by low educational attainment are less likely than other youth to have the option of a lower contact alternative to tackle football. Relying on voluntary community-level adoption of lower contact alternatives to tackle football may result in inequitable access to such sport options. This may contribute to an inequitable burden of brain trauma from youth sport.