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Roberts SP, Stokes KA, Williams S, West SW, Kemp S, Cross M, Moore IS, Bitchell CL, Mathema P, Quarrie K, McDonald W, Fortington L, Rubio Del Castillo E, Readhead C, Sewry N, Falvey É, Tucker R. Injury in Starting and Replacement Players from Five Professional Men's Rugby Unions. Sports Med 2024; 54:2157-2167. [PMID: 38609697 PMCID: PMC11329520 DOI: 10.1007/s40279-024-02014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES The aim of this study was to compare the incidence, severity, and burden of injury in starting and replacement players from professional men's teams of five rugby unions. METHODS Match injuries of greater than 24 h time-loss (including data on the severity, match quarter, event, body region) and player minutes of match exposure data were collated for all starting and replacement players in the men's English Premiership, Welsh Pro14 (both 2016/17-2018/19 seasons), and Australian, New Zealand, and South African Super Rugby (all 2016-2018 seasons) teams. Injury incidences and mean injury burden (incidence × days missed) were calculated, and rate ratios (RRs) (95% confidence intervals [CIs]) were used to compare injury incidence and burden between starting (reference group) and replacement players. RESULTS Overall injury incidence was not different between starters and replacements for all injuries (RR = 0.98, 95% CI 0.88-1.10), nor for concussions (RR = 0.85; 95% CI 0.66-1.11). Mean injury burden was higher for replacement players (RR = 1.31, 95% CI 1.17-1.46). Replacement injury incidence was lower than the starters in the third (RR = 0.68, 95% CI 0.51-0.92) and fourth (RR = 0.78, 95% CI 0.67-0.92) match quarters. Injury incidence was not different between starters and replacements for any match event or body region, but compared with starters, replacements' injury burden was higher in lower limbs (RR = 1.24, 95% CI 1.05-1.46) and in the tackled player (RR = 1.30, 95% CI 1.01-1.66). CONCLUSION This study demonstrated a lower injury incidence in replacement players compared with starters in the second half of matches, with a higher injury burden for replacement players due to higher mean injury severity.
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Affiliation(s)
- Simon P Roberts
- Centre for Health, and Injury and Illness Prevention in Sport, Department for Health, University of Bath, Bath, UK.
- UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, Bath, UK.
| | - Keith A Stokes
- Centre for Health, and Injury and Illness Prevention in Sport, Department for Health, University of Bath, Bath, UK
- UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, Bath, UK
- Rugby Football Union, Twickenham, UK
| | - Sean Williams
- Centre for Health, and Injury and Illness Prevention in Sport, Department for Health, University of Bath, Bath, UK
- UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, Bath, UK
| | - Stephen W West
- Centre for Health, and Injury and Illness Prevention in Sport, Department for Health, University of Bath, Bath, UK
- UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, Bath, UK
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Simon Kemp
- Rugby Football Union, Twickenham, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Matt Cross
- Premiership Rugby, Twickenham, UK
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University-Cyncoed Campus, Cardiff, UK
| | - Charlotte Leah Bitchell
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University-Cyncoed Campus, Cardiff, UK
| | | | - Ken Quarrie
- New Zealand Rugby, Wellington, New Zealand
- Sports Performance Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Warren McDonald
- Rugby Australia, Moore Park, NSW, Australia
- University of Canberra, Bruce, ACT, Australia
| | - Lauren Fortington
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | | | | | - Nicola Sewry
- Sport Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- IOC Research Centre South Africa, Cape Town, South Africa
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Tucker R, Cross M, Stokes K, Starling L, Hyman R, Kemp S, West S, Raftery M, Falvey E, Brown J. Symptom presentation and evolution in the first 48 hours after injury are associated with return to play after concussion in elite Rugby Union. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:387-397. [PMID: 38232900 PMCID: PMC11117005 DOI: 10.1016/j.jshs.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/18/2023] [Accepted: 10/17/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Return to play (RTP) in elite rugby is managed using a 6-stage graduated RTP protocol, which can result in clearance to play within 1 week of injury. We aimed to explore how symptom, cognitive, and balance presentation and evolution during concussion screens 2 h (head injury assessment (HIA) 2) and 48 h (HIA3) after injury were associated with time to RTP) to identify whether a more conservative graduated RTP may be appropriate. METHODS A retrospective cohort study was conducted in 380 concussed rugby players from elite men's rugby over 3 consecutive seasons. Players were classified as shorter or longer returns, depending on whether RTP occurred within 7 days (allowing them to be considered to play the match 1 week after injury) or longer than 8 days, respectively. Symptom, cognitive, and balance performance during screens was assessed relative to baseline (normal or abnormal) and to the preceding screen (improving or worsening). Associations between sub-test abnormalities and RTP time were explored using odds ratios (OR, longer vs. shorter). Median day absence was compared between players with abnormal or worsening results and those whose results were normal or improving. RESULTS Abnormal symptom results during screens 2 h and 48 h after concussion were associated with longer return time (HIA2: OR = 2.21, 95% confidence interval (95%CI): 1.39-3.50; HIA3: OR = 3.30, 95%CI: 1.89-5.75). Worsening symptom number or severity from the time of injury to 2 h and 48 h post-injury was associated with longer return (HIA2: OR = 2.49, 95%CI: 1.36-4.58; HIA3: OR = 3.34, 95%CI: 1.10-10.15. Median days absence was greater in players with abnormal symptom results at both HIA2 and HIA3. Cognitive and balance performance were not associated with longer return and did not affect median days absence. CONCLUSION Symptom presentation and evolution within 48 h of concussion were associated with longer RTP times. This may guide a more conservative approach to RTP, while still adhering to individualized concussion management principles.
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Affiliation(s)
- Ross Tucker
- Institute of Sport and Exercise Medicine (ISEM), Department of Exercise, University of Stellenbosch, Tygerberg 7505, South Africa; World Rugby Ltd., Dublin D02 AE93, Ireland.
| | | | - Keith Stokes
- Centre for Health, and Injury and Illness Prevention in Sport, University of Bath, Claverton Down BA2 7AY, UK; UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, Claverton Down BA2 7AY, UK; Rugby Football Union, London TW2 7BA, UK
| | - Lindsay Starling
- World Rugby Ltd., Dublin D02 AE93, Ireland; Centre for Health, and Injury and Illness Prevention in Sport, University of Bath, Claverton Down BA2 7AY, UK
| | - Rosy Hyman
- London School of Tropical Medicine, London WC1E 7HT, UK
| | - Simon Kemp
- Rugby Football Union, London TW2 7BA, UK; London School of Tropical Medicine, London WC1E 7HT, UK
| | - Stephen West
- Centre for Health, and Injury and Illness Prevention in Sport, University of Bath, Claverton Down BA2 7AY, UK; UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, Claverton Down BA2 7AY, UK; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary T2N 1N4, Canada
| | | | - Eanna Falvey
- World Rugby Ltd., Dublin D02 AE93, Ireland; Department of Medicine, School of Medicine and Health, University College Cork, Cork T12 EC8P, Ireland
| | - James Brown
- Institute of Sport and Exercise Medicine (ISEM), Department of Exercise, University of Stellenbosch, Tygerberg 7505, South Africa; Carnegie Applied Rugby Research (CARR) centre, Carnegie School of Sport, Leeds Beckett University, Leeds LS6 3QS, UK
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