Match and training injuries in rugby league: a review of published studies

Outcomes at Long-term Follow-up After Open Latarjet Versus Open Bankart Repair in Rugby Players

Background

Because rugby is a collision sport, it exposes players to a high risk of recurrence after anterior shoulder stabilization. Therefore, the choice of surgical procedure warrants close attention in order to optimize the time to return to sport and the stability of the shoulder throughout the player's career.

Hypothesis

The open Latarjet procedure would allow for a faster return to play and provide a lower rate of recurrence than the open Bankart repair at long-term follow-up.

Study Design

Cohort study; Level of evidence, 3.

Methods

The study retrospectively enrolled 62 competitive rugby players who had undergone an anterior shoulder instability procedure and had at least 5 years of follow-up data. A total of 32 players treated with an open Bankart repair (BK group) were compared with 30 players (31 shoulders) treated with an open Latarjet procedure (LT group). Outcomes between groups were compared with the Rowe score, Walch-Duplay score, recurrence rate, and osteoarthritis evaluation on plain radiograph (Samilson classification).

Results

The recurrence rate was significantly higher at 18.8% for the BK group (mean follow-up, 6.9 ± 1.7 years) compared with 3.3% for the LT group (mean follow-up, 6.2 ± 1.4 years) (P = .04). No postoperative complications occurred in the BK group, whereas 1 infection and 1 hematoma required a second surgery in the LT group (P = .14). In the BK and LT groups, 97% and 90% of players, respectively, were able to return to rugby at the same level or higher (P = .27), at a mean time of 8 and 6.3 months, respectively (P = .03). The mean Rowe and Walch-Duplay scores were not significantly different between the groups; however, the osteoarthritis rate was significantly higher in the BK versus the LT group (68% vs 38%, respectively; P = .03); 23% of patients, all in the BK group, had Samilson grade 2 osteoarthritis.

Conclusion

The open Latarjet procedure outperformed the open Bankart procedure in terms of stability, time to return to play, and radiological outcomes at long-term follow-up in competitive rugby players.

The associations between unilateral leg strength, asymmetry and injury in sub-elite Rugby League players

OBJECTIVES

The aim of this study was to analyse the relationship between unilateral leg strength, associated asymmetries and the injuries suffered by sub-elite Rugby League (RL) players in one competitive season.

DESIGN

A prospective cohort design was used.

METHOD

Unilateral leg strength was measured using the rear foot elevated split squat five repetition maximum test. Injuries were recorded using the Orchard classification system and were used to quantify relative risk (RR), mean severity, burden, player availability and survival time.

RESULTS

No measures of leg strength were related to RR, relative leg strength was found to have a significant, but not meaningful correlation with total time lost to lower body injury, lower body injury burden and lower body injury survival time.

CONCLUSIONS

The data from the current study indicates a possible positive effect of increasing relative leg strength for injury outcomes in sub-elite RL players. This supports a heuristic that multi-joint lower body strength training for RL players has a potential dual effect of enhancing physical performance and reducing injury time loss, with minimal risk of harm.

The propensity of non-concussive and concussive head contacts during elite-level women's rugby league matches: a prospective analysis of over 14,000 tackle events

OBJECTIVES

Identify the frequency, propensity, and factors related to tackle events which result in contact with the head in elite-level women's rugby league.

DESIGN

Prospective video analysis study.

METHODS

Video footage from 59 Women's Super League matches were analysed (n = 14,378 tackle events). All tackle events were coded as no head contact or head contact. Other independent variables included: area contacting head, impacted player, concussion outcome, penalty outcome, round of competition, time in match and team standard.

RESULTS

There were 83.0 ± 20.0 (propensity 304.0/1000 tackle events) head contacts per match. The propensity of head contact was significantly greater for the tackler than ball-carrier (178.5 vs. 125.7/1000 tackle events; incident rate ratio 1.42, 95 % confidence interval 1.34 to 1.50). Head contacts occurring from an arm, shoulder, and head occurred significantly more than any other contact type. The propensity of concussions was 2.7/1000 head contacts. There was no significant influence of team standard or time in match on the propensity of head contacts.

CONCLUSIONS

The observed head contacts can inform interventions, primarily focusing on the tackler not contacting the ball-carrier's head. The tackler's head should also be appropriately positioned to avoid contact with the ball-carrier's knee (highest propensity for concussion). The findings are consistent with other research in men's rugby. Law modifications and/or enforcement (reducing the number of un-penalised head contacts), concurrent with coaching interventions (optimising head placement or reducing the head being contacted) may help minimise head contact risk factors for women's rugby league.

Composite functional movement screen score predicts injuries in youth volleyball players: a prospective cohort study

We aimed to investigate whether composite Functional Movement Screen (FMS) test scores can predict musculoskeletal injuries (MSI) in youth volleyball players. 131 national young volleyball players (Males: n = 100, age = 16.5 years, height = 1.787 m, mass = 68.32 kg; Females: n = 31, age = 13.83 years, height = 1.684 m, mass = 65.12 kg) participated in this prospective cohort study. The FMS screen was performed before starting the season. MSI and exposure data were collected during the season via each team's certified athletic trainer. The mean FMS score and standard deviation for all volleyball players was 15.85 ± 3.31. A score of ≤ 14 was positive to predict MSI with specificity of 0.60 and sensitivity of 0.93. The odds ratio for (≤ 14/˃14) was 0.048. The relative risk for being injured was 3.46. Positive likelihood ratio was 2.34, and negative likelihood ratio was 0.11. The findings of this study demonstrated that an FMS score of ≤ 14 is an identifiable risk factor for injury in young volleyball players. The FMS can be used as a pre-season screening test to identify volleyball players who may be predisposed to sustaining MSI during the season ahead.

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

Objectives

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

Design

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

Data sources

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

Eligibility criteria for selecting studies

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

Results

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

Summary/Conclusion

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

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

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

•

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

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

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

•

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

•

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

•

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

•

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.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

A Systematic Review of the Prevalence of Mental Health Symptoms and Disorders in Rugby Players

The aim of this systematic review was to investigate the prevalence of mental health symptoms and disorders in rugby players. Six electronic databases were searched in December 2020. Studies were included if they provided quantitative data on mental health symptoms and disorders and consisted of adult rugby players. Eight studies were included, covering symptoms of anxiety, depression, alcohol use/misuse, distress, sleeping/sleep disturbance, and eating disorders/adverse nutrition behaviors. Prevalence of mental health symptoms ranged from 6% (depression) to 68.8% (alcohol use/misuse). Most rates were similar to the general population, while symptoms of sleeping/sleep disturbance were lower, and symptoms of eating disorders/adverse nutrition behaviors and alcohol use/misuse were higher than the general population. One study included female rugby players. Epidemiological evidence comprising of rigorous diagnostic data and inclusive of gender, race, ethnicity, sexuality, and other protected characteristics is needed to inform future mental health support in this population.

Conceptualising Rugby League Performance Within an Ecological Dynamics Framework: Providing Direction for Player Preparation and Development

Across team sports, it is critically important to appropriately define, evaluate and then aptly describe individual and team performance. This is of particular significance when we consider that performance models govern the direction of player preparation (short term) and development (long term) frameworks. Within the context of rugby league, this has traditionally been undertaken through hierarchical and linear processes. Such approaches have resulted in research and performance analysis techniques which aim to support these operational outcomes. Yet, these methods may deliver limited application on how or why match-play unfolds and therefore might be sub-optimal in providing insights to truly support coaches. In this paper, we propose the conceptualisation of rugby league performance through the lens of ecological dynamics, which may offer a different view to this traditional approach. We propose that this approach eliminates the silos of disciplinary information (e.g. technical, physical and medical) that may currently exist, allowing for a holistic approach to performance, preparation and development. Specifically, we consider that through the implementation of this ecological approach, all performance coaches (technical, physical and medical) may (co-)design learning environments that more collaboratively develop players for rugby league match-play. As a result, we put forward a new rugby league performance model from which preparation and development programs can be anchored toward. We conclude the paper by offering practical examples where these concepts are contextualised within the landscape familiar to practitioners working within rugby league.

A Case-Control Study of Tackle-Based Head Injury Assessment (HIA) Risk Factors in the National Rugby League

Background

The tackle is the in-game activity carrying the greatest risk for concussion in rugby. A recent evaluation of tackle characteristics in rugby union precipitated a rule modification to reduce head impact risk during tackles. This study aims to replicate the work conducted in rugby union by examining the association between tackle characteristics and head injury events in professional rugby league.

Methods

There were 446 tackles resulting in a head injury assessment (HIA) and 5,694 tackles that did not result in a head injury from two National Rugby League (NRL) seasons that were reviewed and coded. Tackle height, body position of players, and contact area on an opponent’s body were evaluated, with the propensity of each situation to cause an HIA calculated as HIAs per 1000 events.

Results

The propensity for tacklers to sustain a head injury was 0.99 HIAs per 1000 tackles, 1.74-fold greater than for the ball carrier (0.57 HIAs per 1000 tackles). There was a 3.2-fold higher risk for an HIA when the tackler was upright compared to bent-at-the-waist. The greatest risk of a tackler HIA occurred when head contact was very low (knee, boot) or high (head and elbow). HIAs were most common following head-to-head impacts. The lowest propensity for tackler HIA was found when the tackler’s head was in proximity with the ball carrier’s torso.

Conclusions

The result of this study replicated the findings in professional rugby union. This has implications for the injury prevention initiatives implemented to reduce HIA risk because the majority of injuries are sustained by the tackler.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-021-00377-9.

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

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

Monitoring Prescribed and Actual Resistance Training Loads in Professional Rugby League

ABSTRACT

Redman, KJ, Connick, MJ, Beckman, EM, and Kelly, VG. Monitoring prescribed and actual resistance training loads in professional rugby league. J Strength Cond Res 35(6): 1604-1610, 2021-Coaches devote a considerable amount of time and effort prescribing and selecting exercises to elicit training adaptations. Adherence to the prescribed resistance training load may vary for a number of reasons. The aim of this study was to quantify the difference between prescribed and actual resistance training loads in a team of professional rugby league players. Training loads were quantified using volume load and training intensity throughout a season. The competition was categorized into preseason, early competition, mid-competition, and late competition. Twenty-seven players participated in this study. Four exercises were monitored: back squat, bench press, bench pull, and clean pull. A Friedman's test was used to assess differences between prescribed and actual training loads throughout different phases of the season, for different exercises, and during different weeks in a training block. There were significantly greater differences in prescribed and actual volume loads during the mid-competition in comparison to all other phases of the season (p < 0.01). Although players adherence to prescribed training intensity was significantly greater during the preseason compared with the remainder of the season (p < 0.05), they completed significantly less prescribed training load during week 1 in comparison to week 4 within a training block (p < 0.05). The results of this study demonstrate that regular monitoring of completed resistance training loads may be of greater importance to strength and conditioning coaches to assist in examining potential progress and fatigue or allow for more accurate prescription of load to enhance adaptation throughout a season.

Magnetic Resonance Arthrography in Rugby Players Undergoing Shoulder Stabilization for Glenohumeral Instability: Professionals Have Higher Frequencies of More Pathologies

Purpose

To quantify the magnetic resonance arthrography (MRA) findings in rugby players during preoperative workup for anterior surgical stabilization for glenohumeral instability.

Methods

All patients who underwent glenohumeral instability surgery in our institution between 2008 and 2018 were considered for inclusion. Rugby players were identified using the patient's medical notes, with subsequent identification of all professional players. All rugby player's preoperative MRA findings were recorded and analyzed.

Results

Overall, 267 rugby players were included, 261 of whom were male (97.8%), with a mean age of 22.7 years (range 13-55 years). There were 58 professional rugby players (21.7%). The mean number of pathologies in nonprofessional rugby players was 5.0 pathologies versus 6.2 pathologies in the professional rugby players, with a significant difference in nonprofessional rugby players with up to 3 pathologies versus professional rugby players (26.3% vs 10.3%, P = .01). Professional rugby players had a statistically significant increased incidence of bicipital tendon lesions (25.9% vs 13.9%, P = .009), acromioclavicular joint degeneration (60.3% vs 42.1%, P = .016), glenohumeral bone loss (87.9% vs 69.9%, P = .006), and degenerative changes (67.2% vs 44.0%, P = .002) on their MRAs.

Conclusions

Rugby players undergoing surgical stabilization for glenohumeral instability often have a significant number of pathologies identified on MRA at the time of surgery. Professional rugby players showed concerningly greater frequencies of early degenerative changes when compared with nonprofessional rugby players.

Level of Evidence

III; Retrospective Cohort Study.

The Influence of Injury History on Countermovement Jump Performance and Movement Strategy in Professional Soccer Players: Implications for Profiling and Rehabilitation Foci

CONTEXT

Professional soccer players who have sustained a lower limb injury are up to 3× more likely to suffer a reinjury, often of increased severity. Previous injury has been shown to induce compensatory strategies during neuromuscular screening tests, which might mask deficits and lead to misinterpretation of readiness to play based on task outcome measures.

OBJECTIVE

To investigate the influence of previous injury in professional soccer players on countermovement jump (CMJ) performance and movement strategy.

DESIGN

Cross-sectional.

SETTING

Professional soccer club competing in the English Championship (tier 2). Patients (or Other Participants): Outfield players with a minimum of 6 years as a professional.

INTERVENTION(S)

Players were categorized as previously injured (n = 10) or not injured (n = 10). All players completed double- and single-leg CMJ trials.

MAIN OUTCOME MEASURES

CMJ performance was quantified as jump height and flight time:contraction time ratio. CMJ movement strategy was quantified as force-time history, differentiating eccentric and concentric phases and CMJ depth.

RESULTS

Double-leg CMJ was not sensitive to previous injury in performance or movement strategy. In contrast, single-leg CMJ performance was impaired in players with previous injury, who generated significantly lower eccentric and concentric peak force and rate of force development, and a deeper countermovement. Impaired single-leg CMJ performance was also evident in the nonaffected limb of previously injured players, suggesting cross-contamination. Hierarchical ordering revealed that the eccentric phase of the CMJ contributed little to performance in previously injured players. In noninjured players, the eccentric rate of force development and concentric peak force were able to account for up to 89% of the variation in CMJ performance.

CONCLUSIONS

Single-leg CMJ is advocated for player profiling, being more sensitive to previous injury, and negating the opportunity for interlimb compensation strategies. Movement strategy deficits in previously injured players suggest rehabilitation foci specific to eccentric force development.

Genetic Factors That Could Affect Concussion Risk in Elite Rugby

Elite rugby league and union have some of the highest reported rates of concussion (mild traumatic brain injury) in professional sport due in part to their full-contact high-velocity collision-based nature. Currently, concussions are the most commonly reported match injury during the tackle for both the ball carrier and the tackler (8-28 concussions per 1000 player match hours) and reports exist of reduced cognitive function and long-term health consequences that can end a playing career and produce continued ill health. Concussion is a complex phenotype, influenced by environmental factors and an individual's genetic predisposition. This article reviews concussion incidence within elite rugby and addresses the biomechanics and pathophysiology of concussion and how genetic predisposition may influence incidence, severity and outcome. Associations have been reported between a variety of genetic variants and traumatic brain injury. However, little effort has been devoted to the study of genetic associations with concussion within elite rugby players. Due to a growing understanding of the molecular characteristics underpinning the pathophysiology of concussion, investigating genetic variation within elite rugby is a viable and worthy proposition. Therefore, we propose from this review that several genetic variants within or near candidate genes of interest, namely APOE, MAPT, IL6R, COMT, SLC6A4, 5-HTTLPR, DRD2, DRD4, ANKK1, BDNF and GRIN2A, warrant further study within elite rugby and other sports involving high-velocity collisions.

Epidemiology of injuries in Australian junior rugby league players

OBJECTIVES

Conduct a large-scale epidemiological study of injury characteristics (location, type, mechanism, severity, burden) and incidence in community junior rugby league.

DESIGN

Prospective cohort epidemiology study.

METHODS

Injury surveillance was conducted in three district leagues (Penrith, Canberra, Melbourne) in under 6 (U6) to under 18 years (U18) age groups across the 2016 season. Club sports trainers recorded all match/training medical-attention injuries using a commercial electronic application which recorded injury circumstances and characteristics.

RESULTS

A total of 13,169 players from 897 teams participated and 408 (89% male) players sustained 485 injuries, 94% of which were match related. The overall injury incidence was 5.9 injuries/1000 player hours and highest in U13-U18 female players (22.2 injuries/1000 player hours). The mean injury severity of 16±31 days missed training/match-play caused an overall injury burden of 94.2 days missed/1000 player hours). Tackles accounted for 84% of injuries. Joint and contusion injuries were the most prevalent injury type and the head (35% total injuries, primarily bruising and bleeding) was the most injured body site.

CONCLUSIONS

This is the first study to report injuries across a large cohort of all-age Australian community junior rugby league players over one season. Injury prevalence was lower than previously reported in junior rugby league suggesting the sport has not become more dangerous for junior players. These findings provide an evidence-base to inform or revise policy, training and injury prevention programs and athlete development pathways in relation to game-wide safety and develop best-practice protocols in injury management for rugby league athlete support personnel.

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.

Movement Demands and Injury Characteristics in Under-20-Years University Rugby Union Players

CONTEXT

Rugby union is a field-based collision sport with high injury rates. Associations between injury characteristics and global positioning system-derived movement demands in rugby union athletes are yet to be investigated.

OBJECTIVE

To investigate associations between match injuries and movement demands, anthropometrics, and physical performance in under-20-years university-level rugby union players.

DESIGN

Descriptive epidemiology study.

SETTING

Competition season.

PATIENTS OR OTHER PARTICIPANTS

Rugby union players (n = 34, age = 19.3 ± 0.6 years) from a university club were recruited.

MAIN OUTCOME MEASURE(S)

Acute medical attention non-time-loss (NTL), medical-attention time-loss (TL), and total medical-attention (MA) injuries sustained were recorded. Principal component (PC) analysis was performed on player-movement demand variables to identify independent-movement demand components. Pearson correlation and bivariate linear regression were used to test associations between match injuries and PCs. Anthropometric and physical performance measures were tested as predictors of match injuries using a forward stepwise multiple regression analysis.

RESULTS

Backs had lower anthropometric and performance measures than forwards (P < .05), whereas forwards performed fewer weekly movement demands than backs (P < .05). Increases in body mass and skinfold thickness were associated with more injuries (P < .05). Principal component analysis revealed 3 PCs representing overall performance, high-intensity running (HIR) performance, and impacts. Increases in HIR were associated with decreases in NTL upper limb and trunk (r = -0.32, P = .03), NTL musculoskeletal (r = -0.36, P = .05), NTL total (r = -0.46, P < .01), TL musculoskeletal (r = -0.30, P = .05), MA musculoskeletal (r = -0.41, P < .01), and MA total (r = -0.48, P < .01) injuries. Increases in impacts were associated with increased TL (r = 0.32, P = .03) and MA (r = 0.33, P = .03) head or neck injuries.

CONCLUSIONS

Backs experienced greater weekly movement demands than forwards. Increases in HIR demands were associated with decreased acute injuries in university rugby players. Increases in impacts were associated with more acute head or neck injuries. Positional differences in movement demands, anthropometrics, and physical performance highlight the need for position-specific training.

Change of Direction Performance in Elite Players From Different Team Sports

Loturco, I, Pereira, LA, Reis, VP, Abad, CCC, Freitas, TT, Azevedo, PHSM and Nimphius, S. Change of direction performance in elite players from different team sports. J Strength Cond Res XX(X): 000-000, 2020-The primary aim of this study was to examine the differences in change of direction (COD) deficit between elite futsal, soccer, handball, and rugby players. A secondary aim was to compare the performance in both COD and linear speed tests among these athletes. One-hundred sixty-one elite male players from 4 team sports performed a 20-m linear sprint speed and a Zigzag COD speed test. The COD deficit was calculated as the difference between linear and Zigzag test velocities. Differences in COD speed, COD deficit, and sprint velocity were assessed via 1-way analysis of variance. The significance level was set at p < 0.05. Soccer players displayed significantly lower performance than the remaining team sports, and rugby players performed better than all the other groups in the Zigzag COD test. Moreover, the COD deficit was significantly higher in soccer players in comparison with the other disciplines (p < 0.05). No differences were observed in the COD deficit among rugby, futsal, and handball players (p > 0.05). In summary, soccer players were slower than futsal, handball, and rugby players to change direction and presented the greatest COD deficit magnitude. By contrast, the fastest athletes in the COD speed test (rugby players) were not more effective than futsal and handball players at changing direction (as they exhibited similar levels of COD deficit). Coaches should be aware of this evidence, which reinforces previous findings, indicating that very specialized training strategies might be required to improve COD performance in professional athletes.

Foot accelerations are larger than tibia accelerations during sprinting when measured with inertial measurement units

Accelerometers are often placed on the tibia to measure segmental accelerations, and external mechanical load during running. However, in applied sport settings it is sometimes preferable to place accelerometers on the dorsal foot to avoid tibial impact injuries. This study aimed to quantify the differences in accelerations measured at the dorsal foot compared with the distal tibia during running. Sixteen recreationally active participants performed a sprint protocol on a non-motorised treadmill. Accelerometers were positioned bilaterally on the medial tibia (TIB_Left and TIB_Right), and bilateral dorsal foot surfaces (DOR_Left and DOR_Right). Continuous acceleration signal waveform analysis was performed using one-dimensional statistical parametric mapping (1DSPM). Resultant accelerations were greater for DOR_Left than TIB_Left for 60% of the gait cycle (p < 0.001) and greater for DOR_Right than TIB_Right for 50% of the gait cycle (p < 0.003). The larger accelerations at the dorsal foot than the tibia can be explained by movement at the ankle joint, and the placement location relative to the hip. The dorsal foot location can be used to effectively measure accelerations and external mechanical load when it is not feasible to place the accelerometer on the tibia, however results between the two locations should not be compared.

Sport injury prevalence and risk by level of play and sports played among a representative population of French adolescents. A school-based study

BACKGROUND

Sports practice has both benefits and physical risks. In France, data related to adolescent sports injury are rare. The main purpose of this article is to study the prevalence and risk of injuries by level of play and sports in the southeast of France.

METHODS

Data collection was conducted in French schools among adolescents in 2015 and 2017 (n=1849; aged 14-19). Only sports players were included (n=1366). Two level of play were created. The low-level group included adolescents playing sport either outside or within a club, at the local level of competition or below. The high-level group included adolescents playing sport within a club at the state (regional) level of competition or higher. Odds-ratios and their 95% confidence intervals adjusted for variables selected using stepwise regression procedures were calculated to determine the injury risk of high-level athletes compared with those at low-level, in each sport. We also calculated the injury risk of each sport compared to all the other sports, by level of play.

RESULTS

In almost all sports activities, the prevalence of injured athletes was higher in the high-level of play than in the low-level of play. The increase in injury risk was the highest in tennis, basketball, dance, athletics and volleyball. When comparing sports, at the lowest level, handball, boxing, soccer and gymnastics practitioners were more at risk than the rest of the sample. At the highest level of play, only basketball players were more at-risk. Dancing is the less dangerous sport in terms of injury outcome, regardless the level.

CONCLUSION

From the state level of competition, injury risk increases significantly across most of the sports. Meanwhile, differences appeared regarding the prevalence, severity and nature of the sustained injuries. It would be useful to perform such analysis on a greater sample size, ideally representative of the national population of adolescents.

An Analysis of Knee Injuries in Rugby League: The Experience at the Newcastle Knights Professional Rugby League Team

Background

Epidemiologic data in professional sport is becoming an increasingly valuable tool in identifying frequently occurring injuries and developing strategies to reduce their occurrence. Currently, there is a paucity of literature on the epidemiology of knee injuries in professional male rugby league players.

Methods

We retrospectively reviewed medical records from a single male professional rugby league team (Newcastle Knights), competing in Australia, and evaluated knee injuries and time to return to play.

Results

In total, 89 knee injuries occurred, with an injury incidence of 616.7 injuries per 1000 players. The most frequently occurring knee injuries were medial collateral ligament (416.7 injuries per 1000 players) and chondral/meniscal injuries (416.7 injuries per 1000 players). For all injury types, being tackled was the most common mechanism of injury, and the median time to return to play was 1 day. Anterior cruciate ligament injuries accounted for the longest time to return to play (median 236.0 days).

Conclusion

Medial collateral ligament and chondral/meniscal injury types were the most frequent injuries; however, anterior cruciate ligament injuries accounted for the most time missed from sport despite being less common. Professional male rugby league players incur similar knee injury types compared to rugby union based upon our study and other similar studies.

Electronic supplementary material

The online version of this article (10.1186/s40798-019-0206-z) contains supplementary material, which is available to authorized users.

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.

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.

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.

Cell Therapies in Tendon, Ligament, and Musculoskeletal System Repair

In the last few decades, several techniques have been used to optimize tendon, ligament, and musculoskeletal healing. The evidence in favor of these techniques is still not proven, and level I studies are lacking. We performed an analysis of the therapeutic strategies and tissue engineering projects recently published in this field. Here, we try to give an insight into the current status of cell therapies and the latest techniques of bioengineering applied to the field of orthopedic surgery. The future areas for research in the management of musculoskeletal injuries are outlined. There are emerging technologies developing into substantial clinical treatment options that need to be critically evaluated. Mechanical stimulation of the constructs reproduces a more propitious environment for effective healing.

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.

Intensified Training Period Increases Salivary IgA Responses But Does Not Affect the Severity of Upper Respiratory Tract Infection Symptoms in Prepuberal Rhythmic Gymnasts

This study examined the effect of a 4-week intensified training (IT) period, followed by a 2-week tapering period (TP), on salivary immunoglobulin A (SIgA), salivary cortisol, and the severity of upper respiratory tract infection symptoms in 23 rhythmic gymnasts [12.1 (2.6) y; 143.9 (13.7) cm; 37.2 (9.4) kg]. Saliva sampling was conducted at pre- and post-IT, and post-TP (analyzed using enzyme-linked immunosorbent assay). The Wisconsin Upper Respiratory Symptom Survey (WURSS-21) questionnaire was completed daily to analyze the severity of upper respiratory tract infection symptoms. The session rating of the perceived exertion was used to determine the internal training load and the acute:chronic workload ratio. A higher SIgA concentration [SIgA_abs (μg/mL); F = 7.6; P = .001] for post-IT [234 (104)] versus pre-IT [173 (91)], and post-TP [182 (70)], and a higher SIgA secretion rate [SIgA_rate (μg/min); F = 3.4; P = .04] for post-IT [69 (28)] versus pre-IT [55 (27)], and post-TP [58 (22)] were observed. No significant change was observed for cortisol (F = 0.81; P = .45) or for the severity of upper respiratory tract infection symptoms (χ² = 2.81; P = .24). Internal training load was higher during IT (vs TP; effect size = 2.37). The acute:chronic workload for the IT weeks varied from 1.2 (0.3) to 1.4 (0.3). These results suggest that a 4-week IT may temporarily augment the oral mucosal immunity, and an acute:chronic workload of 1.2-1.4 seems to be a safe approach to periodized training loads in youth rhythmic gymnasts.

Influence of playing rugby on long-term brain health following retirement: a systematic review and narrative synthesis

Objectives

The aim of this review was to systematically investigate long-term brain health in retired rugby players.

Methods

Six databases were systematically searched from inception to January 2018 using Medical Subject Headings and keywords. Two reviewers independently screened studies for inclusion. Cross-sectional studies of living retired male or female rugby players in which at least one cognitive test was used as an outcome measure were included. Data extraction was performed using Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodological quality was assessed independently by two reviewers using the Downs and Black methodological quality tool.

Results

This review yielded six studies with an overall methodological quality of 'moderate'. A total of 672 male retired rugby players (mean ages of 38-52 years) were included in this review. Three studies investigated neuropsychological functioning in retired rugby players in comparison with controls, with no significant evidence of decreased performance in the majority of tests when compared with controls. Five out of the six studies explored self-reported measures of cognition. Three studies compared retired rugby players to controls, one of which found significantly increased subjective cognitive complaints among retired rugby players. The other two studies found that persistent postconcussion symptoms were associated with a higher number of self-reported concussions. Two studies reported decreased fine motor control in retired rugby players in comparison with controls. Neurometabolites and electrophysiological changes were explored by two studies, with minimal and non-significant findings.

Conclusions

Overall findings are mixed. Methodological biases reduce the overall study quality and limited the conclusions that can be drawn. Findings of decreased fine motor control in retired athletes may be influenced by lack of controlling for evidence of upper limb musculoskeletal injuries. While some studies show evidence of reduced cognitive function among former athletes, the results are not significantly lower than population norms. Cognitive findings from this review are inconsistent within and across study cohorts and are biased towards positive findings when self-report methods were selected. Current evidence suggests that large gaps remain in the understanding of the cause-and-effect relationships between playing rugby and long-term brain health in retired players.

Differences in the occurrence and characteristics of injuries between full-time and part-time dancers

Background

Professional dancers are at significant risk of injury due to the physical demands of their career. Despite their high numbers, the experience of injury in freelance or part-time dancers is not well understood. Therefore, the aim of this study was to examine the occurrence and characteristics of injury in part-time compared with full-time Australian professional dancers.

Methods

Data were collected using a cross-sectional survey distributed to employees of small and large dance companies and freelance dancers in Australia. Statistical comparisons between full-time and part-time dancer demographics, dance training, injury prevalence and characteristics were made using χ², two-tailed Fisher’s exact tests, independent t-tests and Mann-Whitney U tests.

Results

A total of 89 full-time and 57 part-time dancers were included for analysis. A higher proportion of full-time dancers (79.8%) than part-time dancers (63.2%) experienced an injury that impacted on their ability to dance in the past 12 months (p=0.035). Injuries characteristics were similar between groups with fatigue being the most cited contributing factor. Part-time dancers took longer to seek treatment while a higher proportion of full-time dancers were unable to dance in any capacity following their injury.

Conclusion

More full-time dancers sustained an injury in the past 12 months, and were unable to dance in any capacity following their injury. However injuries still commonly occurred in part-time dancers without necessarily a large volume of dance activity. Part-time dancers often access general community clinicians for treatment, who may need additional education to practically advise on appropriate return to dance.

Injury Patterns, Physiological Profile, and Performance in University Rugby Union

Context: Rugby union is a physically demanding collision sport with high injury rates. There is a common perception that higher training loads result in greater injury risk in field-based sports. Objectives: To determine injury, anthropometric, and physical-performance characteristics in junior rugby union players and investigate the interaction between training load and injury across a competitive season. Design: Prospective cohort study. Methods: Fifty-one players (age 19.2 ± 0.7 y) from an under-20 university rugby union team (forwards, n = 27; backs, n = 24) participated in a study conducted over a competition season. Training load, injury characteristics, anthropometry, physiological performance, and match time-loss injury incidence were observed. Results: Backs had significantly lower body mass (ES [95% CI] = 1.6 [0.9, 2.2]), skinfold thickness (ES = 1.1 [0.5, 1.7]), strength (squat ES = 0.6 [0.0, 1.2], deadlift ES = 0.6 [0.0, 1.1], bench press ES = 0.9 [0.4, 1.5]), lower-body power (ES = 0.4 [−0.2, 1.0]), and higher maximal aerobic capacity (ES = −0.3 [−0.8, 0.3]) than forwards. Match injury incidence was 107.3 injuries/1000 player hours (forwards 91.4/1000, backs 125.5/1000) during preseason and 110.7 injuries/1000 player hours (forwards 124.1/1000, backs 95.2/1000) during in-season. Forwards showed higher incidence of joint and ligament (P = .049) and upper-limb (P = .011) injuries than backs. No significant relationship between overall training load and match injury incidence was found. However, lower match injury incidence was associated with higher weekly training volume in backs (P = .007). Conclusions: Positional differences in body composition, performance, injury characteristics, and match injury patterns were identified in junior university rugby union players, indicating the need for position-specific training programs to reduce risk of injury.

Observational Review and Analysis of Concussion: a Method for Conducting a Standardized Video Analysis of Concussion in Rugby League

Background

Several professional contact and collision sports have recently introduced the use of sideline video review for club medical staff to help identify and manage concussions. As such, reviewing video footage on the sideline has become increasingly relied upon to assist with improving the identification of possible injury. However, as yet, a standardized method for reviewing such video footage in rugby league has not been published. The aim of this study is to evaluate whether independent raters reliably agreed on the injury characterization when using a standardized observational instrument to record video footage of National Rugby League (NRL) concussions.

Methods

Video footage of 25 concussions were randomly selected from a pool of 80 medically diagnosed concussions from the 2013–2014 NRL seasons. Four raters (two naïve and two expert) independently viewed video footage of 25 NRL concussions and completed the Observational Review and Analysis of Concussion form for the purpose of this inter-rater reliability study. The inter-rater reliability was calculated using Cohen’s kappa (κ) and intra-class correlation (ICC) statistics. The two naïve raters and the two expert raters were compared with one another separately.

Results

A considerable number of components for the naïve and expert raters had almost perfect agreement (κ or ICC value ≥ 0.9), 9 of 22 (41%) components for naïve raters and 21 of 22 (95%) components for expert raters. For the concussion signs, however, the majority of the rating agreement was moderate (κ value 0.6–0.79); both the naïve and expert raters had 4 of 6 (67%) concussion signs with moderate agreement. The most difficult concussion sign to achieve agreement on was blank or vacant stare, which had weak (κ value 0.4–0.59) agreement for both naïve and expert raters.

Conclusions

There appears to be value in expert raters, but less value for naive raters, in using the new Observational Review and Analysis of Concussion (ORAC) Form. The ORAC Form has high inter-rater agreement for most data elements, and it can be used by expert raters evaluating video footage of possible concussion in the NRL.

Concussion in Ice Hockey-A Cohort Study Across 29 Seasons

OBJECTIVE

The aim of this study was to analyze the concussion incidence rate ratios across 29 seasons in a Swedish Hockey League team.

DESIGN

Cohort study over 29 seasons within one Swedish elite series ice hockey team.

PARTICIPANTS

All players who were part of one Swedish elite ice hockey team during the research period gave consent for participation in the study.

INDEPENDENT VARIABLES

Exposure to top-level Swedish ice hockey.

MAIN OUTCOME MEASURES

Incidence rate ratio for concussion and rehabilitation periods due to concussion were calculated and analyzed.

RESULTS

During the research period, 267 players in total were part of the team. A total of 1638 traumatic injuries were registered, of which 162 were concussions. Incidence rates (IRs) ranged from 0/1000 games during the first season to 118/1000 games for the final recorded season. The incidence rate ratio was 1.06 (confidence interval, 1.03-1.10) for the entire research period. A shift toward longer rehabilitation periods was discovered.

CONCLUSIONS

This study showed a significant increase of concussion IR and a trend toward longer rehabilitation periods due to concussion. Possible risk factors were discussed. Risk behavior and rehabilitation protocols should be prioritized areas in the research of concussion in ice hockey.

The Reliability of Functional Movement Screening and In-Season Changes in Physical Function and Performance Among Elite Rugby League Players

This study aimed to (a) assess the reliability of the functional movement screening (FMS) protocol and (b) to establish changes in both FMS and tests of physical performance throughout a season. The reliability of the FMS components (12 in total) was assessed through a nonparametric statistical approach, based on 2 trials, separated by 1 week. Score on the FMS, strength (3 repetition maximum full squat, 1 repetition maximum [1 RM] bench press), running speed (10 and 40 m), and jump height of 12 elite male under-19 rugby league players was monitored at pre-, mid-, and late-season periods. There was no bias (p > 0.05) found between trials for the FMS, with the majority of components reaching 100% "perfect agreement," reflecting the good reliability of the FMS tool. There were no effects (p > 0.05) of season stage on any of the FMS components; however, an improvement (p ≤ 0.05) between the pre- and both mid- and late-season periods was apparent in every component of fitness, such as 1 RM bench press (112.92 ± 24.54 kg; 125.83 ± 21.41 kg; 125.98 ± 24.48 kg) and 40-m sprint time (5.69 ± 0.35 seconds; 5.62 ± 0.31 seconds; 5.64 ± 0.27 seconds). Our findings demonstrate that the FMS can be reliably administered to elite rugby league players but will not change in accordance with physical performance across a competitive season. Our findings should not necessarily deter practitioners from using the FMS but begin to question the specific qualities that are being assessed through its administration.

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.

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.

Could targeted exercise programmes prevent lower limb injury in community Australian football?

BACKGROUND

Australian football is a popular sport in Australia, at both the community and elite levels. It is a high-speed contact sport with a higher incidence of medically treated injuries when compared with most other organized sports. Hamstring injuries, ligament injuries to the knee or ankle, hip/groin injuries and tendinopathies are particularly common and often result in considerable time lost from sport. Consequently, the prevention of lower limb injuries is a priority for both community and elite Australian football organizations. There is considerable literature available on exercise programmes aimed at reducing lower limb injuries in Australian football and other running-related sports. The quality and outcomes of these studies have varied considerably, but indicate that exercise protocols may be an effective means of preventing lower limb injuries. Despite this, there has been limited high-quality and systematic evaluation of these data.

OBJECTIVE

The aim of this literature review is to systematically evaluate the evidence about the benefits of lower limb injury prevention exercise protocols aimed at reducing the most common severe lower limb injuries in Australian football.

METHODS

The Cochrane Central Register of Controlled Trials, the Cochrane Bone Joint and Muscle Trauma Group Specialized Register, MEDLINE and other electronic databases were searched, from January 1990 to December 2010. Papers reporting the results of randomized controlled trials (RCTs), quasi-RCTs, cohort and case-control studies were extracted. Primary outcomes were injury reduction or risk factor identification and/or modification. Secondary outcomes were adherence to any trialled interventions, injury severity and adverse effects such as secondary injuries and muscle soreness. The methodological quality of extracted manuscripts was assessed and results were collated.

RESULTS

Forty-seven papers were identified and reviewed of which 18 related to hamstring injury, eight related to knee or ankle ligament injury, five related to tendon injury and four were hip or groin injury related. Another 12 papers targeted general lower limb injuries. Most (n = 27 [57%]) were observational studies, investigating injury risk factors. Twenty reported the results of intervention trials. Of these, 15 were efficacy trials reporting the effects of an intervention in reducing injury rates, four were biomechanical interventions in which the impact of the intervention on a known injury risk factor was assessed and one reported changes in injury risk factors as well as injury rates. The strength of the evidence base for exercise programmes for lower limb injury prevention was found to be limited, primarily due to the research methods employed, low adherence to interventions by the study participants and a lack of statistical power. Limited evidence obtained from a small number of RCTs suggests that balance and control exercises might be efficacious in preventing ankle ligament injuries and a programme involving a combination of balance and control exercises, eccentric hamstring, plyometrics and strength exercises could be efficacious in preventing all lower limb injuries.

CONCLUSIONS

Overall, the evidence for exercise programmes as an efficacious lower limb injury prevention strategy is predominantly restricted to studies addressing injury aetiology and mechanisms. The findings of this review highlight the need to develop and test interventions in well designed population-based trials with an emphasis on promoting intervention uptake and adherence and, hence, intervention effectiveness. The results of this review can inform the development of the components of a future lower limb injury prevention exercise protocol for community-level Australian football.

Nonelite exercise-related injuries: participant reported frequency, management and perceptions of their consequences

This mixed methods study explored the frequency of sport/exercise-related injuries in nonelite sport, participant-reported management and perceptions of potential injury consequences. Focus group participants, who trained two to four times a week and had previously sustained musculoskeletal sports-related injuries, reported seeking medical advice secondary to advice from teammates or online research. General practitioners were viewed as gatekeepers to specialist secondary care and less able to effectively treat sport-related injuries. Participants displayed limited awareness of potential future implications of injury, and considered physical and psychological benefits of exercise more valuable than potential injury-associated risks. In the survey of physically active people, over half reported sustaining an exercise-related injury (562/1002, 56%). Previously injured respondents were less likely to consider consulting a health professional for injury-related advice than those with no injury history (45% vs 64%; P < 0.001) and more likely to continue exercising despite injury (51% vs 37%; P < 0.001). Concerns about injuries largely related to short-term issues; only 32% were concerned about possible long-term joint problems including osteoarthritis. Exercise-related injury was common in nonelite exercise participants. There was some dissatisfaction with care pathways for sports-related injuries and a lack of awareness about appropriate injury management and potential consequences of injury, particularly in the long-term.

Time-loss injuries versus non-time-loss injuries in the first team rugby league football: a pooled data analysis

OBJECTIVE

To describe the injury rates in first team rugby league in terms of those injuries that require missed playing time and those that do not.

DESIGN

A pooled data analysis from 2 independent databases.

SETTING

Rugby league match and training environment over several seasons from 1990 to 2003.

MAIN OUTCOME MEASURES

Injuries were reported as rates per 1000 hours of participation and as percentages with their associated 95% confidence intervals (CIs).

RESULTS

A total of 1707 match injuries were recorded. Of these injuries, 257 required players to miss the subsequent match. The remaining 1450 injuries did not require players to miss the next game. They represented 85% (95% CI, 83-87) of all injuries received and recorded. The ratio of non-time-loss (NTL) to time-loss (TL) injuries was 5.64 (95% CI, 4.96-6.42). There were 450 training injuries, of which 81 were TL injuries and 369 NTL injuries. The NTL training injury rate was 4.56 (95% CI, 3.58-5.79) times higher than TL injury rate.

CONCLUSIONS

Non-time-loss injuries represent the largest proportion of injuries in rugby league. If NTL injuries are not recorded, the workload of practitioners is likely to be severely underestimated.