Hamstrings injury incidence, risk factors, and prevention in Rugby Union players: a systematic review.

BACKGROUND: Hamstring strain injuries are one of the most common injuries in Rugby Union, representing up to 15% of all injuries sustained. We aimed to systematically review and summarize the scientific literature that addressed hamstring strain injury incidence, risk factors, injury prevention or strengthening strategies, and strength or asymmetry measures in Rugby Union. METHODS: We conducted a systematic search to locate published peer-reviewed articles from PubMed, SPORTDiscusTM, Web of Science®, and Scopus® e-databases. Studies included were original research conducted in Rugby Union that evaluated hamstring strength, hamstring strengthening interventions, and/or hamstring injury outcomes. Included studies were quality assessed using the Newcastle-Ottawa Scale. RESULTS: Twenty-four studies met inclusion and altogether involved 2866 participants. Isokinetic testing was the most common method used to quantify hamstring strength and imbalances in Rugby Union; with data indicating that professionals are stronger than amateurs, and forwards are stronger than backs. Regarding risk factors, we identified playing position, fatigue, previous injuries, between leg strength imbalances, lack of readiness to return to play post injury, and game actions (i.e. running). There is evidence to support the use of Nordic eccentric strength measures to inform practice, with strength and imbalances useful in predicting injuries. Strengthening programs with Nordic exercises significantly increased hamstring strength, increased muscle thickness, and decreased imbalance ratios in female and male players. A significant reduction in injury incidence and severity in professional players has been observed in players performing routines incorporating progressive Nordic exercises. CONCLUSION: The etiology of hamstring strain injuries is multifactorial, with playing position, fatigue, previous injuries, leg imbalances, lack of readiness to return to play, and running actions identified as contributing factors across levels. Combining strategies to prevent hamstring injuries and recurrences, and to inform return to play, is likely worthwhile and should include Nordic strength assessment and Nordic exercises.

Comparing Perceived Sleep Quality, Practices, and Behaviors of Male and Female Elite Rugby Union Athletes with the Use of Sleep Questionnaires.

Objective To evaluate the differences in subjective sleep quality, quantity, and behaviors among male and female elite rugby union athletes through two common sleep questionnaires. Materials and Methods A sample of 38 male and 27 female elite rugby union athletes filled out the Athlete Sleep Behavior Questionnaire (ASBQ) and the Pittsburgh Sleep Quality Index (PSQI). Global scores and individual items for each questionnaire were compared to assess differences between sexes. Results Male athletes reported significantly longer sleep duration (7 h 50 m ± 50 m versus 7h 12 m ± 58 m respectively; p ≤ 0.01; d = 0.70) and higher habitual sleep efficiency (88% versus 83% respectively; p < 0.05; d = 0.54) when compared with female athletes. Individual items of the ASBQ revealed significant differences between male and female athletes for five questions. Male athletes displayed higher instances of taking stimulants before training or competition and consuming alcohol within 4 hours of going to bed. Conversely, female athletes expressed greater thought or worry while in bed and a higher instance of training late at night. Discussion Male athletes displayed better self-reported sleep quality and quantity than female athletes; however, the present study highlighted that male and female elite rugby union athletes face specific challenges that differ. It appears that the differences observed between male and female elite rugby union athletes may be due to differing levels of professionalism or differences in training or competition schedules.

Reliability of Repeated Nordic Hamstring Strength in Rugby Players Using a Load Cell Device.

Hamstring strain injuries are one of the most common injuries in Rugby Union players, representing up to 15% of all sustained injuries. The Nordic eccentric hamstring test assesses the maximal hamstring eccentric strength and imbalances between limbs. Asymmetries and deficits in hamstring strength between legs are commonly assessed and used as screening methods to prevent injuries which can only be proven effective if hamstring strength measures are reliable over time. We conducted a repeated-measures reliability study with 25 male Rugby Union players. Nordic eccentric strength and bilateral strength balance was assessed. Three testing sessions were undertaken over three consecutive weeks. Intrasession and intersession reliabilities were assessed using typical errors (TE), coefficient of variations (CV), and intraclass correlation coefficients (ICC). Our results showed good intrasession reliability (ICC = 0.79-0.90, TE = 26.8 N to 28.9 N, CV = 5.5% to 6.7%), whilst intersession reliability was fair for mean and the max (ICC = 0.52-0.64, TE = 44.1 N to 55.9 N, CV from 7.4% to 12.5%). Regarding the bilateral strength balance ratios, our results showed good intrasession reliability (ICC = 0.62-0.89, TE = 0.5, CV = 4.4% to 7.2%), whilst the intersession reliability for mean and max values was fair (ICC = 0.52-0.54) with a good absolute intersession reliability CV ranging from 8.2% to 9.6%. Assessing the Nordic eccentric hamstring strength and the bilateral strength balance in Rugby players using a load cell device is a feasible method to test, and demonstrated good intrasession and fair intersession reliability. Nordic eccentric strength assessment is a more practical and functional test than isokinetic; we provide data from Rugby Union players to inform clinicians, and to establish normative values in this cohort.

Reliability of Repeated Isometric Neck Strength in Rugby Union Players Using a Load Cell Device.

Concussion is the most common injury in professional Rugby Union (RU) players, with increasing incidence and severity each year. Strengthening the neck is an intervention used to decrease concussion incidence and severity, which can only be proven effective if strength neck measures are reliable. We conducted a repeated-measures reliability study with 23 male RU players. Neck strength was assessed seated in a 'make' test fashion in flexion, extension, and bilateral-side flexion. Flexion-to-extension and left-to-right side ratios were also computed. Three testing sessions were undertaken over three consecutive weeks. Intrasession and intersession reliabilities were assessed using typical errors, coefficient of variations (CV), and intraclass correlation coefficients (ICC). Intrasession reliability demonstrated good-to-excellent relative (ICC > 0.75) and good absolute (CV ≤ 20%) reliability in all directions (ICC = 0.86−0.95, CV = 6.4−8.8%), whereas intersession reliability showed fair relative (ICC: 0.40 to 0.75) and acceptable absolute (CV ≤ 20%) reliability for mean and maximal values (ICC = 0.51−0.69, CV = 14.5−19.8%). Intrasession reliability for flexion-to-extension ratio was good (relative, ICC = 0.86) and acceptable (absolute, CV = 11.5%) and was fair (relative, ICC = 0.75) and acceptable (absolute, CV = 11.5%) for left-to-right ratio. Intersession ratios from mean and maximal values were fair (relative, ICC = 0.52−0.55) but not always acceptable (absolute, CV = 16.8−24%). Assessing isometric neck strength with a head harness and a cable with a load cell device seated in semi-professional RU players is feasible and demonstrates good-to-excellent intrasession and fair intersession reliability. We provide data from RU players to inform practice and assist standardisation of testing methods.

Sleep and Performance during a Preseason in Elite Rugby Union Athletes.

BACKGROUND: Preseason training optimises adaptations in the physical qualities required in rugby union athletes. Sleep can be compromised during periods of intensified training. Therefore, we investigated the relationship between sleep quantity and changes in physical performance over a preseason phase in professional rugby union athletes. METHODS: Twenty-nine professional rugby union athletes (Mean ± SD, age: 23 ± 3 years) had their sleep duration monitored for 3 weeks using wrist actigraphy. Strength and speed were assessed at baseline and at week 3. Aerobic capacity and body composition were assessed at baseline, at week 3 and at week 5. Participants were stratified into 2 groups for analysis: <7 h 30 min sleep per night (LOW, n = 15) and >7 h 30 min sleep per night (HIGH, n = 14). RESULTS: A significant group x time interaction was determined for aerobic capacity (p = 0.02, d = 1.25) at week 3 and for skinfolds at week 3 (p < 0.01, d = 0.58) and at week 5 (p = 0.02, d = 0.92), in favour of the HIGH sleep group. No differences were evident between groups for strength or speed measures (p ≥ 0.05). CONCLUSION: This study highlights that longer sleep duration during the preseason may assist in enhancing physical qualities including aerobic capacity and body composition in elite rugby union athletes.

Neck strength in Rugby Union players: a systematic review of the literature.

The incidence and severity of concussion injuries are increasing every year. Scientific evidence indicates that neck strength and girth could play a role in preventing head and neck injuries, or at least mitigating their severity. We aimed to examine the scientific literature addressing neck strength in Rugby Union with a focus on the potential role of neck strength on injury incidence, neck assessment protocols, neck strength measures, and neck strengthening exercises.We conducted a systematic search of the literature in January 2021 to locate published peer-reviewed articles from PubMed, SPORTDiscusTM, Web of Science®, and Scopus® e-databases. Overall, senior elite male players were stronger than younger-aged players. Forwards were stronger in extension than any other directions assessed, and were generally stronger and possessed larger necks and greater cross-sectional areas when compared to backs. Implementation of isometric exercise routines in professional players was reported to improve neck strength in all directions. There were no studies evaluating the incidence of concussion and neck strength or neck strengthening strategies in Rugby Union. Strengthening the neck continues to be one of the targeted modifiable risk factors with respect to limiting the severity and temporal effects of head injuries in Rugby Union, despite limited evidence regarding direct associations between neck strength and concussion.

Effects of Chronic Cold-Water Immersion in Elite Rugby Players.

PURPOSE: Although the acute effects of cold-water immersion (CWI) have been widely investigated, research analyzing the effects of CWI over a chronic period in highly trained athletes is scarce. The aim of this study was to investigate the effects of CWI during an intense 3-wk preseason phase in elite rugby athletes. METHODS: A total of 23 elite male rugby union athletes were randomized to either CWI (10 min at 10°C, n = 10) or a passive recovery control (CON, n = 13) during 3 wk of high-volume training. Athletes were exposed to either CWI or CON after each training day (12 d in total). Running loads, conditioning, and gym sessions were kept the same between groups. Measures of countermovement jump, perceived muscle soreness, and wellness were obtained twice a week, and saliva samples for determining cortisol and interleukin-6 were collected once per week. RESULTS: Although no significant differences were observed between CWI and CON for any measure, CWI resulted in lower fatigue markers throughout the study as demonstrated by the moderate effects on muscle soreness (d = 0.58-0.91) and interleukin-6 (d = -0.83) and the small effects (d = 0.23-0.38) on countermovement jump in comparison with CON. CONCLUSIONS: CWI may provide some beneficial effect by reducing fatigue and soreness during an intense 3-wk training phase in elite rugby athletes.

Morning based strength training improves afternoon physical performance in rugby union players.

OBJECTIVES: To determine if a morning training session could alter afternoon physical performance. Moreover, as testosterone (T) and cortisol (C) concentrations are significant predictors of physical performance, and both show circadian declines across the day, we examined the effects of morning training on diurnal T and C responses. DESIGN: Eighteen semi-professional rugby union players completed this randomised and counter-balanced study. METHODS: Following morning saliva collection (0900 h), players completed a control (rested), Sprint (5 × 40 m) or Weights (3 repetition-maximum [RM] bench press and squat) trial. In the afternoon (15:00 h) of each trial, a further saliva sample was collected before players completed a performance test (3 RM back squat and bench press, 40 m sprint, countermovement jump [CMJ]). RESULTS: Salivary T concentrations declined from am to pm under Control and Sprint, but not under Weights. Delta T, from am to pm, was greater under Control (-10.9 ± 2.4 pg ml(-1)) compared to Sprints (-6.2 ± 7.1 pg ml(-1)) and Weights (-1.2 ± 5.5 pg ml(-1)) (p ≤ 0.001). Delta C, from am to pm, was greater under Control compared to both Sprint and Weights (p<0.05). Players elicited better CMJ peak power, 40-m time, 3 RM bench and squat performance under Weights compared with Control and Sprint (p<0.05). Faster 40-m times were seen under Sprint, when compared to Control (p<0.05). CONCLUSIONS: Performing morning strength training is associated with improved physical performance in the afternoon. Additionally, the circadian decline in T concentrations appeared offset by morning training. However, it is unclear if T concentrations are, in part, causal of these improved responses or simply a reflective marker.

The influence of the time of day on core temperature and lower body power output in elite rugby union sevens players.

Core temperature typically displays a low circadian in the morning before peaking later in the day, and these changes occur within small physiological ranges. Body temperature plays an important role in physical performance, and some athletes may be required to train and compete in both the morning and evening. However, the influence of the circadian change in body temperature and its influence on physical performance in elite athletes are unclear. This study examined the effects of the time of day on core temperature and lower body power output in elite rugby union sevens players. Sixteen elite rugby union sevens players completed morning (in AM) countermovement jump and core temperature (Tcore) measurement, which were then repeated later the same day (in PM). Countermovement jump was processed for peak power output (PPO). Data were analyzed using paired samples t-test and Pearson's product moment correlation and are presented in mean ± SD. Tcore significantly increased from AM to PM (AM, 36.92 ± 0.23 vs. PM, 37.18 ± 0.18° C; P < 0.001) with PPO significantly increasing from AM to PM in all 16 players (AM, 5248 ± 366 vs. PM, 5413 ± 361 W; P < 0.001). The delta change in Tcore (0.26 ± 0.13° C) and PPO (164 ± 78 W) was significantly related (r = 0.781; P < 0.001). In conclusion, small circadian changes in core temperature can influence physical performance in elite athletes. Coaches should seek to use strategies, which may raise morning body temperature to offset the circadian low in the morning.