Youth Injury Knowledge and Beliefs following Neuromuscular Training Warm-up Implementation in Schools.

Neuromuscular training warm-up programs can reduce injury rates in youth sports, but they often have poor uptake and adherence. Delivering such programs in school physical education classes may provide greater public health benefit, particularly if they promote improved injury knowledge and prevention beliefs amongst students. The purpose of this secondary analysis of a large cluster-randomized controlled trial was to understand how students' (age 11-15 years) knowledge and beliefs change after exposure to an evidence-informed neuromuscular training warm-up program. Six schools delivered the program for a 12-week period in the initial study year (n=566) and two continued to use it in a subsequent "maintenance" year (n=255). Students completed a knowledge and beliefs questionnaire at baseline, 6-week, and 12-week timepoints. Knowledge scores ranged from 7/10 to 8/10 at all timepoints and students generally believed that injuries are preventable. On average, there was less than a one-point change in knowledge between timepoints and there was no change in the median belief scores. There were no meaningful differences between sexes, grades, or previous injury. These findings highlight that knowledge and beliefs are unlikely to change passively through program exposure. More active strategies are needed to improve injury prevention perceptions in this population.

Effectiveness of the Activate injury prevention exercise programme to prevent injury in schoolboy rugby union.

OBJECTIVE: The efficacious Activate injury prevention exercise programme has been shown to prevent injuries in English schoolboy rugby union. There is now a need to assess the implementation and effectiveness of Activate in the applie setting. METHODS: This quasi-experimental study used a 24-hour time-loss injury definition to calculate incidence (/1000 hours) and burden (days lost/1000 hours) for individuals whose teams adopted Activate (used Activate during season) versus non-adopters. The dose-response relationship of varying levels of Activate adherence (median Activate sessions per week) was also assessed. Player-level rugby exposure, sessional Activate adoption and injury reports were recorded by school gatekeepers. Rate ratios (RR), adjusted by cluster (team), were calculated using backwards stepwise Poisson regression to compare rates between adoption and adherence groups. RESULTS: Individuals in teams adopting Activate had a 23% lower match injury incidence (RR 0.77, 95% CI 0.55 to 1.07), 59% lower training injury incidence (RR 0.41, 95% CI 0.17 to 0.97) and 26% lower match injury burden (95% CI 0.46 to 1.20) than individuals on non-adopting teams. Individuals with high Activate adherence (≥3 sessions per week) had a 67% lower training injury incidence (RR 0.33, 95% CI 0.12 to 0.91) and a 32% lower match injury incidence (RR 0.68, 95% CI 0.50 to 0.92) than individuals with low adherence (<1 session per week). While 65% of teams adopted Activate during the season, only one team used Activate three times per week, using whole phases and programme progressions. CONCLUSION: Activate is effective at preventing injury in English schoolboy rugby. Attention should focus on factors influencing programme uptake and implementation, ensuring Activate can have maximal benefit.

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.

Prevalence and burden of health problems in competitive adolescent distance runners: A 6-month prospective cohort study.

To describe all health problems (injuries and illnesses) in relation to type, location, incidence, prevalence, time loss, severity, and burden, in competitive adolescent distance runners in England. Prospective observational study: 136 competitive adolescent distance runners (73 female athletes) self-reported all health problems for 24-weeks between May and October 2019. Athletes self-reported health problems using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. The incidence of running-related injury per 1,000 hours of exposure was markedly higher, compared to previous research. At any time, 24% [95% Confidence Intervals (CI): 21-26%] of athletes reported a health problem, with 11% [95% CI: 9-12%] having experienced a health problem that had substantial negative impact on training and performance. Female athletes reported noticeably more illnesses, compared to male athletes, including higher prevalence, incidence, time loss, and severity. The most burdensome health problems, irrespective of sex, included lower leg, knee, and foot/toes injuries, alongside upper respiratory illnesses. The mean weekly prevalence of time loss was relatively low, regardless of health problem type or sex. Competitive adolescent distance runners are likely to be training and competing whilst concurrently experiencing health problems. These findings will support the development of injury and illness prevention measures.

Effect of Exercise on Cardiometabolic Risk Factors in Adults With Chronic Spinal Cord Injury: A Systematic Review.

OBJECTIVE: To determine the effects of exercise on individual cardiometabolic syndrome (CMS) risk factors in adults with chronic spinal cord injury (SCI). DATA SOURCES: English language searches of PubMed, Web of Science, EMBASE, and Scopus (January 1, 1970, to July 31, 2019). STUDY SELECTION: Articles were included if they met the following criteria: (1) original articles with statistical analysis, (2) participants were adults with a SCI sustained ≥1 year ago, (3) exercise intervention duration ≥2 weeks, and (4) included any CMS risk factor as an outcome. DATA EXTRACTION: The methodological quality of articles was assessed using the Downs and Black score. DATA SYNTHESIS: Sixty-five studies were included for the final analysis, including 9 studies classified as high quality (≥66.7%), 35 studies classified as fair quality (50%-66.6%), and 21 studies classified as low quality (<50%). Improvements in waist circumference (4/6 studies) and markers of hepatic insulin sensitivity (4/5 studies) were reported following upper body aerobic exercise training, but no improvements in fasting glucose (8/8 studies), lipid profile (6/8 studies), systolic blood pressure (8/9 studies), or diastolic blood pressure (9/9 studies) were observed. Improvements in markers of peripheral insulin sensitivity (5/6 studies) were observed following functional electrical stimulation (FES) cycling. Improvements in lipid profile (4/5 studies) were observed following upper body resistance training (RT) (with or without aerobic exercise). No consistent improvements in CMS risk factors were observed following assisted ambulation, FES hybrid, FES rowing, and FES RT. CONCLUSIONS: Upper body aerobic exercise training (>75% maximum heart rate) appears to improve waist circumference and hepatic insulin sensitivity but appears insufficient for improving fasting glucose, lipid profile, or resting blood pressure. The addition of RT to upper body aerobic exercise may elicit favorable changes in the lipid profile. More high-quality studies are needed to confirm if FES cycling is effective at improving peripheral insulin sensitivity.

Implementing a junior high school-based programme to reduce sports injuries through neuromuscular training (iSPRINT): a cluster randomised controlled trial (RCT).

OBJECTIVE: To evaluate the effectiveness of a junior high school-based sports injury prevention programme to reduce injuries through neuromuscular training (NMT). METHODS: This was a cluster randomised controlled trial. Students were recruited from 12 Calgary junior high schools (2014-2017). iSPRINT is a 15 min NMT warm-up including aerobic, agility, strength and balance exercises. Following a workshop, teachers delivered a 12-week iSPRINT NMT (six schools) or a standard-of-practice warm-up (six schools) in physical education classes. The definition of all recorded injuries included injuries that resulted in participants being unable to complete a sport and recreation (S&R) session, lost time from sport and/or seek medical attention. Incidence rate ratios (IRRs) were estimated based on multiple multilevel Poisson regression analyses (adjusting for sex (considering effect modification) and previous injury, offset by S&R participation hours, and school-level and class-level random effects were examined) for intent-to-treat analyses. RESULTS: 1067 students (aged 11-16) were recruited across 12 schools (6 intervention schools (22 classes), 6 control schools (27 classes); 53.7% female, 46.3% male). The iSPRINT programme was protective of all recorded S&R injuries for girls (IRR=0.543, 95% CI 0.295 to 0.998), but not for boys (IRR=0.866, 95% CI 0.425 to 1.766). The iSPRINT programme was also protective of each of lower extremity injuries (IRR=0.357, 95% CI 0.159 to 0.799) and medical attention injuries (IRR=0.289, 95% CI 0.135 to 0.619) for girls, but not for boys (IRR=1.055, 95% CI 0.404 to 2.753 and IRR=0.639, 95% CI 0.266 to 1.532, respectively). CONCLUSION: The iSPRINT NMT warm-up was effective in preventing each of all recorded injuries, lower extremity injuries and medically treated S&R injuries in female junior high school students. TRIAL REGISTRATION NUMBER: NCT03312504.

Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial.

BACKGROUND: Injury risk in youth rugby has received much attention, highlighting the importance of establishing evidence-based injury reduction strategies. AIM: To determine the efficacy of a movement control exercise programme in reducing injuries in youth rugby players and to investigate the effect of programme dose on injury measures. METHODS: In a cluster-randomised controlled trial, 40 independent schools (118 teams, 3188 players aged 14-18 years) were allocated to receive either the intervention or a reference programme, both of which were to be delivered by school coaches. The intervention comprised balance training, whole-body resistance training, plyometric training, and controlled rehearsal of landing and cutting manoeuvres. Time-loss (>24 hours) injuries arising from school rugby matches were recorded by coaches and medical staff. RESULTS: 441 time-loss match injuries (intervention, 233; control, 208) were reported across 15 938 match exposure-hours (intervention, 9083; control, 6855). Intention-to-treat results indicated unclear effects of trial arm on overall match injury incidence (rate ratio (RR)=0.85, 90% confidence limits 0.61 to 1.17), although clear reductions were evident in the intervention arm for concussion incidence (RR=0.71, 0.48 to 1.05). When trial arm comparisons were limited to teams who had completed three or more weekly programme sessions on average, clear reductions in overall match injury incidence (RR=0.28, 0.14 to 0.51) and concussion incidence (RR=0.41, 0.17 to 0.99) were noted in the intervention group. CONCLUSION: A preventive movement control exercise programme can reduce match injury outcomes, including concussion, in schoolboy rugby players when compared with a standardised control exercise programme, although to realise the greatest effects players should complete the programme at least three times per week.

The impact of concussion on cardiac autonomic function: A systematic review.

PRIMARY OBJECTIVE: To evaluate the evidence regarding the effect of concussion on cardiac autonomic function (CAF). INCLUSION CRITERIA: Original research; available in English; included participants with concussion or mild traumatic brain injury (mTBI) and a comparison group; included measures of heart rate (HR) and/or heart rate variability (HRV) as outcomes. Studies of humans (greater than 6 years old) and animals were included. Critical appraisal tools: The Downs and Black (DB) criteria and Structured Effectiveness Quality Evaluation Scale (SEQES). RESULTS: Nine full-length articles and four abstracts were identified. There is conflicting evidence regarding CAF at rest following concussion. There is evidence of elevated HR and reduced HRV with low-intensity, steady-state exercise up to 10 days following concussion. There was no significant difference in HRV during isometric handgrip testing or HR while performing cognitive tasks following concussion. The validity of current literature is limited by small sample sizes, lack of female or paediatric participants, methodological heterogeneity and lack of follow-up. CONCLUSIONS: While there is some evidence to suggest CAF is altered during physical activity following concussion, methodological limitations highlight the need for further research. Understanding the effect of concussion on CAF will contribute to the development of more comprehensive concussion management strategies.

Risk factors for injury in sport climbing and bouldering: a systematic review of the literature.

BACKGROUND: Rock climbing is an increasingly popular sport worldwide, as a recreational activity and a competitive sport. Several disciplines including sport climbing and bouldering have developed, each employing specific movements and techniques, leading to specific injuries. OBJECTIVE: To examine risk factors and prevention measures for injury in sport climbing and bouldering, and to assess the methodological quality of existing studies. METHODS: 12 electronic databases and several other sources were searched systematically using predetermined inclusion and exclusion criteria. Eligible articles were peer-reviewed, based on primary research using original data; outcome measures included injury, morbidity or mortality in rock climbing, and included one or more potential risk factor or injury prevention strategy. Two independent reviewers assessed the methodology of research in each study using the Downs and Black Quality Index. The data extracted is summarised, and appraisals of the articles are presented with respect to the quality of evidence presented. RESULTS: 19 studies met the inclusion criteria, and introduced 35 possible risk factors or injury prevention measures in climbing. Age, increasing years of climbing experience, highest climbing grade achieved (skill level), high climbing intensity score (CIS) and participating in lead climbing are potential risk factors. Results regarding injury prevention measures remain inconclusive. DISCUSSION: This field is relatively new and, as such, the data are not as robust as for more established sports with a larger research foundation. The key need is establishing modifiable risk factors using prospective studies and high quality methodology, such that injury prevention strategies can be developed. The CIS may be a useful measure in this field of research.

Incidence, mechanism and risk factors for injury in youth rock climbers.

BACKGROUND: Rock-climbing participation has grown globally in recent years, and the sport was officially recognised by the International Olympic Committee in 2010. The epidemiology of climbing injuries in adults has been examined, but few studies have investigated injury in youth climbers. OBJECTIVE: To examine the incidence, mechanisms and risk factors for injury in recreational and elite sport climbers and boulderers aged 11-19 years. STUDY DESIGN: Cross-sectional. METHODS: Youth (n=116) were recruited from climbing facilities across Alberta, Canada. Participants completed an anonymous questionnaire from October 2012 to March 2013. Climbing injury incidence proportions and incidence rates (IR) were calculated. ORs with corresponding 95% CIs were estimated for possible risk factors. RESULTS: The injury IR was 4.44 injuries/1000 climbing hours (95% CI 3.74 to 5.23). Sprains (27%) and strains (26%) were the predominant injury types, and repetitive overuse was the primary mechanism of injury (42%). Hands and fingers were the most commonly injured locations (21%). Exploratory analyses showed three risk factors for injury: older age (15-19 vs 11-14 years; OR=11.30, 95% CI 2.33 to 54.85), injury in a sport other than climbing (OR=6.46, 95% CI 1.62 to 25.68) and preventive taping (OR=5.09, 95% CI 1.44 to 18.02). CONCLUSIONS: Injury risk is high in youth climbers. Findings are consistent with the reported rates, types and mechanisms in adults. Modifiable risk factors warrant further investigation to inform the development of injury prevention strategies, targeting high-risk climbers including adolescents and those with previous injury.

Absence of differences between male and female adolescents with prior sport concussion.

OBJECTIVE: Sex differences following concussion are poorly understood. The purpose of this study was to examine whether male and female adolescent athletes with prior concussions differ regarding neurocognitive function and symptom reporting. SETTING: Community-based hockey teams. PARTICIPANTS: Participants included 615 elite hockey players 13 to 17 years old (mean = 15.5, 95% confidence interval [CI] = 15.4-15.6). There were 517 males and 98 females. Players with English as a second language, attention or learning problems, a concussion within 6 months of baseline, or suspected invalid test profiles were excluded from these analyses. DESIGN: Cross-sectional. MAIN MEASURE: Domain scores and symptom ratings from the ImPACT computerized battery. RESULTS: There were no significant neurocognitive differences between males and females with (F5,227 = 1.40, P = .227) or without (F5,376 = 1.33, P = 0.252) a prior history of concussion. Male and female athletes with a history of concussion reported higher raw symptom scores than those without a prior concussion; however, sex differences disappear when symptom scores are adjusted for known sex differences in controls (total score, F2,230 = 0.77, P = .46; Cohen d = 0.01 or domain scores (F4,227 = 1.52, P = .197; Cohen d = 0.07-0.18). CONCLUSIONS: Although those with prior concussions report more symptoms (but do not differ on neurocognition), this study does not support sex differences with cognition or symptoms in adolescent athletes with prior concussions.

The epidemiology of professional ice hockey injuries: a prospective report of six NHL seasons.

BACKGROUND: There is a paucity of literature examining injury and illness rates in men's professional ice hockey. This study aimed to determine injury and illness rates in the NHL over six seasons, and identify predictors of injury-related time loss in this population. METHODS: This study involved an inclusive cohort of hockey players from all NHL teams competing in the 2006-2007 through 2011-2012 seasons. A standardised electronic injury surveillance system was used to report injury and illness events. The primary outcome was regular season and postseason time-loss injury/illness. The secondary outcome was man-games lost from the competition. RESULTS: On the basis of the estimated athlete exposures (AEs), the overall regular season incidence density was 15.6 injuries/1000 AEs and 0.7 illnesses/1000 AEs. Based on recorded time on ice, the injury rates were roughly threefold higher at 49.4 injuries/1000 player game-hours and 2.4 illnesses/1000 player game-hours. There was a reduction in injury rates over the 6-year period, with the greatest reduction between the 2007-2008 and 2008-2009 seasons. Multivariate predictors of time loss greater than 10 days were being a goalie (OR=1.68, 95% CI 1.18 to 2.38), being injured in a road game (OR=1.43, 95% CI 1.25 to 1.63) and the mechanism of injury being a body check (OR=2.21, 95% CI 1.86 to 2.62). CONCLUSIONS: There was an overall reduction in the time-loss injury and illness rates over six seasons. Being a goaltender, being injured on the road and being injured by a body check were the risk factors for time loss greater than five 'man games'.

The effect of coach and player injury knowledge, attitudes and beliefs on adherence to the FIFA 11+ programme in female youth soccer.

BACKGROUND: Injury knowledge and beliefs influence uptake of prevention programmes, but the relationship between knowledge, beliefs and adherence remains unclear. AIM: To describe injury knowledge and beliefs among youth female soccer coaches and players, and to identify the relationship between these factors, different delivery strategies of the FIFA 11+ programme and adherence. METHODS: A subcohort analysis from a cluster-randomised controlled trial of 31 female soccer teams (coaches n=29, players (ages 13-18) n=258). Preseason and postseason questionnaires were used to assess knowledge and beliefs. Teams recorded FIFA 11+ adherence during the season. RESULTS: At baseline, 62.8% (95% CI 48.4% to 77.3%) of coaches and 75.8% (95% CI 71.5% to 80.1%) of players considered 'inadequate warm-up' a risk factor for injury. There was no effect of delivery method (OR=1.1; 95% CI 0.8 to 1.5) or adherence (OR=1.0; 95% CI 0.9 to 1.1) on this belief. At baseline, 13.8% (95% CI 1.3% to 26.4%) of coaches believed a warm-up could prevent muscle injuries, but none believed it could prevent knee and ankle injuries. For players, 9.7% (95% CI 6.1% to 13.3%), 4.7% (95% CI 2.1% to 7.3%) and 4.7% (95% CI 2.1% to 7.3%) believed a warm-up would prevent muscle, knee and ankle injuries, respectively. Years of playing experience were negatively associated with high adherence for coaches (OR=0.93; 0.88 to 0.99) and players (OR=0.92; 0.85 to 0.98). CONCLUSIONS: There were gaps in injury knowledge and beliefs, which differed for coaches and players. Beliefs did not significantly affect adherence to the FIFA 11+, suggesting additional motivational factors should be considered.

Match injuries in English schoolboy rugby union.

Objective: This study describes the incidence, severity and burden of match injuries in schoolboy rugby union in England, across three age groups: under-13 (U13), under-15 (U15) and under-18 (U18). Methods: Data regarding 574 24-hour time-loss match injuries and 18 485 player-hours of match exposure were collected from a total of 35 schools (66 teams) in the 2017/18, 2018/19 and 2019/20 seasons. Injury incidence (injuries/1000 hours), severity (mean and median days lost) and burden (days lost/1000 hours) were calculated for each age group, injury region, event, playing position and match period and were compared using Z scores. Results: The U18 age group had a significantly higher injury incidence (34.6 injuries/1000 hours, 95% CI 31.5 to 38.1) and burden (941 days/1000 hours, 95% CI 856 to 1035) than both the U13 (incidence=20.7 injuries/1000 hours, 95% CI 14.1 to 30.3, p=0.03; burden=477 days lost/1000 hours, 95% CI 325 to 701, p<0.01) and U15 (incidence=24.6 injuries/1000 hours, 95% CI 20.6 to 29.5, p<0.01; burden=602 days lost/1000 hours, 95% CI 503 to 721, p<0.01) age groups, but no significant differences were found between the U13 and U15 age groups. Contact events accounted for 87% of known injury events, with the tackle responsible for 52% (U13), 48% (U15) and 62% (U18) of all injuries. Concussion was the most common injury type in all age groups (U13=4.8 injuries/1000 hours; U15=6.4 injuries/1000 hours; U18=9.2 injuries/1000 hours), but the incidence was not significantly different between age groups. Conclusion: Injury incidence and burden was higher in U18 than U13 and U15 age groups. Concussions and the tackle are priority areas at all age groups and should be the focus of injury prevention strategies.

A similar injury profile observed in franchise men's and women's cricket in England and Wales: injury surveillance analysis from the first three 'The Hundred' competitions.

Objectives: To describe the injury profile of a novel format cricket competition ('The Hundred') and compare injury incidence and prevalence between the men's and women's competitions. Methods: Medical staff prospectively collected injury data from the eight men's and women's teams during the 2021-2023 competitions. Injury definitions and incidence calculations followed the international consensus statement. Results: In the men's competition, 164 injuries were recorded, compared with 127 in the women's competition. Tournament injury incidence was 36.6 (95% CI 31.4 to 42.7) and 32.5 (95% CI 27.3 to 38.7)/100 players/tournament in the men's and women's competition, respectively. Non-time-loss incidence (men's 26.6 (95% CI 22.2 to 31.8), women's 24.6 (95% CI 20.1 to 30.0)/100 players/tournament) was higher than time-loss incidence (men's 10.0 (95% CI 7.5 to 13.5), women's 7.9 (95% CI 5.6 to 11.3)/100 players/tournament). Injury prevalence was 2.9% and 3.6% in the men's and women's competitions, respectively. Match fielding was the most common activity at injury in both competitions. The thigh and hand were the most common body location time-loss injury in the men's and women's competitions, respectively. Conclusion: A similar injury profile was observed between the men's and women's competition. Preventative strategies targeting thigh injuries in the men's competition and hand injuries in the women's competition would be beneficial. Compared with published injury rates, 'The Hundred' men's presents a greater risk of injury than Twenty20 (T20), but similar to one-day cricket, with 'The Hundred' women's presenting a similar injury risk to T20 and one-day cricket. Additional years of data are required to confirm these findings.

Injury Rates and Characteristics Associated with Participation in Organized Dance Education: A Systematic Review.

INTRODUCTION: Several studies and recent systematic reviews have investigated injury in dance settings and have largely focused on specific concert dance genres (i.e., ballet, contemporary) and elite levels (i.e., pre-professional, professional) of dance. Less is known about the health of those who participate in dance education settings, namely teachers and students from private dance studios. Given that these individuals constitute a large proportion of the dance community, greater clarity of risks in the dance training environment could benefit an underserved majority by informing the development of effective injury prevention strategies.
Objective: The primary objective was to describe injury rates and characteristics associated with participation in organized dance education settings.
Methods: Six electronic databases were searched to April 2021 (Medline, EMBASE, SportDiscus, CINAHL, SCOPUS, Cochrane). Selected studies met a priori inclusion criteria that required original data from dance teacher and student samples within formal dance education settings. All genres of dance were eligible. Studies were excluded if no injury outcomes or estimates of dance exposure were reported, if injuries occurred during rehearsal and performance, or if dance was used as a therapeutic intervention or exercise. Two reviewers independently assessed each paper for inclusion at abstract and full text screening stages. The quality of included studies was assessed using the Joanna Briggs Institute Level of Evidence tool.
Results: The initial database search identified 1,424 potentially relevant records, 26 were included and scored. Most studies (n = 22) focused on dance students only, three included only dance teachers, and one study included both. Among both dance students and teachers, the majority of injuries reported were overuse or chronic and involved the lower limb. For studies that reported injury rates (n = 14), estimates ranged from 0.8 to 4.7 injuries per 1,000 dance hours, 4.86 per 1,000 dancer-days, and 0.21 to 0.34 per 1,000 dance exposures.
Conclusions: Based on the current research, dance students and teachers experience a similar rate of injury to concert and professional dancers, and their injuries are most commonly overuse injuries involving the lower extremity. There have been few high-quality investigations of injury specific to the dance training environment. Therefore, consensus around the burden of injury in the dance education settings remains difficult. Future dance epidemiological investigations that examine the burden of injury among dance teachers and students, include operational injury and exposure definitions, and utilize prospective designs are warranted.

Implementation of the Activate injury prevention exercise programme in English schoolboy rugby union.

OBJECTIVES: The implementation of the Activate injury prevention exercise programme has not been assessed in an applied context. This study aimed to (1) describe the knowledge and perceptions of school rugby coaches and players towards injury risk, prevention and Activate and (2) evaluate Activate implementation in schoolboy rugby using the reach, effectiveness, adoption, implementation and maintenance framework. METHODS: Bespoke electronic surveys were administered to coaches (including support staff) and players at participating English schools (2018-2020). Most questions and statements were answered using a 7-point Likert scale. At baseline, participants detailed their Activate awareness and perceptions of injury risk and prevention in schoolboy rugby. At postseason, participants reported Activate use throughout the study and their perceptions towards the programme. RESULTS: At baseline, significant differences existed between coaches (n=106) and players (n=571) in Activate awareness (75% and 13% respectively; χ2=173.5, p<0.001). Coaches perceived rugby had a significantly greater injury risk than players, while holding more positive perceptions towards injury prevention. At postseason, coaches reported greater Activate adoption compared with players (76% and 18% respectively; χ2=41.8, p<0.001); 45% of players were unaware if they used the programme. Median session adherence was twice weekly, with a median duration of 10-15 min. This suggests Activate was not implemented as intended, with recommendations of three 20 min sessions per week. Both groups identified common barriers to implementation, such as lack of time and inclusion of a ball. CONCLUSION: Coaches are instrumental in the decision to implement Activate. Targeting behavioural change in these individuals is likely to have the greatest impact on intervention uptake.