Concussion-Related Biomarker Variations in Retired Rugby Players and Implications for Neurodegenerative Disease Risk: The UK Rugby Health Study.

The health and well-being of retired rugby union and league players, particularly regarding the long-term effects of concussions, are of major concern. Concussion has been identified as a major risk factor for neurodegenerative diseases, such as Alzheimer's and Amyotrophic Lateral Sclerosis (ALS), in athletes engaged in contact sports. This study aimed to assess differences in specific biomarkers between UK-based retired rugby players with a history of concussion and a non-contact sports group, focusing on biomarkers associated with Alzheimer's, ALS, and CTE. We randomly selected a sample of male retired rugby or non-contact sport athletes (n = 56). The mean age was 41.84 ± 6.44, and the mean years since retirement from the sport was 7.76 ± 6.69 for participants with a history of substantial concussions (>5 concussions in their career) (n = 30). The mean age was 45.75 ± 11.52, and the mean years since retirement was 6.75 ± 4.64 for the healthy controls (n = 26). Serum biomarkers (t-tau, RBP-4, SAA, Nf-L, and retinol), plasma cytokines, and biomarkers associated with serum-derived exosomes (Aß42, p-tau181, p-tau217, and p-tau231) were analyzed using validated commercial ELISA assays. The results of the selected biomarkers were compared between the two groups. Biomarkers including t-tau and p-tau181 were significantly elevated in the history of the substantial concussion group compared to the non-contact sports group (t-tau: p < 0.01; p-tau181: p < 0.05). Although between-group differences in p-tau217, p-tau231, SAA, Nf-L, retinol, and Aß42 were not significantly different, there was a trend for higher levels of Aß42, p-tau217, and p-tau231 in the concussed group. Interestingly, the serum-derived exosome sizes were significantly larger (p < 0.01), and serum RBP-4 levels were significantly reduced (p < 0.05) in the highly concussed group. These findings indicate that retired athletes with a history of multiple concussions during their careers have altered serum measurements of exosome size, t-tau, p-tau181, and RBP-4. These biomarkers should be explored further for the prediction of future neurodegenerative outcomes, including ALS, in those with a history of concussion.

Long-term cost-effectiveness analysis of rugby fans in training-New Zealand: a body weight reduction programme for males.

OBJECTIVES: We sought to extrapolate the long-term costs and clinical impacts attributed to the rugby fans in training-New Zealand (RUFIT-NZ) trial in Aotearoa, New Zealand. DESIGN: A modelled cost-effectiveness analysis using efficacy data from RUFIT-NZ was conducted from the Aotearoa New Zealand healthcare perspective. SETTING: A Markov cohort model was constructed with a lifetime time horizon. The model simulated events of myocardial infarction (MI), stroke and type 2 diabetes mellitus (T2DM) occurring among a hypothetical cohort of 10 000 individuals receiving either the RUFIT-NZ intervention or no intervention. Efficacy data were based on the RUFIT-NZ trial, and the latest Global Burden of Disease study was used to extrapolate the impact of body weight reduction on clinical outcomes of T2DM, MI or stroke. Cost and utility data were drawn from the RUFIT-NZ trial and published sources. PRIMARY OUTCOME MEASURES: The incremental cost-effectiveness ratio (ICER). RESULTS: Over a lifetime time horizon, participants in the RUFIT-NZ intervention gained 0.02 (discounted) quality-adjusted life years (QALYs) at an additional cost of NZ$863, relative to no intervention. The estimated ICER was NZ$49 515 per QALY gained (discounted), which is above the arbitrary willingness-to-pay threshold of NZ$45 000 per QALY. Sensitivity analyses supported the robustness of these findings. CONCLUSIONS: RUFIT-NZ was associated with a reduction in cardiovascular and endocrine events for overweight and obese males. However, based on conservative assumptions, RUFIT-NZ was unlikely to be cost-effective from a healthcare system perspective. TRIAL REGISTRATION NUMBER: ACTRN12619000069156.

Validation of field-based running tests to determine maximal aerobic speed in professional rugby league.

Practitioners place importance on high-speed running (HSR) to monitor training practice and match-play demands, whilst attempting to maximise fitness and minimize the risk of injury occurrence. Practitioners apply various methods to quantify HSR, such as absolute thresholds, percentage of maximum sprint speed and maximal aerobic speed (MAS). A recent survey demonstrates the 5-minute run and 1200m shuttle test (ST) to be implemented among rugby league practitioners to quantify HSR by incorporating MAS. However, it is unclear as to how valid these methods are to accurately quantify MAS. Therefore, the aim of this study was to assess the validity of the 5-minute run and 1200m ST when compared to a gold standard measure for MAS. Twenty 1st team professional rugby league players competing in the European Super League participated in this study. Players were required to complete an incremental treadmill test, 5-minute run and 1200m ST over a two-week period in pre-season. MAS, peak heart rate (HRmax), peak lactate (Lapeak) and rating of perceived exertion (RPE) where collected upon completion of each test. Results demonstrated the 1200m ST to have a higher correlation for MAS than the 5-minute run (1200m ST: r = 0.73, 5-minute run: r = 0.64). However, when assessing validity using the level of agreement between data, the 5-minute run underreported MAS by 0.45 m·s-1 whereas the 1200m ST underreported MAS by 0.77 m·s-1. Ultimately, both field-based tests used in this study underreport MAS when compared to an incremental treadmill test, although the 5-minute run provides a closer agreement and therefore a more valid measurement for MAS than the 1200m ST.

Validity, reliability, and the contributing physical characteristics of a modified 15m prone Yo-Yo Intermittent Recovery Test Level-1 test in elite female rugby league players.

This study aims to establish the validity and reliability of the prone Yo-YoIRL1 in elite female rugby league players (part one) and determine the anthropometric and physical characteristics contributing to 15m prone Yo-YoIRL1 performance (part two). Part one, 21 subjects completed one Yo-YoIRL1, one 20m and two 15m prone Yo-YoIRL1 tests over four sessions, with 7-14 days in-between. Part two, ten subjects completed a testing battery, including body mass, height, dual-energy x-ray absorptiometry, isometric mid-thigh pull, isometric bench-press, 10m and 20m sprints and an incremental treadmill test ([Formula: see text]). The 15m prone YoYoIRL1 demonstrated poor reliability with a typical error of 68m (21%) and a smallest worthwhile change of 54m (9%). Validity analysis found the prone versions of the YoYoIRL1 were not sensitive measures of intermittent running performance. Both prone YoYoIRL1 test distances demonstrated large mean bias (76% and -37% respectively) and typical error of the estimate (19% and 21%, respectively) in comparison to the YoYoIRL1. Body mass (r = -0.89), lean mass (r = -0.64), body fat % (r = -0.68), [Formula: see text] (l∙min-1) (r = -0.64), IMTP (r = -0.69), IBP (r = -0.15), 10m (r = -0.77) and 20m (r = -0.72) momentum displayed large negative relationships with 15m prone Yo-YoIRL1 performance. Due to the poor validity of the 20m prone YoYoIRL1, the poor validity and reliability of the 15m prone YoYoIRL1, and the anthropometric and physical characteristics which negatively impact performance, practitioners should reconsider the use of the prone YoYoIRL1 test to monitor high intensity intermittent running performance.

Assessing the locomotor demands of international men's and women's rugby sevens match-play according to passage of play.

This study aimed to evaluate the effect of discrete passages of play on locomotor demands of international men's and women's rugby sevens matches and their relationship with winning or losing. Thirteen men's and thirteen women's international rugby sevens players wore 10 Hz Global Positioning Systems during twelve Tokyo Olympic games matches (966 observations; 507 for men, 459 for women). Discrete ball-in-play periods were categorised as: 'Single-phase defence', 'single-phase attack', 'multi-phase defence', 'multi-phase attack', 'multi-phase defence to attack', or 'multi-phase attack to defence'. Relative total distance, alongside high-speed (>5.0 m∙s-1), acceleration (>3 m∙s-2), and deceleration (>3 m∙s-2) distances were recorded for each passage. Separately for men and women, linear mixed models examined the effect of passage type and match outcome (win or loss) on locomotor demands, whilst controlling for opposition ranking. In men, relative total distance ranged from 137 m∙min-1 to 174 m∙min-1 for 'multi-phase defence to attack' and 'multi-phase attack', respectively. In women, 'multi-phase attack' elicited the lowest relative total distance (118 m∙min-1), whereas the greatest values (186 m∙min-1) were recorded for 'single-phase defence'. For men, there were significant interactions between match outcome and passage type for relative total (p<0.001) and high-speed (p = 0.006) distance. During 'multi-phase attack', relative total distance was greater for wins versus losses (174 vs 138 m.min-1, p = 0.024). However, for 'single-phase defence', relative total distance was lower for wins (128 vs 164 m.min-1, p<0.001). For women, there were significant interactions between match outcome and passage type for relative total (p = 0.036), high-speed (p = 0.003), and deceleration (p = 0.015) distances. Locomotor responses were influenced by passage type and match result for men and women. Knowing the demands of each passage type may inform training drills targeted at developing match-play-specific physical, technical, and tactical adaptations. Understanding how passages differ between matches won and lost could also inform team technical/tactical preparation including selection.

Identification of pattern mining algorithm for rugby league players positional groups separation based on movement patterns.

The application of pattern mining algorithms to extract movement patterns from sports big data can improve training specificity by facilitating a more granular evaluation of movement. Since movement patterns can only occur as consecutive, non-consecutive, or non-sequential, this study aimed to identify the best set of movement patterns for player movement profiling in professional rugby league and quantify the similarity among distinct movement patterns. Three pattern mining algorithms (l-length Closed Contiguous [LCCspm], Longest Common Subsequence [LCS] and AprioriClose) were used to extract patterns to profile elite rugby football league hookers (n = 22 players) and wingers (n = 28 players) match-games movements across 319 matches. Jaccard similarity score was used to quantify the similarity between algorithms' movement patterns and machine learning classification modelling identified the best algorithm's movement patterns to separate playing positions. LCCspm and LCS movement patterns shared a 0.19 Jaccard similarity score. AprioriClose movement patterns shared no significant Jaccard similarity with LCCspm (0.008) and LCS (0.009) patterns. The closed contiguous movement patterns profiled by LCCspm best-separated players into playing positions. Multi-layered Perceptron classification algorithm achieved the highest accuracy of 91.02% and precision, recall and F1 scores of 0.91 respectively. Therefore, we recommend the extraction of closed contiguous (consecutive) over non-consecutive and non-sequential movement patterns for separating groups of players.

Unintended consequences - A qualitative exploration of baseline testing in community rugby concussion management.

OBJECTIVES: Understanding key stakeholders' perceptions around the value of baseline testing, as well as barriers or facilitators experienced as part of the process, may assist with the decision-making process of whether to implement baseline testing in community sport. This study explored coaches', players' and physiotherapists' perceptions of the perceived value, barriers and facilitators of baseline testing as part of New Zealand Rugby's (NZR) community concussion initiative. DESIGN: The study employed a pragmatic, qualitative descriptive design. METHODS: Semi-structured interviews were used to explore participants' perceptions. In total, 73 individual interviews were conducted. The sample consisted of 36 players, 13 coaches and 24 physiotherapists involved in NZR's concussion management pathway. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. RESULTS: In terms of perceived value, baseline testing was reported to play a role in i) facilitating a positive concussion culture; ii) positive perceptions of rugby and player safety and iii) enhancing concussion management as part of the pathway. Barriers and facilitators of the baseline testing process included i) stakeholder buy-in as critical driver of the process and ii) contextual and operational factors. Although contextual and operational challenges exist, these participants, as key stakeholders in the process, perceived the value of baseline testing to be more important than the barriers experienced. CONCLUSIONS: The value of baseline testing extends beyond concussion assessment and management, by enhancing community concussion awareness, attitudes and player safety. The findings of this study may assist in the decision-making process around inclusion of pre-season baseline testing in community rugby.

Longitudinal changes in anthropometric, physiological, and physical qualities of international women's rugby league players.

This is the first study to assess longitudinal changes in anthropometric, physiological, and physical qualities of international women's rugby league players. Thirteen forwards and 11 backs were tested three times over a 10-month period. Assessments included: standing height and body mass, body composition measured by dual x-ray absorptiometry (DXA), a blood panel, resting metabolic rate (RMR) assessed by indirect calorimetry, aerobic capacity (i.e.,[Formula: see text]) evaluated by an incremental treadmill test, and isometric force production measured by a force plate. During the pre-season phase, lean mass increased significantly by ~2% for backs (testing point 1: 47 kg; testing point 2: 48 kg) and forwards (testing point 1: 50 kg; testing point 2: 51 kg) (p = ≤ 0.05). Backs significantly increased their [Formula: see text] by 22% from testing point 1 (40 ml kg-1 min-1) to testing point 3 (49 ml kg-1 min-1) (p = ≤ 0.04). The [Formula: see text] of forwards increased by 10% from testing point 1 (41 ml kg-1 min-1) to testing point 3 (45 ml kg-1 min-1), however this change was not significant (p = ≥ 0.05). Body mass (values represent the range of means across the three testing points) (backs: 68 kg; forwards: 77-78 kg), fat mass percentage (backs: 25-26%; forwards: 30-31%), resting metabolic rate (backs: 7 MJ day-1; forwards: 7 MJ day-1), isometric mid-thigh pull (backs: 2106-2180 N; forwards: 2155-2241 N), isometric bench press (backs: 799-822 N; forwards: 999-1024 N), isometric prone row (backs: 625-628 N; forwards: 667-678 N) and bloods (backs: ferritin 21-29 ug/L, haemoglobin 137-140 g/L, iron 17-21 umol/L, transferrin 3 g/L, transferring saturation 23-28%; forwards: ferritin 31-33 ug/L, haemoglobin 141-145 g/L, iron 20-23 umol/L, transferrin 3 g/L, transferrin saturation 26-31%) did not change (p = ≥ 0.05). This study provides novel longitudinal data which can be used to better prepare women rugby league players for the unique demands of their sport, underpinning female athlete health.

'Probably just sexism'- gendered experiences of resource access in rugby.

Research pertaining to the experiences of women in rugby is scarce, which, coupled with the limited visibility of the sport and difficulty accessing resources, suggest that women's rugby remains undervalued. Indeed, evidence of such gender inequalities remains largely anecdotal, with little rigorous research undertaken to understand the perspectives of women in rugby. This study aimed to explore the experiences of a diverse cohort of rugby players in relation to their participation in the sport and their ability to access resources. Twenty UK-based rugby players (10 men, 9 women and 1 non-binary person aged 29.1 ± 8.3 years) from school, university, club, military, and semi-professional environments, volunteered to participate in semi-structured interviews (36 ± 12 minutes) discussing their rugby experiences in relation to their gender and playing level. Interviews were transcribed verbatim, and a reflexive thematic analysis was undertaken. A widespread under-prioritisation of women in rugby was highlighted. Gender biases were apparent in access to changing rooms, pitches, quality coaches, and playing opportunities, and were reportedly propagated at the managerial level. Irrespective of gender, some amateur players reported difficulty accessing a suitable rugby environment. Insufficient player numbers precluded the formation of second teams, often resulting in inexperienced players competing beyond their ability. Women's rugby players experienced considerable gender bias. This exploratory study highlights a need to address such issues to protect player welfare. Interventions to change the culture in rugby clubs and increased representation of women in managerial positions in rugby are recommended to enact meaningful change.

Concussion response and recovery in men and women's rugby union: A reflexive thematic analysis of player interviews.

Numerous concussion-management protocols have been developed in rugby, though little is known about player's personal experiences of concussion. Specifically, research typically refers to clinical recovery, with social and psychological sequelae post-concussion gaining little attention. This study aimed to explore the experiences of rugby players in relation to being concussed and recovering from concussion. UK-based rugby players (10 men, 9 women and 1 non-binary person) from school, university, club, military and semi-professional teams took part in semi-structured interviews (36 ± 12 minutes). Interviews were transcribed verbatim, and a reflexive thematic analysis was conducted. Players considered pitch-side healthcare a necessity, though amateur players highlighted the difficulty in consistently accessing this resource. In the absence of medical staff, players were reliant on the goodwill of volunteers, but their response to concussion did not always align with current concussion guidance. Players highlighted that concussion recovery could be socially isolating and that current return-to-play programmes did little to restore lost confidence, resulting in retirement from the game in some instances. Participants expressed a desire for more in-person concussion education and for greater coverage of holistic methods to support their recovery. This study highlights a need for further investigation of the post-concussion social and psychological changes that players may experience during their recovery. Greater focus on information relating to concussion recovery and return-to-contact in education programmes would likely benefit player welfare.

Seasonal Variation and Positional Differences in Anthropometry, Strength, and Power Characteristics in English Premiership Women's Rugby Union Players.

ABSTRACT: Yao, X, Austerberry, A, Bishop, C, Wilson, L, Chiang, C-Y, and Turner, A. Seasonal variation and positional differences in anthropometry, strength, and power characteristics in English premiership women's rugby union players. J Strength Cond Res 38(5): 924-931, 2024-Women's rugby is a collision sport that relies heavily on body composition and physical characteristics of strength and power to achieve competitive success. Furthermore, the seasonal nature presents a variety of physical challenges that can cause fluctuations in a player's physical development. Therefore, the purpose of this study was to determine the differences in anthropometry, strength, and power characteristics between forwards and backs in women's rugby union athletes in England and to identify changes throughout a season. Forty-seven players were recruited from the English premiership women's rugby during the 2020-2021 season. Players were split into forwards and backs and underwent body composition testing by dual-energy X-ray absorptiometry and strength and power tests (countermovement jump, drop jump [DJ], and isometric midthigh pull) on 3 separate occasions (preseason, midseason, postseason). Overall, forwards had significantly ( p < 0.01) higher body mass, fat mass, lean mass [LM], bone mineral content, and take off momentum, and backs had significantly higher ( p < 0.01, d > 0.5) jump height, reactive strength, and shorter DJ contact time. When observing seasonal changes, there were statistically significant differences ( p < 0.01) or moderate-to-large practical differences ( d > 0.5) in LM, reactive strength index modified, time to take-off, and DJ flight time [FT] among forwards when comparing 3 testing time frames. For backs, statistically significant differences ( p < 0.01) or moderate-to-large practical differences ( d > 0.5) were reported in LM and DJ FT throughout the season. In conclusion, the strength and power testing and characteristics shown in this study could support coaches and junior women's rugby athletes to have a basic understanding of English premiership physical standards.

Psychosocial experiences of competitive rugby players on the "long, long journey" to recovery following ACL ruptures and reconstruction.

Anterior Cruciate Ligament (ACL) injuries are serious and potentially career-ending. Reconstruction surgery and extended rehabilitation typically follow, but some athletes never attain the same level of sport performance. The psychosocial experiences of athletes who sustain ACL injuries and their cognitive appraisal, emotional and behavioral responses to the injury, and reconstruction require further attention during the different recovery phases. The aim is to explore these psychosocial experiences, social support needs and sources thereof of competitive athletes who sustained unilateral ACL ruptures and underwent reconstruction surgery. Semi-structured interviews with six competitive rugby players (M age: 22.3 ± 2.92 years), elicited information at seven time-points. We analyzed the qualitative information through thematic analysis. Five common themes emerged: (1) cognitive appraisal, (2) emotional responses (negative and positive affective responses), (3) behavioral responses, (4) social support needs and sources thereof, and (5) adversity-induced identity expansion (athletic and person-centered identities). In-vivo quotes gave a rich description of the athletes' experiences throughout the "long, long journey" to return-to-sport. These findings may sensitize and assist sports healthcare professionals, coaches, teammates, family, and friends to explore various psychosocial experiences throughout the injury and recovery period. Phase-appropriate psychosocial support or referral to sport psychology services is recommended to enhance the recovery process, improve long-term physical and mental health, and subsequent performance.

Position-specific workload of professional rugby union players during tactical periodization training.

The positional workload characteristics in rugby union on three acquisition days (i.e. strength, endurance, and speed days) of tactical periodization are still relatively unknown. Therefore, the primary aim of this study was to shed light on the positional external workload variables (10 Hz Global Positioning System and accelerometer microtechnology) and internal workload indicators (the session rating of perceived exertion) of players in a professional rugby union team by utilizing and comparing two tactical periodization models. Twenty-six male players (15 forwards and 11 backs) were recruited from a French second-division rugby club. Data were obtained over 10 weeks of in-season home games: a total of 780 observations were analyzed. Student's t-test observed different external workload profiles between positions among acquisition days. Mean external workload values, except PlayerLoadslow, were significantly higher (p≤0.01; effect size: 0.41-1.93) for backs than forwards for all acquisition days. Moreover, forwards perceived a higher internal workload than backs on the strength day of both models. The findings demonstrate that applying these two tactical periodization models could result in effective rugby union training. Validating external and internal workload characteristics on tactical periodization acquisition days enables extensive analysis of training load monitoring data; these data can be utilized to discover the unique characteristics of each position and design position-specific acquisition days to improve performance.

Chronic traumatic encephalopathy neuropathologic change in former Australian rugby players.

AIMS: We applied the 2021 consensus criteria for both chronic traumatic encephalopathy neuropathological change and traumatic encephalopathy syndrome in a small case series of six former elite-level Australian rugby code players. METHODS: Neuropathological assessment of these cases was carried out at the Sydney and Victorian Brain Banks. Clinical data were collected via clinical interviews and health questionnaires completed by the participants and/or their next of kin, and neuropsychological testing was conducted with participants who were capable of completing this testing. RESULTS: All cases exhibited progressive cognitive impairment during life. Chronic traumatic encephalopathy neuropathological change was identified in four out of the six cases. However, coexisting neuropathologies were common, with limbic-predominant age-related TDP-43 encephalopathy and ageing-related tau astrogliopathy seen in all cases, intermediate or high Alzheimer's disease neuropathological change seen in four cases and hippocampal sclerosis seen in two of the six cases. CONCLUSION: The presence of multiple neuropathologies in these cases complicates clinical diagnostic efforts for traumatic encephalopathy syndrome. It will be important for further clinicopathological studies on larger groups to report all neuropathological comorbidities found in cases diagnosed with either chronic traumatic encephalopathy neuropathological change and/or traumatic encephalopathy syndrome.

Sporting tournaments and changed birth rates 9 months later: a systematic review.

Introduction: Major sporting tournaments may be associated with increased birth rates 9 months afterwards, possibly due to celebratory sex. The influence of major sporting tournaments on birth patterns remains to be fully explored. Methods: Studies that examined the relationship between such events and altered birth metrics (number of births and/or birth sex ratio (male/total live births)) 9(±1) months later were sought in PubMed and Scopus and reported via standard guidelines. Database searches were conducted up to 7 November 2022. Results: Five events led to increased birth metrics 9(±1) months later and these included the Super Bowl, the 2009 UEFA Champions League, the 2010 FIFA World Cup, the 2016 UEFA Euros and the 2019 Rugby World Cup. Several la Liga soccer matches also had effects. With a few exceptions, major American football, Association football (soccer) and Rugby apex tournaments in Africa, North America, Asia and Europe were associated with increases in the number of babies born and/or in the birth sex ratio 9(±1) months following notable team wins and/or hosting the tournament. Furthermore, unexpected losses by teams from a premier soccer league were associated with a decline in births 9 months on. Conclusions: This systematic review establishes that major sporting tournaments have a notable impact on birth patterns, influencing both birth rates and sex ratios. Emotional intensification during these events likely triggers hormonal shifts, driving changes in sexual activity and subsequently shaping birth rates, often positively, about 9 months later. The context is crucial, especially when a region/country hosts a major single-sport tournament or participates for the first time, as population excitement is likely to be at its peak. These findings hold significance for healthcare planning and highlight the role of societal events in shaping demographic trends. PROSPERO registration: CRD42022382971.

Association between Low Energy Availability (LEA) and Impaired Sleep Quality in Young Rugby Players.

Low energy availability (LEA) has been associated with several physiological consequences, but its impact on sleep has not been sufficiently investigated, especially in the context of young athletes. This study examined the potential association between energy availability (EA) status and objective sleep quality in 42 male rugby players (mean age: 16.2 ± 0.8 years) during a 7-day follow-up with fixed sleep schedules in the midst of an intensive training phase. Participants' energy intake was weighed and recorded. Exercise expenditure was estimated using accelerometry. Portable polysomnography devices captured sleep on the last night of the follow-up. Mean EA was 29.3 ± 9.14 kcal·kg FFM-1·day-1, with 47.6% of athletes presenting LEA, 35.7% Reduced Energy Availability (REA), and 16.7% Optimal Energy Availability (OEA). Lower sleep efficiency (SE) and N3 stage proportion, along with higher wake after sleep onset (WASO), were found in participants with LEA compared to those with OEA (p = 0.04, p = 0.03 and p = 0.005, respectively, with large effect sizes). Segmented regression models of the EA-sleep outcomes (SE, sleep onset latency [SOL]), WASO and N3) relationships displayed two separate linear regions and produced a best fit with a breakpoint between 21-33 kcal·kg FFM-1·day-1. Below these thresholds, sleep quality declines considerably. It is imperative for athletic administrators, nutritionists, and coaches to conscientiously consider the potential impact of LEA on young athletes' sleep, especially during periods of heavy training.

Management of recurrent pinna haematoma following rugby injury: a surgical approach.

A young adult male developed a left-sided pinna haematoma after a rugby injury. The haematoma reaccumulated after multiple attempts at drainage under local anaesthetic in emergency rooms and required incision and drainage in the theatre under general anaesthetic. Intraoperatively, multiple venous bleeding points were identified and these were controlled with bipolar diathermy. The wound was closed and dressed with bolster and crepe bandage. On day 7 postoperatively, the sutures and dressings were removed and the haematoma had not recurred. He returned to playing rugby on day 21 postoperatively and sustained another blunt impact to his left ear. He noticed new swelling over the posterior aspect of the same ear. This was drained via needle aspiration and there was no further reaccumulation of the pinna haematoma.

The role of concussion history and biological sex on baseline concussion clinical profile symptoms in adolescent rugby players.

BACKGROUND: Accurate concussion monitoring requires access to preinjury baseline data. This is particularly important in adolescent athletes who have a high risk of concussion and are prone to prolonged recovery. As Rugby Union is governed by similar laws for men and women, it is also an ideal population to rigorously examine the impact of biological sex on concussion symptoms. AIMS: To evaluate self-reported concussion symptoms at baseline in adolescent rugby union players, and examine if subtype-specific symptoms are affected by concussion history and biological sex. METHODS: Adolescent rugby union players aged 16-18 years were recruited during the 2022-2023 playing season. Participants completed a series of questionnaires covering post-concussion symptoms, concussion clinical profiles, anxiety, depression and fear avoidance behaviours. Independent variables of interest in analysis were biological sex and concussion history. RESULTS: 149 participants (75% male) were included. 42% (63/149) reported at least one previous concussion (average time since concussion: 18.7 months, range 1-72). Adolescents with a concussion history reported significantly higher scores than those with no history, across two clinical profiles (ocular and sleep), concussion symptom severity, and depression, all based on medium effect sizes (SMD 0.3-0.5). Females had significantly higher scores across cognitive/fatigue, ocular and sleep clinical profiles, concussion symptoms, anxiety and depression, each with large effect sizes (SMD > 0.5). CONCLUSIONS: Concussion history and sex are associated with higher baseline scores on specific concussion clinical profile, concussion symptom severity, and anxiety symptoms. These findings highlight the importance of considering baseline differences when interpreting post-injury clinical profile symptoms in adolescent rugby players. (Trial registration: ACTRN12622000931774).

Role of the Menstrual Cycle on Performance and Injury Risk: A Survey of Female Professional Rugby Players in the United Kingdom.

BACKGROUND: Female athletic performance and injury risk is impacted by variations in the menstrual cycle (MC), but the understanding of the impacts and mechanisms influenced by the menstrual cycle on exercise performance are not fully delineated. AIMS AND OBJECTIVES: Evaluate associations between the menstrual cycle, perceived performance, and injury risk of elite female rugby players using an online survey. METHODS: An anonymous online questionnaire was completed by 150 elite female rugby players from two English rugby leagues, the Betfred Women's Super League (BWSL) and the Allianz Premier 15s (AP15s). The collected data were analysed thematically. RESULTS: The Chi-square test was used to assess associations between age groups and contraception usage, weight change, and training and playing performance; none of the associations were statistically significant (all p values > 0.05). Thematic analysis of 11,660 words of data revealed four themes: (a) MC impact on training and competition, (b) education and period management plans, (c) openness of conversations and comfort taking time off, and (d) injury risk. The impacted performance areas were physical (83.7%), psychological (85.7%), and nutritional (80.3%); players experienced decreased appetite, nausea, fatigue, strength declines, heighted emotions, and worsened focus. In total, 87.8% of athletes perceived the MC to negatively impact performance, 85.7% of players desired to be educated further to prevent injuries, improve nutrition, and training adaptions, 51.7% of participants perceived risk of injury to be higher during MC, and 86.4% of participants did not feel comfortable taking time off due to the MC, worrying that selection would be affected and about opinions from others. CONCLUSION: A clear negative impact on perceived performance and injury risk was reported by survey participants. The interaction of physical, psychological, and nutritional factors, and a lack of awareness and education emphasise the need for further comprehensive studies and interventions, with measures such as MC monitoring and profiling, education, and training adaptions to develop openness, knowledge, and understanding.