The economics of a national anterior cruciate ligament injury prevention program for amateur football players: a Markov model analysis.

OBJECTIVES: To estimate the long term cost savings, return on investment, and gain in quality-adjusted life years (QALYs) that could be achieved by a national anterior cruciate ligament (ACL) injury prevention program for amateur football (soccer) players in Australia. STUDY DESIGN: Markov model decision analysis. SETTING, PARTICIPANTS: Two hypothetical scenarios including all amateur football players in Australia (340 253 players): no intervention, and a national ACL injury prevention program. Transitions between health states, including ACL rupture, meniscal injury, knee osteoarthritis, and total knee replacement were made in one-year cycles over 35 years from a societal perspective. MAIN OUTCOME MEASURES: Cost savings, return on investment, and QALY gain achieved in the prevention program scenario relative to control scenario, by age group (10-17, 18-34, 35 years or older) and gender. SECONDARY OUTCOMES: incidence of ACL rupture, knee osteoarthritis, total knee replacement, and total knee replacement revision. RESULTS: The total mean cost of an ACL injury was estimated to be $30 665. The national injury prevention program was projected to save $52 539 751 in medical and societal costs caused by ACL ruptures in amateur footballers over 35 years; the estimated return on each dollar invested in the program was $3.51. Over this period, the number of players with ruptured ACLs could be reduced by 4385 (9%), the number of knee osteoarthritis cases by 780 (8.1%), and the number of total knee replacements by 121 (8.1%); 445 QALYs were gained. CONCLUSION: Our findings support investing in a national, evidence-based program for the primary prevention of ACL injuries in amateur football players.

Heading in football: a systematic review of descriptors, definitions, and reporting methods used in heading incidence studies.

The primary objective of this systematic review was to describe the number and type of heading descriptors used in all published studies which report on heading incidence in football. The secondary objective was to detail the data collection and reporting methods used in the included studies to present heading incidence data. Eligible studies were identified through searches of five electronic databases: Ovid MEDLINE, CINAHL, EMBASE, SPORTDiscus, and Web of Science, using a combination of free-text keywords (inception to 12th September 2023). Manual searching of reference lists and retrieved systematic reviews was also performed. A descriptive overview and synthesis of the results is presented. From 1620 potentially eligible studies, 71 studies were included, with the following key findings: 1) only 61% of studies defined a header with even fewer (23%) providing an operational definition of a header within the methods; 2) important study and player demographic data including year and country were often not reported; 3) reported heading descriptors and their coding options varied greatly; 4) visual identification of headers was essential when inertial measurement units were used to collect heading incidence data; and 5) there was a lack of standardisation in the reporting methods used in heading incidence studies making comparison between studies challenging. To address these findings, the development of a standardised, internationally supported, operational definition of a header and related heading descriptors should be prioritised. Further recommendations include the development of minimum reporting criteria for heading incidence research.

Broadening our understanding of injury mechanisms to include at-risk situations: an overview of potential injuries at the FIFA men's World Cup Qatar 2022TM.

This study aims to examine and describe the characteristics of potential injury situations during a men's professional international tournament quantified using the FIFA Football Language Medical Coding. A prospective study was conducted during the 64 matches of the FIFA World Cup Qatar 2022™, during which five analysts recorded potential injury situations from video analysis. "Potential injuries" were recorded when players stayed down > 5 s and/or requested medical attention. Characteristics were further recorded for variables such as opponent's action and body location. In total, 720 potential injury situations were recorded of which 139 required medical assessment. The actions which resulted in most potential injuries were running while receiving a pass (74; 10%), while passing the ball (59; 8%), and while progressing with the ball (48; 7%). Duels and ball progression led to a potential injury in 3.0% and 2.1% of all similar actions in total. Both aerial duels and ball progression led to an potential injury that required medical assessment on 0.4% of occasions. Most potential injuries involved the head (149; 21%), foot (120; 17%), or lower leg (110; 15%) with most medical assessments of the head (35; 25%), lower leg (17; 12%), and knee (15; 11%) with a median duration of 47 seconds (IQR 28-61). This study provides a detailed overview of match circumstances that may have a higher injury risk. Although some variables within the coding system need improvement to increase reliability, its use will allow a more detailed comparison of differences between high-risk player actions leading to injury and those that do not, which can improve future prevention strategies.

The Acute Effects of Ball Pressure on Anticipation Timing Following a Series of Purposeful Headers in Adult Football (Soccer) Players.

The purpose of this study is to investigate the acute effects of ball pressure on anticipation timing following a series of purposeful headers in adult football (soccer) players. There is evidence to suggest acute neurophysiological changes to the brain following purposeful heading; this may lead to altered anticipation timing as a result, potentially having future safety implications for players. A repeated measures crossover design was used. Seventeen participants aged between 20 and 30 years performed (i) 20 rotational headers with a lower-pressure match ball (58.6 kPa; 8.5 psi), (ii) 20 rotational headers with a higher-pressure match ball (103.4 kPa; 15 psi), or (iii) 20 non-headers (kicks) as a control each on separate days. The effect of ball pressure on anticipation timing accuracy, measured as absolute, constant, and variable errors, was assessed before and immediately after each intervention session using an anticipation timing task. Differences between group means were compared using repeated measures ANOVA and linear mixed effects models, with p-values of <0.05 considered statistically significant. No significant differences in anticipation timing accuracy across interventions were detected between control, occluded, and non-occluded trials. This finding differs from the previous literature regarding the measurable, acute effects of purposeful heading. The anticipation timing task may lack sensitivity for detecting the effects of repeated heading on brain function.

The incidence and characteristics of heading in the 2019 FIFA Women's World Cup™.

INTRODUCTION: To quantify the incidence and characteristics of purposeful heading and other head impacts in professional women's football at the 2019 FIFA Women's World Cup™. METHODS: This cross-sectional cohort study analysed purposeful headers (uncontested and contested) and their characteristics (e.g. playing position, match situation, field location, and distance ball travelled), and other head impact events using video analysis. Total headers and head impact events, and incidence rate (IR) per 1000 match-hours were calculated for countries, positions, and other characteristics, such as location on the pitch. RESULTS: Purposeful headers accounted for 76% of all coded events (uncontested: 71%; contested: 29%), followed by attempted headers (21%), unintentional ball-head impacts (2%), and other head impacts (1%). Headers ranged from 0 to 22 per player, per match with a mean of 4.8 [±1.2]. Of all field positions, centrebacks had the highest heading rates and wingers the lowest. Strikers performed significantly more contested headers than any other position, and significantly less uncontested headers. Most headers occurred in the middle third (48%), from free game play (72%) and from long balls (>20 m) (68%). CONCLUSION: The findings of this study could assist the development of player heading risk profiles, sex-specific heading guidelines, and coaching practices.

Quality Criteria for Studies Assessing the Acute Effects of Heading: Results from a UEFA Expert Panel.

There is increasing concern regarding the effects of heading in football on brain health including cognitive, behavioural and neuromotor function, with research suggesting an association between repeated ball-head impacts and neurodegenerative disease. While longitudinal studies to determine the long-term consequences of heading are challenging, there have been short-term 'acute' studies conducted, with some studies lacking appropriate methodology to ensure valid results. The Union of European Football Associations (UEFA) established a panel of experts to determine methodological recommendations for the conduct of studies that explore the acute effects of heading (defined as a single session of heading conducted either in a laboratory setting or following match play or a training session). The aim of this panel was to create quality criteria for acute heading studies that will form part of the eligibility assessment when applying for UEFA research funding (although the criteria can be applied to the conduct of acute heading research more widely). This process was deemed necessary to counter studies with poor methodological quality that used heading trials that did not accurately represent player exposure to ball-head impacts through football practice and match play (such as small sample sizes, unrealistically high heading exposure, and a lack of consideration of confounding variables). The panel identified core design decisions that authors should consider when designing and conducting acute heading research, with key methodological requirements for each domain pertaining to participants, heading trials, confounding variables, statistics and dependent/target variables and their measurement. After two rounds of reviews, the final list of quality criteria was agreed by the panel and will be applied to the next round of UEFA grant applications.

Reply to "Asking the Right Question Is Key to Getting a Valuable Answer".

Author response to the JOSPT Letter to the Editor-in-Chief "Asking the Right Question is Key to Getting a Valuable Answer" J Orthop Sports Phys Ther 2023;53(11):726-727. doi:10.2519/jospt.2023.0204-R.

Financial burden of anterior cruciate ligament reconstructions in football (soccer) players: an Australian cost of injury study.

OBJECTIVES: To estimate the financial burden of anterior cruciate ligament (ACL) reconstructions in amateur football (soccer) players in Australia over a single year, including both direct and indirect cost. METHODS: Available national direct and indirect cost data were applied to the annual incidence of ACL reconstructions in Australia. Age-adjusted and sex-adjusted total and mean costs (ACL and osteoarthritis (OA)) were calculated for amateur football (soccer) players in Australia using an incidence-based approach. RESULTS: The estimated cost of ACL reconstructions for amateur football players is $A69 623 211 with a mean total cost of $A34 079. The mean indirect costs are 19.8% higher than the mean direct costs. The mean indirect costs are lower in female (11.5%, $A28 628) and junior (15.3%, $A29 077) football players. The mean ACL costs are 3-4-fold greater than the mean OA costs ($A27 099 vs $A6450, respectively), remaining consistent when stratified by sex and age group. Our model suggests that for every 10% increase in adherence to injury prevention programmes, which equates to approximately 102 less ACL injuries per year, $A9 460 224 in ACL costs could be saved. CONCLUSION: While the number of ACL reconstructions per year among football players in Australia is relatively small, the annual financial burden is high. Our study suggests that if injury prevention exercises programmes are prioritised by stakeholders in football, significant cost-savings are possible.

Incidence, characteristics and cost of head, neck and dental injuries in non-professional football (soccer) using 3 years of sports injury insurance data.

AIM: This descriptive epidemiological study aimed to quantify the incidence, characteristics and costs of head, neck and dental injuries in non-professional football players. METHODS: Injury data were coded (using Orchard Sports Injury and Illness Classification System) from a de-identified insurance database containing three seasons (2018-2020) of data. Cost data included direct and indirect costs presented by type of injury, age group and sex using means ± SD, range of costs ($AU) and total costs ± SE. Chi-squared tests were used to analyse the data (significance level p < .05) with injury incidence rates (IR) calculated per 1000 match hours and per 1000 injury insurance claims. RESULTS: A total of 388 injuries affecting 240 players were sustained. Of these, 43% (n = 102) of players also sustained one or more secondary injuries, mainly to the head or neck area. Dental injuries (n = 143, 39%, IR = 0.008) accounted for the highest number of primary and secondary injuries and the highest mean direct cost per injury ($AU1152), while head and facial injuries accounted for the highest proportion of total costs ($AU434,101). Players who sustained one or more secondary injuries had the highest direct and indirect mean cost per injury. CONCLUSIONS: Given the frequency and cost of dental injuries in non-professional football players, injury prevention initiatives warrant further investigation.

The Relationship Between Neck Strength and Sports-Related Concussion in Team Sports: A Systematic Review With Meta-analysis.

OBJECTIVE: We aimed to quantify the relationship between neck strength and sports-related concussion (SRC) for athletes participating in team sports. DESIGN: Etiology systematic review with meta-analysis. LITERATURE SEARCH: PubMed, PsycINFO, MEDLINE, CINAHL, CENTRAL, and Scopus were searched on March 17, 2022, and updated on April 18, 2023. STUDY SELECTION CRITERIA: Team sports where an opponent invades the player's territory (eg, football, rugby, basketball) that reported at least 1 measure of neck strength, and 1 measure of SRC incidence, using cohort, case-control, or cross-sectional study designs. The Newcastle-Ottawa scale was used to assess risk of bias; certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. DATA SYNTHESIS: Studies were summarized qualitatively and quantitatively. To understand the relationship between neck strength and future SRC incidence, random-effects meta-analysis was conducted on prospective longitudinal studies. RESULTS: From a total of 1445 search results, eight studies including 7625 participants met the inclusion criteria. Five studies reported a relationship between greater neck strength or motor control and reduced concussion incidence. Pooled results from 4 studies indicated small (r = 0.08-0.14) nonsignificant effects with substantial heterogeneity (I2>90%). The considerable heterogeneity is likely a result of synthesized studies with vastly different sample characteristics, including participant age, playing level, and sports. CONCLUSIONS: There was very low-certainty evidence suggesting a small, nonsignificant relationship between greater neck strength and a lower risk of sustaining a SRC. J Orthop Sports Phys Ther 2023;53(10):1-9. Epub: 10 July 2023. doi:10.2519/jospt.2023.11727.

Where are We Headed? Evidence to Inform Future Football Heading Guidelines.

Given the scientific and public concern regarding the short-, medium- and long-term consequences of heading on brain health, being proactive about developing and implementing guidelines that help reduce the burden (volume, impact magnitude and injury risk) of heading in young and beginner players appears justified. This narrative review explores the evidence underpinning strategies that could be incorporated into future heading guidelines to reduce heading burden in players across all levels of football. A four-step search strategy was utilised to identify all data-based papers related to heading in football. Eligibility criteria for inclusion were: (1) original data, (2) study population included football players, (3) outcome measures included one or more of the following: number of headers, measurement of head acceleration during heading, or head/brain injury incidence, and (4) published in English or English translation available. In total, 58 papers were included that outlined strategies based on (1) game or team development, (2) player skill development and (3) equipment. In particular, greater emphasis existed for small-sided games (particularly in young players) where fewer headers are observed when compared with the conventional 11 versus 11 game, as well as reducing headers from goal kicks and corners. Evidence also existed for developing a heading coaching framework that focusses on technical proficiency as well as neuromuscular neck exercises integrated into general injury reduction exercise programs, enforcement of rules related to deliberate head contact and using lower-pressure match and training balls. To mitigate potential risks of heading on brain health, a number of pragmatic strategies have been examined in scientific studies and may be considered as part of future heading guidelines.

Insurance cost and injury characteristics of anterior cruciate ligament injuries in sub-elite football: A population analysis involving 3 years of Australian insurance data.

OBJECTIVES: To investigate the injury characteristics and insurance cost of anterior cruciate ligament injuries in sub-elite football players in New South Wales, Australia. DESIGN: Descriptive epidemiological study. METHODS: Three years of insurance records (2018-2020) was used to describe anterior cruciate ligament injury costs and characteristics. Concomitant injuries and the mechanism of injury were determined by analysing the injury descriptions. Claim characteristics and costs are presented by age group (junior = 7-17 years, senior = 18-34 years, and veteran = 35 + years) and sex. Categorical data (including age-groups and sex) are presented as counts and percentages and analysed using a Chi squared or Fisher's exact test. Cost data are reported as means ±â€¯standard deviation with 95 % confidence intervals. RESULTS: Over the course of three football seasons (2018-2020), 786 anterior cruciate ligament injuries were reported to the injury insurance company. The total insurance cost was AU$3,614,742 with direct injury insurance costs accounting for 36.3 % of the total costs. The mean indirect insurance costs were six-fold higher than direct insurance costs (AU$11,458 vs AU$1914). Isolated injuries had an average cost of $4466 whilst concomitant injuries had an average cost of $4951. Surgical costs are excluded from direct cost calculations. The peak injury count occurred in the first month of all three football seasons, immediately after the pre-season. CONCLUSIONS: Anterior cruciate ligament injuries represent a substantial economic burden to the insurer and individual. The cost data provided can be used for future economic and modelling studies.

Heading in Football: insights from stakeholders in amateur football.

Despite emerging research questioning the long-term effect of purposeful heading on players' brain health, heading-related perspectives and behaviours of stakeholders in amateur football in Australia (a country without heading guidelines) remain unknown. This study aimed to explore the current heading-related perspectives and behaviours of football stakeholders. In total, 290 players (aged over 11 years), 54 coaches, 34 non-coaching staff and 14 medical staff completed the survey. Of the 290 players, 56.5% reported being formally trained in heading, with female players less likely to be trained than male players (p < 0.05). Players were the least concerned about the long-term effects of heading, while medical staff were the most concerned (33.1% and 57.1%, respectively). From proposed strategies to reduce heading burden, a heading ban for all ages was least popular (2.3%), while teaching heading technique was most popular (67.3%). Our study provides insights into football stakeholders' heading-related perspectives, which could be used, along with scientific evidence, to inform pragmatic future heading guidelines.

Injury-Reduction Programs Containing Neuromuscular Neck Exercises and the Incidence of Soccer-Related Head and Neck Injuries.

CONTEXT: Concern is growing among soccer players, coaches, and parents regarding head and neck injuries, including concussion, particularly from heading a ball. Thus, we need to explore soccer-specific head injury risk-reduction initiatives. One such initiative is to condition the neck musculature of young players by adding neuromuscular neck exercises to existing injury-reduction exercise programs. OBJECTIVE: To investigate the effect of neuromuscular neck exercises completed as part of an injury risk-reduction exercise program on the incidence of soccer-related head and neck injuries in adolescent soccer players. DESIGN: Prospective cohort study. SETTING: Two sports high schools and 6 soccer clubs during the 2021 soccer season. PATIENTS OR OTHER PARTICIPANTS: A total of 364 male and female soccer players, aged 12 to 18 years. INTERVENTION(S): Members of 1 sports high school and 2 soccer clubs performed neuromuscular neck exercises as part of an injury-reduction program during training (neck training group). Members of another sports high school and 4 soccer clubs performed an injury-reduction program but without neck exercises (comparison group). MAIN OUTCOME MEASURE(S): Self-reported injury data were collected from each player at the end of the season and used to calculate incidence rate ratios (IRRs) with 95% CIs. RESULTS: In total, 364 players completed the study, including 146 players in the neck training group and 218 players in the comparison group. Despite players in the neck training group being less likely to self-report a concussion (IRR = 0.23; 95% CI = 0.03, 1.04) and pain on heading a ball (IRR = 0.62; 95% CI = 0.34, 1.07), only a lower incidence of possible concussive events (IRR = 0.38; 95% CI = 0.14, 0.90; P < .05) was significant. CONCLUSIONS: Integrating neuromuscular neck exercises into injury-reduction exercise programs has the potential to reduce the risk of adolescent soccer players sustaining a possible concussive event, concussion, or pain on heading a ball.

Cognitive and Behavioral Outcomes in Male and Female NCAA Soccer Athletes across Multiple Years: A CARE Consortium Study.

PURPOSE: The purpose of this study was to determine changes in neurocognitive, psychosocial, and balance functioning in collegiate male and female soccer players across three consecutive years of baseline testing compared with a control group of noncontact athletes. METHODS: Generalized estimating equations were used to compare changes in annual, preseason baseline measures of neurocognitive function, neurobehavioral and psychological symptoms, and postural stability between collegiate soccer players ( n = 75; 51 [68%] female soccer players) and noncontact athletes ( n = 210; 133 [63%] female noncontact athletes) across three consecutive years. RESULTS: Among all participants, the group-time interaction was not significant for any outcome measures. Overall, soccer players reported lower (better) Brief Symptom Inventory 18 Depression ( P = 0.004, Exp(B) = 0.36, 95% confidence interval [CI] = 0.18-0.73), Global Severity Index ( P = 0.006, Exp(B) = 0.53, 95% CI = 0.33-0.84), and Post-Concussion Symptom Scale Symptom Severity ( P < 0.001, Exp(B) = 0.45, 95% CI = 0.22-0.95) scores than noncontact athletes. No other outcome measures were different between soccer players and noncontact athletes. CONCLUSIONS: Among collegiate athletes, soccer players report similar or better psychosocial functioning and symptom scores than noncontact athletes. Importantly, neurocognitive functioning, neurobehavioral and psychological symptoms, and postural stability do not worsen over time in collegiate soccer players relative to their noncontact counterparts. Our findings suggest that despite possible exposure to repetitive head impacts, collegiate soccer players do not exhibit changes in observable function and symptoms across multiple seasons.

'Benched' the effect of the COVID-19 lockdown on injury incidence in sub-elite football in Australia: a retrospective population study using injury insurance records.

OBJECTIVES: The primary aim of this study was to compare injury rates pre- and post-COVID-19 lockdown in sub-elite football (soccer) players by analysing the full season and the first month of each season between 2018 and 2020. Secondary aims were to describe the incidence, location and type of injuries and to compare injuries by age group and sex. DESIGN: Descriptive epidemiological study. METHODS: A de-identified insurance database was retrospectively coded using the Orchard Sports Injury Classification System. Injury incidence per 1000 hours as well as incidence rate ratios (IRR) with confidence intervals were calculated. RESULTS: No significant difference was found in the overall incidence rate in 2020 compared with the 2018 and 2019 seasons (IRR, 1.04 [95% CI, 0.96-1.13]; p = 0.294). However, overall injuries increased by 26% (IRR: 1.26 [95% CI 1.07-1.47]; p < 0.005) and joint sprains increased by 45% (IRR: 1.45 [95% CI 1.14-1.84]; p < 0.005) in the first month of 2020 compared with 2018-2019. Between 2018 and 2020, there were 4149 injury insurance claims, with anterior cruciate ligament (ACL) ruptures accounting for 19% of all injuries. When comparing sex, female players had significantly more ankle sprains whilst male players suffered more dental injuries. CONCLUSIONS: This study adds to a growing body of evidence investigating injury rates post-COVID-19 lockdowns in sport. Sub-elite players appear to be at higher risk of joint injuries within the first month of training following a period of lockdown. Overall, stakeholders involved in sub-elite football should prioritise knee and ankle joint injury prevention.

Effect of Sex and Maturation on Knee Extensor and Flexor Strength in Adolescent Athletes.

BACKGROUND: Despite knee extensor and flexor strength reportedly being associated with injury risk, including rupture of the anterior cruciate ligament in girls, there is limited evidence for the longitudinal changes in lower extremity strength. PURPOSE: To investigate the sex-specific relationship with longitudinal changes of knee extensor and flexor strength associated with maturation. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Adolescent boys and girls (N = 257; 208 adolsecent girls) participating in high school basketball, volleyball, and soccer were assessed longitudinally in at least 2 different pubertal stages. Pubertal status (prepubertal, pubertal, and postpubertal) was determined with the modified Pubertal Maturation Observation Scale questionnaire. After a warm-up of 5 submaximal repetitions, participants were tested for concentric peak isokinetic strength for knee extension and flexion at 300 deg/s over 10 repetitions and normalized to body weight. Linear mixed models were used to test for the effect of pubertal stage, sex, and their interaction. RESULTS: Significant interactions were identified that indicated different maturational trajectories for knee muscle strength for adolescent boys and girls, particularly between prepubertal and pubertal stages, in which boys demonstrated greater mass normalized knee extensor increases than girls (right, +12% vs +5%; left, +13% vs +7%; P < .001). For knee flexors, boys demonstrated increased strength, while girls demonstrated decreased relative knee flexor strength (right, +4% vs -1%, P = .03; left, +3 vs -3%, P = .009). CONCLUSION: The findings of this study support a differential effect of sex and maturation on important knee strength outcomes that may have implications for knee injury reduction, particularly in adolescent girls as they mature.

Direct and indirect costs associated with injury in sub-elite football in Australia: a population study using 3 years of sport insurance records.

OBJECTIVES: To determine the direct and indirect costs of injuries in sub-elite footballers in New South Wales (NSW), Australia, stratified by injury location, type, sex and age groups. DESIGN: Descriptive epidemiological study. METHODS: A de-identified insurance database containing three seasons (2018-2020) of football injuries in NSW was used to determine injury costs. Injuries were coded using the Orchard Sports Injury and Illness Classification System. Claim costs are presented by age group (Junior = 7-17 years, Senior = 18-34 years, and Veteran = 35+ years), sex and injury location and type. Cost data are reported as means ±â€¯standard deviation (SD) with 95 % Confidence Intervals (CI). RESULTS: There were 4145 total injury claims, totalling AU$13,716,173, at a mean cost of $3309 (95 % CI 3042-3577) per injury. Joint sprains accrued the largest costs ($6,665,938) with knee injuries accounting for just under half of the total costs of all injuries over the three-season period (49.1 %). ACL injuries accounted for 26.2 % of total costs with a high mean cost per injury ($4564 SD ±â€¯346) alongside lower limb fractures ($4787 SD ±â€¯425) and tendon ruptures ($4659 SD ±â€¯1053). Despite only 22.5 % of injuries accruing indirect costs, these costs accounted for 70.2 % of the total cost ($9,623,665) with the mean indirect cost per injury being ten-times higher than the mean direct cost per injury ($10,337 vs. $987, respectively). CONCLUSIONS: Knee injuries (mainly ACL ruptures), joint sprains, fractures and tendon ruptures are the costliest injuries in sub-elite football in NSW. With effective preventative measures available, there is potential to reduce injury rates and subsequent costs.

The implementation of a neck strengthening exercise program in elite rugby union: A team case study over one season.

OBJECTIVES: To investigate the effect of a neck strengthening program on maximal isometric neck strength and incidence of head and neck injuries including concussion, and to evaluate the acceptability and feasibility of the program within one professional men's rugby union team over one season. DESIGN: Pre- and post-intervention study. METHODS: A phased neck strengthening program was implemented in one rugby union team (n = 26 Forward Group; n = 13 Back Group) throughout the 2020 Super Rugby season, with maximal isometric neck strength measured at each training phase. Strength changes were analysed using one-way, repeated measures analysis of variance and paired samples t-test. Injury data from 2019 to 2020 were compared using incidence rate ratios (IRR). Player and staff surveys, reported as percentage of agreement, assessed program acceptability and feasibility. RESULTS: Forward Group's neck flexors (p < 0.001), left-lateral flexors (p = 0.04) and flexor/extensor ratio (p < 0.001) and Back Group's neck flexors (p = 0.01) significantly improved across the season, with uncertain evidence to support the reduction of head and neck injuries (IRR:0.86 (0.23-2.56) and concussion (IRR:0.63 (0.06-3.34) between seasons. Survey responses revealed high percentages of agreement for the program's acceptability and feasibility. CONCLUSIONS: Targeted sport-specific neck exercises have the potential to increase the maximal isometric neck strength of professional rugby players and may assist in reducing head and neck injuries including concussion.