Validation of an instrumented mouthguard in rugby union-a pilot study comparing impact sensor technology to video analysis.

Background: To better understand the biomechanical profile of direct head impacts and the game scenarios in which they occur in Rugby Union, there is a need for an on-field validation of a new instrumented mouthguard (IMG) against the reference standard. This study considers the potential of a combined biomechanical (IMG) and video analysis approach to direct head impact recognition, both of which in isolation have limitations. The aim of this study is to assess the relationship between an instrumented mouthguard and video analysis in detection of direct head impacts in rugby union. Design: Pilot Study - Observational Cohort design. Methods: The instrumented mouthguard was worn by ten (3 backs, 7 forwards) professional Rugby Union players during the 2020-21 Gallagher Premiership (UK) season. Game-day video was synchronized with timestamped head acceleration events captured from the instrumented mouthguard. Direct Head Impacts were recorded in a 2 × 2 contingency table to determine sensitivity. Impact characteristics were also collected for all verified head impacts to further the understanding of head biomechanics during the game. Results: There were 2018 contact events that were reviewed using video analysis. Of those 655 were categorized as direct head impacts which also correlated with a head acceleration event captured by the IMG. Sensitivity analysis showed an overall sensitivity of 93.6% and a positive predictive value (PPV of 92.4%). When false positives were excluded due to ball out of play, mouthguard removal or handling after a scoring situation or stoppage, PPV was improved (98.3%). Most verified head impacts occurred in and around the ruck contest (31.2%) followed by impacts to the primary tackler (28.4%). Conclusion: This pilot validation study demonstrates that this IMG provides a highly accurate measurement device that could be used to complement video verification in the recognition of on-field direct head impacts. The frequency and magnitude of direct head impacts derived from specific game scenarios has been described and allows for greater recognition of high-risk situations. Further studies with larger sample sizes and in different populations of Rugby Union players are required to develop our understanding of head impact and enable strategies for injury mitigation.

A retrospective analysis of hamstring injuries in elite rugby athletes: More severe injuries are likely to occur at the distal myofascial junction.

OBJECTIVES: To describe the most common hamstring injury scenarios and outcomes in elite rugby union. DESIGN: Retrospective investigation. SETTING: Hamstring injury data from an elite rugby union team was collected over five seasons and retrospectively analysed. PARTICIPANTS: 74 professional rugby players. MAIN OUTCOME MEASURES: Injuries were classified as new or recurrent. Injury severity, activity, player position, and whether the injury occurred during a match or training was determined for each injury. Injury location and grade were determined for more clinically severe injuries where Magnetic Resonance Imaging (MRI) data was available (15 injuries). RESULTS: Thirty hamstring injuries were sustained over the five seasons. The majority of injuries were new (93%), moderate in severity (60%) and occurred during running (77%). For more clinically severe injuries, the biceps femoris long head (BFlh) was the most commonly injured muscle (73%) and the distal myofascial junction (DMFJ) was the most common injury site (58% of BFlh injuries). CONCLUSIONS: Hamstring injuries most commonly occurred while running and in the BFlh muscle, which is similar to other sports. However, the most common intramuscular injury site was the DMFJ, which contrasts with reports from other cohorts. Future studies should ensure to include the myofascial junction when classifying injury location.

Sleep and Salivary Testosterone and Cortisol During a Short Preseason Camp: A Study in Professional Rugby Union.

Purpose: To examine changes in, and relationships between, sleep quality and quantity, salivary testosterone, salivary cortisol, testosterone-to-cortisol ratio (T:C), and self-reported muscle soreness during a residential-based training camp in elite rugby players. Methods: Nineteen male rugby players age 26.4 (3.9) years, height 186.0 (9.4) cm, and weight 104.1 (13.4) kg (mean [SD]) participated in this study. Wrist actigraphy devices were worn for 8 nights around a 4-d training camp (2 nights prior, during, and 2 nights after). Sleep-onset latency, sleep duration, sleep efficiency, and waking time were measured. Participants provided saliva samples during camp on waking and again 45 min later, which were then assayed for testosterone and cortisol levels. They also rated their general muscle soreness daily. Results: Little variation was observed for sleep quality and quantity or testosterone. However, significant differences were observed between and within days for cortisol, T:C, and muscle soreness (P < .001). Few relationships were observed for sleep and hormones; the strongest, an inverse relationship for sleep efficiency and T:C (r = -.372, P < .01). Conclusions: There may be no clear and useful relationship between sleep and hormone concentration in a short-term training camp context, and measures of sleep and testosterone and cortisol should be interpreted with caution because of individual variation. Alterations in hormone concentration, particularly cortisol, may be affected by other factors including anticipation of the day ahead. This study adds to our knowledge that changes in hormone concentration are individual and context specific.