The influence of an artificial playing surface on injury risk and perceptions of muscle soreness in elite Rugby Union.

This prospective cohort study investigated the influence of an artificial playing surface on injury risk and perceptions of muscle soreness in elite English Premiership Rugby Union players. Time loss (from 39.5 matches) and abrasion (from 27 matches) injury risk was compared between matches played on artificial turf and natural grass. Muscle soreness was reported over the 4 days following one match played on each surface by 95 visiting players (i.e., normally play on natural grass surfaces). There was a likely trivial difference in the overall injury burden relating to time-loss injuries between playing surfaces [rate ratio = 1.01, 90% confidence interval (CI): 0.73-1.38]. Abrasions were substantially more common on artificial turf (rate ratio = 7.92, 90% CI: 4.39-14.28), although the majority of these were minor and only two resulted in any reported time loss. Muscle soreness was consistently higher over the 4 days following a match on artificial turf in comparison with natural grass, although the magnitude of this effect was small (effect sizes ranging from 0.26 to 0.40). These results suggest that overall injury risk is similar for the two playing surfaces, but further surveillance is required before inferences regarding specific injury diagnoses and smaller differences in overall injury risk can be made.

Injury-prevention priorities according to playing position in professional rugby union players.

OBJECTIVE: To examine the match injury profile of professional rugby union players by individual playing position. DESIGN: 4-season prospective cohort design. SETTING: 14 English Premiership clubs. PARTICIPANTS: 899 professional players. MAIN OUTCOME MEASURE: Incidence of match injury (recorded as the number of injuries/1000 player-hours of match exposure), severity of injury (recorded as the number of days of absence) and days of absence due to injury per 1000 player-hours of match exposure. ASSESSMENT OF RISK FACTORS: Injury diagnosis and individual playing position during a match. RESULTS: 2484 injuries were reported. While there were no significant differences in the total days of absence as a result of injury between different positions in the forwards and the backs, there were a number of significant differences in injury profile for players in individual playing positions. Although three common body locations caused a high proportion of days of absence due to match injury for forwards (shoulder, knee, ankle/heel) and backs (shoulder, hamstring, knee), there were significant differences in injury profile between individual positions. CONCLUSIONS: The results clearly demonstrate the need for individual position-specific injury-prevention programmes in rugby union. When devising such programmes, a player's previous injury history should also be taken into account.

Strategies used by professional rugby union clubs to manage players for artificial turf exposure.

Background: The use of artificial turf on rugby pitches is increasingly commonplace but there is limited evidence around its effects on injury, recovery, and performance. It is unclear whether this uncertainty influences player management strategies in professional clubs. Objectives: To understand how professional rugby union clubs in England approach player management for artificial turf, to explore how the beliefs of medical and strength/conditioning staff influence these decisions, and to determine whether differences exist between clubs with different levels of exposure to artificial surfaces. Methods: The study was a cross-sectional mixed methods study. Twenty-three medical and strength/conditioning staff members from 12 English Premiership Rugby Union clubs completed two bespoke questionnaires and participated in a semi-structured interview. Results: Two-thirds of the participants described formal club-level approaches to artificial turf. All participants from low-exposure clubs (<50% training and match time on artificial pitches) reported adjusting player recovery strategies following games on artificial turf to mitigate elevated muscle soreness and fatigue. Clubs with artificial surfaces at their home venues were less likely to adapt recovery than clubs with natural turf pitches. Regardless of exposure participants believed switching between surface types was a risk factor for injury. Medics reported that acute injuries associated with artificial turf exposure typically occurred at the foot or ankle, whereas abrasions and overuse injuries were more common and often affected the knees, hips and lower back. Players with compromised joints were less likely to be selected for matches on artificial surfaces. Conclusion: Player management around artificial turf is a focus for staff at professional rugby union clubs. Club practices vary by exposure and may consequently influence injury risk estimates.

Collegiate rugby union injury patterns in New England: a prospective cohort study.

OBJECTIVE: To establish injury profile of collegiate rugby union in the USA. DESIGN/ SETTING: 31 men's and 38 women's collegiate rugby union teams prospectively recorded injuries during games and practice during the 2005-06 season. Three teams withdrew before data collection. An injury was defined as one: (1) occurring in an organised intercollegiate game or practice; and (2) requiring medical attention during or after the game or practice, or (3) resulting in any restriction of the athletes' participation for >or=1 day(s) beyond the day of injury, or in a dental injury. MAIN OUTCOME MEASURES: In total, 847 injuries (447 in men; 400 in women) during 48,026 practice (24,280 in men; 23,746 in women) and 25,808 game (13,943 in men; 11,865 in women) exposures were recorded. RESULTS: During games, injury rates of 22.5 (95% CI 20.2 to 25.0) and 22.7 (20.2 to 25.5) per 1000 game athletic exposures or 16.9 (15.1 to 18.9) and 17.1 (15.1 to 19.1) per 1000 player game hours were recorded for men and women, respectively. Over half of all match injuries were of major severity (>7 days' absence) (men 56%; women 51%) and the tackle was the game event most often associated with injury (men 48%; women 53%). CONCLUSIONS: Collegiate game injury rates for rugby were lower than rates recorded previously in men's professional club and international rugby and lower than reported by the National Collegiate Athletic Association Injury Surveillance System for American football, but similar to rates reported for men's and women's soccer in 2005-06.

The accuracy and reproducibility of video assessment in the pitch-side management of concussion in elite rugby.

OBJECTIVES: To investigate the accuracy and reliability of side-line video review of head impact events to aid identification of concussion in elite sport. DESIGN: Diagnostic accuracy and inter-rater agreement study. METHODS: Immediate care, match day and team doctors involved in the 2015 Rugby Union World Cup viewed 20 video clips showing broadcaster's footage of head impact events occurring during elite Rugby matches. Subjects subsequently recorded whether any criteria warranting permanent removal from play or medical room head injury assessment were present. The accuracy of these ratings were compared to consensus expert opinion by calculating mean sensitivity and specificity across raters. The reproducibility of doctor's decisions was additionally assessed using raw agreement and Gwets AC1 chance corrected agreement coefficient. RESULTS: Forty rugby medicine doctors were included in the study. Compared to the expert reference standard overall sensitivity and specificity of doctors decisions were 77.5% (95% CI 73.1-81.5%) and 53.3% (95% CI 48.2-58.2%) respectively. Overall there was raw agreement of 67.8% (95% CI 57.9-77.7%) between doctors across all video clips. Chance corrected Gwets AC1 agreement coefficient was 0.39 (95% CI 0.17-0.62), indicating fair agreement. CONCLUSIONS: Rugby World Cup doctors' demonstrated moderate accuracy and fair reproducibility in head injury event decision making when assessing video clips of head impact events. The use of real-time video may improve the identification, decision making and management of concussion in elite sports.

The efficacy of a movement control exercise programme to reduce injuries in youth rugby: a cluster randomised controlled trial.

BACKGROUND: Injuries to youth rugby players have become an increasingly prominent health concern, highlighting the importance of developing and implementing appropriate preventive strategies. A growing body of evidence from other youth sports has demonstrated the efficacy of targeted exercise regimens to reduce injury risk. However, studies have yet to investigate the effect of such interventions in youth contact sport populations like rugby union. OBJECTIVE: To determine the efficacy of an evidence-based movement control exercise programme compared with a sham exercise programme to reduce injury risk in youth rugby players. Exercise programme compliance between trial arms and the effect of coach attitudes on compliance will also be evaluated. SETTING: School rugby coaches in England will be the target of the researcher intervention, with the effects of the injury prevention programmes being measured in male youth players aged 14-18 years in school rugby programmes over the 2015-2016 school winter term. METHODS: A cluster-randomised controlled trial with schools randomly allocated to either a movement control exercise programme or a sham exercise programme, both of which are coach-delivered. Injury measures will derive from field-based injury surveillance, with match and training exposure and compliance recorded. A questionnaire will be used to evaluate coach attitudes, knowledge, beliefs and behaviours both prior to and on the conclusion of the study period. OUTCOME MEASURES: Summary injury measures (incidence, severity and burden) will be compared between trial arms, as will the influence of coach attitudes on compliance and injury burden. Additionally, changes in these outcomes through using the exercise programmes will be evaluated. TRIAL REGISTRATION NUMBER: ISRTCNN13422001.

Epidemiology of injuries in English professional rugby union: part 2 training Injuries.

OBJECTIVES: To undertake a detailed epidemiological study of training injuries sustained by professional rugby union players in order to define their incidence, nature, severity, and causes. METHODS: A two season prospective design was used to study training injuries associated with 502 rugby union players at 11 English Premiership clubs. Team clinicians reported all training injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury. Training exposures for individual players were recorded on a weekly basis. Loss of time from training and match play was used as the definition of an injury. RESULTS: The overall incidence of injury was 2.0 per 1000 player-hours, and each injury resulted on average in 24 days lost time. Recurrences, which accounted for 19% of injuries, were more severe (35 days) than new injuries (21 days). Twenty two per cent of all training occurred during the preseason but 34% of all injuries were sustained in this period. Hamstring, calf, hip flexor/quadriceps, and adductor muscle injuries were the most common for backs, whereas hamstring, lateral ankle ligament, and lumbar disc/nerve root injuries predominated for forwards. Lumbar disc/nerve root, shoulder dislocation/instability, and hamstring muscle injuries for forwards and hamstring muscle and anterior cruciate ligament injuries for backs caused the greatest number of days absence. Running was the predominant cause of injury for both forwards and backs, although the overall incidence and severity of injuries sustained during skills training were significantly greater than those sustained during conditioning training. CONCLUSIONS: On average, a club will have 5% of their players unavailable for selection as a consequence of training injuries.

Epidemiology of injuries in English professional rugby union: part 1 match injuries.

OBJECTIVES: To undertake a detailed, large scale epidemiological study of match injuries sustained by professional rugby union players in order to define their incidence, nature, severity, and causes. METHODS: A two season prospective design was used to study match injuries associated with 546 rugby union players at 12 English Premiership clubs. Team clinicians reported all match injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury. Match exposures for individual players were recorded on a weekly basis. Loss of time from training and match play was used as the definition of an injury. RESULTS: The overall incidence of injury was 91 injuries/1000 player-hours, and each injury resulted on average in 18 days lost time. Recurrences, which accounted for 18% of injuries, were significantly more severe (27 days) than new injuries (16 days). Thigh haematomas were the most common injury for forwards and backs, but anterior cruciate ligament injuries for forwards and hamstring injuries for backs caused the greatest number of days absence. Contact mechanisms accounted for 72% of injuries, but foul play was only implicated in 6% of injuries. The ruck and maul elements of the game caused most injuries to forwards, and being tackled caused most injuries to backs. The hooker and outside centre were the playing positions at greatest risk of injury. CONCLUSIONS: On average, a club will have 18% of their players unavailable for selection as a consequence of match injuries.

A prospective study of injuries and training amongst the England 2003 Rugby World Cup squad.

OBJECTIVES: To assess the aetiology, incidence, severity, and causes of injuries to England rugby union players during preparation for and participation in the 2003 Rugby World Cup. METHOD: A 63 week prospective design was employed to study the training practices and injuries of England rugby players. The team physician reported all training and match injuries and provided details of the location, diagnosis, severity, and mechanism of each injury. The team fitness coach reported details of the number and duration of training sessions and the time dedicated to rugby and conditioning training. Players' stature, body mass, and skinfolds were measured at the beginning and end of the study period. RESULTS: The overall incidence of injury was 17 injuries/1000 h of exposure (match: 218 injuries/1000 h; training: 6.1 injuries/1000 h). The major locations of injuries were the lower (60%) and upper (17%) limbs and the most common diagnoses were muscle and tendon (50%) and joint (non-bone) and ligament (41%) injuries. The highest incidences of match injuries occurred whilst being tackled (50 injuries/1000 h) and in a ruck or maul (35 injuries/1000 h), whilst the greatest incidences of training injuries occurred during endurance running (24 injuries/1000 h) and contact activities (20 injuries/1000 h). Players' average body mass increased and skinfold measurement decreased significantly over the study period. CONCLUSIONS: The incidence of match injuries at international level was found to be higher than previously reported. The tackle, ruck, and maul elements of match play and the endurance running and contact elements of training presented the highest risk of injury for all players.

Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union.

Wide variations in the definitions and methodologies used for studies of injuries in rugby union have created inconsistencies in reported data and made interstudy comparisons of results difficult. The International Rugby Board established a Rugby Injury Consensus Group (RICG) to agree on appropriate definitions and methodologies to standardize the recording of injuries and reporting of studies in rugby union. The RICG reviewed the consensus definitions and methodologies previously published for football (soccer) at a meeting in Dublin to assess their suitability for and application to rugby union. Following this meeting, iterative draft statements were prepared and circulated to members of the RICG for comment; a follow-up meeting was arranged in Dublin at which time all definitions and procedures were finalized. At this stage, all authors confirmed their agreement with the consensus statement. The agreed-on document was presented to and approved by the International Rugby Board Council. Agreement was reached on definitions for injury, recurrent injury, nonfatal catastrophic injury, and training and match exposures together with criteria for classifying injuries in terms of severity, location, type, diagnosis, and causation. The definitions and methodology presented in this consensus statement for rugby union are similar to those proposed for football. Adoption of the proposals presented in this consensus statement should ensure that more consistent and comparable results will be obtained from studies of injuries within rugby union.