Publications by authors named "Simon P T Kemp"

39 Publications

Plasma glial fibrillary acidic protein and neurofilament light chain, but not tau, are biomarkers of sports-related mild traumatic brain injury.

Brain Commun 2020 7;2(2):fcaa137. Epub 2020 Sep 7.

Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, Queen Square, UK.

Mild traumatic brain injury is a relatively common event in contact sports and there is increasing interest in the long-term neurocognitive effects. The diagnosis largely relies on symptom reporting and there is a need for objective tools to aid diagnosis and prognosis. There are recent reports that blood biomarkers could potentially help triage patients with suspected injury and normal CT findings. We have measured plasma concentrations of glial and neuronal proteins and explored their potential in the assessment of mild traumatic brain injury in contact sport. We recruited a prospective cohort of active male rugby players, who had pre-season baseline plasma sampling. From this prospective cohort, we recruited 25 players diagnosed with mild traumatic brain injury. We sampled post-match rugby players without head injuries as post-match controls. We measured plasma neurofilament light chain, tau and glial fibrillary acidic protein levels using ultrasensitive single molecule array technology. The data were analysed at the group and individual player level. Plasma glial fibrillary acidic protein concentration was significantly increased 1-h post-injury in mild traumatic brain injury cases compared to the non-injured group ( = 0.017). Pairwise comparison also showed that glial fibrillary acidic protein levels were higher in players after a head injury in comparison to their pre-season levels at both 1-h and 3- to 10-day post-injury time points ( = 0.039 and 0.040, respectively). There was also an increase in neurofilament light chain concentration in brain injury cases compared to the pre-season levels within the same individual at both time points ( = 0.023 and 0.002, respectively). Tau was elevated in both the non-injured control group and the 1-h post-injury group compared to pre-season levels ( = 0.007 and 0.015, respectively). Furthermore, receiver operating characteristic analysis showed that glial fibrillary acidic protein and neurofilament light chain can separate head injury cases from control players. The highest diagnostic power was detected when biomarkers were combined in differentiating 1-h post-match control players from 1-h post-head injury players (area under curve 0.90, 95% confidence interval 0.79-1.00,  < 0.0002). The brain astrocytic marker glial fibrillary acidic protein is elevated in blood 1 h after mild traumatic brain injury and in combination with neurofilament light chain displayed the potential as a reliable biomarker for brain injury evaluation. Plasma total tau is elevated following competitive rugby with and without a head injury, perhaps related to peripheral nerve trauma and therefore total tau does not appear to be suitable as a blood biomarker.
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http://dx.doi.org/10.1093/braincomms/fcaa137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846133PMC
September 2020

The relationships between rugby union, and health and well-being: a scoping review.

Br J Sports Med 2021 Mar 28;55(6):319-326. Epub 2020 Oct 28.

Physical Activity for Health Research Centre, The University of Edinburgh, Edinburgh, UK.

Objective: To scope the relationships between rugby union, and health and well-being.

Design: Scoping review.

Data Sources: Published and unpublished reports of any age, identified by searching electronic databases, platforms and reference lists.

Methods: A three-step search strategy identified relevant published primary, secondary studies and grey literature, which were screened using inclusion criteria. Data were extracted using a standardised tool, to form (1) a numerical analysis and (2) a thematic summary.

Results And Discussion: 6658 records were identified, and 198 studies met the inclusion criteria. All forms of rugby union can provide health-enhancing physical activity (PA). 'Non-contact' and wheelchair rugby in particular provide a wide range of physical and mental health and well-being benefits. The evidence is either mixed or unclear in relation to 'contact' rugby union and its effects on a range of physical health domains. Injury and concussion incidence rates are high for contact rugby union relative to other sports.

Conclusions: A wide range of stakeholders as well as existing and potential participants can use this information to make a more informed decision about participating in and promoting rugby union as a health-enhancing activity. Industry and policy-makers can use this review to inform policies and strategies that look to increase participation rates and use rugby union as a vehicle to contribute positively to population health. Further research understanding rugby union's contribution to PA as well as to muscle-strengthening and balance is indicated, as well as research examining more health and well-being outcomes across more diverse cohorts.
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http://dx.doi.org/10.1136/bjsports-2020-102085DOI Listing
March 2021

Training Load, Injury Burden, and Team Success in Professional Rugby Union: Risk Versus Reward.

J Athl Train 2020 Sep;55(9):960-966

Department for Health, University of Bath, United Kingdom.

Context: Individual and team injury burden and performance are 2 key considerations facing practitioners in the daily prescription of an athlete's training load. Whereas a considerable number of researchers have examined univariate relationships between training load and performance, training load and injury, or injury and performance, few investigators have examined all 3 concurrently.

Objective: To assess the association among training load, injury burden, and performance in professional rugby union.

Design: Descriptive epidemiology study.

Setting: The English Premiership competition.

Patients Or Other Participants: Individual injury and training load data, as well as team performance data, were captured during the 2015-2016 (n = 433 players) and 2016-2017 (n = 569 players) seasons.

Main Outcome Measure(s): Data were aggregated into team average scores for each week, including weekly (acute) load, smoothed chronic load, changes in load, injury burden, and weekly performance. Linear mixed modelling techniques were used to assess the association among measures.

Results: Injury burden was negatively associated with performance, with a high weekly burden associated with a likely harmful (P = .01) decrease in performance. Training load measures displayed only trivial associations with performance. Only the acute:chronic workload ratio measure was clearly associated with injury burden, with a possibly harmful effect (P = .02). Both squad size and player availability were associated with only trivial changes in performance.

Conclusions: Whereas no association between average training load and performance existed, associations between training load and injury burden and between injury burden and performance were clear. Further investigation using more sensitive and individualized measures of load, performance, and injury may elicit a clearer relationship and should be considered for future work.
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http://dx.doi.org/10.4085/1062-6050-0387.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534937PMC
September 2020

The epidemiology of kicking injuries in professional Rugby Union: A 15-season prospective study.

Scand J Med Sci Sports 2020 Sep 18;30(9):1739-1747. Epub 2020 Jun 18.

Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, UK.

Purpose: While kicking in Rugby Union can be influential to match outcome, the epidemiology of kicking injuries remains unknown. This study therefore aimed to investigate the epidemiology of injuries attributed to kicking in professional rugby, including playing position-specific effects and differences in kicking volumes and kick types.

Methods: Fifteen seasons of injury surveillance data and two seasons of match kicking characteristics from professional rugby players were analyzed. Incidence, propensity, and severity of kicking-related injuries were calculated together with the locations and types of these injuries. Position-related differences in match kicking types and volumes were also established.

Results: Seventy-seven match and 55 training acute-onset kicking injuries were identified. The match kicking injury incidence for backs was 1.4/1000 player-match-hours. Across all playing positions, the propensity for match kicking injury was 0.57 injuries/1000 kicks. Fly-halves sustained the greatest proportion of match kicking injuries (47%) and performed the greatest proportion of match kicks (46%); an average propensity for match kicking injury (0.58/1000 kicks). Scrum-halves executed 27% of match-related kicks but had a very low propensity for match kicking injury (0.17/1000 kicks). All other positional groups executed a small proportion of match-related kicks but a high propensity for match kicking injury. Ninety-two percent of match kicking injuries occurred in the pelvis or lower limb, with the majority sustained by the kicking limb. 21% of all match kicking injuries were associated with the rectus femoris muscle.

Conclusion: Match kicking profiles and kicking injuries sustained are position-dependent, which provides valuable insight for developing player-specific conditioning and rehabilitation protocols.
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http://dx.doi.org/10.1111/sms.13737DOI Listing
September 2020

Returning to Play after Prolonged Training Restrictions in Professional Collision Sports.

Int J Sports Med 2020 Oct 29;41(13):895-911. Epub 2020 May 29.

Department for Health, University of Bath, Bath, United Kingdom of Great Britain and Northern Ireland.

The COVID-19 pandemic in 2020 has resulted in widespread training disruption in many sports. Some athletes have access to facilities and equipment, while others have limited or no access, severely limiting their training practices. A primary concern is that the maintenance of key physical qualities (e. g. strength, power, high-speed running ability, acceleration, deceleration and change of direction), game-specific contact skills (e. g. tackling) and decision-making ability, are challenged, impacting performance and injury risk on resumption of training and competition. In extended periods of reduced training, without targeted intervention, changes in body composition and function can be profound. However, there are strategies that can dramatically mitigate potential losses, including resistance training to failure with lighter loads, plyometric training, exposure to high-speed running to ensure appropriate hamstring conditioning, and nutritional intervention. Athletes may require psychological support given the challenges associated with isolation and a change in regular training routine. While training restrictions may result in a decrease in some physical and psychological qualities, athletes can return in a positive state following an enforced period of rest and recovery. On return to training, the focus should be on progression of all aspects of training, taking into account the status of individual athletes.
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http://dx.doi.org/10.1055/a-1180-3692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7799169PMC
October 2020

Concussion and long-term cognitive impairment among professional or elite sport-persons: a systematic review.

J Neurol Neurosurg Psychiatry 2020 05 27;91(5):455-468. Epub 2020 Feb 27.

Department of Medical Statistics, London School of Hygiene and Tropical, London, UK.

Introduction: Understanding whether concussion in sport is associated with worsening cognitive function in later life will likely have immediate repercussion on sports concussion prevention and management policy and sporting rules and regulations. This systematic review aims to summarise the evidence on the association between concussion sustained by professional/elite athletes and long-term cognitive impairment.

Methods: Embase, PubMed and Web of Science were used to search for eligible studies. Studies including professional/elite athletes from any sport were considered. Three comparison groups were considered: internal comparison (concussed vs non-concussed athletes within the same sample); between-sport comparison (contact sport athletes vs non-contact sports ones); external comparison (athletes vs samples of the general population or population norms).

Results: 14 studies were included (rugby, American football, ice hockey players, boxers and marital art fighters). The general quality of the evidence was poor. The overall evidence, weighted for type of comparison and study quality, points towards an association between sustaining a sport-related concussion and poorer cognitive function later in life in rugby, American football and boxing, although it is unclear to what extent this is clinically relevant. Data on ice hockey and martial arts were too sparse to allow conclusions to be drawn.

Conclusion: High-quality, appropriately designed and powered epidemiological studies are urgently needed to assess the association between sustaining a sport-related concussion and cognitive impairment later in life. Particular emphasis should be put on the clinical translational value of findings.
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http://dx.doi.org/10.1136/jnnp-2019-321170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231435PMC
May 2020

Patterns of training volume and injury risk in elite rugby union: An analysis of 1.5 million hours of training exposure over eleven seasons.

J Sports Sci 2020 Feb 22;38(3):238-247. Epub 2019 Nov 22.

Department for Health, University of Bath, Bath, UK.

Rugby union is a popular team sport that demands high levels of physical fitness and skill. The study aim was to examine trends in training volume and its impact on injury incidence, severity and burden over an 11-season period in English professional rugby. Data were recorded from 2007/08 through 2017/18, capturing 1,501,606 h of training exposure and 3,782 training injuries. Players completed, on average, 6 h 48 minutes of weekly training (95% CI: 6 h 30 mins to 7 h 6 mins): this value remained stable over the 11 seasons. The mean incidence of training-related injuries was 2.6/1000 player-hours (95% CI: 2.4 to 2.8) with a mean severity rising from 17 days in 2007/08 to 37 days in 2017/18 (Change/season = 1.773, 0.01). Rate of change in severity was dependent on training type, with conditioning (non-gym-based) responsible for the greatest increase (2.4 days/injury/season). As a result of increasing severity, injury burden rose from 51 days absence/1000 player-hours in 2007/08 to 106 days' absence/1000 player-hours in 2017/18. Despite the low incidence of injury in training compared to match-play, training accounted for 34% of all injuries. Future assessments of training intensity may lead to a greater understanding of the rise in injury severity.
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http://dx.doi.org/10.1080/02640414.2019.1692415DOI Listing
February 2020

The relationships between rugby union and health: a scoping review protocol.

BMJ Open Sport Exerc Med 2019 24;5(1):e000593. Epub 2019 Aug 24.

Rugby Football Union, Twickenham, UK.

Introduction: Rugby union is played by over eight million people across the world and is considered a form of moderate-to-vigorous physical activity. Consequently, playing rugby may confer health benefits; however, to date, the principal focus of research has been on associated injuries and potential detrimental long-term health sequelae. This protocol outlines the methods behind studying any potential associations between rugby union and both physical and mental health.

Methods And Analysis: Best practice methodological frameworks (Arksey and O'Malley, Levac and the Joanna Briggs Institute) and previously published scoping review protocols in sport informs the methodology of this protocol. This protocol enables us to map the key concepts and evidence available, summarise and share existing research findings, and identify research gaps in the current literature. A three-step search strategy will identify reviews, original research, and published and grey literature. An initial search will identify suitable search terms, followed by a search using keyword and index terms. Two reviewers will independently screen identified studies for final inclusion.

Dissemination: When publishing the scoping review, we will map key concepts and evidence both numerically and thematically, as well as identify key research priorities for further studies. The review will subsequently be disseminated to stakeholder groups, practitioners and policymakers through a variety of peer-reviewed and non-peer-reviewed publications, conferences and via multimedia platforms.
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http://dx.doi.org/10.1136/bmjsem-2019-000593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733317PMC
August 2019

Guidelines for community-based injury surveillance in rugby union.

J Sci Med Sport 2019 Dec 12;22(12):1314-1318. Epub 2019 Aug 12.

Colin Fuller Consultancy, United Kingdom.

Objectives: The vast majority of rugby union ('rugby') participants are community-based players; however, the majority of injury surveillance studies reported relate to the elite, professional game. A potential reason for this dearth of studies could be the perceived difficulty of using the consensus statement for injury recording at the community level. The aim of this study was to identify areas where the consensus statement could be adapted for easier and more appropriate implementation within the community setting.

Design: Round-table discussion.

Methods: All community-based injury surveillance issues were discussed during a 2-day facilitated round-table meeting, by an 11-person working group consisting of researchers currently active in rugby-related injury surveillance, sports medicine and sports science issues. The outcomes from the meeting were summarised in a draft guidance document that was then subjected to an extensive iterative review prior to producing methodological recommendations.

Results: Each aspect of the rugby-specific consensus statement was reviewed to determine whether it was feasible to implement the standards required in the context of non-elite rugby and the resources available within in a community setting. Final recommendations are presented within a community-based injury report form.

Conclusions: It is recommended that whenever possible the rugby-specific consensus statement for injury surveillance studies be used: this paper presents an adapted report form that can be used to record injury surveillance information in community rugby if suitable medical support is not available.
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http://dx.doi.org/10.1016/j.jsams.2019.08.006DOI Listing
December 2019

Athlete Monitoring in Rugby Union: Is Heterogeneity in Data Capture Holding Us Back?

Sports (Basel) 2019 Apr 27;7(5). Epub 2019 Apr 27.

Department for Health, University of Bath, Bath BA2 7AY, UK.

In an effort to combat growing demands on players, athlete monitoring has become a central component of professional sport. Despite the introduction of new technologies for athlete monitoring, little is understood about the practices employed in professional rugby clubs. A questionnaire was circulated amongst conditioning staff across the 12 Premiership rugby clubs to capture the methods used, relative importance, perceived effectiveness and barriers to the use of multiple different athlete monitoring measurements. Previous injury, Global Positioning System (GPS) metrics, collision counts and age were deemed the most important risk factors for managing future injury risk. A wide range of GPS metrics are collected across clubs with high-speed running (12/12 clubs), distance in speed zones (12/12 clubs) and total distance (11/12 clubs) the most commonly used. Of the metrics collected, high-speed running was deemed the most important for managing future injury risk (5/12 clubs); however, there was considerable variation between clubs as to the exact definition of high-speed running, with both absolute and relative measures utilised. While the use of such monitoring tools is undertaken to improve athlete welfare by minimising injury risk, this study demonstrates the significant heterogeneity of systems and methods used by clubs for GPS capture. This study therefore questions whether more needs to be done to align practices within the sport to improve athlete welfare.
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http://dx.doi.org/10.3390/sports7050098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571870PMC
April 2019

Educational concussion module for professional footballers: from systematic development to feasibility and effect.

BMJ Open Sport Exerc Med 2019 7;5(1):e000490. Epub 2019 Mar 7.

Rugby Football Union, Twickenham, UK.

Objectives: To describe: (1) how we developed a concussion module and (2) whether the concussion module is feasible (in terms of relevance, added value and suitability) and enhances knowledge and changes attitude of professional footballers about concussion.

Developing The Concussion Module: We developed the concussion module based on two structured and systematic processes. First, our needs assessment (questionnaire and interviews) in professional football (especially players) revealed that a 5-10 min concussion module was needed, ideally disseminated during club visits. Second, the objectives were defined (from published literature and by experts) as to disseminate essential information about what concussion is (definition), how to recognise it and the importance of removing a player with (suspected) concussion from the football field. We included an introductory video featuring a high-profile professional footballer and an animated educational component on defining concussion, recognising it and removing affected players from the field.

Feasibility And Effect: A quasiexperimental study (pretest post-test design) was conducted among 61 professional footballers. These players were asked to complete two questionnaires related to knowledge about and attitude towards concussion and feasibility of the module: one before and one after viewing the concussion module. Potential increase in knowledge and attitude was explored by comparing the pretest and post-test scores of the Rosenbaum Concussion Knowledge and Attitudes Survey with the non-parametric Wilcoxon signed-rank test (p<0.05). The mean knowledge score of the participants was stable between tests (Z=213; p=0.16), while mean attitude score increased significantly (Z=331; p=0.01). Nearly all participants (85%-100%) were positive about the relevance, added value, duration and form of the concussion module.

Conclusion: The developed educational concussion module leads to better attitude of professional footballers towards concussion.
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http://dx.doi.org/10.1136/bmjsem-2018-000490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407555PMC
March 2019

Study of Concussion in Rugby Union through MicroRNAs (SCRUM): a study protocol of a prospective, observational cohort study.

BMJ Open 2018 11 25;8(11):e024245. Epub 2018 Nov 25.

NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Introduction: The diagnosis of mild traumatic brain injury or sports-related concussion is a challenge for all clinicians, players, coaches and parents involved in contact sports. Currently, there is no validated objective biomarker available to assess the presence or severity of concussion in sport, and so it is necessary to rely on subjective measures like self-reporting of symptoms which depend on the cooperation of the athlete. There is a significant health risk associated with repetitive injury if the diagnosis is missed, and so there is great value in an objective biomarker to assist diagnostic and prognostic decisions.

Objective: To establish a panel of non-invasive MicroRNA biomarkers in urine and saliva for the rapid diagnosis of sports-related concussion and investigate the kinetics and clinical utility of these biomarkers in assisting diagnostic, prognostic and return-to-play decisions.

Methods And Analysis: Observational, prospective, multicentre cohort study recruiting between the 2017-2018 and 2018-2019 Rugby Union seasons. Professional rugby players in the two highest tiers of senior professional domestic rugby competition in England will be recruited prospectively to the study. During the season, three groups will be identified: athletes entering the World Rugby Head Injury Assessment (HIA) protocol, uninjured control athletes and control athletes with musculoskeletal injuries. Saliva and urine will be collected from these athletes at multiple timepoints, coinciding with key times in the HIA protocol and return-to-play process.

Ethics And Dissemination: Ethics approval has been obtained. The compiled and analysed results will be presented at national and international conferences concerning the care of patients with traumatic brain injury. Results will also be submitted for peer review and publication in the subject journals/literature.
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http://dx.doi.org/10.1136/bmjopen-2018-024245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254405PMC
November 2018

Modelling the HRV Response to Training Loads in Elite Rugby Sevens Players.

J Sports Sci Med 2018 Sep 14;17(3):402-408. Epub 2018 Aug 14.

Department for Health, University of Bath, Bath, UK.

A systems modelling approach can be used to describe and optimise responses to training stimuli within individuals. However, the requirement for regular maximal performance testing has precluded the widespread implementation of such modelling approaches in team-sport settings. Heart rate variability (HRV) can be used to measure an athlete's adaptation to training load, without disrupting the training process. As such, the aim of the current study was to assess whether chronic HRV responses, as a representative marker of training adaptation, could be predicted from the training loads undertaken by elite Rugby Sevens players. Eight international male players were followed prospectively throughout an eight-week pre-season period, with HRV and training loads (session-RPE [sRPE] and high-speed distance [HSD]) recorded daily. The Banister model was used to estimate vagally-mediated chronic HRV responses to training loads over the first four weeks (tuning dataset); these estimates were then used to predict chronic HRV responses in the subsequent four-week period (validation dataset). Across the tuning dataset, high correlations were observed between modelled and recorded HRV for both sRPE (r = 0.66 ± 0.32) and HSD measures (r = 0.69 ± 0.12). Across the sRPE validation dataset, seven of the eight athletes met the criterion for validity (typical error <3% and Pearson >0.30), compared to one athlete in the HSD validation dataset. The sRPE validation data produced lower mean bias values, and higher Pearson correlations, compared to the HSD validation dataset. These data suggest that a systems theory approach can be used to accurately model chronic HRV responses to internal training loads within elite Rugby Sevens players, which may be useful for optimising the training process on an individual basis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090397PMC
September 2018

Does the Reliability of Reporting in Injury Surveillance Studies Depend on Injury Definition?

Orthop J Sports Med 2018 Mar 19;6(3):2325967118760536. Epub 2018 Mar 19.

Department for Health, University of Bath, Bath, UK.

Background: Choosing an appropriate definition for injury in injury surveillance studies is essential to ensure a balance among reporting reliability, providing an accurate representation of injury risk, and describing the nature of the clinical demand.

Purpose: To provide guidance on the choice of injury definition for injury surveillance studies by comparing within- and between-team variability in injury incidence with >24-hour and >7-day time-loss injury definitions in a large multiteam injury surveillance study.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: Injury data were reported for 2248 professional rugby union players from 15 Premiership Rugby clubs over 12 seasons. Within-team percentage coefficient of variation and mean between-team standard deviation (expressed as a percentage coefficient of variation) in injury incidence rates (injuries per 1000 player match hours) were calculated. For both variables, a comparison was made between >24-hour and >7-day injury incidence rates in terms of the magnitude of the observed effects.

Results: The overall mean incidence across the population with a >24-hour time-loss injury definition was approximately double the reported incidence with the >7-day definition. There was a 10% higher between-team variation in match injury incidence rates with the >24-hour time-loss definition versus the >7-day definition.

Conclusion: There was a likely higher degree of between-team variation in match injury incidence rates with a >24-hour time-loss definition than with a >7-day definition of injury. However, in professional sports settings, it is likely that the benefits of using a more inclusive definition of injury (improved understanding of clinical demand and the appropriate and accurate reporting of injury risk) outweigh the small increase in variation in reporting consistency.
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http://dx.doi.org/10.1177/2325967118760536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862373PMC
March 2018

King-Devick concussion test performs poorly as a screening tool in elite rugby union players: a prospective cohort study of two screening tests versus a clinical reference standard.

Br J Sports Med 2019 Dec 21;53(24):1526-1532. Epub 2018 Mar 21.

Rugby Football Union, London, UK.

Background: The King-Devick (KD) test is an objective clinical test of eye movements that has been used to screen for concussion. We characterised the accuracy of the KD test and the World Rugby Head Injury Assessment (HIA-1) screening tools as methods of off-field evaluation for concussion after a suspicious head impact event.

Methods: A prospective cohort study was performed in elite English rugby union competitions between September 2016 and May 2017. The study population comprised consecutive players identified with a head impact event with the potential to result in concussion. The KD test was administered off-field, alongside the World Rugby HIA-1 screening tool, and the results were compared with the preseason baseline. Accuracy was measured against a reference standard of confirmed concussion, based on the clinical judgement of the team doctor after serial assessments.

Results: 145 head injury events requiring off-field medical room screening assessments were included in the primary analysis. The KD test demonstrated a sensitivity of 60% (95% CI 49.0 to 70) and a specificity of 39% (95% CI 26 to 54) in identifying players subsequently diagnosed with concussion. Area under the receiver operating characteristic curve for prolonged KD test times was 0.51 (95% CI 0.41 to 0.61). The World Rugby HIA-1 off-field screening tool sensitivity did not differ significantly from the KD test (sensitivity 75%, 95% CI 66 to 83, P=0.08), but specificity was significantly higher (91%, 95% CI 82 to 97, P<0.001). Although combining the KD test and the World Rugby HIA-1 multimodal screening assessment achieved a significantly higher sensitivity of 93% (95% CI 86% to 97%), there was a significantly lower specificity of 33% (95% CI 21% to 48%), compared with the HIA-1 test alone.

Conclusions: The KD test demonstrated limited accuracy as a stand-alone remove-from-play sideline screening test for concussion. As expected with the addition of any parallel test, combination of the KD test with the HIA-1 off-field screening tool provided improved sensitivity in identifying concussion, but at the expense of markedly lower specificity. These results suggest that it is unlikely that the KD test will be incorporated into multimodal off-field screening assessments for concussion at the present time.
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http://dx.doi.org/10.1136/bjsports-2017-098560DOI Listing
December 2019

Health amongst former rugby union players: A cross-sectional study of morbidity and health-related quality of life.

Sci Rep 2017 09 28;7(1):11786. Epub 2017 Sep 28.

Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford, UK.

In the general population, physical activity is associated with improved health outcomes. However, long-term sports participation may be associated with adverse outcomes, particularly at the elite level. The aims of this study were to assess morbidity and health-related quality of life (HrQoL) amongst former rugby players, compared to an age-standardised general population sample. A cross-sectional study of former elite, male, rugby players (n = 259) was undertaken, and standardised morbidity ratios (SMR) calculated, assessing morbidity prevalence relative to English Longitudinal Study of Aging participants (ELSA, n = 5186). HrQoL, measured using the EQ-5D, was compared to a Health Survey for England (HSE, n = 2981) sample. In SMR analyses of participants aged 50+, diabetes was significantly lower amongst former players, (0.28, 95% CI 0.11-0.66), whereas osteoarthritis (4.00, 95% CI 3.32-4.81), joint replacement (6.02, 95% CI 4.66-7.77), osteoporosis (2.69, 95% CI 1.35-5.38), and anxiety (2.00, 95% CI 1.11-3.61) were significantly higher. More problems in HrQoL were reported amongst former players within the domains of mobility (p < 0.001), self-care (p = 0.041), usual activities (p < 0.001) and pain/discomfort (p < 0.001). Morbidity and HrQoL differ between players and the general population, with higher musculoskeletal morbidity and lower diabetes amongst former players. The magnitude of musculoskeletal morbidity may warrant proactive osteoarthritis management within this population.
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http://dx.doi.org/10.1038/s41598-017-12130-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620077PMC
September 2017

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

Br J Sports Med 2017 Aug 17;51(15):1140-1146. Epub 2017 May 17.

Department for Health, University of Bath, Bath, UK.

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.
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http://dx.doi.org/10.1136/bjsports-2016-097434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530334PMC
August 2017

How Much Rugby is Too Much? A Seven-Season Prospective Cohort Study of Match Exposure and Injury Risk in Professional Rugby Union Players.

Sports Med 2017 Nov;47(11):2395-2402

Department for Health, University of Bath, Bath, BA2 7AY, UK.

Introduction: Numerous studies have documented the incidence and nature of injuries in professional rugby union, but few have identified specific risk factors for injury in this population using appropriate statistical methods. In particular, little is known about the role of previous short-term or longer-term match exposures in current injury risk in this setting.

Objectives: Our objective was to investigate the influence that match exposure has upon injury risk in rugby union.

Method: We conducted a seven-season (2006/7-2012/13) prospective cohort study of time-loss injuries in 1253 English premiership professional players. Players' 12-month match exposure (number of matches a player was involved in for ≥20 min in the preceding 12 months) and 1-month match exposure (number of full-game equivalent [FGE] matches in preceding 30 days) were assessed as risk factors for injury using a nested frailty model and magnitude-based inferences.

Results: The 12-month match exposure was associated with injury risk in a non-linear fashion; players who had been involved in fewer than ≈15 or more than ≈35 matches over the preceding 12-month period were more susceptible to injury. Monthly match exposure was linearly associated with injury risk (hazard ratio [HR]: 1.14 per 2 standard deviation [3.2 FGE] increase, 90% confidence interval [CI] 1.08-1.20; likely harmful), although this effect was substantially attenuated for players in the upper quartile for 12-month match exposures (>28 matches).

Conclusion: A player's accumulated (12-month) and recent (1-month) match exposure substantially influences their current injury risk. Careful attention should be paid to planning the workloads and monitoring the responses of players involved in: (1) a high (>≈35) number of matches in the previous year, (2) a low (<≈15) number of matches in the previous year, and (3) a low-moderate number of matches in previous year but who have played intensively in the recent past. These findings make a major contribution to evidence-based policy decisions regarding match workload limits in professional rugby union.
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http://dx.doi.org/10.1007/s40279-017-0721-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633632PMC
November 2017

Monitoring What Matters: A Systematic Process for Selecting Training-Load Measures.

Int J Sports Physiol Perform 2017 Apr 11;12(Suppl 2):S2101-S2106. Epub 2016 Nov 11.

Purpose: Numerous derivative measures can be calculated from the simple session rating of perceived exertion (sRPE), a tool for monitoring training loads (eg, acute:chronic workload and cumulative loads). The challenge from a practitioner's perspective is to decide which measures to calculate and monitor in athletes for injury-prevention purposes. The aim of the current study was to outline a systematic process of data reduction and variable selection for such training-load measures.

Methods: Training loads were collected from 173 professional rugby union players during the 2013-14 English Premiership season, using the sRPE method, with injuries reported via an established surveillance system. Ten derivative measures of sRPE training load were identified from existing literature and subjected to principal-component analysis. A representative measure from each component was selected by identifying the variable that explained the largest amount of variance in injury risk from univariate generalized linear mixed-effects models.

Results: Three principal components were extracted, explaining 57%, 24%, and 9% of the variance. The training-load measures that were highly loaded on component 1 represented measures of the cumulative load placed on players, component 2 was associated with measures of changes in load, and component 3 represented a measure of acute load. Four-week cumulative load, acute:chronic workload, and daily training load were selected as the representative measures for each component.

Conclusions: The process outlined in the current study enables practitioners to monitor the most parsimonious set of variables while still retaining the variation and distinct aspects of "load" in the data.
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http://dx.doi.org/10.1123/ijspp.2016-0337DOI Listing
April 2017

Evaluation of World Rugby's concussion management process: results from Rugby World Cup 2015.

Br J Sports Med 2017 Jan 1;51(1):64-69. Epub 2016 Sep 1.

World Rugby, Dublin, Ireland.

Objective: To evaluate World Rugby's concussion management process during Rugby World Cup (RWC) 2015.

Design: A prospective, whole population study.

Population: 639 international rugby players representing 20 countries.

Method: The concussion management process consisted of 3 time-based, multifaceted stages: an initial on-pitch and/or pitch-side assessment of the injury, a follow-up assessment within 3 hours and an assessment at 36-48 hours. The initial on-pitch assessment targeted obvious signs of concussion, which, if identified, lead to a 'permanent removal from play' decision and a diagnosis of concussion. If the on-pitch diagnosis was unclear, a 10-min off-pitch assessment was undertaken for signs and symptoms of concussion leading to a 'suspected concussion with permanent removal from play' or a 'no indication of concussion with return to play' decision. Evaluations at 3 and 36-48 hours postmatch lead to diagnoses of 'confirmed concussion' or 'no concussion'. Medical staff's decision-making was supported during each stage by real-time video review of events. Players diagnosed with confirmed concussion followed a 5-stage graduated-return-to-play protocol before being allowed to return to training and/or competition.

Results: Players were evaluated for concussion on 49 occasions, of which 24 resulted in diagnoses of concussion. Fourteen players showing on-pitch signs of concussion were permanently removed from play: 4 of the 5 players removed from play following off-pitch medical room evaluation were later diagnosed with a confirmed concussion. Five players not exhibiting in-match signs or symptoms of concussion were later diagnosed with concussion. The overall incidence of concussion during RWC 2015 was 12.5 concussions/1000 player-match-hours.

Conclusions: This study supports the implementation of a multimodal, multitime-based concussion evaluation process to ensure that immediate and late developing concussions are captured.
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http://dx.doi.org/10.1136/bjsports-2016-096461DOI Listing
January 2017

Rugby World Cup 2015: World Rugby injury surveillance study.

Br J Sports Med 2017 Jan 26;51(1):51-57. Epub 2016 Jul 26.

World Rugby, World Rugby House, Dublin 2, Ireland.

Objective: To determine the incidence, severity and nature of injuries sustained during the Rugby World Cup (RWC) 2015 together with the inciting events leading to the injuries.

Design: A prospective, whole population study.

Population: 639 international rugby players representing 20 countries.

Method: The study protocol followed the definitions and procedures recommended in the consensus statement for epidemiological studies in rugby union; output measures included players' age (years), stature (cm), body mass (kg) and playing position, and the group-level incidence (injuries/1000 player-hours), mean and median severity (days-absence), location (%), type (%) and inciting event (%) for match and training injuries.

Results: Incidence of injury was 90.1 match injuries/1000 player-match-hours (backs: 100.4; forwards: 81.1) and 1.0 training injuries/1000 player-training-hours (backs: 0.9; forwards: 1.2). The mean severity of injuries was 29.8 days-absence (backs: 30.4; forwards: 29.1) during matches and 14.4 days-absence (backs: 6.3; forwards: 19.8) during training. During matches, head/face (22.0%), knee (16.2%), muscle-strain (23.1%) and ligament-sprain (23.1%) and, during training, lower limb (80.0%) and muscle-strain (60.0%) injuries were the most common locations and types of injury. Being-tackled (24.7%) was the most common inciting event for injury during matches and rugby-skills-contact activities (70.0%) the most common during training.

Conclusions: While the incidence, nature and inciting events associated with match injuries at RWC 2015 were similar to those reported previously for RWCs 2007 and 2011, there were increasing trends in the mean severity and total days-absence through injury.
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http://dx.doi.org/10.1136/bjsports-2016-096275DOI Listing
January 2017

Time loss injuries compromise team success in Elite Rugby Union: a 7-year prospective study.

Br J Sports Med 2016 Jun 9;50(11):651-6. Epub 2015 Nov 9.

Department for Health, University of Bath, Bath, UK.

Background: A negative association between injuries and team success has been demonstrated in professional football, but the nature of this association in elite Rugby Union teams is currently unclear.

Aim: To assess the association between injury burden measures and team success outcomes within professional Rugby Union teams.

Methods: A seven-season prospective cohort design was used to record all time-loss injuries incurred by English Premiership players. Associations between team success measures (league points tally and Eurorugby Club Ranking (ECR)) and injury measures (injury burden and injury days per team-match) were modelled, both within (changes from season to season) and between (differences averaged over all seasons) teams. Thresholds for the smallest worthwhile change in league points tally and ECR were 3 points and 2.6%, respectively.

Results: Data from a total of 1462 players within 15 Premiership teams were included in the analysis. We found clear negative associations between injury measures and team success (70-100% likelihood), with the exception of between-team differences for injury days per team-match and ECR, which was unclear. A reduction in injury burden of 42 days (90% CI 30 to 70) per 1000 player hours (22% of mean injury burden) was associated with the smallest worthwhile change in league points tally.

Conclusions: Clear negative associations were found between injury measures and team success, and moderate reductions in injury burden may have worthwhile effects on competition outcomes for professional Rugby Union teams. These findings may be useful when communicating the value of injury prevention initiatives within this elite sport setting.
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http://dx.doi.org/10.1136/bjsports-2015-094798DOI Listing
June 2016

Training activities and injuries in English youth academy and schools rugby union.

Am J Sports Med 2015 Feb 15;43(2):475-81. Epub 2014 Dec 15.

Sport, Health, and Exercise Science, Department for Health, University of Bath, Bath, UK

Background: All rugby training activities carry an injury risk, but in the training environment these injury risks should be more controllable than during matches.

Purpose: To (1) describe the incidence, severity, anatomic location, and type of youth rugby training injuries; (2) determine the injury events and type of training activities associated with injuries; and (3) compare 2 levels of play (professional academy vs school) within English youth rugby union.

Study Design: Cohort study; Level of evidence, 2.

Methods: A 2-season (2006-2007 and 2007-2008) study recorded exposure to training activities and time-loss injuries in male youth rugby union players (age range, 16-18 years) from 12 English Premiership academies (250 player-seasons) and 7 schools (222 player-seasons). Players from the Premiership academies, associated with the top-level professional clubs in England, represented the elite level of youth rugby; the school players were from established rugby-playing schools but were overall considered at a lower level of play.

Results: There was a trend for training injury incidence to be lower for the academy group (1.4/1000 player-hours; 95% CI, 1.0-1.7) compared with the school group (2.1/1000 player-hours; 95% CI, 1.4-2.9) (P = .06). Injuries to the ankle/heel and thigh were most common in academy players and injuries to the lumbar spine and ankle/heel region most common in school players. The training activities responsible for injury differed between the 2 groups: technical skills (scrummaging) for school players and contact skills (defense and ruck/maul drills) for academy players.

Conclusion: For injury risk management in youth rugby, coaches of school players should focus on the development of the correct technique during practice of technical skills such as scrummaging, weight training, and skills training, and coaches of academy players should consider the extent to which contact drills are necessary during training.
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http://dx.doi.org/10.1177/0363546514560337DOI Listing
February 2015

The International Rugby Board (IRB) Pitch Side Concussion Assessment trial: a pilot test accuracy study.

Br J Sports Med 2015 Apr 4;49(8):529-35. Epub 2014 Jul 4.

French Federation of Rugby, Neurosurgical Department, Medical School René Diderot Paris 7, Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Clichy, Paris, France.

Background: 'On the field and on the run' assessments of head impact events in professional rugby have resulted in a high proportion of players subsequently diagnosed with confirmed concussion not leaving the field of play at the time of injury. The International Rugby Board (IRB) consequently developed a process to support team doctors in the recognition and management of players at risk of concussion, including development of a multimodal assessment instrument-the Pitch Side Concussion Assessment (PSCA) tool.

Methods: This was a pilot cohort study designed to determine the feasibility of assessing the accuracy of the IRB PSCA tool in elite male rugby. The study population comprised consecutive players identified with a head impact event with the potential to result in concussion during eight international/national competitions. Players were assessed off field by match-day or team doctors, following a temporary substitution. The accuracy of the PSCA tool was measured against a reference standard of postmatch confirmed concussion, based on clinical judgement aided by an established concussion support instrument.

Results: A total of 165 head injury events with the potential to cause concussion were included in the study. The PSCA tool demonstrated a sensitivity of 84.6% (95% CI 73.5% to 92.4%) and a specificity of 74% (95% CI 64.3% to 82.3%) to identify players subsequently diagnosed with confirmed concussion. The negative predictive value was 88.1% (95% CI 79.2% to 94.1%); the positive predictive value was 67.9% (95% CI 56.6% to 77.8%). There were no major barriers identified that would prevent the evaluation of the PSCA process or tool in a future large-scale study.

Conclusions: This pilot study has provided the first preliminary estimates for the performance of the PSCA tool, suggesting a potentially favourable balance between positive and negative predictive values. The study has also offered a strong basis to conduct a further larger trial, providing information for sample size calculations and highlighting areas for methodological development.
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http://dx.doi.org/10.1136/bjsports-2014-093498DOI Listing
April 2015

Match injuries in English youth academy and schools rugby union: an epidemiological study.

Am J Sports Med 2013 Apr 4;41(4):749-55. Epub 2013 Feb 4.

Sport, Health and Exercise Science, University of Bath, Bath, BA2 7AY, UK.

Background: Numerous injury epidemiology studies have reported injury patterns in senior rugby union, but investigations in youth rugby are limited.

Purpose: To describe the nature of injuries resulting from match play within the English youth rugby union, including a comparison between 2 levels of play within the same age group: professional academy versus school rugby.

Study Design: Cohort study; Level of evidence, 2.

Methods: A 2-season (2006-2007 and 2007-2008) study obtained information on injuries sustained in male youth rugby union players (age, 16-18 years) from 12 English Premiership academies (n = 250) and 7 schools (n = 222). Match exposure (player-hours) and injury details were recorded.

Results: Match injury incidence was 47 per 1000 player-hours for the academy and 35 per 1000 player-hours for the school groups; these rates were statistically different (P = .026). The most common injury site was the lower limb and the most common injury type was a ligament sprain, with injuries to the knee and shoulder region resulting in the greatest burden of injury for both groups. The tackle event was the most common cause of match injury for both academy (51% of injuries) and school (57% of injuries) groups.

Conclusion: Overall, the incidence of injury for youth rugby was lower than for previous studies in senior rugby, but injury patterns (location, type) and causes were similar. The study confirmed that match injury incidence was significantly greater in elite academy youth rugby union than schools rugby. The results suggest that the specific focus for injury risk management in youth rugby should be on players' tackle technique and prevention strategies for knee and shoulder injuries.
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http://dx.doi.org/10.1177/0363546512473818DOI Listing
April 2013

Changes in the stature, body mass and age of English professional rugby players: a 10-year review.

J Sports Sci 2013 18;31(7):795-802. Epub 2012 Dec 18.

International Rugby Board, Dublin, Ireland.

The aim of the study was to evaluate changes in the stature, body mass, age and number of players by playing position in the first team squads of English Premiership rugby union teams from 2002 to 2011. Medical personnel at each club reported the individual data for every first team squad player. The average annual number of players included in the study was 485.2 players per season (standard deviation: 58.0). The mean stature of players in all positions increased in the period 2002 to 2011 but statistically significant trends (P < 0.01) were only observed at fly half and prop. While the mean body mass of players increased in most positions only fly half and back row players showed statistically significant (P < 0.01) upward trends. Apart from second row forwards, the average age of players in all positions decreased but this trend was only significant (P < 0.01) at prop. The numbers of registered players in every position increased but these trends were only significant (P < 0.01) at prop. English Premiership professional rugby players are generally getting taller, heavier and younger but statistically significant changes were limited to fly halves (taller and heavier), props (taller and younger) and back row forwards (heavier).
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http://dx.doi.org/10.1080/02640414.2012.753156DOI Listing
September 2013

Shoulder instability in professional rugby players-the significance of shoulder laxity.

Clin J Sport Med 2012 Sep;22(5):397-402

Graduate Institute of Coaching Science, National Taiwan Sport University, TaoYuan, Taiwan.

Objective: Shoulder instability is a common cause of morbidity among professional rugby union players. This study explores whether the risk of shoulder dislocation is associated with innate shoulder laxity.

Design: Retrospective cohort study.

Setting: Clinical sports medicine research at professional rugby clubs.

Participants: One hundred sixty-nine healthy rugby players (mean age 25.1 years) with no history of instability in either shoulder and 46 players (mean age 27.5 years) with shoulder instability in one shoulder (patient group).

Main Outcome Measures: Anterior, inferior, and posterior laxity was measured in both shoulders for healthy players and in the uninjured shoulder only for injured players using dynamic ultrasound.

Results: There was no significant difference between the nondominant (anterior: mean 2.9 ± 1.2 mm; inferior: mean 3.1 ± 1.0 mm; posterior: mean 5.1 ± 1.7 mm) and dominant (anterior: mean 3.1 ± 1.1 mm; inferior: mean 2.9 ± 1.0 mm; posterior: mean 4.9 ± 1.7 mm) shoulders in healthy players (P > 0.05). The comparison between healthy shoulders (anterior: mean 3.0 ± 1.2 mm; inferior: mean 3.0 ± 1.0 mm; posterior: mean 5.0 ± 1.7 mm) and the uninjured shoulder (anterior: mean 4.2 ± 1.7 mm; inferior: mean 3.4 ± 1.2 mm; posterior: mean 6.2 ± 3.0 mm) from injured players identified that players with unstable shoulders have a significantly higher shoulder translation in their uninjured shoulder than healthy players (P < 0.05).

Conclusions: Formal assessment of shoulder translation using dynamic ultrasound should enable sports medicine practitioners to identify players at greatest risk of subsequent shoulder instability for targeted prehabilitation programs.
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http://dx.doi.org/10.1097/JSM.0b013e31825b5d42DOI Listing
September 2012

The epidemiology of foot injuries in professional rugby union players.

Foot Ankle Surg 2011 Sep 5;17(3):113-8. Epub 2010 Mar 5.

Trauma & Orthopaedic Dept, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, UK.

Background: Foot injuries represent a small but important proportion of injuries to professional rugby union players. There are no detailed epidemiological studies regarding these injuries. The aim of this study was to describe the epidemiology of foot injuries sustained by a cohort of professional rugby union players and identify areas that may be targeted for injury prevention in the future.

Methods: Medical personnel prospectively recorded injuries in professional Premiership rugby union players in England over four seasons. Injuries to the foot were identified and the time away from training and playing was reported.

Results: A total of 147 foot injuries were sustained resulting in 3542 days of absence in total. Acute events accounted for 73% of all foot injuries, with chronic, mostly overuse conditions, accounting for 25% (undiagnosed 2%). Chronic conditions led to proportionately more time away from training and playing (p=<0.001). Specifically, stress fractures in the foot accounted for 8% of the total foot injuries but 22% of the absence. Navicular stress fractures had the longest recovery time with the mean return to training and match play of 188 days.

Conclusion: In collision sports such as rugby, some injuries may be inevitable but clinicians should always be seeking ways to minimise their occurrence and impact. This study revealed a high proportion of morbidity associated with chronic and overuse foot injuries in these professional athletes. With greater attention paid to risk factors, some of these injuries, and importantly, recurrent injuries may be avoided.
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http://dx.doi.org/10.1016/j.fas.2010.02.004DOI Listing
September 2011

The epidemiology of ankle injuries in professional rugby union players.

Am J Sports Med 2008 Dec 8;36(12):2415-24. Epub 2008 Sep 8.

University College Hospital, London, England, UK.

Background: Ankle injuries represent a considerable proportion of injuries to professional rugby union players; however, there is a scarcity of detailed epidemiology about these injuries.

Purpose: To describe the epidemiology and assess the risk factors associated with ankle injuries sustained by a cohort of professional rugby union players.

Study Design: Descriptive epidemiology study.

Method: Medical personnel prospectively reported time-loss injuries in professional rugby union in England, and the ankle injuries were evaluated.

Results: Lateral ankle ligament injuries were the most common injury reported during matches and training, and together with Achilles tendon injuries, they accounted for more than half of the absence due to injury. The incidence rate of injuries was highest in second-row forwards. More than a quarter of injuries were recurrences.

Conclusion: Lateral ankle ligament injuries and Achilles tendon injuries should be a focus of injury prevention, treatment, and rehabilitation strategies in professional rugby union players.
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http://dx.doi.org/10.1177/0363546508322889DOI Listing
December 2008

Injury risks associated with tackling in rugby union.

Br J Sports Med 2010 Feb 22;44(3):159-67. Epub 2008 Aug 22.

University of Nottingham, UK.

Objective: To examine factors associated with tackles in rugby union and to assess their impact on the risk of injury.

Design: Two-season (2003/2004 and 2005/2006) prospective cohort design with video analysis.

Setting: 13 English Premiership clubs.

Participants: 645 players.

Main Outcome Measure: RR (95% CI) calculated by comparing the frequency of occurrence of risk factors in a cohort of players injured during tackles with their frequency of occurrence in tackles in general play.

Risk Factors: Playing position; player's speed, impact force, head position, head/neck flexion and body region struck in the tackle; sequence, direction and type of tackle; and location and type of injury.

Results: High-speed going into the tackle, high impact force, collisions and contact with a player's head/neck were identified as significant (p<0.01) risk factors for ball carriers (BCs) and tacklers. Midfield backs were significantly (p<0.01) more prone to injury when tackling than other players. Relatively few tacklers were penalised by referees for collision tackles (general play: 2.0%; injured players: 3.3%) and tackles above the line of the shoulder (general play: 5.9%; injured players: 16.7%).

Conclusions: Advice in national and international injury prevention programmes for reducing the risk of injury in tackles is strongly supported by the results obtained from this study. These programmes should be reviewed, however, to provide specific advice for each type of tackle. Stricter implementation of the Laws of Rugby relating to collisions and tackles above the line of the shoulder may reduce the number of head/neck injuries sustained by BCs.
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February 2010
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