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ObjectiveTo establish match injury rates and patterns in elite female rugby union players in England.MethodWe conducted a six-season (2011/2012–2013/2014 and 2017/2018–2019/2020) prospective cohort study of time-loss match injuries in elite-level female players in the English Premiership competition. A 24-hour time-loss definition was used.ResultsFive-hundred and thirty-four time-loss injuries were recorded during 13 680 hours of match exposure. Injury incidence was 39 injuries per 1000 hours (95% CIs 36 to 42) with a mean severity of 48 days (95% CIs 42 to 54) and median severity of 20 days (IQR: 7–57). Concussion was the most common specific injury diagnosis (five concussions per 1000 hours, 95% CIs 4 to 6). The tackle event was associated with the greatest burden of injury (615 days absence per 1000 hours 95% CIs 340 to 1112), with ‘being tackled’ specifically causing the most injuries (28% of all injuries) and concussions (22% of all concussions).ConclusionsThis is the first multiple-season study of match injuries in elite women’s rugby union players. Match injury incidence was similar to that previously reported within international women’s rugby union. Injury prevention strategies centred on the tackle would focus on high-burden injuries, which are associated with substantial player time-loss and financial costs to teams as well as the high-priority area of concussions.

Background/aimConcussion, the most common injury in professional rugby union, occurs most commonly during the tackle. Thus, we investigated the association between tackle characteristics and concussion.Methods182 video clips of tackles leading to clinically diagnosed concussion and 4619 tackles that did not were coded across three professional rugby union competitions. A variable selection process was undertaken to identify the most important variables for interpretation. A multivariate generalised linear model was used to model the association between retained variables and concussion risk. Magnitude-based inferences provided an interpretation of the real-world relevance of the outcomes.ResultsThe four retained variables were: accelerating player, tackler speed, head contact type and tackle type. Overall, 70% of concussions occurred to the tackler and 30% to the ball carrier. There was a higher risk of concussion if the tackler accelerated into the tackle (OR: 2.49, 95% CI 1.70 to 3.64) or the tackler was moving at high speed (OR: 2.64, 95% CI 1.92 to 3.63). Head contact with the opposing player’s head (OR: 39.9, 95% CI 22.2 to 71.1) resulted in a substantially greater risk of concussion compared with all other head contact locations.ConclusionsInterventions that reduce the speed and acceleration of the tackler and reduce exposure to head-to-head contact would likely reduce concussion risk in professional rugby union.

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.

We read with great interest the recent letter, “Time to bin the term ‘overuse’ injury: is ‘training load error’ a more accurate term?”1 and in particular its associated PostScript correspondence, “Are rolling averages a good way to assess training load for injury prevention?”2 We are currently investigating the association between training loads and injury risk,3 and so we have also been considering the best way to model this relationship. We share Dr Menaspa's concerns regarding the use of rolling averages for the calculation of ‘acute’ and ‘chronic’ loads. Namely, that they fail to account for the decaying nature of fitness and …

Background Player welfare concerns have been raised by a number of professional Rugby Union stakeholders regarding the match exposure demands faced by players. Objective To investigate the influence that acute and chronic match exposures have upon injury risk. Design A seven-season (2006/7–2012/13) prospective cohort design was used to record time-loss injuries (>24 h) and match exposure. Setting English Premiership Professional Rugby Union. Participants 1253 professional players. Assessment of Risk Factors A player9s 12-month match exposure (number of matches a player was involved in for ≥20 mins in the preceding 12 months) and month match exposure (number of full-game equivalent matches in preceding 30 days) were assessed as ‘chronic’ and ‘acute’ risk factors, respectively. Main Outcome Measurements A nested-frailty model was applied to calculate adjusted hazard ratios (HR) for the assessed risk factors. Thresholds for beneficial and harmful effects were 0.90 and 1.11, respectively. Results 12-month match exposure was associated with injury in a non-linear fashion, with players who had been involved in less than ≈15 or greater than ≈35 matches (for ≥20 mins) over the preceding 12-month period being more susceptible to injury. Monthly match exposure was linearly associated with injury (HR: 1.14 per 2-SD increase, 90% CI: 1.08–1.20; likely harmful), although this effect was substantially attenuated for players in the upper quartile for 12-month match exposure (>28 matches). Conclusions A player9s accumulated and recent match exposure substantially influences their current injury risk. Careful attention should be paid to planning the workload and monitoring the responses of players involved in: 1) a high number of matches in the previous year; 2) a low number of matches in the previous year; 3) a low-moderate number of matches in the previous year but have played intensively in the recent past. These findings could inform match workload planning in professional Rugby Union.

Background Structured pre-activity exercise programmes have demonstrated injury prevention in a variety of settings, but their efficacy is largely unknown in contact-orientated sports. Objective To assess the efficacy of a pre-activity movement control exercise programme to reduce injury risk in youth rugby when compared with a standardised exercise programme. Design Single-blind cluster-randomised controlled trial. Setting Independent schools within England during the 2015/16 playing season. Participants Schools with onsite medical provision were eligible to participate in this trial. 31 schools (intervention, 17 schools, 1,325 players; control, 14 schools, 1,127 players) completed the trial. Interventions Both programmes were completed for 15–20 minutes prior to main sessions, with team coaches acting as delivery agents. The intervention programme combined progressive proprioceptive, resistance, and plyometric activities. The standardised programme combined dynamic stretching, wrestling-based and speed-based activities. Main Outcome Measures Trial-arm comparisons were made across summary measures of time-loss (>24 hours) injuries, with effects analysed through magnitude-based inference against thresholds for the smallest worthwhile effects (RR=0.90 & 1.11). Results 441 time-loss injuries (intervention, 233; control, 208) were reported across 15,953 match exposure-hours (intervention, 9,083 hours; control, 6,870 hours). Intention-to-treat analyses revealed a 15% reduction in overall match injury incidence favouring the intervention (relative risk=0.85, 90% CI 0.61–1.17, unclear effect), whilst reductions were also identified in match concussion incidence (RR=0.71, 0.48–1.05, likely beneficial effect). Per-protocol analyses revealed that completing the intervention programme compared with the control programme an average of 2x/week was associated with a further reduction in overall match injury incidence (RR=0.73, 0.45–1.20, unclear effect), whilst an average use of 3x/week halved overall match injury incidence (RR=0.50, 0.22–1.13, likely beneficial effect). Conclusions This study presents encouraging evidence that using a preventive exercise programme 2–3x/week prior to training and matches can reduce injury risk in youth rugby when compared with a standardised programme.

Background Match and training demands differ between seven and fifteen-a-side rugby. The association between training load and injury risk has not been examined in elite Rugby Sevens. Objective To explore the association between training load measures and injury risk in elite Rugby Sevens players. Design Two-season (2014/15 and 2015/16) prospective cohort study. Setting The England men9s Rugby Sevens squad. Participants 42 players (31 players followed over one-season, 11 players over two-seasons). Assessment of Risk Factors Training loads were recorded for all sessions using the session-Rating of Perceived Exertion method. A generalised linear mixed effects model examined the association between training load measures and injury risk in the subsequent week. The acute:chronic workload variable (one-week load divided by four-week average load) was parsed into tertiles: low= 1.45. Main Outcome Measurements Injury and the relative risk (RR) associated with increases in training load measures. Results 152 training and 30 match injuries were recorded. The incidence rate was 91/1000 player-match-hours (90% CI: 68–123) and 14/1000 player-training-hours (90% CI: 12–16). Mean severity (day9s absence) of injuries was 31 days during matches and 21 days during training. There was a substantial interaction between four-week cumulative load and acute:chronic workloads, such that typically high versus typically low four-week cumulative loads (i.e., a 7140 AU difference) coupled with high acute:chronic workloads were clearly associated with injury risk (RR: 2.08, 90% CI 1.17–3.68). This effect was unclear in the low (RR: 1.02, 90% CI: 0.62–1.68) and medium (RR: 1.44, 90% CI: 0.81–2.55) acute:chronic workload ranges. Conclusions The injury incidence rate in elite Rugby Sevens training is substantially higher than in the 15-a-side game. The coupling of high cumulative loads with high acute:chronic workloads was associated with an increased injury risk, therefore practitioners should avoid high acute:chronic workloads during periods of high cumulative load.

Background Approximately 25% of Rugby Union injuries occur to players executing a tackle and they mostly involve upper-body regions. Objective To investigate how upper-body biomechanical loading changes depending on the tackle characteristics, such as side of body used and direction of approach. Design A repeated-measures study where a group of Rugby Union players performed full tackling trials against a bespoke tackle simulator. Two conditions (both within-group factors) were analysed: laterality (left/right shoulder) and direction (front/diagonal/lateral) of the tackler9s approach. Setting A laboratory-based study. Patients (or Participants) Six male players (26.7±7.6 years, 1.82±0.09 m, 95.7±14.0 kg), all right-side dominant. Interventions (or Assessment of Risk Factors) Participants completed up to 2 dynamic tackles in each of the 6 testing conditions. A 40 kg punch-bag was accelerated manually to simulate the ball carrier and the tackler executed a full tackling movement bringing the punch-bag to the ground. Main Outcome Measurements Peak shoulder impact forces and head linear accelerations were measured through pressure sensors and inertial measurement units. Linear mixed models and magnitude-based inferences were used to assess differences between conditions. Results Dominant (right) shoulder tackles in the frontal direction generated the highest impact forces (5.3±1.0 kN), and overall they were substantially higher (by 15%) than non-dominant (left) shoulder tackles. Impact load decreased going from frontal to diagonal −3%) and lateral tackling (−10%). The lowest peak head accelerations (substantially lower [−5%] compared to frontal tackles) were recorded during diagonal tackles, with the right shoulder (9.1±3.5 g). Conclusions Both laterality (dominant side) and tackle direction have a substantial effect on the loads applied to the upper-body. Where feasible, the tackler should approach from a slightly offset angle from frontal and coaching should aim to reduce the deficiencies in tackling technique on the non-dominant side.

Background Injury risk in youth rugby is perceived as high when compared with other youth sports, and has become a notable public health topic. Objective To investigate the incidence and nature of match-related injuries sustained in youth rugby union. Design Two-season prospective cohort study. Setting Independent schools within England during 2013/14 and 2015/16 playing seasons. Participants Eligible schools had onsite medical personnel for injury treatment and data capture. All male players within the under-15 to under-18 age groups of included schools were eligible to participate. In total, 3,179 rugby players (aged 14–18 years) from 40 schools participated. Main Outcome Measures Time-loss (>24 hours) match injury incidence (per 1000 match hours) and burden (days lost per 1000 match hours), classifications made on injury location, severity, and inciting event. Results 598 time-loss injuries were reported from 21,865 match exposure-hours, giving an overall match injury incidence of 27 injuries/1000 match-hours (90% CI 26 to 29) and burden of 731 days lost/1000 match-hours (90% CI 721 to 740). The head was the most frequently injured location (31% of injuries), followed by the shoulder (14%), wrist/hand (12%), and knee (8%). Moderate time-loss injuries (8–28 days) were the most commonly reported (38%), followed by minor injuries (2–7 days, 33%), whilst over a quarter of injuries were severe (>28 days, 27%). Most injuries were associated with contact events (88%), particularly the tackle (58%) and ruck (14%), with 8% associated with running. Concussion incidence was 6/1000 match-hours (90% CI 5 to 7). Conclusions Match injury incidence was similar to figures reported in recent studies, whilst injury burden and the proportion of severe injuries were lower than previously reported. Implications of this study9s findings would include focusing further on identifying risk factors and preventive strategies for tackle-related injuries as well as for head injuries, particularly concussion, in youth rugby.