Tackling the tackle 1: A descriptive analysis of 14,679 tackles and risk factors for high tackles in a community-level male amateur rugby union competition during a lowered tackle height law variation trial.

OBJECTIVES: In rugby union (rugby), the tackle is the most frequent cause of concussion and thus a target for intervention to reduce concussion incidence. The aim of this study is to describe tackle characteristics and factors associated with illegal high tackles in amateur community-level rugby during a lowered (armpit level) tackle height law variation trial. DESIGN: Prospective observational cohort study. METHODS: Video surveillance of a single season, four-league competition with coding of video data according to a predefined coding framework. Descriptive statistics of tackle detail and logistic regression was performed to analyse factors associated with high tackles. RESULTS: One hundred and eight matches with 14,679 tackles and a mean of 137 (±30) tackles per match were analysed. High tackles (above armpit level) had significantly greater odds of occurring in the lower (2nd-4th) leagues (OR: 1.95; 95 % CI: 1.6-2.4; p < 0.001), front-on tackles (OR: 1.61; 95 % CI: 1.3-2.0; p < 0.001), arm tackles (OR: 1.65; 95 % CI: 1.3-2.1; p < 0.001), bent-at-waist ball carrier (OR: 1.93; 95 % CI: 1.6-2.4; p < 0.001), falling/diving ball carrier (OR: 2.21; 95 % CI: 1.6-3.1; p < 0.001), and an upright tackler (OR: 3.38; 95 % CI: 2.7-4.2; p < 0.001). A falling/diving tackler had significantly lower odds of being associated with a high tackle (OR: 0.44; 95 % CI: 0.3-0.6; p < 0.001). CONCLUSIONS: Overall mean tackles per match were similar to those of senior amateur and elite rugby. League, tackle type, tackle aspect, and player body positions were associated with high tackles. These findings reiterate the need for ongoing efforts to identify and implement mitigating strategies to reduce tackle-related injury risk.

A 6-year retrospective review of injuries sustained during the Singapore Cricket Club International Rugby Sevens tournament.

There are limited studies looking at injury statistics for Rugby Sevens. This study aims to assess injury patterns among amateur players participating in the annual Singapore Cricket Club Rugby Sevens International tournament from 2012 to 2017, by performing a retrospective review of their injury data. Outcome measures include injury incidence rate, injury site, and comparative injury incidence between successive days of competition. A total of 343 injuries were recorded over 6 tournaments, with an injury incidence of 348.0 per 1000 player hours. The lower limb was the most commonly injured site (45.8%), and there was greater incidence of injuries on day 3 of competition compared to day 1 in 2013 and 2016. This study reports a higher level of background risk to Rugby Sevens than is reported in literature. A well designed-prospective injury surveillance study will be necessary to confirm these findings and to investigate risk factors to guide injury prevention programmes.

Match Injuries in the Spanish Rugby Union Division de Honor.

OBJECTIVE: To describe the injury rate, severity, cause, anatomical location (tissue damaged), recurrence, place and time during matches throughout a season in the Spanish Rugby Union Division de Honor. METHODS: Observational, prospective and descriptive study conducted in the competition of the Spanish División de Honor de Rugby with 258 players. The data were reported by the medical services of the previously formed clubs. RESULTS: Total exposure was 4100 h, during which 220 injuries occurred. The average number of sick days was 36.8. The total injury rate was 53.6 injuries/1000 h of exposure. Three quarters suffered 93 injuries and the forwards sustained a total of 127 injuries, with a total of 48.6 and 58.1 injuries/1000 h of exposure, respectively. Moderate injuries were the most frequent. Specifically, ligament injury was the most frequent, and dislocation was the injury that caused the most sick days. The most injuries occurred in the third quarter of the match, and the most serious injuries occurred in the second quarter. CONCLUSIONS: The injury rate of Spanish rugby competitors is 53.6 injuries/1000 match hours, with an average of 36.8 sick days. Contact injuries are the most frequent, taking place especially when tackling or being tackled.

Genetics and Sport Injuries: New Perspectives for Athletic Excellence in an Italian Court of Rugby Union Players.

Several genes are involved in sport performance, especially in injuries incidence. The aim of this study was to investigate the association of ACE, ACTN3, COL1A1, and MCT1 genotypes and injuries in rugby players in order to find a genotype/phenotype correlation and provide useful information improving athletic performance. One-hundred male professional and semiprofessional rugby players were selected. Analysis was performed genotyping the genes ACE, ACTN3, COL1A1, and MCT1 as candidate gene of interest involved in athletic performance. A control group of non-athletic Italian male participants was analyzed to compare the results. We found statistical significance of MCT1 rs1049434 AA for total injuries (χ2 = 0.115; p = 0.003) and bone injuries (χ2 = 0.603; p = 0.007) in the rugby athlete population. No statistical significance was found between injury incidence and ACE, ACTN3, COL1A1 genotypes. The MCT1 AA genotype is associated with the incidence of total and bone injuries in the rugby player population. Although environmental factors such as lifestyle, diet, training, and stress can influence athletic performance, our data demonstrated the importance of genetic study in sport aimed at developing personalized training and achieving the best possible athletic excellence.

Concussion-Associated Polygenic Profiles of Elite Male Rugby Athletes.

Due to the high-velocity collision-based nature of elite rugby league and union, the risk of sustaining a concussion is high. Occurrence of and outcomes following a concussion are probably affected by the interaction of multiple genes in a polygenic manner. This study investigated whether suspected concussion-associated polygenic profiles of elite rugby athletes differed from non-athletes and between rugby union forwards and backs. We hypothesised that a total genotype score (TGS) using eight concussion-associated polymorphisms would be higher in elite rugby athletes than non-athletes, indicating selection for protection against incurring or suffering prolonged effects of, concussion in the relatively high-risk environment of competitive rugby. In addition, multifactor dimensionality reduction was used to identify genetic interactions. Contrary to our hypothesis, TGS did not differ between elite rugby athletes and non-athletes (p ≥ 0.065), nor between rugby union forwards and backs (p = 0.668). Accordingly, the TGS could not discriminate between elite rugby athletes and non-athletes (AUC ~0.5), suggesting that, for the eight polymorphisms investigated, elite rugby athletes do not have a more 'preferable' concussion-associated polygenic profile than non-athletes. However, the COMT (rs4680) and MAPT (rs10445337) GC allele combination was more common in rugby athletes (31.7%; p < 0.001) and rugby union athletes (31.8%; p < 0.001) than non-athletes (24.5%). Our results thus suggest a genetic interaction between COMT (rs4680) and MAPT (rs10445337) assists rugby athletes in achieving elite status. These findings need exploration vis-à-vis sport-related concussion injury data and could have implications for the management of inter-individual differences in concussion risk.

Neck strength and concussion prevalence in football and rugby athletes.

OBJECTIVES: To determine the maximal isometric neck strength of male and female rugby and football (soccer) athletes, and to investigate the relationship between neck strength and sport played, sex, age, anthropometric measurements and concussion history. DESIGN: Cross-sectional observational study. METHODS: In total, 358 (70% male) healthy football and rugby playing adolescents and adults participated. Isometric neck strength and anthropometry measurements were collected, as well as completion of a sociodemographic survey. The mean (standard deviation) of all measurements for each age group was calculated and compared between sports and sexes, with correlation analyses performed to determine associations between all variables. RESULTS: In general, rugby athletes had stronger neck musculature compared to football athletes, and males had stronger neck musculature compared to age-matched females, with these strength differences becoming increasingly significant with age (p < 0.05). The athletes with stronger neck muscles were older, taller, heavier, had higher bilateral grip strength and larger neck girth compared to those with weaker neck muscles (p < 0.05). Male rugby athletes who self-reported higher rates of a previous concussion had lower neck flexor/extensor strength ratio (p < 0.01). In 11-12-year-old male footballers, increased heading was associated with increased self-reported previous concussion (p < 0.01). CONCLUSIONS: These normative neck strength data can form important reference values for rugby and football athletes from adolescence into adulthood. Male rugby athletes with a previous history of concussion demonstrated strength imbalances of their neck musculature (lower flexor/extensor ratio), with this finding having potentially important implications for training protocols and injury prevention initiatives.

Protein S100B and Brain Lipid-Binding Protein Concentrations in the Serum of Recently Concussed Rugby Players.

The purpose of this study was to test the ability of serum protein S100B (S100B) and brain lipid-binding protein (BLBP) to identify athletes who sustained a sports-related concussion (SRC). Subjects included a non-athlete group, whereas the rugby players were separated into two match-control and two SRC groups. The match-control <1-h group included players undergoing venipuncture within 60-min post-match, and the match-control >1-h/<8-h group included players undergoing venipuncture between 1 and 8 h post-match; the SRC <1-h group included players undergoing venipuncture within 60-min post-SRC, and the SRC >1-h/<8-h group included players undergoing venipuncture between 1 and 8 h post-SRC. Serum S100B concentrations were not significantly different (p = 0.112) among protocols. Serum BLBP was greater in the match-control <1-h group (p < 0.001) and the SRC >1-h/<8-h group (p = 0.003) compared to the non-athlete group. The ability of serum BLBP to distinguish between SRC groups and the non-athlete group was shown to be good to excellent (AUROC, >0.8; p < 0.05), and between match-control groups and the non-athlete group were shown to be excellent (AUROC, >0.9; p < 0.05). Our results show that serum S100B is not useful in distinguishing concussed or post-match athletes from non-athletes. However, serum BLBP was shown to distinguish non-athletes from post-match or concussed athletes. Serum BLBP could not distinguish between athletes experiencing an SRC within 1 h of blood draw and those participating in a contact sport.

Seasonal Changes in Lumbar Multifidus Muscle in University Rugby Players.

PURPOSE: Although smaller lumbar multifidus muscle (LMM) was reported to be a strong predictor of lower limb injury (LLI) in Australian Football League players, LMM morphology has not been investigated in rugby athletes. This study examined seasonal changes in LMM in rugby players and whether LMM characteristics were associated with low back pain (LBP) and LLI. METHODS: Ultrasound examinations of the LMM were acquired in 21 university-level rugby players (12 women, 9 men) at preseason and end-season. LMM cross-sectional area (CSA), thickness at rest, and thickness during submaximal contraction (e.g., contralateral arm lift) measurements in prone and standing were obtained bilaterally at the L5-S1 level. The percent change in LMM thickness during contraction was calculated as follows: [(thicknesscontracted - thicknessrest)/thicknessrest × 100]. Self-reported questionnaires were used to acquire data on LBP and LLI. RESULTS: There was no significant difference in LMM characteristics between preseason and end-season measurements (P > 0.05). Preseason LMM CSA, side-to-side CSA asymmetry, and thickness at rest or during contraction were not associated with LBP or LLI. However, a lower percent thickness change in the standing position was significantly associated with having LBP during the preseason (P = 0.01) and playing season (P = 0.001), as well as LLI during the preseason (P = 0.03). CONCLUSIONS: This study provides preliminary evidence that LMM contractile ability and behavior during functional movement, such as standing, may have important implications for the susceptibility to injury among rugby athletes.

White Matter Abnormalities in Retired Professional Rugby League Players with a History of Concussion.

The topic of potential long-term neurological consequences from having multiple concussions during a career in collision sports is controversial. We sought to investigate white matter microstructure using diffusion tensor imaging (DTI) in retired professional Australian National Rugby League (NRL) players (n = 11) with a history of multiple self-reported concussions compared with age- and education-matched controls (n = 13) who have had no history of brain trauma. Diffusion-weighted images were acquired with a Siemens 3T scanner. All participants completed a clinical interview. There were no significant differences between groups on measures of depression, anxiety, stress, or post-concussion symptoms; however, NRL players scored significantly higher on the alcohol use disorder identification test (AUDIT). Voxelwise analyses of DTI measures were performed using tract-based spatial statistics (TBSS) with age and AUDIT scores included as covariates. TBSS revealed significantly reduced fractional anisotropy (FA), and increased radial diffusivity (RD), axial diffusivity (AD), and trace (TR) in white matter regions of recently retired NRL players compared with controls. FA was significantly reduced in the right superior longitudinal fasciculus and right corticospinal tract while TR, RD, and AD were increased in these regions, as well as the corpus callosum, forceps major, right uncinate fasciculus, and left corticospinal tract. In summary, DTI in a small cohort of recently retired professional NRL players with a history of multiple concussions showed differences in white matter microstructure compared with age- and education-matched controls with no history of brain trauma.

Lumbar Multifidus Muscle Characteristics, Body Composition, and Injury in University Rugby Players.

CONTEXT: A smaller lumbar multifidus (LM) muscle was reported to be a strong predictor of lower limb injury in professional Australian Football League players. However, despite the high prevalence of low back pain (LBP) and lower limb injury in rugby players, their LM characteristics have yet to be explored. OBJECTIVE: To (1) examine LM characteristics in male and female university rugby players and their possible associations with LBP and lower limb injury and (2) investigate the relationship between LM characteristics and body composition in this group of athletes. DESIGN: Cross-sectional study. SETTING: University research center. PATIENTS OR OTHER PARTICIPANTS: Thirty-four university rugby players (20 women, 14 men). MAIN OUTCOME MEASURE(S): Ultrasound measurements of LM cross-sectional area (CSA), thickness, and percentage change in thickness during contraction were obtained bilaterally, at the L5-S1 level, in prone and standing positions. Body composition measures were obtained using dual-energy x-ray absorptiometry. Self-reported questionnaires were used to obtain LBP and lower limb injury history. RESULTS: Players who reported LBP in the previous 3 months showed a smaller percentage change in thickness during contraction in the standing position (F = 5.21, P = .03). The LM CSA side-to-side asymmetry (right versus left) was greater in players who reported having a lower limb injury in the previous 12 months (F = 4.98, P = .03). The LM CSA was significantly associated with body composition measurements. A greater percentage change in thickness during contraction was significantly associated with a lower percentage of body fat. The LM echo intensity was strongly associated with the total percentage of body fat and was significantly greater in women. CONCLUSIONS: The influence of body composition on LM morphology in athletes cannot be ignored and warrants further investigation. Our findings also provide preliminary evidence of an association among LM morphology, LBP, and lower limb injury in university rugby players.

Use and perception of breast protective equipment by female contact football players.

OBJECTIVES: Female contact football players sustain contact breast injuries that can negatively affect their sporting performance. This study investigated what female contact football players wear on their breasts during training and competition, and their perceptions on the protection provided by these garments against contact breast injury. DESIGN: A custom-designed survey about breast injuries and prevention strategies was distributed via an online link to coaches and team staff of contact football teams throughout Australia. The fit and features of breast support and/or protection that players wore during training and competition were also directly assessed. METHODS: 207 female Australian Football League (AFL), Rugby League, Rugby Union (XVs) and Rugby 7s players completed the survey. The breast support of 112 of these players was also assessed. RESULTS: Only 17% (n=35) of players reported using breast protective equipment, of which 66% (n=23) perceived it provided protection against contact breast injuries. Reasons reported for not using protective equipment included not knowing it existed (n=79, 53%), it was too uncomfortable/hot (n=50, 24%) and that it did not fit or was restrictive (n=33, 22%). Although most players (n=97, 87%) reported to wear a sports bra, 52% (n=58) wore an ill-fitted bra and only 31% (n=63) perceived it provided any protection against contact breast injuries. CONCLUSIONS: Breast protective equipment is not commonly worn by female contact football players reportedly due to a lack of awareness of its existence, discomfort or poor fit. Although most female contact football players usually wore a sports bra, most players perceived these bras did not provide breast protection.