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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 Epidemiology studies from 2002 to 2011 reported a stable concussion incidence in professional Rugby Union. From 2011, multiple player welfare initiatives have been introduced to increase the awareness, identification and management of concussion. Objective To investigate the incidence of reported concussion and players9 time to return to play following match concussions in professional Rugby Union. Design In a five-season (2011–2016) prospective cohort study, match concussions and the time taken for players to return to play were recorded. The seasonal incidences of concussion were calculated alongside all injury incidence and contact injury incidence (both excluding concussion) and mean player body mass and height. Setting English Premiership Professional Rugby Union. Participants 788 players. Independent Variables Player match exposure (hours). Main Outcome Measurement Match injury incidence (concussion and all injuries) was calculated as injuries/1000 player-hours with 95% confidence intervals (CI). Results Mean incidence of time-loss match concussions over the period was 10.4 (95% CI: 9.4–11.5). The incidence increased year-on-year: 2011–12, 5.1 (95% CI: 3.8–6.9); 2012–13, 6.7 (95% CI: 5.1–8.7); 2013–14, 10.5 (95% CI: 8.5–13.0); 2014–15, 13.4 (95% CI: 11.1–16.2); 2015–16, 15.9 (95% CI 13.2–19.1). This rise occurred in the absence of any significant change in the incidence of all time-loss injuries, contact time-loss injuries and player size. Conclusions Since 2011, the reported incidence of concussion in professional Rugby Union has risen season-by-season, highlighting the need for a focused injury prevention strategy. It is not possible to separate the effect of an improvement in reporting practice from an inherent increased risk of concussion, but the stable incidence of other time-loss injuries and player size over the same period suggests that changes in reporting behaviour, a lowering of the diagnostic threshold and increased awareness have all had a major influence on the reporting of concussion in recent years.

Objective To assess and evaluate injuries sustained during the 2010 Women9s Rugby World Cup. Design Prospective, cohort. Participants 285 women rugby players. Results Incidence of match injury was 35.5/1000 player-hours; mean severity was 55.0 days and median severity 9 days. Only one training injury was reported. Knee-ligament injuries were the most common (15%) and resulted in most days lost (43%). The tackle was the cause of most injuries. Conclusions The risk of injury in international rugby is significantly lower for women than for men. Further research is required to assess knee-ligament injuries in women9s rugby.

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.

Objectives:Evaluate the advantages and disadvantages of Evicel fibrin sealant when used in thyroid surgery closure, taking into account the following endpoints: postoperative drain output, time to drain removal, length of admission, and adverse events.Methods:From June 2010 to January 2014, an institutional review board–approved prospective, randomized, double-blind study of Evicel versus a saline control was conducted on 70 subjects receiving total thyroidectomy or hemithyroidectomy. Twenty-eight received Evicel and 27 received saline; data from 15 subjects were eliminated due to protocol violations. The mean age was 50.3 (range, 21 to 73).Results:Comparisons of baseline characteristics, including age, sex, and type of surgery, revealed successful subject randomization. There was no significant difference in drain output between Evicel (median [interquartile range]: 96.3 mL [73.3-139.3 mL]) and placebo (120.0 mL [68.8-161.5 mL], P = .334). Drain time (37.9 hours [25.2-48.7 hours] vs 43.6 hours [37.6-58.1...

To determine the incidence, nature and causes of concussions sustained during men's elite professional Rugby-7s and Rugby-15s.A prospective cohort study recording injuries classified as a time-loss concussion.Players competing in the following tournaments: Rugby 15s-English Premiership (2007/2008 to 2010/2011), Rugby World Cup (2007, 2011), Pacific Nations Cup (2012, 2013), Junior World Championship (2008, 2010-2013), Junior World Rugby Trophy (2008, 2010-2013); Rugby 7s-Sevens World Series (2008/2009, 2010/2011 to 2012/2013).The study was implemented according to the international consensus statement for epidemiological studies in rugby union; the main outcome measures included the number, incidence (number of concussions/1000 player-match-hours), mean and median severity (days absence) and cause of concussion.The incidence of concussion in Rugby-7s was significantly higher than that in Rugby-15s (risk ratio=1.84; p0.001). The severity of concussions were significantly higher in Rugby-7s than Rugby-15s (mean-Rugby-7s: 19.2, Rugby-15s: 10.1; median-Rugby 7s: 20, Rugby-15s: 7; p0.001). The main causes of concussion were tackling (44.1%) in Rugby-7s and collisions (43.6%) in Rugby-15s. Significantly more (risk ratio=1.49; p=0.004) concussed players were removed immediately from the game in Rugby-7s (69.7%) compared to Rugby-15s (46.7%).Six actions were identified to improve the management of concussion in rugby: implement a pitch-side concussion assessment protocol; improve compliance with return-to-play protocols; work with referees to review the nature and consequences of collisions; improve players' tackle technique; investigate the forces involved in tackles and collisions; and evaluate reasons for the higher incidence of concussions in Rugby-7s.

The aim of this study was to assess whether differences in competing teams’ body mass and playing performance affected the risk of injury in rugby union. The study was a prospective, whole population survey of players representing all countries competing at the Rugby World Cup in 2007. The study design followed the consensus statement for epidemiological studies in rugby with the main outcome measures being the incidence and severity of match injuries. Differences in players’ average body mass and mismatches in the teams’ overall and match performances did not create greater risks of injury for the lighter or less successful teams competing at Rugby World Cup 2007.

A theoretical model, which describes continuous improvement and benchmarking processes, was developed. The model was based on the concepts that improvements in management inputs should produce organizational benefits and that management inputs are limited by budget constraints. The model was developed using health and safety as an example of operational management issues. In this example, organizational benefits related to reductions in the number and costs of accidents and management inputs referred to the provision and costs of accident prevention control measures. The utility of the model was demonstrated with five health and safety scenarios, which tested the model against the continuous improvement philosophy and benchmarking with respect to reducing costs, improving performance, minimising organizational change and assessing performance within different work environments.

A case study is described in which an audit programme was developed as a measure of health and safety performance. The audit programme was implemented as a safety competition in a UK water utility over a period of three years with the results also used for benchmarking the company’s health and safety management system. The audit programme, which was based on the Health and Safety Executive’s guidance for effective health and safety management, was used to assess; how well health and safety management was understood; how well health and safety procedures were implemented; and accident frequency rates within the company. An important aspect of the audit programme was the inclusion of managers, supervisors, operators and examples of all operational activities in the assessment process. Weaknesses in the company’s health and safety management performance, which were identified in the benchmarking exercise, are discussed.

This paper reports an employee‐management consensus approach for identifying safety initiatives that are both appropriate to the working environment and also perceived to be appropriate by the workforce. Issues affecting the success of employee involvement schemes are discussed and the methods used during the implementation stages of the programme to address them are described. The case study was set in the UK distribution division of an international oil company and was applied to safety issues affecting the division’s tanker drivers. The study used an employee questionnaire to assess drivers’ perceptions of safety management, workplace conditions and safety concerns. Factor analysis and structural equation modelling were used to develop a management/workplace/workforce model to describe the drivers’ working environment. The model was then used to discuss and explain the drivers’ choices of safety initiatives.

Professional football clubs have a duty under UK health and safety legislation to carry out risk assessments of their activities; one requirement under this duty is to assess the impact of ground layout on player safety. To assist clubs in meeting this requirement, a Ground Player-safety Score (GPS) has been developed that is defined by a base-factor, determined from the position of perimeter fencing in relation to the pitch, but which is degraded when other hazards, e.g. advertising hoardings, photographers and TV equipment, are present in the areas contiguous with the playing area. This approach has been used to assess the layouts of forty seven English and Scottish professional football clubs. The assessment showed that only 42% of the English and 71% of the Scottish clubs achieved an acceptable score. However, in all but a few cases the clubs could modify their ground layout to improve the GPS and reduce risks to players without capital expenditure. With these changes, acceptable GPS figures could be achieved by 92% of the English and by 100% of the Scottish clubs.

Objective To summarize the literature published to date on the use of radiofrequency ablation (RFA) in the treatment of benign thyroid nodules, to evaluate the effectiveness of this treatment, and to attempt an evaluation of factors that may influence treatment outcome. Study Design Systematic review with meta-analysis. Methods Systematic literature search was performed by two separate authors in four commonly used literature databases. Trials included in meta-analysis included only those presenting prospective data. Meta-analysis compared pretreatment values to post-treatment outcomes. Results Of 46 full-text articles identified, nine articles satisfied inclusion criteria. Two of these articles were randomized controlled trials comparing RFA to placebo or to some other treatment. One article was a randomized controlled trial comparing one RFA treatment to two treatments. The remaining six articles were noncontrolled, prospective observational studies. All analyzed outcomes showed statistically significant improvements from baseline to final follow-up, including reduction in nodule size, improvement of symptom and cosmetic scores, and withdrawal from methimazole. Improvement in nodule size remained significant in both “hot” and “cold” nodule subgroups. Twelve adverse events were identified across all studies out of 306 total treatments. Two of these events qualified as significant adverse events. None of these events resulted in hospitalization or death. Conclusions Radiofrequency ablation is a safe and effective treatment for symptomatic thyroid nodules that are confirmed benign. However, the paucity of level 1 evidence comparing RFA to surgical or to other nonsurgical treatment modalities is concerning. Level of Evidence NA Laryngoscope, 124:346–353, 2014

Background. Describing the frequency, severity, and causes of sports injuries and illnesses reliably is important for quantifying the risk to athletes and providing direction for prevention initiatives.Methods. Time-loss and/or medical-attention definitions have long been used in sports injury/illness epidemiology research, but the limitations to these definitions mean that some events are incorrectly classified or omitted completely, where athletes continue to train and compete at high levels but experience restrictions in their performance. Introducing a graded definition of performance-restriction may provide a solution to this issue.Results. Results from the Great Britain injury/illness performance project (IIPP) are presented using a performance-restriction adaptation of the accepted surveillance consensus methodologies. The IIPP involved 322 Olympic athletes (males: 172; female: 150) from 10 Great Britain Olympic sports between September 2009 and August 2012. Of all injuries (n=565), 216 were classified as causing time-loss, 346 as causing performance-restriction, and 3 were unclassified. For athlete illnesses (n=378), the majority (P<0.01) resulted in time-loss (270) compared with performance-restriction (101) (7 unclassified).Conclusions. Successful implementation of prevention strategies relies on the correct characterisation of injury/illness risk factors. Including a performance-restriction classification could provide a deeper understanding of injuries/illnesses and better informed prevention initiatives.

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 (P0.01) 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 (P0.01) upward trends. Apart from second row forwards, the average age of players in all positions decreased but this trend was only significant (P0.01) at prop. The numbers of registered players in every position increased but these trends were only significant (P0.01) 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).

Objective To determine the frequency and nature of injuries sustained during the IRB 2011 Rugby World Cup. Design A prospective, whole population survey. Population 615 international rugby players representing 20 teams competing at the IRB 2011 Rugby World Cup in New Zealand. Method The study was implemented according to the international consensus statement for epidemiological studies in rugby union; the main measures included the players9 age (years), stature (cm) and body mass (Kg) and the incidence (number of injuries/1000 player-hours), mean and median severity (days absence), location (%), type (%) and cause (%) of match and training injuries. Results The incidences of injuries were 89.1/1000 player-match-hours (forwards: 85.0; backs: 93.8) and 2.2/1000 player-training-hours (forwards: 2.7; backs: 1.7). The mean severity of injuries was 23.6 days (forwards: 21.2; backs: 26.2) during matches and 26.9 (forwards: 33.4; backs: 14.3) during training. During matches, lower-limb muscle/tendon (31.6%) and ligament (15.8%) and, during training, lower-limb muscle/tendon (51.4%) and trunk muscle/tendon (11.4%) injuries were the most common injuries. The most common cause of injury during matches was the tackle (forwards: 43.6%, backs: 45.2%), and during training was full and semicontact skills activities. Conclusion The results confirm that rugby, like other full-contact sports, has a high incidence of injury: the results from IRB Rugby World Cup (RWC) 2011 were similar to those reported for RWC 2007.

Background Sport and exercise have long-term health benefits, but there is also a risk that participants will sustain injuries and/or ill health from these activities. For this reason, international sports governing bodies have a responsibility to identify the risks that exist within their sport and to provide guidance to participants and other stakeholders on how these risks can be controlled within acceptable levels. Purpose To demonstrate how Federation Internationale de Football Association (FIFA), as football9s governing body, uses a risk management framework to identify, quantify, mitigate and communicate the risks of injury and ill health in football for men, women and children in all environments. Method All the research papers published by FIFA9s Medical Assessment and Research Centre (F-MARC) during the period 1994 to 2011 were reviewed and categorised according to an established sport-related risk management framework. Conclusions F-MARC investigated and mitigated 17 areas of risk to footballers9 health in a coherent and consistent approach through the process of risk management.

Objectives To investigate whether higher presence of the palmaris longus muscle is associated with sports that require hand grip. Design Cross-sectional study. Participants Six hundred and forty-two medical students, members of sports clubs and national athletes. Methods Participants were invited to complete a questionnaire that assessed their main sport, elite or non-elite level of participation, and level of activity. The presence of the palmaris longus was assessed visually using a standardised test. Main outcome measures Presence of the palmaris longus, type of hand grip required for the sport and the level of participation. Results The presence of the palmaris longus was higher in elite athletes (21/22, 96%) than non-elite athletes (66/84, 79%; P = 0.066) for sports that require a dominant-handed or two-handed cylindrical grip (18/22, 82% and 19/35, 54%, respectively; P = 0.034). For both elite and non-elite athletes, the presence of the palmaris longus was higher in those participating in sustained grip sports (325/387, 84%) compared with sports that do not require a sustained grip (150/197, 76%; P = 0.012). Conclusions The palmaris longus may provide an advantage in certain types of sport that require hand grip, and for elite athletes participating in sports that require a dominant-handed or two-handed cylindrical hand grip. Orthopaedic specialists considering the use of the palmaris longus for a grafting procedure on an athlete should consider the level of participation and the type of hand grip required in the athlete's sport.

Objectives To develop, implement and assess an interactive, football-based health education programme for children in South Africa. Design Prospective cohort study with control group. Setting Two schools in Khayelitsha township, South Africa. Participants 370 children making up two intervention groups (Grade 6: 125; Grade 7: 131) and one control group (Grade 7: 114). Intervention Eleven 90 min sessions, each divided into two 45 min halves of Play Football (football skills) and Play Fair (health issues), each session focused on one specific health risk factor. Main outcome measures Health knowledge using a 20-item questionnaire; coaches' attitudes towards their training programme using a 10-item questionnaire and children's attitudes towards the health education programme using a six-item questionnaire. Results Children in the Grade 7 intervention group showed significant (p

The aim of this study was to compare the incidence, nature, and cause of injuries sustained in rugby union played on artificial turf and grass. The study comprised a two-season investigation of match injuries sustained by six teams competing in Hong Kong's Division 1 and training injuries sustained by two teams in the English Premiership. Injury definitions and recording procedures were compliant with the international consensus statement on epidemiological studies of injuries in rugby union. There were no significant differences in the overall incidence (rate ratio = 1.42; P = 0.134) or severity (P = 0.620) of match injuries sustained on the two surfaces. The lower limb and joint (non-bone)/ligament injuries were the most common location and type of match injury on both surfaces; the incidence of anterior cruciate ligament injuries was nearly four times higher on artificial turf than grass but the difference was not statistically significant (rate ratio = 3.82; P = 0.222). There were no significant differences in the overall incidence (rate ratio = 1.36; P = 0.204) or severity (P = 0.302) of training injuries sustained on artificial turf and grass. The lower limb and muscle/tendon injuries were the most common location and type of training injury on both surfaces. The results indicate that the overall risks of injury on artificial turf are not significantly different from those experienced on grass; however, the difference in the incidence of anterior cruciate ligament injuries on the two surfaces is worthy of further study.

Background: The reported incidence, severity and nature of injuries sustained in tennis vary considerably between studies. While some of these variations can be explained by differences in sample populations and conditions, the main reasons are related to differences in definitions and methodologies employed in the studies. Objective: This statement aims to review existing consensus statements for injury surveillance in other sports in order to establish definitions, methods and reporting procedures that are applicable to the specific requirements of tennis. Design: The International Tennis Federation facilitated a meeting of 11 experts from seven countries representing a range of tennis stakeholders. Using a mixed methods consensus approach, key issues related to definitions, methodology and implementation were discussed and voted on by the group during a structured 1-day meeting. Following this meeting, two members of the group collaborated to produce a draft statement, based on the group discussions and voting outcomes. Three revisions were prepared and circulated for comment before the final consensus statement was produced. Results: A definition of medical conditions (injuries and illnesses) that should be recorded in tennis epidemiological studies and criteria for recording the severity and nature of these conditions are proposed. Suggestions are made for recording players’ baseline information together with recommendations on how medical conditions sustained during match play and training should be reported. Conclusions: The definitions and methodology proposed for recording injuries and illnesses sustained during tennis activities will lead to more consistent and comparable data being collected. The surveillance procedures presented here may also be applicable to other racket sports.

To examine factors associated with tackles in rugby union and to assess their impact on the risk of injury.Two-season (2003/2004 and 2005/2006) prospective cohort design with video analysis.13 English Premiership clubs.645 players.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.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.High-speed going into the tackle, high impact force, collisions and contact with a player's head/neck were identified as significant (p0.01) risk factors for ball carriers (BCs) and tacklers. Midfield backs were significantly (p0.01) 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%).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.

Objectives: To determine acceptable levels of risk in sport and to compare these with values used in occupational settings. Design: Cross-sectional, questionnaire-based study. Settings: Seven soccer and 11 rugby union teams. Subjects: 140 male athletes and 108 male and 100 female spectators associated with soccer and rugby union teams. Main outcomes: Views on acceptable frequencies with which athletes sustain acute injuries of various levels of severity. Results: The responses of athletes and spectators were similar, although spectators consistently indicated a higher acceptable frequency of injury than athletes. There were no significant differences in responses as a function of respondents’ gender and age. The results confirmed an inverse relationship between the acceptable frequency of occurrence and the severity of injury, although the relationships identified by the risk-averse and risk-taking minorities within the sample population were widely different. Conclusion: The mean frequency–severity risk relationship identified by athletes and spectators in soccer and rugby was similar to the relationship routinely used for risk assessments in industry and commerce.

A prospective cohort study was used to assess the influence of training volume on injuries sustained by 502 professional rugby union players in England. Training volumes (excluding warm-ups, cool-downs, and recovery sessions), player injuries, and player match exposure times were reported weekly. Higher training volumes (9.1 hours per week) did not increase the incidence of match or training injuries. However, higher training volumes did increase the severity of match injuries, particularly during the second half, and consequently resulted in a significant increase in the number of days' absence due to match injuries. Although lower-limb injuries were the most common match and training injuries, shoulder dislocations/instabilities resulted in more days' absence during weeks of higher training volumes, but the differences were not significant. The least number of days lost due to injuries occurred during weeks of intermediate training volumes (6.2-9.1 h per week). Training volume was not correlated with final league position. Fitness testing, defence, and rucking and mauling components were identified as being very high- or high-risk training activities. Our results provide evidence of the benefits of modifying the volume and content of rugby union training to reduce the risk associated with injuries to professional players.

Objective: to determine the incidence, nature and causes of injuries sustained during the International Rugby Board (IRB) Rugby World Cup 2007. Design: Pospective, whole-population survey. Population: 626 international rugby players representing 20 teams competing at the IRB Rugby World Cup 2007 in France. Methods: The survey followed the international consensus procedures for studies of injuries in rugby union; the main outcome measures were incidence of match and training injuries (number of injuries/1000 player hours), severity (days absence), location, type and cause of injury. Results: the incidence of injuries was 83.9/1000 player-match hours (forwards 84.0; backs 83.7) and 3.5/1000 player-training hours (forwards 3.5; backs 3.6). The average severity of injuries was 14.7 days (forwards 14.0; backs 15.5) during matches and 17.8 (forwards 15.9; backs 19.8) during training. Lower limb muscle and ligament injuries were the main injuries during both matches and training. Most injuries were sustained in the tackle during matches and in full-contact skills activities during training. Conclusions: This study shows the application of the methodology described in the international consensus statement on injury surveillance studies in rugby union and provides benchmark values for the incidence, severity, nature and causes of match and training injuries sustained during the IRB Rugby World Cup.

Background: Analyses of tackle parameters in injury situations have provided valuable information regarding men’s football. However, there are no similar data for women’s football. Objective: To categorise the tackle mechanisms leading to injury in elite women’s football. Study design: Retrospective video analysis of injury situations. Methods: Events associated with all reported injuries during six women’s top-level tournaments were analysed on video recordings for tackle parameters. Results: More than half of all injuries were due to tackles from the side (52%, 103/200), whereas tackles from behind were much less commonly involved in injury situations (11%, 21/200). One-footed (65%, 130/200) and upper body (21%, 42/200) tackle actions were most common. Sliding-in tackles leading to injury were the least likely to be sanctioned by match referees. Tackling players (45%, 90/200) were almost as likely to be injured as the tackled player (55%). Conclusion: The present study found differences between injury mechanisms in women’s football and previously published data on men’s football. Further research, especially using video analysis, is needed for a better understanding of risk situations in football.

Several tools have been used for assessing risk situations and for gathering tackle information from international football matches for men but not for women.To analyse activities in women's football and to identify the characteristics and risk potentials of tackles.Retrospective video analysis.Video recordings of 24 representative matches from six women's top-level tournaments were analysed for tackle parameters and their risk potential.3531 tackles were recorded. Tackles in which the tackling player came from the side and stayed on her feet accounted for nearly half of all challenges for the ball in which body contact occurred. 2.7% of all tackles were classified as risk situations, with sliding-in tackles from behind and the side having the highest risk potential. Match referees sanctioned sliding-in tackles more often than other tackles (20% v 17%, respectively). Tackle parameters did not change in the duration of a match; however, there was an increase in the number of injury risk situations and foul plays towards the end of each half.Match properties provide valuable information for a better understanding of injury situations in football. Staying on feet and jumping vertically tackle actions leading to injury were sanctioned significantly more times by the referee than those not leading to injury (p0.001), but no such difference was seen for sliding-in tackles (previously reported to have the highest injury potential in women's football). Therefore, either the laws of the game are not adequate or match referees in women's football are not able to distinguish between sliding-in tackles leading to and those not leading to injury.

Because the risk of injury in many sports is high, governing bodies and individuals involved with these sports have a responsibility to manage the risks at acceptable levels. Risk management provides a structured framework within which risks can be identified, evaluated, assessed, and controlled through appropriate mitigation strategies. Exploring inferences obtained from the relationship between risk and the incidence and severity of injury contributes to the understanding and control of risks in sport. Studies related to intrinsic and extrinsic risk factors should be focused on determining which factors cause an athlete's risk level to fall within the high-risk or low-risk regions of the population's risk distribution. Risk values can be used to derive risk contours, which illustrate the interdependence of incidence and severity on the development of effective risk mitigation strategies. The wide variation in the levels of risk across different sports is used to demonstrate the impact that athletes' perception and acceptance of risk have on their choice of sport. Finally, the use of incidence and severity data for predicting the prevalence of injury in a team and for the economic evaluation of intervention programmes is discussed.

A previous injury can increase the risk of sustaining a similar injury by up to an order of magnitude. To understand the role of previous injury as a risk factor, it is necessary to consider, among other issues, the clinical status of the first (index) injury at the time of the subsequent (recurrent) injury: currently, the inconsistent use of descriptive terms for recurrent injuries makes this extremely difficult. Although recent consensus statements on injury definitions based on return-to-play criteria have provided a consistent methodology for recording and reporting index and recurrent injuries, these statements do not differentiate between the types of recurrent injuries that can occur. This paper presents a recording and reporting framework that subcategorizes recurrent injuries into reinjuries and exacerbations on the basis of whether a player was fully recovered from the preceding index injury, with the state of fully recovered determined by medical opinion. A reinjury is a repeat episode of a fully recovered index injury and an exacerbation is a worsening in the state of a nonrecovered index injury. With this more detailed framework, researchers will be able to investigate risk factors for reinjuries and exacerbations separately, and they will be able to investigate how well players have been rehabilitated before returning to full training and match play.

Objective: The objective of this study was to determine the incidence of contact events in professional rugby union matches and to assess their propensity to cause injury. Design: The study was a two-season (2003/2004 and 2005/2006) prospective cohort design. It included 645 professional rugby union players from 13 English Premiership rugby union clubs. The main outcome measures were: incidence of match contact events (events per game); incidence (injuries per 1000 player-hours and per 1000 contact events), risk (days lost per 1000 player-hours and per 1000 contact events) and diagnosis of injury; referee’s decision. Risk factors were player–player contact, position on pitch and period of play. Results: Tackles (221.0 events/game) and rucks (142.5 events/game) were the most common events and mauls (13.6%) and scrums (12.6%) the most penalised. Tackles (701.6 days/1000 player-hours) were responsible for the greatest loss of time but scrums (213.2 days lost/1000 events) and collisions (199.8 days lost/1000 events) presented the highest risk per event. Conclusions: Tackles were the game event responsible for the highest number of injuries and the greatest loss of time in rugby union because they were by far the most common contact event. Collisions were 70% more likely to result in an injury than a tackle and scrums carried a 60% greater risk of injury than a tackle. The relative propensities for contact events to cause injury were rated as: lineout – very low; ruck – low; maul and tackle – average; collision and scrum – high.

To determine the incidence, severity, nature, and causes of cervical, thoracic, and lumbar spine injuries sustained during competition and training in professional rugby union.A 2 season prospective cohort design.Twelve English Premiership rugby union clubs.Five hundred and forty-six male rugby union players of whom 296 were involved in both seasons.Location, diagnosis, severity (number of days unavailable for training and matches), and cause of injury: incidence of match and training injuries (injuries/1000 player-hours).Player age, body mass, stature, playing position, use of headgear, and activity and period of season.The incidences of spinal injuries were 10.90 (9.43 to 12.60) per 1000 player match-hours and 0.37 (0.29 to 0.47) per 1000 player training-hours. No player sustained a catastrophic spinal injury, but 3 players sustained career-ending injuries. Overall, players were more likely to sustain a cervical injury during matches and a lumbar injury during training. Forwards were significantly more likely to sustain a spinal injury than backs during both matches (P0.01) and training (P = 0.02). During matches, injuries to the cervical (average: 13 days; P0.01) and lumbar (13 days; P0.01) spine were more severe than injuries to the thoracic (5 days) spine; during training, injuries to the lumbar spine (26 days) were more severe than injuries to the cervical (13 days; P = 0.10) or thoracic (12 days; P = 0.06) spine. A total of 4037 days were lost to competition and training through spinal injuries with lumbar disc injuries sustained during training accounting for 926 days (23%) and cervical nerve root injuries sustained during matches for 621 days (15%). During matches, more injuries were caused by tackles (37%), and during training more injuries were caused by weight-training (33%).The results showed that rugby union players were exposed to a high risk of noncatastrophic spinal injury during tackling, scrummaging, and weight-training activities; injury prevention strategies, therefore, should be focused on these activities.

Data obtained from epidemiological studies of sports injuries are an essential requirement for developing injury prevention, treatment and rehabilitation strategies. Although many authors have discussed the strengths and weaknesses of research methods employed in epidemiology, the potential effects that variations in research design and methods of analysis can have on study conclusions have not been clearly illustrated. This article addresses a number of methodological issues and illustrates their potential effects using examples based on injury data obtained from a single, large epidemiological study in professional rugby union. The examples demonstrate that conflicting conclusions can be reached depending on how the data are collected and analysed. The pivotal roles played by injury definition (loss-of-time, missed matches, diagnostic assessment and surgery), recurrent injury definition (clinical judgement and same injury/same location/same season), method of reporting injuries (number, proportions and incidence) and method of calculating incidence (injuries per 1000 player-hours, per 1000 athlete-exposures and per 1000 matches) are highlighted and illustrated. Other examples show that if training and match injuries are combined, the incidence of injury is more likely to reflect the incidence of training injuries but the distributions of injuries are more likely to reflect the distributions of match injuries. An example is presented that demonstrates that the identification of injuries causing the greatest concern within a sport depends on whether the assessment is based on injury incidence, severity or risk. Finally, examples are presented to show that the relationships identified between sports injuries and risk factors may be dependent on whether case-control or cohort study designs are used. Although there are no simple solutions available to resolve the issues raised, the discussion demonstrates the importance, at least within a sport, of reaching consensus agreements on acceptable study designs and methods of data analysis in sports epidemiology.

Currently, in all regions of the world apart from Africa, more deaths are linked to non-communicable diseases (NCDs) than communicable diseases (WHO, 2010). Being overweight is a major contributory risk factor for NCDs such as high blood pressure, coronary heart disease and type II diabetes. Of the six WHO-designated regions, the Region of the Americas has the highest prevalence (>60%) of overweight adults (aged 20+ years). Mexico is no exception—the proportion of Mexican adults who are overweight or obese has increased from 61.8% in 2000 to 69.7% in 2006 to 71.2% in 2012.1 The prevalence of overweight and obese adolescents is, however, of even greater concern; for example, the prevalence of overweight and obesity among girls (12–19 years old) has grown rapidly in less than 30 years; in this period, the prevalence has more than tripled, rising from 11.1% in 1988 to 28.3% in 1999 to 33.4% in 2006, and is now standing at 35.8% in 2012.2 This situation sent strong alarm bells to the Government and Ministry of Health in Mexico …

Purpose To understand how tackling leads to injury in football, to develop a framework for classifying tackles, and to identify tackles with the greatest propensity to cause injury. Method Video recordings of 123 matches in three FIFA tournaments were used to identify tackling parameters. Team physicians prepared reports of postmatch medical attention to players. Results Tackles from the side were twice as likely to require postmatch medical attention as tackles from behind. Injuries to the head/neck of tackled and tackling players and the torso of tackling players were more likely to receive on-pitch medical attention than other injuries. Injuries to the foot for tackled and tackling players and the lower leg and thigh for tackling players were less likely to receive on-pitch medical attention than other injuries. Tackles with the greatest propensity for causing injury involved clash of heads and two-footed tackles for tackled players and clash of heads, two-footed tackles, jumping vertically, and tackles from the side for tackling players. Conclusion The laws of football relating to tackling should be reviewed to provide greater protection from injury by reducing the overall level of risk and, in particular, by protecting players from tackles with the highest propensity for causing injury.

Players from five English professional football clubs completed a questionnaire containing 52 items relating to injury prevention practices and advice received on these issues. Responses were received from 55 players, which represents a mean response of 11 (4) and a response rate of 38 (14)% from each club (means (SD)). The main deficiencies in awareness of injury prevention strategies for players were identified as: use of shin pads during training, carbohydrate intake before and after training and after matches, cool downs after training and matches, and flexibility work. These deficiencies indicate a need for wider education of players in current injury prevention strategies.

The need for health surveillance for professional footballers has been assessed against criteria specified in UK health and safety legislation. As footballers suffer from chronic injuries under normal playing conditions, professional football clubs have a requirement to implement health surveillance programmes to protect their players. A health surveillance programme, based on benchmarking a player's fitness and addressing the issues of pre-recruitment, pre-season, during-season, post-season, and rehabilitation assessment, is proposed.

There are a large number of injuries in most professional sports every year, and research interest has usually centred around the medical aspects of these injuries. However, health and safety legislation also applies to professional sport, and it is important, as with any other occupation, to understand the underlying causes of the incidents leading to the injuries and to take steps to minimize future injuries. The introduction of the Management of Health and Safety at Work Regulations 1992 formalized a risk assessment approach to health and safety issues; an approach that has always been implicit in the Health and Safety at Work etc. Act 1974. This review assesses how the relevant UK health and safety legislation impacts on the professional sportsperson.

Background Prevention of injury and illness in elite sport can have not only athlete health benefits but also potential positive performance gains. As the first step towards prevention, valid injury/illness surveillance data is needed. Objective Develop and implement a valid and sensitive multisport surveillance model for elite sport in Great Britain, to identify incidence, severity, nature, and risk factors for injury/illness in both individual and team sports. Design A longitudinal prospective surveillance study, with definitions for injury/illness, time loss and restriction severity, and implementation practices, was developed by the research group, and methodology framework modified from recent injury surveillance consensus statements to be applicable for individual and team sports. Setting National training centres for elite sport in Great Britain, including domestic and international competition venues. Participants National team lottery funded athletes from identified sport national governing bodies. Interventions Report forms recording all athlete injuries/illnesses causing complete time loss or restricted participation in competition or training are completed by medical support staff, and competition and training exposure by coaching support staff. Data collection commenced pre season 2009/2010 and is ongoing. Main outcome measure Sport specific injury incidence and illness prevalence, time loss and restriction severity, and risk factors for the most common and severe injuries/illnesses. Results 14 Olympic sports are involved in the surveillance study. Sport specific results reports on injury incidence, illness prevalence, and associated risk factors are being produced, with targeted sport specific recommendations for prevention strategies. Conclusion The injury/illness performance project provides objective information to medical and coaching support staff, and elite sports are starting to implement prevention interventions for key risk factors. The long term aim is to reduce the number and severity athlete injuries/illnesses, the detrimental effects of time loss and restriction in competition and training, and ultimately through this enhance athlete performance.