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The use of artificial playing surfaces in professional rugby union is growing, but their effect on the injury risk profile remains unclear. The aim of this study was to examine the effect of playing surface on match injury risk in men's professional rugby in England. Six seasons of injury data (2013/14–2018/19) were collected from 15 professional English, men's rugby teams participating in domestic and European competition. The incidence, severity, and burden of match injuries were compared across playing surfaces. The dataset included 3351 injuries from a combined European and domestic data set (separated in to 2 categories; artificial and natural/hybrid surfaces) and 2675 injuries from a domestic only dataset (separated into 3 categories; artificial, hybrid, and natural surfaces). There were no differences in incidence rates between surface types on combined European and domestic match data, but injury burden was significantly greater on artificial (3082 days/1000 h, 95% CI 2847-3337) in comparison with natural/hybrid surfaces (2364 days/1000 h, 95% CI 2277–2454, p < 0.001). These differences were primarily driven by a significantly greater mean severity of hip/groin, and foot/toe injuries on artificial surfaces. This is the largest study to date to examine the relationship between surface type and injury risk in rugby union. The average severity and burden of injuries sustained on artificial surfaces was significantly greater compared with those sustained on hybrid/natural grass surfaces. This study can inform those involved in selection of surface for elite sport, weighing up the positive and negative elements of the varying surface types.

Background The most recent meta-analytic review of injuries in elite senior men’s Rugby Union was published in 2013. The demands of the game at the elite level are continually changing alongside law amendments and developments in player preparation. As such, an updated meta-analysis of injury data in this setting is necessary. Objective To meta-analyse time-loss injury data in elite senior men’s Rugby Union between 2012 and 2020. Methods Electronic databases were searched using the keywords ‘rugby’ and ‘inj*’. Nineteen studies met the inclusion criteria. Injury incidence rate data were modelled using a mixed-effects Poisson regression model. Days missed data were modelled using a general linear mixed model. Results The included data encompassed a total of 8819 match injuries and 2801 training injuries. The overall incidence rate of injuries in matches was 91 per 1000 h (95% confidence interval (CI) 77–106). The estimated mean days missed per match injury was 27 days (95% CI 23–32). The overall incidence rate of match concussions was 12 per 1000 h (95% CI 9–15). The overall incidence rate of training injuries was 2.8 per 1000 h (95% CI 1.9–4.0). Playing level was not a significant effect modifier for any outcome. Conclusions The injury incidence rate and mean days missed per injury in the present meta-analysis were higher, but statistically equivalent to, the 2013 meta-analysis (81 per 1000 h and 20 days, respectively). The injury incidence rate for match injuries in elite senior men’s Rugby Union is high in comparison to most team sports, though the training injury incidence rate compares favourably. The tackle event and concussion injuries should continue to be the focus of future preventative efforts.

ObjectiveRugby union (‘rugby’) is popular globally, with most of its participants being amateur. Concern regarding sport-related concussion (SRC) sustained during rugby is increasing. SRC occurs most frequently in the tackle, yet few interventions have aimed to mitigate this risk factor. This study investigated the influence of a lowered legal tackle height on SRC incidence in amateur rugby.DesignCross-sectional analytical study: 2018 (control—standard tackle height) and 2019 (intervention—lowered legal tackle height) seasons.SettingSouth African collegiate student rugby competition.ParticipantsBetween 800 and 900 male amateur student players (age: 20±1.6 years) in each year.InterventionMaximum legal tackle height lowered from line of the shoulder on the ball carrier to the line of the armpit.Outcome measuresNumber of overall (medical attention) and time-loss (≥1 day lost) injuries, head injuries and SRCs in 2018 and 2019 (dependent variables); events associated with injury incidents (independent variables).ResultsThere was no statistically significant difference in incidences of time-loss injuries (IRR: 0.79; 95% CI: 0.6 to 1.1; p=0.13), head injuries (IRR: 0.83; 95% CI: 0.5 to 1.3; p=0.42) and SRC (IRR: 0.69; 95% CI: 0.4 to 1.2; p=0.20). In 2018 and 2019, most time-loss head injuries (57%, n=43) and SRCs (55%, n=26) occurred during the tackle.ConclusionsDespite a trend towards reducing injuries, head injuries and SRC, lowering maximum legal tackle height to armpit level did not change SRC incidence in this amateur male rugby cohort. Most time-loss head injuries and SRCs occurred during the tackle. Further tackle-related interventions to reduce SRC incidence require investigation.

Sports-related concussion (SRC) is a common injury mostly in contact sports. Specifically, it is a public health concern for collegiate rugby athletes because at least one concussion is reported in every two games and concussion has been reported to increase the risk of developing neuro-degenerative disorders later in life. To clinically audit concussions to examine commonly reported signs/symptoms in the Sports Concussion Assessment Tool (SCAT). Retrospective audit of a South African University health services medical electronic records database for all concussion International Classification of Diseases 10 (ICD10) diagnoses codes: S06.0, S06.00 and S06.01 in 367 rugby players (age 24.6 ± 4.3, height 1.8 ± 0.1 and weight; 90.7 ± 14.4) for the period 2013–2018. SCAT data was obtained for 70% of the 434 concussions. Headache (57%), “pressure in head” (56%), feeling slowed down (55%) and fatigue/low energy (54%) were the most frequently reported concussion symptoms on the SCAT. A significant reduction in the serial SCAT symptom (p

Regular monitoring of players in a team can be a challenge because it is time consuming, expensive and impractical. The Fatigue and Fitness Test for Teams (FFITT) was developed to satisfy the demands of a practical monitoring protocol for frequent use in team sports. This study aimed to quantify the sensitivity of the FFITT and assess the practicality of implementing the FFITT in a rugby team. The FFITT was completed before and after three university 1st XV rugby union matches. The FFITT was sensitive to the demands of a rugby match in some individuals. Grouped results (

Background: One strategy to prevent and manage concussion is to reduce head impacts, both those resulting in concussion and those that do not. Because objective data on the frequency and intensity of head impacts in rugby union (rugby) are sparse, stakeholders resort to individual perceptions to guide contact training. It is unknown whether there is a level of contact training that is protective in preparing elite players for contact during matches. Objectives: This study aimed to describe how contact training is managed in elite male rugby, and how staff and players perceive contact training load and head impact load. Methods: This was a sequential explanatory mixed-methods study. Forty-four directors of rugby, defence coaches, medical and strength/conditioning staff and 23 players across all 13 English Premiership Rugby Union clubs and the National senior team participated in semi-structured focus groups and completed two bespoke questionnaires. Results: The study identified the varied understanding of what constitutes head impact exposure across all stakeholder groups, resulting in different interpretations and a range of management strategies. The findings suggest that elite clubsconduct low levels of contact training; however, participants believe that some exposure is required to prepare players andthat efforts to reduce head impact exposure must allow for individualised contact training prescription. Conclusion: There is a need for objective data, possibly from instrumented mouthguards to identify activities with a high risk for head impact and possible unintended consequences of reduced exposure to these activities. As data on head impact exposure develop, this must be accompanied with knowledge exchange within the rugby community.

The outbreak of the Coronavirus pandemic (COVID19) resulted in the 2020 Super Rugby competition being suspended in March 2020, at completion of round 7 of the competition, and the 2020 Carling Currie Cup competition did not take place as originally scheduled. Seven South African Rugby franchises returned to official competition on 9 October 2020. The seven franchises first played in a 7-round 2020 Super Rugby Unlocked tournament, after which the winners of this part of the combined tournaments, the Vodacom Blue Bulls, were crowned as the Super Rugby Unlocked Champions. This was followed immediately by a 7-round 2020/21 Carling Currie Cup, with knockout play-off rounds. The points from the Super Rugby Unlocked tournament were carried over into the Carling Currie Cup. This culminated in the Vodacom Blue Bulls also being crowned as the Carling Currie Cup 2020/21 Champions after the final play-off match. As the Super Rugby Unlocked and Carling Currie Cup competitions included the same seven franchises, with no break afforded between competitions, this report presents the combined data from both tournaments. Although the structure of the 2020/21 season was unique, data analysis revealed no apparent reasons for these data to be treated differently to previous seasons' data. As such the collective competition data is referred to as the 'Carling Currie Cup' 2020/21 throughout this report. Despite the disruptions to the 2020 season, and players potentially being unable to maintain the physical qualities necessary to protect themselves against injury, our analysis tells a positive story about how players were managed during these times, with injury rates being comparable to previous seasons' injury rates, and within the expected season-to-season limits of variation for the Carling Currie Cup. As part of the SA Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP), the Carling Currie Cup 2020/21 Premiership Division Competition (the 'Carling Currie Cup') injury data were recorded throughout the tournament by the medical doctors and medical support staff of the respective teams. All seven teams were required to record every match and training injury that occurred in their team. The injury rate of Time-Loss injuries for the Carling Currie Cup 2020/21 was 91 (76 to 106) injuries per 1000 player hours (mean and 95% confidence intervals), which is higher than the international rate of 81 (63 to 105) injuries per 1000 player hours [1], but within the expected limits of season-to-season variation for the Carling Currie Cup. This equates to 1.8 injuries per team per match. The Cell C Sharks had the highest injury rate for Time-Loss injuries for the 2020/21 tournament and this was significantly higher than their 2014-2019 tournament average. Despite having the highest injury rate, the Cell C Sharks had the lowest average severity and thus experienced a low burden of injury. What this means, is that although they had a high number of injuries, they did not lose many days of training and match play due to these injuries. This finding is interesting to note as the Cell C Sharks ranked 2nd in the tournament, and in previous years the teams who ranked in 1st or 2nd positions of the competition had significantly lower injury rates than those who ranked in last position [2]. The Vodacom Blue Bulls, who won both the Super Rugby Unlocked phase of the tournament and the Carling Currie Cup, had a moderate injury rate and average severity, resulting in them experiencing a moderate injury burden as a team. Conversely, the Xerox Golden Lions, who had the second lowest injury rate, had a high average severity of injury resulting in a high injury burden. This means, that although having a low number of injuries, these injuries resulted in many training and match days missed. Although teams may have a low injury rate, injuries of a high severity still represent a sizable burden to the team, resulting in many training and match days lost due to injury for that team. This highlights the importance of collecting severity data, and not simply injury rates on their own.

ObjectiveTo analyse tackler and ball-carrier technical proficiency during moderate and severe contact injuries (≥8 days lost) in professional rugby union, and compare it with injury-free event-matched controls from the same player and from the same team.MethodsTechnical proficiency for 74 (n=74) (moderate and severe; ≥8 days lost) tackler and ball-carrier injuries during The Currie Cup (2014–2018) and 623 matched non-injury events (253 own controls, 370 team controls) were examined through video analysis using a standardised list of technical criteria.ResultsMean technical proficiency score for injured tacklers during front-on tackles was 6.19/16 (arbitrary units (AU) 95% CI 4.89 to 7.48), which was significantly different to their own controls (8.90/16 AU, 95% CI 8.37 to 9.43, pConclusionFor the tackler and ball-carrier, for both front-on and side-on/behind tackles, overall technical proficiency scores were significantly lower for the injury-causing event, when compared with the player’s own injury-free tackles and the team’s injury-free tackles. Through analysing player and team controls, player technique deficiencies for the injured player and player technique deficiencies that expose all players to injury were highlighted, which may inform injury prevention strategies and policies, and assist coaches in optimising training to reduce tackle injury risk.

ObjectivesThe Professional Rugby Injury Surveillance Project is the largest and longest running rugby union injury surveillance project globally and focuses on the highest level of rugby in England.MethodsWe examined match injuries in professional men’s rugby over the period 2002/2003 to 2018/2019 and described trends in injuries over this time.ResultsOver the period 2002/2003–2018/2019, 10 851 injuries occurred in 1 24 952 hours of match play, equating to a mean of 57 injuries per club per season and one injury per team per match. The mean incidence, severity (days absence) and burden (days absence/1000 hours) of injury were 87/1000 hours (95% CI 82 to 92), 25 days (95% CI 22 to 28) and 2178 days/1000 hours (95% CI 1872 to 2484), respectively. The tackle accounted for 43% injuries with running the second most common activity during injury (12%). The most common injury location was the head/face with an incidence of 11.3/1000 hours, while the location with the highest overall burden was the knee (11.1 days/1000 hours). Long-term trends demonstrated stable injury incidence and proportion of injured players, but an increase in the mean and median severity of injuries. Concussion incidence, severity and burden increased from the 2009/2010 season onwards and from 2011 to 2019 concussion was the most common injury.ConclusionThe rise in overall injury severity and concussion incidence are the most significant findings from this work and demonstrate the need for continued efforts to reduce concussion risk as well as a greater understanding of changes in injury severity over time.

The content of the report is based on data collected by the SA Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP) steering group.

We developed the Fatigue and Fitness Test for Teams (FFITT) to address the challenges of monitoring players in a team simultaneously. The test, which takes 8 min for the entire team, incorporates s...

The study investigated whether countermovement jump (CMJ) metrics and subjective responses to a readiness-to-train questionnaire (RTT-Q) tracked simulated match-induced acute fatigue. This was a randomized cross-over repeated measures study. Participants were assigned into one of two groups; CONTROL or LIST. The LIST group performed the Loughborough Intermittent Shuttle Run (LIST), which was designed to simulate the demands of a soccer match. The CONTROL performed light physical activity at an intensity of

ObjectivesThis study assessed the mass of international rugby players in the men’s and women’s Rugby World Cups between 1991 and 2019. The objective was to quantify changes in mass of players by position, and to compare changes between men and women, and between established (Tier 1 (T1)) and emerging (Tier 2 (T2)) rugby nations.SettingRugby World Cups from 1991 to 2019 for men’s players and 2010 to 2017 for women’s players.Participants4447 elite male and 958 elite female players.Primary and secondary outcome measuresPlayer body mass, grouped as men and women, T1 and T2 nations, and by playing position, assessed over time.ResultsMen’s player mass increased significantly between 1991 and 2019 (T1 overall 9.7% increase), but this increase occurred almost entirely up to 2011. Women’s forwards mass increased by 4.8% in T1, with no changes in T2 or backs from either tier. Significant differences in mass were found between T1 and T2 forwards and backs for both men and women.ConclusionsThe body mass of men’s players has stabilised after initial increases following professionalisation. Player body mass may be approaching a plateau, beyond which no further performance advantages occur. Changes to laws and tactical approaches by coaches may have contributed to this, by changing match demands on players, necessitating endurance, agility and speed. Trends in the evolution of T2 players suggest a barrier to identifying and developing heavy athletic players, and may require intervention to ensure competitive parity.

Background: Professional football teams that rank high on the log at the end of the season generally have fewer injuries than teams that rank lower on the log. This highlights the importance of implementing injury prevention measures, not only to protect player welfare and ensure their longevity in the sport, but also to improve the performance of the team. The association between a low incidence of injury and superior performance during a season may be even more relevant in sports with a higher incidence of injury than football, such as rugby union. Discussion: To examine this association in the South African Currie Cup rugby union competition, time-loss (≥ 1 day training/match play missed) injury data and final position in the competition was examined over five-seasons. Teams who ranked in 1st position had significantly lower average injury rates than teams who ranked in last position [48 injuries per 1 000 player hours (95% C.I 20 to 76) vs 130 injuries per 1 000 player hours (95% C.I 79 to 180)]. More specifically, the team with the lowest injury rate in each season ranked in 1st or 2nd position. This team performance aspect of injury prevention should be highlighted more. In particular, this should be used to assist with communicating the importance of injury prevention programmes to stakeholders directly involved with budgetary allocations in the team.

Purpose: The advantages of monitoring players in a team are well documented. However, barriers associated with lack of resources and time prevent teams from implementing systematic monitoring programs. This study aimed to identify (1) the methods rugby teams use to monitor the training load and associated response to the training load and (2) prerequisites of a monitoring protocol that are scientifically suitable and practically applicable for monitoring fitness and fatigue of rugby players. Methods: Coaches and support staff working with varying levels of rugby union were invited to complete an online questionnaire. Results: Of the 55 respondents, 96% indicated that although they regarded monitoring the training load and training-load response as important, there is no monitoring protocol that is cost-effective, time efficient, and nonaversive to the players. Respondents measured several variables when monitoring and incorporated more subjective than objective measures. Respondents (41%) indicated that they would like a protocol that is time efficient (5–10 min) and provides immediate feedback on players who identify as fatigued (50%). For coaches to have confidence in the information provided by the protocol, it needs to meet basic clinimetric principles of reliability and validity. The technical and biological error in the measurement needs to be known so that meaningful changes in fatigue and fitness can be distinguished from natural variations in the measurements. Conclusions: Prerequisites of an ideal monitoring protocol for rugby players were identified. It follows that a monitoring protocol that fulfills these prerequisites should satisfy both scientific principles and the coach’s demands.

Background The tackle event in rugby is a technical and physical contest between opposing players. A player9s ability to tolerate and contest during a tackle is a prerequisite for safe participation and success in rugby. The attitude and behaviour of players towards safety have been identified as risk factors for injury. How a skill is coached may influence the player9s attitude and actions when executing the skill in training and match play. Objective The purpose of this study was to investigate the relationship between tackle coaching methods and players9 tackle training attitudes and behaviours. Design Cross-sectional Survey. Setting High Schools. Participants 164 Under-19 rugby male players. Assessment of Risk Factors Questionnaire using a 5-point Likert scale for importance (attitude), quantity (behaviour) and frequency (behaviour). Main Outcome Measurements Associations between tackle coaching methods and players9 tackle training attitudes and behaviours using the χ2 test and Cramer9s V. Results The more time spent on coaching proper technique to prevent injuries, the higher players rated the importance of injury prevention (28% somewhat important-very important, χ2 (16)=29.13, p Conclusions This is the first study to report on the relationship between tackle coaching methods and players9 tackle training attitudes and behaviours. When coaches offered verbal instruction and spent more time coaching proper technique to prevent injuries, players tended to have a more positive attitude toward injury prevention when training the tackle.