High School Rugby Research Articles

Between 2008 and 2022, Lower-Extremity Injuries Declined in Male Rugby Players, Whereas Noncontact Knee Injuries Showed No Decline in Female Rugby Players

PurposeThe purpose of this study was to assess the distribution and mechanisms of lower extremity injuries among high school and college age rugby players presenting to United States (US) emergency departments (EDs) from 2008 to 2022. MethodsThe National Electronic Injury Surveillance System (NEISS) was queried for lower extremity rugby injuries (ages 14-23) from January 2008 to December 2022. Patient demographics, injury location, diagnosis, and disposition were extracted for each case. Linear regression analysis assessed differences over time. Injury distribution for males versus females was evaluated using Pearson’s chi-square analysis. ResultsAn estimated 31,318 (845 NEISS cases) high school and college-age rugby players presented to US EDs with a lower extremity injury during the study period. Males accounted for 66.9% of the injuries. Linear regression analysis revealed a significant decrease in annual frequency of lower extremity injuries presenting to US EDs from 2008 to 2022 (p=0.001). The most common injury mechanism was overwhelmingly a non-contact twisting motion (11,108, 35.5%) followed by a hit/collision (5,298, 16.9%). Strains/sprains were the most common diagnosis (17,243, 55.1%). Injuries most commonly occurred at the ankle (12,659, 40.4%) and knee (11,016, 35.2%). In a sex-specific linear regression analysis, there was a significant decrease in lower extremity injuries sustained by male players (p=0.001), but no significant decrease among female players (p=0.112). Furthermore, chi-squared analysis revealed that females sustained a significantly higher proportion of knee injuries secondary to twists (15.9% for females vs. 9.0% for males, p=0.01). ConclusionLower extremity injuries are declining among high school and college-age male rugby players. However, there has not been a corresponding decrease among female rugby players. Furthermore, females are disproportionately affected by non-contact twisting knee injuries.

High school rugby coaches’ knowledge and opinions of concussion in KwaZulu Natal province in South Africa: an ecological cross-sectional study

BackgroundConcussions in Rugby Union are common with an increased risk to adolescent players. Coaches are key to injury prevention and a greater understanding of their knowledge and sentiments may guide future initiatives. There is a lack of data on rugby coaches, especially in South Africa. This study aimed to investigate the knowledge and opinions of high school rugby coaches regarding concussion management.MethodsThis cross-sectional study of 37 high school rugby coaches in South Africa, was conducted via a self-reported questionnaire. Concussion knowledge was scored for correct answers only with closed-question scaling methods to measure the importance of items of concussion management using a graphical rating scale. An attitude scale (Likert) was used to assess self-reported opinions and behaviours. Associations were calculated for participant characteristics and overall concussion injury knowledge.ResultsMore participants showed good overall knowledge of ≥ 75% (n = 22, 59% vs. n = 15, 40%), especially those with greater coaching experience (p = 0.021). Player welfare was perceived more important than player performance (185 vs. 164), with concussion prevention most important (184 of 185). Appealing characteristics of an injury prevention programme were the improvement of player skill (173, SD ± 0.75, mean 4.68), being adaptable (171, ± 0.86, 4.62), and being completed in the warm-up (167, ± 0.93, 4.51). The biggest perceived barriers were duration (138, ± 1.59, mean 3.73), effort (130, ± 1.56, 3.51), compliance and lack of knowledge (both 127, ± 1.68, 3.43).ConclusionThese results support the implementation of ongoing concussion education for rugby coaches and identify areas for promoting awareness and knowledge of concussion injury prevention, identification, and specific management of younger athletes. Appealing characteristics and barriers are highlighted and may allow for improved implementation and adherence to concussion prevention programmes.

Integration of diffusion tensor imaging parameters with mesh morphing for in-depth analysis of brain white matter fibre tracts.

Averaging is commonly used for data reduction/aggregation to analyse high-dimensional MRI data, but this often leads to information loss. To address this issue, we developed a novel technique that integrates diffusion tensor metrics along the whole volume of the fibre bundle using a 3D mesh-morphing technique coupled with principal component analysis for delineating case and control groups. Brain diffusion tensor MRI scans of high school rugby union players (n = 30, age 16-18) were acquired on a 3 T MRI before and after the sports season. A non-contact sport athlete cohort with matching demographics (n = 12) was also scanned. The utility of the new method in detecting differences in diffusion tensor metrics of the right corticospinal tract between contact and non-contact sport athletes was explored. The first step was to run automated tractography on each subject's native space. A template model of the right corticospinal tract was generated and morphed into each subject's native shape and space, matching individual geometry and diffusion metric distributions with minimal information loss. The common dimension of the 20 480 diffusion metrics allowed further data aggregation using principal component analysis to cluster the case and control groups as well as visualization of diffusion metric statistics (mean, ±2 SD). Our approach of analysing the whole volume of white matter tracts led to a clear delineation between the rugby and control cohort, which was not possible with the traditional averaging method. Moreover, our approach accounts for the individual subject's variations in diffusion tensor metrics to visualize group differences in quantitative MR data. This approach may benefit future prediction models based on other quantitative MRI methods.

Epidemiology of rugby injuries in a South African high school over a one-year period

Adolescent rugby players have a high risk for injuries; however, injury prevention programmes have reduced the incidence of injuries amongst this group. The purpose of this retrospective analysis was to evaluate the epidemiology of rugby injuries at a South African high school over one season. There were 99 participants over a total of 98 matches and the participants were aged between 13 and 18 years. Information on the type of injuries was documented and the injury proportion (IP), injury incidence and 95% confidence intervals (CI) were calculated, with 1000 player-hours as the denominator. Ninety-nine injuries were recorded, with a total injury incidence of 34.1 injuries/1000 player-hours (95% CI 27.4–40.8). Injuries were predominantly of moderate severity (IP: 25.3%) with a time-loss period of 8 to 28 days. Injuries to the head, neck and spine were the most common (IP: 38.4%; incidence: 13.1; 95% CI 8.9–17.2). The findings on the nature of injuries were largely consistent with current local and international research on high school rugby, with the head, neck and spine remaining at a significant risk of injury. It is recommended that injury prevention programmes further enforce safety guidelines for the protection of the head, neck and spine amongst high school athletes.

Differences in injury and concussion rates in a cohort of Canadian female and male youth Rugby Union: a step towards targeted prevention strategies

ObjectiveTo examine differences in match and training musculoskeletal injury and concussion rates and describe mechanisms of concussion while considering previous playing experience in female and male Canadian high school Rugby...

Concussion education for New Zealand high school rugby players: A mixed-method analysis of the impact on concussion knowledge, attitudes and reporting behaviours

Players who lack the knowledge to recognise the signs and symptoms of concussions may be less likely to disclose their injury. New Zealand Rugby's Community Concussion Initiative includes an interactive education session highlighting peer-recognition of concussions. This mixed-method study examined the effect of an education session on high school players’ concussion knowledge and attitudes as well as the impact of player demographics on these variables. Focus groups were used to explore player experiences. The RoCKAS-ST was used to measure concussion knowledge/attitudes before and after the education session. Multiple linear regression examined associations between demographic variables, including school decile (relative wealth of the geographic region the school serves), and pre-education concussion knowledge/attitudes scores. Wilcoxon signed-rank tests compared pre-concussion and post-concussion knowledge/attitudes scores. Qualitative data were analysed via thematic analysis. Overall, 532 players completed questionnaires; 75 players participated in focus groups. Pasifika players had lower concussion knowledge than NZ Europeans ( p < .001). Mid-decile schools had higher concussion attitudes scores than low decile schools ( p < .001). Pre-education and post-education session concussion attitudes and knowledge scores did not differ significantly, suggesting the one-off education session was not successful in improving these outcomes. Players identified: (i) the education session to be valuable, but some uncertainties remained; (ii) the importance of player comfort, interaction and comprehension; (iii) the need for role models, real stories and regular content refreshers. Requests for presenter diversity, support and easily understood information were more prominent in Māori/Pasifika and low-decile groups. Greater consideration of these factors is necessary in the development of education interventions.

Differences in the Outcomes of Face-to-Face and Distance Nutrition Education during the Coronavirus Pandemic: A Study in Elementary and Junior High School Rugby Players

Differences in the Outcomes of Face-to-Face and Distance Nutrition Education during the Coronavirus Pandemic: A Study in Elementary and Junior High School Rugby Players

Investigation of the knowledge of South African high school rugby coaches on concussion and the return-to-play protocol.

Coaches are pivotal in the management of concussed players. Assessing the knowledge of high school rugby coaches with regard to concussion management will enable relevant future education on this topic to be covered. To investigate the knowledge of South African high school rugby coaches on concussion symptom recognition, knowledge and stepwise return-to-play (RTP) protocols. A cross-sectional descriptive study involving 143 first team, high school rugby coaches was completed via an electronic questionnaire. Independent variables included coach demographics, qualifications, experience, BokSmart accreditation, and school size. Dependent variables included knowledge scores on concussion symptoms, general concussion knowledge, stepwise RTP and Maddocks questions. Relationships between total scores for different demographic groupings were established using non-parametric techniques. The coaches had high general, symptom and overall concussion knowledge scores (77% - 80%) in contrast with low RTP scores (62%) and very low Maddocks questions knowledge scores (26%). The 35-44-year age group received top scores for symptom recognition (p=0.034) and total concussion knowledge (p=0.041). Larger category school coaches (p=0.008) and BokSmart accredited coaches (p=0.041) outperformed all other coaches in general concussion knowledge and total knowledge, respectively. However, respondents were not familiar with emotional symptoms or the importance of cognitive rest after a concussion. Educational programmes were the most popular knowledge source for coaches. In general, coaches presented with good general concussion knowledge but lesser expertise on emotional symptoms, cognitive rest and RTP management. Modifiable predictors of knowledge included the expansion of BokSmart accreditation, focussing information sessions on smaller rugby size schools and the education of coaches younger than 35 years or older than 45 years of age.

Sport supplement use among high school rugby players in South Africa: A scoping review.

The use of sport supplements has increased for all types and levels of sport, with an estimated increase of 5.8% annually. Sport supplement usage and doping among high school athletes has increased over the years to meet the demands of the sports. This scoping review identifies the trends and gaps in current literature regarding sport supplement use among high school rugby players in South Africa. A search was conducted using six electronic databases, namely Oxford Academic, Emerald Publishing, ResearchGate, SABINET, PubMed and Google Scholar. The eligibility of the articles was determined by means of a PRISMA flow diagram with the following inclusion criteria: (1) research concerning supplement use among rugby players, (2) research concerning supplement use among high school rugby players. Five articles all comprising of cross-sectional study designs were included in this scoping review. The prevalence of sport supplement use among adolescent rugby players ranged from 30% to 45%. Protein supplements (31% - 79%) were the most commonly identified supplement used among adolescent rugby players with the aim to improve sport performance as the most common reason for use. The internet (74%) and magazines (72%), followed by coaches comments (28% to 30%), were given as the most common sources of information. The use of sport supplements is increasing among high school athletes due to the belief that these substances will provide sporting performance benefits or enhance the competitive 'edge' of these athletes. Additional education regarding the safety of supplements is necessary to lower the incidences of doping among young athletes and avoid the adverse health effects that uncontrolled supplement use can cause.

Sport concussion assessment in New Zealand high school rugby players: a collaborative approach to the challenges faced in primary care

ABSTRACT Primary Objective To describe the collaborative development of a New Zealand Rugby Concussion Assessment (NZRCA) for primary care and to provide normative baseline data from a representative group of high school rugby players. Methods This study, conducted over the 2018 and 2019 community rugby season where players were baseline tested during the pre- or start of season period. Results Data were collected from 1428 players (males n = 1121, females n = 307) with a mean age of 15.9 ± 1.4 years. The mean ± SD symptom severity score was 11.3 ± 8.6, the mean number of endorsed symptoms was 8.5 ± 5.3 and the percentage feeling “normal” was 80.2 ± 15.3%. Only 5.3% of players reported no symptoms at baseline. The most common reported were: ‘distracted easily’ (72.5%), ‘forgetful’ (68.5%), and ‘often tired’ (62.6%). None of the participants achieved a perfect score for the SAC50. The majority of participants (89.7%) passed the tandem gait test with a time of 12.2 ± 1.7 seconds. Age, gender, and ethnicity were associated with NZRCA performance; albeit weakly. Conclusion This study provides normative reference values for high-school rugby players. These data will aid healthcare providers in their identification of suspected concussion in the absence of individualized baselines.

Pre-Match Collective Efficacy and Group Cohesion in High School and University Rugby Teams:

Pre-Match Collective Efficacy and Group Cohesion in High School and University Rugby Teams:

Injuries and Concussions in Female High School Rugby: Prevention is Worth a Try.

To describe injury and concussion rates and mechanisms in female high school rugby players. Two-year prospective cohort study. High school rugby. Participants included 214 female High school rugby players (year 1) and 207 female High school players (year 2) from the Calgary Senior High School Athletics Association 2018 and 2019 rugby competition. None. Match and training injury and concussion. Injury definition included any injury resulting in time loss, inability to complete a session, and/or requiring medical attention. Details of reported injuries were collected on injury report forms and validated by a certified athletic therapist on a validated online injury surveillance platform. Exposure hours for players were tracked using paper or virtual weekly exposure forms by team designates. A match incidence rate (IR) = 93.7 injuries/1000 match hours (95% confidence intervals (CI): 78.6-11.7) and training IR = 5.3 injuries/1000 training hours (95% CI: 4.0-6.9) were estimated. The tackle accounted for 109 (70%) match and 37 (44%) training injuries. Tackling was the most frequent mechanism of injury (IR = 37.5 injuries/1000 match hours, 95% CI: 27.5-51.8 and 1.2 injuries/1000 training hours, 95% CI: 0.7-2.4). Sixty-two match concussions (IR = 37.5 concussions/1000 match hours, 95% CI: 26.8-52.3) and 16 training concussions (IR = 1.0 concussions/1000 training hours, 95% CI: 0.7-1.4) occurred. Of 78 reported concussions, 78% for match and 56% for training were physician diagnosed. Tackling was the most frequent mechanism of concussion in matches (IR = 18.1 concussions/1000 match hours, 95% CI:11.4-28.6). Injury and concussion rates in female high school rugby are high. The tackle accounted for the highest proportion of injuries. Prevention strategies (eg, tackle policy change, tackle-training programs, and neuromuscular training) should be explored to increase sport safety.

Canadian High School Rugby Coaches Readiness for an Injury Prevention Strategy Implementation: Evaluating a Train-the-Coach Workshop.

Background: Canadian rugby coach injury prevention beliefs and attitudes have not been studied, yet are key to informing injury prevention strategy implementation. Despite neuromuscular training (NMT) warm-up success in reducing injury, adoption of these programs is variable. Therefore, objectives of this study included (1) describing Canadian youth rugby coach injury prevention beliefs and attitudes and current warm-up practices and (2) evaluating intention to use a rugby-specific NMT warm-up.Methods: High school rugby coaches completed a questionnaire before and after a rugby-specific NMT warm-up workshop. The pre-workshop questionnaire captured demographics, current warm-up practice, and NMT warm-up knowledge and use. Both questionnaires captured injury prevention beliefs, attitudes and behavioral intention.Results: Forty-eight coaches participated in the workshops. Pre-workshop, 27% of coaches were aware of NMT warm-ups. Coaches primarily included aerobic and stretching components, while balance components were not common in their warm-ups over the past year. Additionally, 92% of coaches agreed to some extent they would “complete a rugby-specific warm-up program prior to every game and training session this season.” Post-workshop, 86% of coaches agreed to some extent that they would use the program in every rugby session. No differences were observed between pre- and post-workshop intention to implement the warm-up (p = 0.10).Interpretation: This is the first study to examine current Canadian youth rugby coach warm-up practices and intention to use NMT warm-ups. Canadian rugby coach intention to use a rugby-specific NMT warm-up is high, providing ample opportunity to investigate the efficacy of a NMT warm-up in youth rugby.

Acute Subdural Hematoma in High School Rugby Players in Japan: The Importance of Playing Experience for Injury Prevention

Acute subdural hematoma (ASDH) is known to be devasting sport-related head injury but it is relatively rare in rugby compared with other contact sports. Certain cases of ASDH have happened in high school rugby players in Japan. To prevent them from the injury we report a background of the players. Data of high school rugby players who suffered ASDH were extracted from injury reports in the Japan Rugby Football Union between April 2004 and March 2020. The number of injured players, diagnosis on the report, school year, phase of play where the injury occurred, and playing career were analyzed. There were 30 cases of ASDH including 16 cases in the first year, 9 in the second year, and 5 in the third year of playing. Phase of play was mainly being tackled in 11 (37%), and tackling in 13 (43%). Novice players, defined as a player having less playing experience of rugby during junior high school, accounted for 77% of phase of tackling, 82% of being tackled. First year novice players accounted for 100% of phase of being tackled. Outcome within 6 months after injury was recovery in 14, morbidity in 6, mortality in 2, and unknown in8. Playing experience in high school rugby players should be considered as an important factor for prevention of ASDH-in particular, phase of being tackled is riskier than that of tackling for first year novice players.

2 years an athletic trainer support and injury report in high school rugby union team

2 years an athletic trainer support and injury report in high school rugby union team

Injuries in high school level rugby union: how do coaches manage injuries?

PurposeThe purpose of the investigation was to determine the injuries and injury prevention strategies in high school rugby union players, as reported by the coaches.MethodsA cross-sectional, descriptive study was conducted where participants (from fee-paying and no-fee-paying schools) were required to complete an electronically based questionnaire focusing specifically on injuries and injury prevention strategies in male high school level rugby players.ResultsThe results indicated that the most common injured position was the back row, while 60% of all injuries were to the shoulder region. Furthermore, while the majority (75%) of coaches did record injury statistics, only a limited number implemented injury prevention strategies (mainly from fee-paying schools). The most common injury prevention tool reported was ‘strengthening target areas’ConclusionsIt was concluded that all schools should monitor injuries and implement some form of strength and conditioning program to reduce the risk of player injury. Furthermore, it was noted that for this to occur, the education of the coach as well as the player was highly important.

Concussion knowledge, attitude and reporting intention in rugby coaches and high school rugby players

The aim of this study was to evaluate New Zealand high school rugby union players’ and community coaches’ concussion knowledge (CK), concussion attitude (CA) and concussion reporting intentions (CRI) and to explore the impact gender, age, ethnicity, socio-economic status, experience, and concussion history had on these outcome measures. This cross-sectional study utilised the Rosenbaum Concussion Knowledge and Attitudes survey to evaluate CK, CA and CRI. The survey and demographic information were completed by 533 high school players (61.5% male, M = 16.2 yrs) and 733 community rugby coaches (93.0% male, M = 42.2 yrs). Coaches displayed greater awareness, safer attitudes, and stronger reporting intentions towards concussion than players. Among players, differences in CK, CA and CRI were observed by gender, ethnicity, and socio-economic status. Among coaches, differences in CRI were found by age and coaching experience. No differences were observed for age or concussion history in players. Gender, ethnicity, and grade coached were not significant for coaches. Players who identified as Māori or Pasifika and those from schools in low socio-economic areas displayed poorer CK and CA. Years of experience for both players and coaches played a critical role in improving CA and is a factor that should be considered when welcoming new participants to either role. Concussion non-disclosure is a systemic issue and is common across gender, ethnicity and socio-economic status and appears to worsen as the playing season progresses. More work is needed to develop educational strategies that are both culturally responsive, sustainable, and address reporting behaviours.

2020 CASEM Poster Presentations

2020 CASEM Poster Presentations

What they know and who they are telling: Concussion knowledge and disclosure behaviour in New Zealand adolescent rugby union players

ABSTRACT The purpose of this study was to survey high school rugby players from a range of ethnic, geographic and socioeconomic backgrounds in New Zealand (NZ) to gain an understanding of concussion knowledge, awareness of NZ Rugby’s (NZR) guidelines and attitudes towards reporting behaviours. Male and female high school rugby players (n= 416) from across NZ were surveyed. The findings indicated that 69% of players had sustained a suspected concussion, and 31% had received a medical diagnosis of concussion. 63% of players indicated they were aware of NZR’s guidelines. Māori and Pasifika players were less likely to be aware of the guidelines compared to NZ European, Adjusted OR 0.5, p = 0.03. Guideline awareness was significantly higher for those from high decile schools when compared to low (Unadjusted OR 1.63, p = 0.04); however, when ethnicity and school locations were controlled for this became non-significant (Adjusted OR= 1.3, p=0.37). The coach was the key individual for the provision of concussion information and disclosure of symptoms for players. The findings of this study will inform the development and delivery of NZR’s community concussion initiative and how these examined factors influence a high school player’s concussion knowledge and reporting behaviour.

Baseline Performance of High School Rugby Players on the Sport Concussion Assessment Tool 5.

Version 5 of the Sport Concussion Assessment Tool (SCAT5) was released in 2017 with an additional 10-word list option in the memory section and additional instructions for completing the symptom scale. To provide reference scores for high school rugby union players on the SCAT5, including immediate memory using the 10-word list, and examine how age, sex, and concussion history affected performance. Cross-sectional study. Calgary, Alberta high schools. High school rugby union players (ages 15-18 years) participating in a 2018 season cohort study (n = 380, males = 210, females = 170). Sport Concussion Assessment Tool 5 scores, including total number of symptoms (of 20), symptom severity (of 132), 10-word immediate memory (of 30), delayed memory (of 10), modified Standardized Assessment of Concussion (of 50), and balance examination (of 30). The median number of symptoms reported at baseline ranged from 5 to 8 across sex and age stratifications. Median symptom severity was lowest in males with no concussion history (7; range, 0-28) and highest in females with a concussion history (13, range = 0-45). Median total scores on immediate memory were 2-3 (range = 0-4) for males and 21 (range = 9-29) for females. Median total scores were 3 (range = 0-4) on digits backward and 7 (range = 0-20) on delayed memory (all groups). Based on simultaneous quantile (q) regression at 0.50 and 0.75, adjusted for age and concussion history, being female was associated with a higher total symptoms score (q0.75 βfemale = 2.85; 99% confidence interval [CI] = 0.33, 5.37), higher total symptom severity score (q0.75 βfemale = 8.00; 99% CI = 2.83, 13.17), and lower number of errors on the balance examination (q0.75 βfemale = -3.00; 99% CI = -4.85, -1.15). Age and concussion history were not associated with any summary measures. The 10-word list option in the memory section reduced the likelihood of a ceiling effect. A player's sex may be an important consideration when interpreting the SCAT5 after concussion.