Rugby Union Players Research Articles

Barriers, Attitudes, and Influences Towards Dietary Intake Amongst Elite Rugby Union Players.

Background: Dietary intakes can impact an athletes health and performance. Although evidence exists about what an athlete should eat, an athlete's nutritional intake is influenced by many factors. The limited research available suggests the main barriers preventing optimal nutritional intakes reported by athletes are lack of time, food accessibility, poor cooking skills, costs, taste, and time spent in “off-season.” Although these factors have been shown to influence dietary intake they remain relatively unexplored in Rugby Union. This study aimed to describe the nutritional influences on dietary intake amongst Rugby Union player's.Methods: This was a qualitative study utilising in person individual interviews with all participants. Participants were Rugby Union players (n = 30) for either a Super Rugby franchise or one of their development squads in New Zealand. Participant's undertook recorded face to face interviews, which were later transcribed. A thematic approach was used to code the transcripts by the primary coder and the themes were subsequently evaluated by the research team.Results: Childhood upbringing, organisational skills, time and food security also emerged as barriers. Body composition and sport nutrition knowledge emerged as both barriers and enablers to nutritional intake. Influence on performance was an enabler to optimal dietary intake. Fully professional rugby players have access to dietitians, whereas development and semi-professional rugby players only have limited if any access, and they were more likely to seek nutritional information via social media.Conclusion: This study suggests a need for greater nutrition education at developmental levels with an emphasis on affordable food choices, meal planning and skills for interpreting online nutrition information.

Influence of Physical and Technical Aspects on Change of Direction Performance of Rugby Players: An Exploratory Study.

We examined the relationships between change of direction (COD) speed and deficit, and a series of speed- and power-related measurements in national team rugby union players and analyzed the influence of movement patterns on COD ability. Eleven male athletes completed the following physical assessments on different days: day 1—anthropometric measurements, and lower-body kinematic parameters (assessed with eight inertial sensors) and completion time in COD tests (pro-agility, 45° cutting maneuver (CUT), and “L” (L-Drill)); day 2—bilateral and unilateral squat and countermovement jumps, 40 m linear sprint, and bar-power output in the jump squat and half-squat exercises. Pearson’s product–moment correlations were performed to determine the relationships between COD velocities, COD deficits, and the speed–power variables. Differences between players with higher and lower COD deficits were examined using magnitude-based inferences. Results showed that (1) greater sprint momentum was associated with higher COD deficits, particularly in drills with sharper angles and multiple directional changes (L-drill and pro-agility); (2) higher unilateral jump heights were associated with greater COD deficits in the pro-agility and L-drill but not in the CUT; (3) faster athletes were less efficient at changing direction and presented greater trunk and knee flexion angles during COD maneuvers, probably as a consequence of higher inertia.

Differences in Adiposity Profile and Body Fat Distribution between Forwards and Backs in Sub-Elite Spanish Female Rugby Union Players.

The purpose of this study was to analyze the adiposity profile and the body fat distribution in 56 sub-elite female rugby union players involved in the Spanish National Women’s Rugby Union Championships. The participants included in this study, which was the first to analyze sub-elite players, show thinner skinfolds, lower fat mass, and lesser fat percentage than previously reported for elite female rugby union players. Forwards were heavier and had higher body mass index (BMI) and fat mass, thicker skinfolds, and higher fat percentage than back players. Forwards also possessed significantly greater total fat-free mass than backs. All these differences were applicable only to players under 25 years of age. A negative correlation between age and both abdominal and lower extremity fat was found in forward players but not in the backs. Both Yuhasz and Faulkner equations tended to underestimate fat percentage in comparison to Reilly equation. Although Yuhasz equation provided higher systematic error, random error was lower in comparison to Faulkner equation. This study shows the relevance of analyzing and monitoring adiposity in female rugby union players to optimize adaptation to the sports requirements of different playing positions and age.

Association Between Position-Specific Impact and Movement Characteristics of Professional Rugby Union Players During Game Play.

Peek, RJ, Carey, DL, Middleton, KJ, Gastin, PB, and Clarke, AC. Association between position-specific impact and movement characteristics of professional rugby union players during game play. J Strength Cond Res 37(1): 161-166, 2023-The aim of this study was to understand the association between impact and movement characteristics during whole game and peak 1- to 10-minute rolling windows in professional rugby union. Maximal impact (impacts·min-1) and corresponding running (m·min-1) characteristics as well as maximal running (m·min-1) and corresponding impact (impacts·min-1) characteristics were obtained for 160 athletes from 4 teams across the 2018 and 2019 Super Rugby seasons. A linear mixed-effects model reported a positive association between whole-game running and impacts, where greater impact characteristics corresponded with greater running characteristics. The average 1-minute peak running characteristics (150-160 m·min-1) typically occurred when no impacts occurred. The average 1-minute peak impact characteristics (4-6 impacts·min-1) corresponded with an average relative distance of 90-100 m·min-1. Worst case scenario observed impact characteristics as large as 15 impacts·min-1 with a corresponding relative distance of 140 m·min-1. When training for peak period characteristics, running may be completed in isolation; however, peak impacts often occur in conjunction with moderate to high running movements. Given running and impact characteristics can appear concurrently within game play, this highlights the need to train them accordingly. As such, when prescribing training drills to replicate the peak characteristics in rugby union, consideration should be taken for both running and impact characteristics.

Anthropometric and physical performance profiles of elite junior rugby union players in the Western Cape, South Africa

Anthropometric and physical performance profiles of elite junior rugby union players in the Western Cape, South Africa

Dimensions of social identification with the team as predictors of the coach-created training climate in rugby: A group-actor partner interdependence modelling perspective

Recently, social identity approach has been giving stimulating insights in leadership in sport, considering social identification as a consequence regarding leadership processes. Nonetheless, social identity theory fundamentally posits social identification as a subjacent parameter of cognitions implied in the frame of interpersonal and intergroup relations. The current study aimed to enrich the existing literature by investigating athletes’ team identification as a predictor of the perception of coach-created climate. French male rugby union players (N = 248) completed an online survey measuring the multidimensionality of their social identification to the team, and their perception of the coach-created climate in terms of empowering and disempowering motivational climate. Using Group Actor-Partner Interdependence Modelling, the analyses revealed that the perception of the climate as empowering was driven by high scores on ingroup ties, especially when teammates’ ingroup ties scores were low. Team’s ingroup affect and cognitive centrality resulted in lower perception levels of the empowering climate. Neither player's ingroup ties nor cognitive centrality predicted the perception of the climate as empowering, and when player’s ingroup affect fitted into the group, his perception of a disempowering motivational climate decreased when ingroup affect score was high. The results are mainly discussed to the light of intergroup permeability by underlying the importance of considering social identification as a predictor of the perception of coach-athletes’ relationship. Some practical applications are put forward along with future directions for research on coach-athletes’ relationship. Especially, this study points out the importance of considering the social identity approach of leadership as a transactional relationship encapsulated in a mutual influence between the ingroup member social identification and that of the team as a whole.

Mental Health and Wellbeing of Retired Elite and Amateur Rugby Players and Non-contact Athletes and Associations with Sports-Related Concussion: The UK Rugby Health Project

BackgroundConcerns have intensified over the health and wellbeing of rugby union and league players, and, in particular, about the longer-term effects of concussion. The purpose of this study was to investigate whether there were differences in mental health, sleep and alcohol use between retired elite and amateur rugby code players and non-contact athletes, and to explore associations with sports-related concussion.Methods189 retired elite (ER, n = 83) and amateur (AR, n = 106) rugby code players (rugby union n = 145; rugby league n = 44) and 65 former non-contact athletes (NC) were recruited to the UK Rugby Health Project between 2016 and 2018. Details on sports participation and concussion history were obtained by questionnaire, which also included questions on mental health, anger, sleep, mood, alcohol use, social connections and retirement from injury. Data were compared between sports groups (ER, AR and NC), between exposure of three or more or five or more concussions and for years in sport.ResultsER reported more concussions than AR (5.9 ± 6.3 vs. 3.7 ± 6.3, p = 0.022) and NC (0.4 ± 1.0, p < 0.001). ER had a higher overall negative mental health score (indicating poor mental health) than AR (10.4 ± 6.3 vs. 7.4 ± 6.5, d = 0.47, p = 0.003) and NC (7.1 ± 4.8, d = 0.57, p = 0.006) and a lower overall positive score (indicating good mental health) than NC (8.9 ± 4.1 vs. 10.7 ± 3.4, d = 0.46, p = 0.021). Negative scores were highest and positive scores lowest in those reporting three or more concussions (d = 0.36, p = 0.008; d = 0.28, p = 0.040, respectively) or five or more concussions (d = 0.56, p < 0.001; d = 0.325, p = 0.035, respectively). Reported symptoms for sleep disruption were more prevalent in ER than NC, and in former athletes with three or more concussions (d = 0.41–0.605, p < 0.05). There were no significant differences in alcohol score (p = 0.733). Global anger score and covert anger expression was higher in former athletes with five or more concussions (d = 0.32, p = 0.035; d = 0.37, p = 0.016). AR reported greater attachment to friends than NC (d = 0.46, p = 0.033) and 20% of ER reported that they would not turn to anyone if they had a problem or felt upset about anything.ConclusionThere was a significantly higher prevalence of adverse mental health and sleep disruption in ER and in former athletes who reported a higher number of concussions. Anger and irritability were more prevalent in former athletes with a history of five or more concussions. Strategies are needed to address mental health and sleep disturbance in elite rugby code athletes, who are also less likely to seek help should they need it. Further research is needed to elucidate causation, and the neurobiological connection between concussion, sub-concussions and longer-term psychological health and wellbeing.

Head Accelerations during a 1-on-1 Rugby Tackling Drill Performed by Experienced Rugby Union Players.

Rugby Union is a popular sport played by males and females worldwide, from junior to elite levels. The highly physical skill of tackling occurs every few seconds throughout a match and various injuries associated with tackling are relatively common. Of particular interest are head injuries that result in a concussion. Recently, repeated non-injurious head impacts in sport have attracted the attention of researchers interested in brain health. Therefore, this study assessed head movement during repeated rugby tackle drills among experienced Rugby Union players. Experienced male and female participants performed 15 1-on-1 tackles in a motion analysis laboratory to measure the head movements of the ball carrier and tackler during each tackle, using three-dimensional motion capture. The average peak acceleration of the head for ball carriers was 28.9 ± 24.08 g and 36.67 ± 28.91 g for the tacklers. This study found that the type of head impacts common while performing a tackle in Rugby Union are similar to those experienced by soccer players during heading, which has been found to alter brain function that lasts hours after the event. This has important implications for player health and suggests that mitigation strategies should be considered for Rugby Union.

Electromyography, Stiffness and Kinematics of Resisted Sprint Training in the Specialized SKILLRUN® Treadmill Using Different Load Conditions in Rugby Players.

This study’s aim was to analyze muscle activation and kinematics of sled-pushing and resisted-parachute sprinting with three load conditions on an instrumentalized SKILLRUN® treadmill. Nine male amateur rugby union players (21.3 ± 4.3 years, 75.8 ± 10.2 kg, 176.6 ± 8.8 cm) performed a sled-push session consisting of three 15-m repetitions at 20%, 55% and 90% body mas and another resisted-parachute session using three different parachute sizes (XS, XL and 3XL). Sprinting kinematics and muscle activity of three lower-limb muscles (biceps femoris (BF), vastus lateralis (VL) and gastrocnemius medialis (GM)) were measured. A repeated-measures analysis of variance (RM-ANOVA) showed that higher loads during the sled-push increased (VL) (p ≤ 0.001) and (GM) (p ≤ 0.001) but not (BF) (p = 0.278) activity. Furthermore, it caused significant changes in sprinting kinematics, stiffness and joint angles. Resisted-parachute sprinting did not change kinematics or muscle activation, despite producing a significant overload (i.e., speed loss). In conclusion, increased sled-push loading caused disruptions in sprinting technique and altered lower-limb muscle activation patterns as opposed to the resisted-parachute. These findings might help practitioners determine the more adequate resisted sprint exercise and load according to the training objective (e.g., power production or speed performance).

Objective classification of countermovement jump force-time curve modality: within athlete-consistency and associations with jump performance

ABSTRACT Force-time curves produced during a countermovement jump (CMJ) have traditionally been classified by visual observation as either unimodal (one concentric phase peak) or bimodal (two peaks). The association between CMJ modality and jump performance remains unclear and future studies may benefit from standardising and expanding modality classification. This study described a numerical method based on the timing and relative magnitude of concentric force-time curve prominences. Adult male elite rugby union players (n = 214) performed six CMJs on a force-instrumented treadmill and an algorithm using turning-point logic was applied to categorise jumps and define modality sub-groups. A sensitivity analysis demonstrated that the minimum prominence threshold (MPT) affected categorisation, as the proportion of bimodal jumps decreased with each 1% increase in MPT. Within-athlete consistency was also affected; between 43% and 63% of participants were consistently categorised as bimodal or unimodal depending on the selected MPT. Modified reactive strength index (RSImod), but not jump height or take-off momentum, was greater in unimodal jumps. Take-off momentum and RSImod were greater in subcategories where maximum force occurred early in the concentric phase. Future research should implement objective classification methods to enhance transparency and comparability and consider subcategories to investigate CMJ force production strategies.

International female rugby union players’ anthropometric and physical performance characteristics: A five-year longitudinal analysis by individual positional groups

ABSTRACT Longitudinal changes in anthropometric and physical performance characteristics of International female rugby union players were evaluated across 5-seasons, according to field position. Sixty-eight international female rugby union players from a top 2 ranked international team, undertook anthropometric and physical performance measurements across five seasons. Anthropometric and physical performance changes occurred, with skinfolds decreasing between 2015 and 2017 and body mass increasing between 2017 and 2019. Single-leg isometric squat (SL ISO), 0–10 m momentum (0–10 Mom) and 20–30 m momentum (20–30Mom) were higher in 2018 and 2019 than all years. Front-row players were characterised by greater SL ISO and 1-RM bench press than inside and outside backs, with higher skinfolds and lower endurance levels than all positions. Between 2017 and 2019, front-row players had larger decreases and increases in endurance and one repetition maximum (1-RM) bench press, respectively, compared to all other positions. Forwards had the highest 0–10Mom and 20–30Mom, and scrum-half the lowest, while outside backs had faster 0–10, 30–40, and 40 m (TT40 m) times, and greater peak velocity (Vmax) compared to forward positions. These longitudinal findings show that physical performance has increased, with anthropometric and performance characteristics becoming more distinctive between positions, among elite female rugby union players.

Sex differences in neck strength and head impact kinematics in university rugby union players

ABSTRACT Globally, over three million women participate in rugby union, yet injury prevention and training strategies are predominantly based on androcentric data. These strategies may have limited generalisability to females, given the cervical spine is more susceptible to whiplash and less adept at resisting inertial loading. A total of 53 university rugby union players (25 female, 28 male, 20.7 ± 1.8 years) had their isometric neck strength measured. Bespoke instrumented mouthguards were used to record the magnitude of head impact events in six female and seven male competitive matches. Mean female maximal isometric neck strength was 47% lower than male. Independent samples Mann–Whitney U tests showed no significant differences for peak linear head acceleration (female: median 11.7 g, IQR 7.9 g; male: median 12.5 g, IQR 7.0 g p=.23) or peak rotational head acceleration (female: median 800.2 rad·s−2, IQR 677.7 rad·s−2; male: median 849.4 rad·s−2, IQR 479.8 rad·s−2; p=.76), despite the mean male body mass being 24% greater than female. Coded video analysis revealed substantial differences in head-impact mechanisms; uncontrolled whiplash dominated >50% of all recorded female impact events and <0.5% in males. Direct head-to-ground impacts comprised 26.1% of female and 9.7% of male impacts, with whiplash occurring in 78.0% and 0.5%, respectively. Overall, the data provided in this study do not support the generalisation of male-derived training and injury-prevention data to female rugby athletes. These results suggest a considerable research effort is required to identify specific weakness of female rugby players and derive appropriate training, injury prevention and return to play protocols. Highlights Video analysis revealed substantial differences in head-impact mechanisms, with uncontrolled whiplash dominating >50% of all recorded female impact events but rarely in males. Isometric neck strength was 47% lower in female players than males. Direct head-to-ground impacts accounted for 26.1% and 9.7% of female and male impacts, with whiplash occurring in 78.0% and 0.5%, respectively.

Concussion and long-term cognitive function among rugby players-The BRAIN Study.

ObjectiveThe BRAIN Study was established to assess the associations between self‐reported concussions and cognitive function among retired rugby players.MethodsFormer elite‐level male rugby union players (50+ years) in England were recruited. Exposure to rugby‐related concussion was collected using the BRAIN‐Q tool. The primary outcome measure was the Preclinical Alzheimer Cognitive Composite (PACC). Linear regressions were conducted for the association between concussion and PACC score, adjusting for confounders.ResultsA total of 146 participants were recruited. The mean (standard deviation) length of playing career was 15.8 (5.4) years. A total of 79.5% reported rugby‐related concussion(s). No association was found between concussion and PACC (β –0.03 [95% confidence interval (CI): –1.31, 0.26]). However, participants aged 80+ years reporting 3+ concussions had worse cognitive function than those without concussion (β –1.04 [95% CI: –1.62, –0.47]).ConclusionsOverall there was no association between concussion and cognitive function; however, a significant interaction with age revealed an association in older participants.

The reliability of the scapular posture and scapular dyskinesis tests in rugby union players.

Impact forces during rugby can contribute to scapula dysfunction and shoulder pain. Reliable assessment of static and dynamic scapula position is paramount in managing athletes with, and those at risk of developing, shoulder pain. To determine the reliability of static scapular posture (SP), clavicular tilt angle (CTA) and the scapular dyskinesis (SD) assessments by expert and student therapists. The study design was an inter-rater and intra-rater reliability study in male university level rugby union players. Four sport rehabilitation students and one experienced physiotherapist evaluated the position of the scapular and clavicle of male university-level rugby union players (inter-rater participants: session 1: n=17, session 2: n=12 and session 3: n=16; (intra-rater participants: n = 12). Participants attended 3 testing sessions, each 1 week apart. Scapular orientation and motion were assessed in five planes of movement and using the Scapular Dyskinesis Test (SDT) respectively. The inter-rater analysis included all participants from each session, while in the intra-rater analysis included only the 12 participants who attended all three testing sessions. Kappa coefficient values and percentage agreement ratings for students compared to the experienced therapist were: SP=poor to fair (-0.01 to 0.33), (27% - 94%); SDT=slight (0.16; 41%); CTA=fair (0.21; 59%). Test-retest (intra-rater) agreement was fair to moderate (0.22 - 0.44; 69% - 95%), slight (0.12; 47%), and fair (0.39; 77%) for the SP, SDT, and CTA, respectively. Static and dynamic evaluation of the shoulder by students and an experienced therapist has poor to moderate reliability and should not be used to make clinical decisions based on observation alone.

The Landing Error Scoring System (LESS) and Lower Limb Power Profiles in Elite Rugby Union Players.

BackgroundThe Landing Error Scoring System (LESS) is a clinical test that assesses landing biomechanics during a drop-jump task. Performance measures such as jump height, power, contact time and reactive strength index are used commonly in athletic populations. Comparing results from the LESS against these performance measures has not been reported in elite rugby union.PurposeTo report i.) normative LESS scores for elite rugby union players ii.) correlations between LESS scores and performance measures and iii.) differences in performance measures between LESS scoring groups. A secondary purpose was to report the intra- and inter-rater reliability of the LESS test when used in elite rugby union players. # Study DesignCross-sectional design.MethodsThirty-six male, elite rugby union players participated. Each participant completed three trials of the LESS and performance measures were recorded concurrently using the OptojumpTM. LESS trials were scored independently by the authors. Statistical analyses were used to confirm reliability, data normality, and between group differences (p<0.05).ResultsThe LESS test is a reliable testing tool in elite rugby union players (excellent intra- (ICC=0.96) and inter-rater (ICC=0.94) reliability). One player demonstrated an excellent LESS score, six players had good scores, eight players moderate scores and the majority of the group, 21 players, scored poorly. LESS scores were correlated to contact time (r = -0.461, p = 0.005) only. Participants with moderate to poor LESS scores (a score ≤5) produced greater power (p=0.036, η2 = 0.139), contact time (p=0.002, η2 = 0.268) and reactive strength index (p=0.016, η2 = 0.180). There were no differences in jump height (p=0.842) between players scoring excellent to good and moderate to poor.ConclusionThe results of the current study demonstrate excellent intra- and inter-rater reliability for the LESS, supporting its use as a clinical assessment tool in elite rugby union players. The majority of players presented with moderate to poor LESS scores, indicating an area of concern in this population. Participants scoring moderate to poor in the LESS recorded significantly higher power and reactive strength index, increased contact time but not jump height. This suggests participants with high-risk landing biomechanics may also produce higher performance measures, but these do not necessarily result in an improved jump height.

Season-Long Changes in the Body Composition Profiles of Competitive Female Rugby Union Players Assessed via Dual Energy X-Ray Absorptiometry

ABSTRACT Background: Reference data for the body composition values of female athletes are limited to very few sports, with female Rugby Union players having mostly been omitted from such analyses.Methods: Using dual energy X-ray absorptiometry (DXA) scans, this study assessed the body composition profiles (body mass, bone mineral content; BMC, fat mass; FM, lean mass; LM, bone mineral density; BMD) of 15 competitive female Rugby Union players before and after the 2018/19 competitive season. Total competitive match-play minutes were also recorded for each player.Results: Body mass (73.7 ± 9.6 kg vs 74.9 ± 10.2 kg, p ≤ 0.05, d = 0.13) and BMC (3.2 ± 0.4 kg vs 3.3 ± 0.4 kg, p ≤ 0.05, d = 0.15) increased pre- to post-season for all players. Conversely, FM (21.0 ± 8.8 kg), LM (50.7 ± 3.9 kg), and BMD (1.31 ± 0.06 g·cm−2) were similar between time-points (all p > .05). Accounting for position, body mass (r partial(12) = 0.196), FM (r partial(12) = −0.013), LM (r partial(12) = 0.351), BMD (r partial(12) = 0.168) and BMC (r partial(12) = −0.204) showed no correlation (all p > .05) against match-play minutes.Conclusion: The demands of the competitive season influenced specific body composition indices (i.e., body mass, BMC) in female Rugby Union players; a finding which was unrelated to the number of minutes played in matches. While the causes of such differences remain unclear, practitioners should be cognizant of the body composition changes occurring throughout a female Rugby Union competitive season and, where necessary, consider modifying variables associated with adaptation and recovery accordingly.

Intensified Training Supersedes the Impact of Heat and/or Altitude for Increasing Performance in Elite Rugby Union Players.

To investigate whether including heat and altitude exposures during an elite team-sport training camp induces similar or greater performance benefits. The study assessed 56 elite male rugby players for maximal oxygen uptake, repeated-sprint cycling, and Yo-Yo intermittent recovery level 2 (Yo-Yo) before and after a 2-week training camp, which included 5 endurance and 5 repeated-sprint cycling sessions in addition to daily rugby training. Players were separated into 4 groups: (1)control (all sessions in temperate conditions at sea level), (2)heat training (endurance sessions in the heat), (3)altitude (repeated-sprint sessions and sleeping in hypoxia), and (4)combined heat and altitude (endurance in the heat, repeated sprints, and sleeping in hypoxia). Training increased maximal oxygen uptake (4% [10%], P = .017), maximal aerobic power (9% [8%], P < .001), and repeated-sprint peak (5% [10%], P = .004) and average power (12% [14%], P < .001) independent of training conditions. Yo-Yo distance increased (16% [17%], P < .001) but not in the altitude group (P = .562). Training in heat lowered core temperature and increased sweat rate during a heat-response test (P < .05). A 2-week intensified training camp improved maximal oxygen uptake, repeated-sprint ability, and aerobic performance in elite rugby players. Adding heat and/or altitude did not further enhance physical performance, and altitude appears to have been detrimental to improving Yo-Yo.

Eight Weeks of Self-Resisted Neck Strength Training Improves Neck Strength in Age-Grade Rugby Union Players: A Pilot Randomized Controlled Trial.

Greater neck strength is associated with fewer head and neck injuries. Neck-strengthening programs are commonly burdensome, requiring specialist equipment or significant time commitment, which are barriers to implementation. Completing a neck-strengthening program will increase isometric neck strength in age-group rugby players. A pilot randomized controlled exercise intervention study. Level 2. Twenty-eight U18 (under 18) male regional age-group rugby union players were randomized (intervention n =15/control n = 13). An 8-week exercise program was supervised during preseason at the regional training center. Control players continued their "normal practice," which did not include neck-specific strengthening exercises. The 3-times weekly trainer-led intervention program involved a series of 15-second self-resisted contractions, where players pushed maximally against their own head, in forward, backward, left, and right directions. Peak isometric neck strength (force N) into neck flexion, extension, and left and right side flexion was measured using a handheld dynamometer. Postintervention between-group mean differences (MDs) in isometric neck strength change were adjusted for baseline strength and favored the intervention for total neck strength (effect size [ES] = 1.2, MD ± 95% CI = 155.9 ± 101.9 N, P = 0.004) and for neck strength into extension (ES = 1.0, MD ± 95% CI = 59.9 ± 45.4 N, P = 0.01), left side flexion (ES = 0.7, MD ± 95% CI = 27.5 ± 26.9 N, P = 0.05), and right side flexion (ES = 1.3, MD ± 95% CI = 50.5 ± 34.4 N, P = 0.006). This resource-efficient neck-strengthening program has few barriers to implementation and provides a clear benefit in U18 players' neck strength. While the present study focused on adolescent rugby players, the program may be appropriate across all sports where head and neck injuries are of concern and resources are limited. Greater neck strength is associated with fewer head and neck injuries, including concussion. Performing this neck exercise program independently, or as part of a whole-body program like Activate, an interactive guide for players and coaches, could contribute to lower sports-related head and neck injuries.

Pressure. A Qualitative Analysis of the Perception of Concussion and Injury Risk in Retired Professional Rugby Players.

This study interviewed retired professional rugby union players (≤10 years since retirement) to discuss their careers in the game of rugby union. The primary aim of the study was to document their understanding of concussion knowledge and the analogies they use to describe concussion. In addition, these interviews were used to determine any explicit and implicit pressures of playing professional rugby as described by ex-professional rugby players. Overall, 23 retired professional rugby players were interviewed. The participants had played the game of rugby union (n = 23) at elite professional standard. A semi-structured individual interview design was conducted with participants between June to August 2020. The research team reviewed the transcripts to identify the major themes from the interviews using a reflexive thematic analysis approach. Four major themes were identified: (1) medical and theoretical understanding of concussion, (2) descriptions of concussion and disassociated language, (3) personal concussion experience, and (4) peer influences on concussion within the sport. These were further divided into categories and subcategories. The interviews highlighted that players did not fully understand the ramifications of concussive injury and other injury risk, as it became normalised as part of their sport. This normalisation was supported by trivialising the seriousness of concussions and using dismissive language amongst themselves as players, or with coaching staff. As many of these ex-professional players are currently coaching rugby (48%), these interviews could assist coaches in treating concussion as a significant injury and not downplaying the seriousness of concussion in contact sports.

Concussion history in rugby union players is associated with depressed cerebrovascular reactivity and cognition.

Recurrent contact and concussion in rugby union remains a significant public health concern given the potential increased risk of neurodegeneration in later life. This study determined to what extent prior-recurrent contact impacts molecular-hemodynamic biomarkers underpinning cognition in current professional rugby union players with a history of concussion. Measurements were performed in 20 professional rugby union players with an average of 16 (interquartile range [IQR] 13-19) years playing history reporting 3 (IQR 1-4) concussions. They were compared to 17 sex-age-physical activity-and education-matched non-contact controls with no prior history of self-reported concussion. Venous blood was assayed directly for the ascorbate free radical (A•- electron paramagnetic resonance spectroscopy) nitric oxide metabolites (NO reductive ozone-based chemiluminescence) and select biomarkers of neurovascular unit integrity (NVU chemiluminescence/ELISA). Middle cerebral artery blood flow velocity (MCAv doppler ultrasound) was employed to determine basal perfusion and cerebrovascular reactivity (CVR) to hyper/hypocapnia ( ). Cognition was assessed by neuropsychometric testing. Elevated systemic oxidative-nitrosative stress was confirmed in the players through increased A•- (p<0.001) and suppression of NO bioavailability (p<0.001). This was accompanied by a lower CVR range ( ; p=0.045) elevation in neurofilament light-chain (p=0.010) and frontotemporal impairments in immediate-memory (p=0.001) delayed-recall (p=0.048) and fine-motor coordination (p<0.001). Accelerated cognitive decline subsequent to prior-recurrent contact and concussion history is associated with a free radical-mediated suppression of CVR and neuronal injury providing important mechanistic insight that may help better inform clinical management.