Sports Medicine Research: In the Lab & In the Field: Injury Prevention Programs Collide with Rugby…& Are Effective! (Sports Med Res)


Wednesday, April 25, 2018

Injury Prevention Programs Collide with Rugby…& Are Effective!

Efficacy of a movement control injury prevention programme in adult men’s community rugby union: a cluster randomized controlled trial

Attwood MJ, Roberts SP, Trewartha G, England ME, & Stokes KA. Br J Sports Med. 2018; 52: 368-374.  

Take Home Message: A 42-week progressive injury prevention program reduced the incidence and burden of head, neck, and concussion injuries among rugby teams.
Sports Med Res has many posts reporting the efficacy of injury prevention programs (see sample below); however, we know little about the efficacy of injury prevention programs within collision sports, such as rugby.  The authors of this randomized trial investigated the effects of a 42-week exercise program among adult men’s rugby clubs on injuries during a match. The authors recruited 81 teams randomized to an injury prevention program or normal practice exercises. The injury prevention program involved seven stages of 6-week blocks of exercise programming that progressively got more difficult.  Similar to many prevention programs (e.g., 11+ program), the exercises involved a warm up, balance/proprioception, resistance and perturbation, landing, cutting, and plyometric exercises.  These were performed twice per week in season, and once per week at pre-match. The study team tracked injury incidence and injury burden. The researchers defined injury as missing greater than 8 days of play and categorized them as overall or “targeted” (i.e., specific injury to a body part diagnosed as strain, sprain, joint and neurological injury that was not a contusion, fracture, laceration, or of unknown origin).  Injury burden was defined as how many days missed from practice/match play.  Nearly half of the teams dropped out or failed to report data.  Among clubs reporting data, the injury prevention program likely reduced targeted injury incidence and injury burden compared to standard exercises. Specifically, the program offered a 40% reduction in lower extremity injuries, and a 60 to 70% reduction in injuries to the head or neck (including concussion).  Interestingly, the authors reported the program may increase the risk of shoulder injuries.  Program compliance was a key factor linked to a greater reduction in targeted injury burden. 

This study shows that there are some clear benefits to injury prevention programs within a collision sport, and reemphasizes that compliance is critical to success.  This program was only done 2 to 3 times per week, yet lasted for the majority of the year.  This may explain why almost half the clubs in each group dropped out or failed to report data. The teams may have not liked the length of the program, or the program exercises itself.  Due to the high dropout rate, the results of this study should be interpreted with caution.  It would be interesting to learn why some clubs stopped performing the program since this would be beneficial to breaking down barriers for injury prevention program integration into sport culture.  This injury prevention program also helped in reduced concussions, and the authors related this to isometric neck exercises that were incorporated into their program.  This is a great reminder that injury prevention programs can be tailored to meet the sport-specific demands and commonly seen injuries.  It would be interesting to continue to look at program modifications within different sports.  Surprisingly, the injury prevention program was associated with an increase in shoulder injuries, specifically muscle/tendon.  While the authors did not provide a reason, it may be related to the volume/load of exercises performed and possible fatigue before participation minimizing eccentric control.  More information regarding contact/non-contact injuries and at what point in the season they occurred may be beneficial to better understanding the application of a program like this.  But ultimately, injury prevention programming can be tailored and seem to work in collision sports to reduce injury incidence and burden. 

Questions for Discussion:  What modifications might you make to an injury prevention program based on the sport that you work with?  Do you see any implications for injury prevention programming in other areas than sports teams?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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Sarah said...

Hi Nicole,

Thank you for the post! I found the correlation between compliance with the injury prevention program and reduction in the incidence of concussion to be very interesting. I think it was a bold statement by the author to relate this to the isometric neck exercises. There are so many factors that play into the incidence and occurrence of concussion that without a baseline, this is a hard statement to justify. Also, with about half the teams dropping out of the study, what is this reduction compared to?

Overall, I do think that injury prevention programs are very important. I am currently working with an upper extremity sport so I tailor my prevention to upper extremity injuries. I also make sure to review injury history and modify my programs towards what this may indicate they need more. I believe that injury prevention can also be transferred to the industrial setting. This could be a very important role that Athletic Trainers can play in the future, educating and leading industrial companies in injury prevention programs.

Dana said...

Thanks for sharing Nicole. Even with the anticipated 50% drop-out [resulting in estimated 54 clubs], having only 41 clubs complete the study is commendable. Especially for the length of the intervention. I was surprised that they defined an injury as one that kept a person from competition for more than eight days. I’m curious what their results would have garnered if there was a shorter timeline.

I agree with Sarah that it is important to avoid ‘cookie-cutter’ programs for the sport[s] that you work with. Taking into account unique movements of the sport and common injuries that are present will benefit the team and create a sustainable program. I can see this translating to any profession. It is a matter of identifying what may keep employees from doing their job and finding a solution.

Adrienne said...

Thank you for posting this, Nicole. I currently work with football and women’s rowing which are two very different sports in terms of the type of activity the teams do. With this said, I agree with Dana and Sarah that each injury prevention program should be tailored to a certain sport. In football, much of the warm-up is focused on quick and variable explosive movements, while rowing involves more mobility to prepare for the repeated flexion, extension, and rotation movements that rowers complete in a boat or on an erg. It would be interesting to know how the retention rate for the program would have changed if it was completed before every practice and game for a season rather than for only a few days a week for multiple seasons in the year. I also am skeptical of the decrease in concussions to only be due to the neck muscle strengthening program, but it would be interesting to see what further research on this would show. In my experience, I have seen an increased number of Athletic Trainers implementing injury prevention programs and I look forward to seeing more research on the benefits of them.

Nicole Cattano said...

Thanks Adrienne, Dana, & Sarah for commenting. Very interesting points, & I agree that it is a high drop out rate, as well as an interesting definition of injury. Most injury prevention programs aren't so intensive, and I wonder what the effects would have been like had they been shorter or looked at injury differently.

It is great to see so many clinicians keeping an open mind to injury prevention programming and the sport specific individualization. What kinds of exercises are you all doing with your sports?

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