Efficacy
of a movement control injury prevention programme in adult men’s community
rugby union: a cluster randomized controlled trial
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.
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.
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.
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.
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?
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
by: Nicole Cattano
Reviewed
by: Jeffrey Driban
by: Jeffrey Driban
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Posts:
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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.
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.
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.
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?