musculoskeletal injury and concussion risk in schoolboy rugby players with a
pre-activity movement control exercise programme: a cluster randomized control
Hipslop MD, Stokes KA, Williams S, McKay CD, England
ME, Kemp SPT, Trewartha G . B J Sport Med. 2017; ahead of print
Take Home Message: Completing
a sport-specific movement control exercise program 3 times per week reduced
musculoskeletal and concussion injuries in school-age rugby athletes.
Injury prevention warm-up programs decrease the risk of injury in sports
such as basketball and soccer. However, little is known about whether these
programs prevent injuries in rugby, which is a sport with a lot of player
contact and a high risk of concussion and musculoskeletal injuries. Therefore,
the authors conducted a cluster-randomized trial to determine if a movement
control exercise program could prevent musculoskeletal injuries and concussions
among school-age rugby players. They also sought to assess the effect of
different doses (via compliance/adherence) on injury risk. All of the invited
schools had onsite nurses and physiotherapists who would treat rugby-related
injuries. The authors randomized 40 independent schools (participating in
either under-15, 16, or 18 rugby teams) to either a movement control program or
a basic exercise program. Both programs were comprised of 4 progressive phases,
which would be performed during the first 20 minutes of each pitch-based
training session and match warm-up. The coaches attended a 1-hour pre-study
workshop on how and when to implement the programs. Seventeen schools completed
the movement control program (44 teams, 1,325 players), which integrated
balance/perturbation training, resistance training, plyometric training, and
controlled rehearsal of sports-specific landing and cutting maneuvers with
verbal feedback and reinforcement of technique from the coach. Fourteen schools
(39 teams, 1,127 players) completed the basic exercise program, which consisted
of running-based warm up, dynamic stretching, controlled wrestling, mobility
and speed of direction drills (without coach feedback). The authors counted an
injury if it resulted in a time loss of > 24 hours. The school medical staff
recorded each injury location and diagnosis. Coaches reported the length of
each training session, number of players attending each session, information
about the matches played, and the number and level of each program phase the
athletes completed each week. Overall, there were no differences between
interventions; however, a closer look shows that athletes who performed the movement
control program may be 28 to 34% less at risk for head/neck, upper extremity, or
concussion injuries compared with the athletes in the control program.
Additionally, the authors found that athletes who performed the movement
control program at least 3 times per week suffered 72% fewer injuries and 59% fewer
concussions compared with those who performed the basic exercise program more than
3 times a week.
authors demonstrated that a movement control, sport-specific excise protocol
that is implemented at least 3 times per week may alter the amount of injuries
high school rugby athletes sustain. It is important to note that there was
likely a dose effect, which highlights that a good injury prevention program
will only be effective if the coaches and athletes commit to performing the
program as prescribed. Only 12 out of 63 teams performed the programs 3 or more
times/week on average. One issue may be the duration of the program. The
recently released Consensus Opinion for Best Practice Features of Injury Prevention Programs advocated that
programs should only take 10 to 15 minutes to promote compliance. The 20-minute
warm-up program may be too long, which led to a low compliance rate. These
findings also support the consensus opinion’s recommendation that injury
prevention programs should be performed at least 2 to 3 times/week. This study
offers strong evidence that an injury prevention program can reduce the risk of
injury in rugby but there is a need to find approaches to promote compliance.
Currently, medical professionals should be aware of these prevention programs.
They should also try to implement a shorter version of this program or ensure
compliance with the current program to help reduce the risk of injury among rugby
Question for
Discussion: Are you currently using any preventative warm up protocols? If not,
would you consider implementing them? If so, which sports in particular would
you focus on?
Written by: Jane McDevitt, PhD
by: Jeff Driban
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