Exposure to impacts across a competitive rugby season impairs balance and neuromuscular function in female rugby athletes

An Original research paper that went under the radar, another science paper coming out of Canada.

Authors

Stephanie E Black

Bruno Follmer

Rinaldo André Mezzarane

Gregory E P Pearcey

Yao Sun

Dr. E Paul Zehr

  1. Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC, Canada
  2. School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
  3. Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada
  4. Laboratory of Signal Processing and Motor Control, Faculty of Physical Education, University of Brasilia, Brasilia, DF, Brazil
  5. Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
  6. Division of Medical Sciences, University of Victoria, Victoria, BC, Canada

The study did an objective assessment tools to detect subtle neurological deficits that accompany repetitive and mild head impacts in contact sport across a
season.

What are the new findings in the study:

► A competitive rugby season induces subtle deteriorations in neuromuscular function that is not captured in traditional sideline assessment.

► Differentiation between static stances which range

in difficulty is relevant to uncover subtle changes in

balance.

► Tandem-leg and double-leg static stances are sensitive to detect centre of pressure alteration following

a season of recurrent head impacts.

► Spinal cord excitability measurements suggest deviated values at baseline

 

The study also found impact in clinical practices in Future studies.

► Implementing an objective balance measure as a clinical assessment may uncover subtle neurological. impairments without diagnosed concussion.

► Double-leg stance is often overlooked by subjective assessments, but it provides an insightful outcome if performed using a sensitive tool.

► The challenging tandem-leg stance over a foam pad notably contributes to a clinical assessment after recurrent mild head impacts.

► Spinal cord excitability may be suitable for detecting particular neurological patterns in female athletes exposed to head impacts performed using a sensitive tool.

Study Conclusions:

The study concluded that quantitative measures revealed that exposure to impacts across a competitive rugby season impair balance in two specific stances in female rugby athletes. Tandem-leg stance on an unstable surface and double-leg stance on firm surface are useful assessment conditions when performed over a low-cost balance board, even without clinically diagnosed concussion.

Click on link for full study: Exposure to impacts across a competitive rugby season impairs balance and neuromuscular function in female rugby athletes

Implementation of the Activate injury prevention exercise programme in English schoolboy rugby union

(Activate is the RFU’s Injury Prevention Exercise Programme) which all coaches should be made aware.

Authors:

Craig Barden1, Keith A Stokes1,2, Carly D McKay1,3

1.- Department for Health, University of Bath, Bath, UK
2.- Rugby Football Union, Twickenham, London, UK
3.- Centre for Motivation and Health Behaviour Change, University of Bath, Bath, UK

Fascinating paper just published on the 4th of May 2021, The Objectives of the study about the implementation of the Activate injury prevention exercise programme has not been assessed in an applied context.

This study aimed to

(1) describe the knowledge and perceptions of school rugby coaches and players towards injury risk, prevention and Activate and

(2) evaluate Activate implementation in schoolboy rugby using the reach, effectiveness, adoption, implementation and maintenance framework.

►► Coaches reported significantly greater baseline Activate awareness than players (75% and 18%,respectively).
►► Coaches had significantly greater Activate adoption during the study period (76% and 13%).
►► Coaches appear to be critical in the adoption and delivery of Activate in a school rugby environment.
►► Focus on behavioural change in coaches will likely have the greatest effect of Activate implementation.

Addressing coach barriers and using behavioural change theories may aid this.

Conclusion

Coaches had significantly greater awareness and adoption of Activate, with players largely unaware of the programme and if they used it. Coaches are instrumental in the decision to implement Activate. Targeting behavioural change in these individuals is likely to have the greatest impact on intervention uptake.

FULL PAPER Here A MUST Read: Activate Injury Prevention

For further reading click on the link from England Rugby: https://www.englandrugby.com/participation/coaching/activate

A qualitative investigation into the individual injury burden of amateur rugby players

Authors: Gemma P. Murphy & Rachel B. Sheehan
Department of Physical Education and Sport Sciences, University of Limerick, Ireland

Highlights

Players shared similar experiences of burden when recovering from a severe injury.

Themes relating to personal and situational factors affect players during injury.

The highest burden of injury occurred during onset of injury and rehabilitation.

Burden of injury has the potential to affect a player’s rehabilitation outcome.

The Author’s findings indicate that individual injury experiences can affect a player’s recovery and rehabilitation outcome, potentially extending the injury process and affecting player availability for the team. As such, injury management should focus on alleviating any injury-related burden experienced by players, as well as burden placed on the team, to maximise rehabilitation outcomes.

Click on link to read the PDF Article: A qualitative investigation into the in..

Hydration in Amateur Sport

After a year away from the sporting pitches and with the possible return to full training of Semi Professional and Amateur (Grass roots) sports in June, we must never forget the fundamental role that water plays in our body, cooling, nutrient transport, joint lubrication, digestion, and absorption.

Ref: EU Hydration institute.

The Human body is 60 or 70% made up of water, many of it is found in the blood and muscles. The amount of water in the body is limited, if the losses are not replaced there may be a decrease in heat transmission from the muscles to the skin, the consequence of which will be the increase in body temperature, favouring the risk of dehydration, the first signs are intense thirst, dry body, hot, dry skin and mucous membranes, cramps (sodium is lost due to perspiration), depletion by hydro-electrolytic imbalance (which manifests with dizziness, sweat, tachycardia, headache, paleness, etc.), heatstroke (decreased level of consciousness, neuromuscular un-coordination).

Dehydration causes a decrease in aerobic capacity, maximum aerobic potency, muscle endurance and the ability to develop physical work. In addition to the physical qualities mentioned, mental faculties, fine coordination and therefore it is essential to provide fluids during exercise, mainly when large water losses occur. The proper way to hydrate will depend on:

  • The goal to achieve (increase muscle mass, decrease adipose tissue, optimize performance, etc.)
  • The intensity, frequency, duration, etc. of the training to be performed
  • The weather (temperature and humidity)
  • Individual variations (there are people who sweat more than others) Having these factors present should opt for the right drink (water and / or sports drink) and rehydration strategies should be practiced during training. Recommendation: Never try a new strategy on match day, that is what training is for.

HYDRATATION (PARTY/TRAINING)

The goal is to ensure a state of euhydration (i.e. normal hydration) and prevent gastrointestinal discomfort. Avoid diuretic or gas drinks (alcohol, coffee, etc) and Drink between 300-600ml of water (without gas) in the pre-match time (preheating); and more if the temperature and/or humidity are high or if you are a “profuse sweater”.

Normal hydration status is defined the presumed condition of healthy individuals who maintain water balance. Evaluation of hydration status is not easy, as during daily activities or exercise, fluid compartments are constantly fluctuating and therefore the evaluation of a single body fluid compartment volume is insufficient to provide valid information about total body water (TBW) .

HYDRATION DURING (Matches/Training)

Players need to be educated regarding the benefits of fluid replacement to promote performance and safety and the potential risks of both hypohydration and hyperhydration on health and physical performance. Quantify sweat rates for physically active individuals during exercise in various environments. Work with individuals to develop fluid-replacement practices that promote sufficient but not excessive hydration before, during, and after physical activity.

The goal is to replenish sweat-lost water and provide an energy source, to delay glycogenic emptying and therefore fatigue.

With high-performance athletes, restricting dehydration to no more than 2% body mass loss helps to maintain the physiological, perceptual, and safety aspects of their exercise while aiding in exercise recovery and subsequent training sessions.

Dehydration is the process of water loss from the body and being in a dehydrated state means you no longer have sufficient fluid in your body to optimally function. Naturally, even at rest we lose fluid by as much as 1-3L per day.

In any training greater than 60 minutes long and high intensity, Water and/or sports drink, if possible, containing the necessary and sufficient nutrients such as sodium (to promote water absorption) and carbohydrates. The latter delay, but do not prevent, muscle fatigue; since the utilization rate is higher than the ability to eat carbohydrates during exercise.

Always have drinks during a pause in a game such as penalties, conversions, at half-time and, always when the referee allows you to… or between exercise sessions in the gym/field. Pay special attention to those who remain substitutes, they must rehydrate in the substitutes’ bench, to be prepared in case they have to enter the game.

If we are dehydrated our performance will NOT be optimal, with weight loss of 2% there is decreased athletic performance, 3% decrease in physical endurance 4% there is decreased muscle strength, thus having a personal plan and drinking a sufficient amount of fluid could be the difference between winning and losing.

You should not wait to be thirsty to drink liquid; at that moment you are already dehydrated!!

Other reasons for inadequate liquid intakes are lack of availability of liquids, unrespecting liquids, sports tradition, lack of awareness in the subject.

REHYDRATION (PARTY/TRAINING)

The volume of liquid lost depends on the intensity and duration of the activity, the temperature and ambient humidity, the clothing used, the acclimatization of the person to heat, the movement of air and solar radiation. The thirst mechanism is activated when a lot of fluid has already been lost, so it is important to control losses by comparing pre- and post-activity weight and urine color (the more yellow, the greater fluid loss, usually).

Example of how urine colour might vary with Hydration status:

Ref: EU Hydration Institute

The strategy to follow is: drink 1/2 litre of sports drink as soon as you finish training/playing and then you should consume up to 150% of the lost weight, within 2-3 hours. Example: 90Kg player with a dehydration of 2% lost 1.8Kg, the volume to consume would be 2.7 litres (2700ml): 1st half litre and then 2200ml.

As a rule, consume between 500-1000ml/hour of sports drink or mineral water (without gas), larger amounts may be necessary on days of high temperatures.

Although there is no exact answer for how much water you should consume as everyone may have different needs depending on individual and environmental factors, aim for approximately 35ml of fluid per kg body weight. That is just over 2 litres for a 60kg adult, or 2.8 litres for an 80kg adult. Active children should aim for 1-1.5 litres per day (approx. 4-6 glasses) and everyone should consume extra fluid if exercising.

All this is plannable and trainable!! Do not leave hydration released at random. Do not test these strategies for the first time in a match; but try to get used to drinking workouts every 15-20 minutes.

DEHYDRATION is one of the main 5 nutritional factors related to fatigue and decreased performance, along with the emptying of glycogen deposits (energy) in active muscles, decreased blood glucose (hypoglycemia), gastrointestinal discomfort, excess adipose mass (ballast). All is preventable with food education and “training” habits.

It is up to you to be hydrated.

Some ideas

1-2 hours before exercise – suitable foods include:

  • Milk shake or smoothie
  • Breakfast cereal with milk
  • Cereal bars
  • Fruit-flavoured yoghurt
  • Fruit

Less than 1 hour before exercise – suitable foods include:

  • Sports drinks
  • Squash drinks
  • Jelly sweets

References:

Maintaining Euhydration Preserves Cognitive Performance, But Is Not Superior to Hypohydration Stephen P. J. Goodman, Ashleigh T. Moreland & Frank E. Marino Journal of Cognitive Enhancement volume 3, pages338–348(2019)

Eat Well, Feel Well: The Importance Of Hydrationhttps://www.irishrugby.ie/2020/05/12/eat-well-feel-well-the-importance-of-hydration/

National Athletic Trainers’ Association Position Statement: Fluid Replacement for the Physically Active J Athl Train. 2017 Sep; 52(9): 877–895.

Key tips on hydration Educational tool-measuring hydration status – European Hydration Institute

Water: http://www.Scienceforsport.com 

 

Game playing in Youth Rugby

It is a challenge and a great responsibility to play and train with young children. Because of their nature they are curious, they love  challenges, try things, new situations and discover the world around them for themselves.

The suggestion in the early years of schooling poses that the most important thing is not the teaching of motor skills, but you have to take seriously the needs of children in this area with actions such as climbing, jumping, spinning, spinning, playing with balance, looking for risky situations.

One of the most interesting proposals from World Rugby is the organization of training in seasons. Children choose more or less in the seasons, they can determine the degree of difficulty and learn from mistakes. Many children are able to assess their own risk. It should be noted that some  six-year-olds, for example, tend to have a developmental level for four-year-olds, while others develop eight-year-olds.

So, What would training could look like?

Creating a positive environment for the young player is crucial – develop players who can make correct decisions during a match, the (coaching) environment should be conditioned to allow players to practice recognising situations, work out solutions and then react accordingly.

It is here that coaches can make the most significant impact by encouraging Young players to try things and learn from their mistakes.

A training, encounter or game session with youth players can have various edges. The prerequisite for success is a good organisation. Drawings and photos are often better than long verbal explanations to help all participants who have to get used to new  tools and become more independent, with autonomy you do not lose the quality of the movement.

  • Always have a purpose / objective to your session
  • Question your players to check for understanding to ensure they are aware of:
    • What they are doing (the technical detail)
    • How it relates to the principles of play (the tactical detail)
    • What the effect of their actions will be on play

It is important, however, to remember that there is a lot of spontaneous motor activity (of movements) in children. Coaches should observe,  help when  needed, and/or  work  with children. Safety issues should not be forgotten.

  • Continually improve ALL players(not just the skilled ones)
  • Develop techniques into skills(by placing players into game situations)
  • Develop players’ game-sense’ (their ability to understand the game and the consequence of their actions)
  • See what is right and praise it
  • See what is wrong, recognise why it is wrong, and be able to correct it.

This is the optimal level for the acquisition of all motor skills, enabling many positive experiences of movement, and thus allowing the development of skills not only coordinative and conditional, but also cognitive, emotional, and even socialization.

  • Encourage skill learning for everyone (slow starters may be successful later)
  • Allow all players to experience every playing position – the prop of today could be the scrum half of tomorrow! Rugby is a late specialisation sport – so, no need to define players into position too early – if you do so you may be limiting their development!

Undoubtedly Modified games are extremely useful to help players to develop both their skills and game understanding for training ages is best for open, intensive teaching in terms of motor learning and several experiences.

World Rugby recommends coaches should ensure that they adopt a game-based approach to their coaching activities and actually coach through the game (focus on specifics, observe and analyse critically, correct errors, praise good practice and encourage learning) rather than manage the activity (e.g., commentating on play). This means providing specific feedback on both good practice and areas to develop, in relation to the aim set out at the start.

With Youth players It is important that the aim (e.g., tackle or pass technique) is maintained throughout the session as the tendency can be for the coach to fix other faults. This can result in the key message to the players be diluted through a focus on too much detail at once. distraction and loss of interest is common in young age groups.

To challenge players with realistic training activities, coaches should be creative in the tasks they set for their players to encourage them to solve problems and make decisions. Consider the following tips when designing the activities and always relate what you are asking the players to do in relation to the outcome of the session:

  • Condition the opposition in attack or defence to put players in decision making situations – by altering number in attack/defence, placing conditions on what they can or cannot do and giving some players specific roles
  • Utilise scoring zones and systems – the position and numbers of areas that can be scored in as well as what is required to score – relate to objective.
  • Alter the dimensions of playing area to maximise opportunity to practice (e.g. narrow for developing contact skills)
  • Allowing /disallowing some skills in certain zones (e.g. only 3 passes in the middle zone/ no kicking in own half etc.)

Coaching girls – considerations

When dealing with Youth players, coaches should take into consideration that just like boys, girls will develop at different rates and times.

Training programmes should take this into account and be tailored to the development stage of the player. For example, a ten-year-old girl may have been playing since she was six years of age and therefore has four years’ experience playing the game while a 12-year-old may just have taken up the sport and be in her first year of rugby.

Some key areas which are particularly useful to consider when coaching girls.

From World Rugby:

  • As girls can tend to be more people-orientated, how a coach engages and communicates with them is very important as this sets a foundation for their learning and encourages participation
  • Girls can respond more positively when their coach knows them as individuals and understands their personalities, motivations, and goals
  • Girls tend to ask more questions than boys as they usually need to understand the detail of an instruction before willingly completing it as the process is as important as the outcome
  • Be mindful of physical interaction. Physical touch needs to be appropriate. If it is required to demonstrate a particular skill, permission should be obtained from the player provided that it is within cultural norms. Coaches may need to use a full range of questioning and demonstration strategies (for example, use of experienced players to demonstrate, use of video)
  • Having females involved in managing or coaching is good practice
  • Physical differences between male and female children aged ten to twelve years of age are usually minimal.

World Rugby guide:

References:

World Rugby Guidelines :  World Rugby Coaching : The home of Rugby coaching on the web : Coaching Children

I Coach Kids : iCoachKids: Home

International Safeguards for Children in Sport: org/en/toolkit/child-protection-and-safeguarding

Balyi, I. & Hamilton, A., 2004. Long Term Athletic Development: Trainability in Childhood and Adolescence. Victoria, British Columbia: National Coaching Institute and Advanced Training and Performance LTD

 

Head impact exposures in women’s collegiate rugby

Original Research

Authors: Taylor L. Langevin ,Daniel Antonoff,Christina Renodin,Erin Shellene,Lee Spahr,Wallace A. Marsh &John M. Rosene

Published online: 01 Jun 2020 https://www.tandfonline.com/doi/abs/10.1080/00913847.2020.1770568?journalCode=ipsm20

OBJECTIVES: To describe the incidence, magnitude, and distribution of head impacts and track concussions sustained in a collegiate level women’s rugby season.

METHODS: Data on head impact incidence and magnitude were collected via Smart Impact Monitors (SIM) (Triax Technologies, Inc., Norwalk, CT) within fitted headbands during practices and games of one competitive season. Magnitude data included peak linear acceleration (PLA) and peak rotational velocity (PRV) measurements and were reported as median [IQR].

RESULTS: Players sustained 120 head impacts ≥ 15g (18.1g – 78.9g) with 1199 total athlete exposures. In eight games, 67 head impacts were recorded with a mean rate of 0.40 ± 0.22 hits per-player per-match, median PLA of 32.2g and PRV of 13.5 rad.sec-1. There were 53 head impacts in 47 practices with a mean rate of 0.05 ± 0.04 hits per-player per-practice, median PLA of 29.8g and PRV of 15.7 rad.sec-1. Four concussions were reported and monitored.

CONCLUSION: The incidence and magnitude of head impacts in collegiate level women’s rugby over one season of practices and games were fewer than those reported in other comparable studies. These findings give insight into the impact burden that female collegiate rugby athletes withstand throughout a competitive season.

A Team Sport Risk Exposure Framework to Support the Return to Sport

With Amateur Sports returning to training this is a timely reminder how to training and player proximity interactions when following guidelines in minutiae.

BLOG: British Journal of Sports Medicine Published 1/7/2020

Useful for sports to quantify risk in training & matches, & help guide contact tracing

Authors : Ben Jones 1,2,3,4,5, Gemma Phillips 2,6, Simon PT Kemp 7,10, Steffan A Griffin 7,8, Clint Readhead 4,9, Neil Pearce 10, Keith A Stokes 7,11

Background

The COVID-19 pandemic has resulted in global disruption to many sports. There are a number of challenges in returning to sport, especially given the unprecedented duration of time that athletes have not been able to train or compete in normal environments(1), the potential health risk to athletes, their coaches, support staff, the wider public, and the limited evidence base available to inform decisions. Every sport will carry different infection risks, given the specific match demands and training requirements(2). Furthermore, considerations regarding the return to training and match play will be greatly influenced by the national impact of COVID-19(3). A good example is the comparison of United Kingdom (COVID-19 mortality of >42,000), vs. Australia and New Zealand (COVID-19 mortality of <150)(4). In particular, New Zealand has now eliminated SARS-CoV-2, and rugby and other sports are now occurring ‘as normal’.

Full Blog can be found here:Blogs BJSM

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Returning to Play after Prolonged Training Restrictions in Professional Collision Sports

Authors Keith A. Stokes1, 2 , Ben Jones3, 4, 5, 6, Mark Bennett7, 8, Graeme L. Close9, 10, Nicholas Gill11, 12, James H. Hull13, Andreas M. Kasper10, Simon P. T. Kemp2, Stephen D. Mellalieu14, Nicholas Peirce15, Bob Stewart2, Benjamin T. Wall16, Stephen W. West1, Matthew Cross1,

On the 29th of May the International Journal of sports medicine published on line the attached article, with the easing of Pandemic conditions the following article should be read by sports alevels when returning to play.

Abstract: The COVID-19 pandemic in 2020 has resulted in widespread training disruption in many sports. Some athletes have access to facilities and equipment, while others have limited or no access, severely limiting their training practices. A primary concern is that the maintenance of key physical qualities (e. g. strength, power, high-speed running ability, acceleration, deceleration and change of direction), game-specific contact skills (e. g. tackling) and decision-making ability, are challenged, impacting performance and injury risk on resumption of training and competition.

In extended periods of reduced training, without targeted intervention, changes in body composition and function can be profound. However, there are strategies that can dramatically mitigate potential losses, including resistance training to failure with lighter loads, plyometric training, exposure to high-speed running to ensure appropriate hamstring conditioning, and nutritional intervention.

Athletes may require psychological support given the challenges associated with isolation and a change in regular training routine. While training restrictions may result in a decrease in some physical and psychological qualities, athletes can return in a positive state following an enforced period of rest and recovery. On return to training, the focus should be on progression of all aspects of training, taking into account the status of individual athletes.

For the full article and conclusions: Click on the link Return to Play

 

 

Association of artificial turf and concussion in competitive contact sports: a systematic review and metaanalysis

Authors Frank O’ Leary 1, Nic Acampora 2, Fiona Hand 3, James O’ Donovan 1

BMJ Open Sport & Exercise Medicine 2020;6:e000695. doi:10.1136/bmjsem-2019-000695
1 Department of Performance
Medicine, Sport Ireland Institute,
Dublin, Ireland
2 Faculty of Life Sciences,
University of South Wales,
Pontypridd, UK
3 Department of Surgery, St.
Vincent’s University Hospital,
Elm Park, Dublin, Ireland

An interesting study published in May 2020 by the BMJ in Sports Exercise and Medicine concerning artificial pitches:

Artificial turf can be defined as ‘a surface of synthetic fibres made to look like natural grass’. Since its introduction in 1965, safety concerns have been raised over its use as a playing surface in competitive contact sports. The higher number of knee and ankle injuries occurring on artificial turf has been established.

Despite these safety concerns, an ongoing replacement of natural grass with synthetic turf continues to occur in contact sport.

The aim of this review was to compare the incidence of head injuries and concussion on both artificial turf and natural grass in those competitive contact sports (of any standard) using both surfaces. From this, the risk of such injuries can be directly compared on either playing surface.

What is already known?
► With increasing awareness of head injuries in contact sports, the diagnosis of concussion is becoming more common. Artificial turf is frequently used as a
playing surface for contact sports. There remains no consensus on whether playing surface contributes to the incidence of significant head injury.

What are the new findings?
► Analysis of the limited publications on artificial turf playing surface demonstrates a lower incidence of concussion and head injury in competitive contact sports. On subgroup analysis, this effect is most marked in rugby and American football, with no significant association of playing surface on the incidence of head injury or concussion in soccer.

This systematic review demonstrates an overall lower concussion and head injury rate occurring on artificial turf in competitive contact sports combined, yet when assessing the sports (soccer, American football and rugby) individually, the link between head injury and concussion with playing surface type is not as clear.

Future research in this area would be important to ascertain reasons for this result.

Further examination on what other factors exist that could lead to lower head injury and concussion rates on artificial turf in contact sports should be established. This may include: number
of collisions on artificial turf, the incidence of surface to head contact, the maintenance of the artificial turf as well as its surface properties including temperature and HIC (Head Injury Criterion).

For a full read of the article click on the link Artificial Turf and Concussion