Training load and injury risk in elite Rugby Union:The largest investigation to date

AbstractTraining load monitoring has grown in recent years with the acute:chronic workload ratio (ACWR) widely used to aggregate data to inform decision-making on injury risk. Several methods have been described to calculate the ACWR and numerous methodological issues have been raised. Therefore, this study examined the relationship between the ACWR and injury in a sample of 696 players from 13 professional rugby clubs over two seasons for 1718 injuries of all types and a further analysis of 383 soft tissue injuries specifically. Of the 192 comparisons undertaken for both injury groups, 40% (all injury) and 31% (soft tissue injury) were significant. Furthermore, there appeared to be no calculation method that consistently demonstrated a relationship with injury. Some calculation methods supported previous work for a “sweet spot” in injury risk, while a substantial number of methods displayed no such relationship. This study is the largest to date to have investigated the relationship between the ACWR and injury risk and demonstrates that there appears to be no consistent association between the two. This suggests that alternative methods of training load aggregation may provide more useful information, but these should be considered in the wider context of other established risk factors.</jats:p

Escherichia coli isolates from extraintestinal organs of livestock animals harbour diverse virulence genes and belong to multiple genetic lineages

Escherichia coli, the most common cause of bacteraemia in humans in the UK, can also cause serious diseases in animals. However the population structure, virulence and antimicrobial resistance genes of those from extraintestinal organs of livestock animals are poorly characterised. The aims of this study were to investigate the diversity of these isolates from livestock animals and to understand if there was any correlation between the virulence and antimicrobial resistance genes and the genetic backbone of the bacteria and if these isolates were similar to those isolated from humans. Here 39 E. coli isolates from liver (n=31), spleen (n=5) and blood (n=3) of cattle (n=34), sheep (n=3), chicken (n=1) and pig (n=1) were assigned to 19 serogroups with O8 being the most common (n=7), followed by O101, O20 (both n=3) and O153 (n=2). They belong to 29 multi-locus sequence types, 20 clonal complexes with ST23 (n=7), ST10 (n=6), ST117 and ST155 (both n=3) being most common and were distributed among phylogenetic group A (n=16), B1 (n=12), B2 (n=2) and D (n=9). The pattern of a subset of putative virulence genes was different in almost all isolates. No correlation between serogroups, animal hosts, MLST types, virulence and antimicrobial resistance genes was identified. The distributions of clonal complexes and virulence genes were similar to other extraintestinal or commensal E. coli from humans and other animals, suggesting a zoonotic potential. The diverse and various combinations of virulence genes implied that the infections were caused by different mechanisms and infection control will be challenging

The National ReferAll Database: An Open Dataset of Exercise Referral Schemes Across the UK

In 2014, The National Institute for Health and Care Excellence (NICE) called for the development of a system to collate local data on exercise referral schemes (ERS). This database would be used to facilitate continued evaluation of ERS. The use of health databases can spur scientific investigation and the generation of evidence regarding healthcare practice. NICE’s recommendation has not yet been met by public health bodies. Through collaboration between ukactive, ReferAll, a specialist in software solutions for exercise referral, and the National Centre for Sport and Exercise Medicine, which has its research hub at the Advanced Wellbeing Research Centre, in Sheffield, data has been collated from multiple UK-based ERS to generate one of the largest databases of its kind. This database moves the research community towards meeting NICEs recommendation. This paper describes the formation and open sharing of The National ReferAll Database, data-cleaning processes, and its structure, including outcome measures. Collating data from 123 ERSs on 39,283 individuals, a database has been created containing both scheme and referral level characteristics in addition to outcome measures over time. The National ReferAll Database is openly available for researchers to interrogate. The National ReferAll Database represents a potentially valuable resource for the wider research community, as well as policy makers and practitioners in this area, which will facilitate a better understanding of ERS and other physical-activity-related social prescribing pathways to help inform public health policy and practice

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

BACKGROUND: 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. HYPOTHESIS: Completing a neck-strengthening program will increase isometric neck strength in age-group rugby players. STUDY DESIGN: A pilot randomized controlled exercise intervention study. LEVEL OF EVIDENCE: Level 2. METHODS: 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. OUTCOME MEASURE: Peak isometric neck strength (force N) into neck flexion, extension, and left and right side flexion was measured using a handheld dynamometer. RESULTS: 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). CONCLUSION: 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. CLINICAL RELEVANCE: 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

Training and match load in professional rugby union: Do contextual factors influence the training week?

Background: Rugby union demands a multifaceted approach to training, given the multiple physical and technical attributes required to play the sport. Objectives: The aim of this study is to describe the distribution of training throughout the week and investigate how this may be influenced by match-related factors. Methods: Training load data (session Rating of Perceived Exertion [sRPE], total distance and high-speed running [HSR]) were collected from six professional English rugby teams during the 2017/18 season. Five contextual factors were also recorded including: standard of opposition, competition type, result of previous fixture, surface type, and match venue. Results: The day prior to matches demonstrated the lowest training load (101 AU (95% CIs: 0-216 AU) , 1 047 m (95% CIs:1 128-1 686 m) and 59 m (95% CIs: 0-343 m), respectively), while four days prior to the match demonstrated the highest training load (464 AU (95% CIs: 350-578), 2 983 m (95% CIs: 2 704-3 262m) and 234m (95% CIs: 0-477m), respectively). Of the five contextual factors, competition type was the only variable that demonstrated greater than trivial findings, with training before European fixtures the lowest stimulus across the four different competition types. Standard of opposition, previous result, surface type and venue had only trivial effects on training load (effect sizes = -0.13 to 0.15). Conclusion: Future studies should outline the distribution of other training metrics, including contact and collision training. This study provides a multi-club evaluation that demonstrates the variety of loading strategies prior to competitive match play and highlights competition type as the most influential contextual factor impacting the average training load

Absence of Face-specific Cortical Activity in the Complete Absence of Awareness: Converging Evidence from Functional Magnetic Resonance Imaging and Event-related Potentials

In this study, we explored the neural correlates of perceptual awareness during a masked face detection task. To assess awareness more precisely than in previous studies, participants employed a 4-point scale to rate subjective visibility. An event-related fMRI and a high-density ERP study were carried out. Imaging data showed that conscious face detection was linked to activation of fusiform and occipital face areas. Frontal and parietal regions, including the pre-SMA, inferior frontal sulcus, anterior insula/frontal operculum, and intraparietal sulcus, also responded strongly when faces were consciously perceived. In contrast, no brain area showed face-selective activity when participants reported no impression of a face. ERP results showed that conscious face detection was associated with enhanced N170 and also with the presence of a second negativity around 300 msec and a slow positivity around 415 msec. Again, face-related activity was absent when faces were not consciously perceived. We suggest that, under conditions of backward masking, ventral stream and fronto-parietal regions show similar, strong links of face-related activity to conscious perception and stress the importance of a detailed assessment of awareness to examine activity related to unseen stimulus events

The influence of in-season training loads on injury risk in professional rugby union

Purpose:To explore the association between in-season training-load (TL) measures and injury risk in professional rugby union players.Methods:This was a 1-season prospective cohort study of 173 professional rugby union players from 4 English Premiership teams. TL (duration × session-RPE) and time-loss injuries were recorded for all players for all pitch- and gym-based sessions. Generalized estimating equations were used to model the association between in-season TL measures and injury in the subsequent week.Results:Injury risk increased linearly with 1-wk loads and week-to-week changes in loads, with a 2-SD increase in these variables (1245 AU and 1069 AU, respectively) associated with odds ratios of 1.68 (95% CI 1.05–2.68) and 1.58 (95% CI 0.98–2.54). When compared with the reference group (&lt;3684 AU), a significant nonlinear effect was evident for 4-wk cumulative loads, with a likely beneficial reduction in injury risk associated with intermediate loads of 5932–8651 AU (OR 0.55, 95% CI 0.22–1.38) (this range equates to around 4 wk of average in-season TL) and a likely harmful effect evident for higher loads of &gt;8651 AU (OR 1.39, 95% CI 0.98–1.98).Conclusions:Players had an increased risk of injury if they had high 1-wk cumulative loads (1245 AU) or large week-to-week changes in TL (1069 AU). In addition, a U-shaped relationship was observed for 4-wk cumulative loads, with an apparent increase in risk associated with higher loads (&gt;8651 AU). These measures should therefore be monitored to inform injury-risk-reduction strategies.</jats:sec

Efficacy of a movement control injury-prevention programme in an adult community rugby union population; a cluster randomised controlled trial

Background Exercise programmes aimed at reducing injury have been shown to be efficacious for some non-collision sports, but evidence in collision sports such as rugby union is lacking. Objective To evaluate the efficacy of an evidence-informed injury prevention exercise programme in reducing match injuries in adult community rugby union players. Design Prospective cluster randomised (single-blind) controlled trial. Clubs were the unit of randomisation. Setting English adult community clubs (2015–2016 season) with a formally qualified medical professional to diagnose and report match-injuries. Participants 860 clubs were invited to participate of which 81 volunteered and were randomly assigned. Data was received from 41 clubs (control, 19; intervention, 22). Interventions A 42-week exercise programme comprising 6-week graduated exercise blocks was introduced during pre-season. The control programme reflected ‘normal practice’ exercises, whereas the intervention focused on proprioception, balance, cutting, landing, and resistance exercises. Main Outcome Measurements Match-injury incidence and burden for: all ≥8 days time-loss injuries and targeted (lower-limb, shoulder, head and neck, excluding fractures and lacerations) ≥8 days time-loss injuries. Results Poisson regression identified unclear differences between groups for overall injury incidence (rate ratio (RR), 90% confidence interval (CI)=0.9, 0.6–1.3) and injury burden (RR, 90% CI=0.8, 0.5–1.4). A likely beneficial difference in targeted injury incidence (RR, 90% CI=0.6, 0.4–1.0) was identified, with ∼40% lower lower-limb incidence (RR, 90% CI=0.6, 0.4–1.0) and ∼60% lower concussion incidence (RR, 90%CI=0.36, 0.18–0.70) in the intervention group. Completing the intervention at least once per week was associated with a likely beneficial difference between groups (intervention n=15, control n=13; RR, 90% CI=0.7, 0.4–1.0). Conclusions This movement-control injury-prevention programme appeared efficacious, with likely beneficial differences for lower-limb injuries and concussion for the treatment clubs. Targeted injury incidence was ∼30% lower when 1 or more intervention sessions were completed each wee

Monitoring what matters:A systematic process for selecting training load measures

Purpose:Numerous derivative measures can be calculated from the simple session rating of perceived exertion (sRPE), a tool for monitoring training loads (eg, acute:chronic workload and cumulative loads). The challenge from a practitioner’s perspective is to decide which measures to calculate and monitor in athletes for injury-prevention purposes. The aim of the current study was to outline a systematic process of data reduction and variable selection for such training-load measures.Methods:Training loads were collected from 173 professional rugby union players during the 2013–14 English Premiership season, using the sRPE method, with injuries reported via an established surveillance system. Ten derivative measures of sRPE training load were identified from existing literature and subjected to principal-component analysis. A representative measure from each component was selected by identifying the variable that explained the largest amount of variance in injury risk from univariate generalized linear mixed-effects models.Results:Three principal components were extracted, explaining 57%, 24%, and 9% of the variance. The training-load measures that were highly loaded on component 1 represented measures of the cumulative load placed on players, component 2 was associated with measures of changes in load, and component 3 represented a measure of acute load. Four-week cumulative load, acute:chronic workload, and daily training load were selected as the representative measures for each component.Conclusions:The process outlined in the current study enables practitioners to monitor the most parsimonious set of variables while still retaining the variation and distinct aspects of “load” in the data.</jats:sec

Cost-effectiveness of replacing versus discarding the nail in children with nail bed injury

Every year in the UK, around 10 000 children need to have operations to mend injuries to the bed of their fingernails. Currently, most children have their fingernail placed back on the injured nail bed after the operation. The NINJA trial found that children were slightly less likely to have an infection if the nail was thrown away rather than being put back, but the difference between groups was small and could have be due to chance. This study looked at whether replacing the nail is cost-effective compared with throwing it away. Using data from the NINJA trial, we compared costs, healthcare use, and quality of life and assessed the cost-effectiveness of replacing the nail. It was found that throwing the nail away after surgery would save the National Health Service (NHS) £75 (€85) per operation compared with placing the nail back on the nail bed. Changing clinical practice could save the NHS in England £720 000 (€819 000) per year