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Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension—the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.

ObjectivesThe Professional Rugby Injury Surveillance Project is the largest and longest running rugby union injury surveillance project globally and focuses on the highest level of rugby in England.MethodsWe examined match injuries in professional men’s rugby over the period 2002/2003 to 2018/2019 and described trends in injuries over this time.ResultsOver the period 2002/2003–2018/2019, 10 851 injuries occurred in 1 24 952 hours of match play, equating to a mean of 57 injuries per club per season and one injury per team per match. The mean incidence, severity (days absence) and burden (days absence/1000 hours) of injury were 87/1000 hours (95% CI 82 to 92), 25 days (95% CI 22 to 28) and 2178 days/1000 hours (95% CI 1872 to 2484), respectively. The tackle accounted for 43% injuries with running the second most common activity during injury (12%). The most common injury location was the head/face with an incidence of 11.3/1000 hours, while the location with the highest overall burden was the knee (11.1 days/1000 hours). Long-term trends demonstrated stable injury incidence and proportion of injured players, but an increase in the mean and median severity of injuries. Concussion incidence, severity and burden increased from the 2009/2010 season onwards and from 2011 to 2019 concussion was the most common injury.ConclusionThe rise in overall injury severity and concussion incidence are the most significant findings from this work and demonstrate the need for continued efforts to reduce concussion risk as well as a greater understanding of changes in injury severity over time.

ObjectivesTo evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk.DesignThis systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesEight databases (MEDLINE, CINAHL, APA PsycINFO, Cochrane (Systematic Review and Controlled Trails Registry), SPORTDiscus, EMBASE, ERIC0 were searched in October 2019 and updated in March 2022, and references searched from any identified systematic review.Eligibility criteriaStudy inclusion criteria were as follows: (1) original data human research studies, (2) investigated SRC or head impacts, (3) evaluated an SRC prevention intervention, unintended consequence or modifiable risk factor, (4) participants competing in any sport, (5) analytic study design, (6) systematic reviews and meta-analyses were included to identify original data manuscripts in reference search and (7) peer-reviewed. Exclusion criteria were as follows: (1) review articles, pre-experimental, ecological, case series or case studies and (2) not written in English.ResultsIn total, 220 studies were eligible for inclusion and 192 studies were included in the results based on methodological criteria as assessed through the Scottish Intercollegiate Guidelines Network high (‘++’) or acceptable (‘+’) quality. Evidence was available examining protective gear (eg, helmets, headgear, mouthguards) (n=39), policy and rule changes (n=38), training strategies (n=34), SRC management strategies (n=12), unintended consequences (n=5) and modifiable risk factors (n=64). Meta-analyses demonstrated a protective effect of mouthguards in collision sports (incidence rate ratio, IRR 0.74; 95% CI 0.64 to 0.89). Policy disallowing bodychecking in child and adolescent ice hockey was associated with a 58% lower concussion rate compared with bodychecking leagues (IRR 0.42; 95% CI 0.33 to 0.53), and evidence supports no unintended injury consequences of policy disallowing bodychecking. In American football, strategies limiting contact in practices were associated with a 64% lower practice-related concussion rate (IRR 0.36; 95% CI 0.16 to 0.80). Some evidence also supports up to 60% lower concussion rates with implementation of a neuromuscular training warm-up programme in rugby. More research examining potentially modifiable risk factors (eg, neck strength, optimal tackle technique) are needed to inform concussion prevention strategies.ConclusionsPolicy and rule modifications, personal protective equipment, and neuromuscular training strategies may help to prevent SRC.PROSPERO registration numberCRD42019152982.

Background/aimConcussion, the most common injury in professional rugby union, occurs most commonly during the tackle. Thus, we investigated the association between tackle characteristics and concussion.Methods182 video clips of tackles leading to clinically diagnosed concussion and 4619 tackles that did not were coded across three professional rugby union competitions. A variable selection process was undertaken to identify the most important variables for interpretation. A multivariate generalised linear model was used to model the association between retained variables and concussion risk. Magnitude-based inferences provided an interpretation of the real-world relevance of the outcomes.ResultsThe four retained variables were: accelerating player, tackler speed, head contact type and tackle type. Overall, 70% of concussions occurred to the tackler and 30% to the ball carrier. There was a higher risk of concussion if the tackler accelerated into the tackle (OR: 2.49, 95% CI 1.70 to 3.64) or the tackler was moving at high speed (OR: 2.64, 95% CI 1.92 to 3.63). Head contact with the opposing player’s head (OR: 39.9, 95% CI 22.2 to 71.1) resulted in a substantially greater risk of concussion compared with all other head contact locations.ConclusionsInterventions that reduce the speed and acceleration of the tackler and reduce exposure to head-to-head contact would likely reduce concussion risk in professional rugby union.

Using an expert consensus-based approach, a rugby union Video Analysis Consensus (RUVAC) group was formed to develop a framework for video analysis research in rugby union. The aim of the framework is to improve the consistency of video analysis work in rugby union and help enhance the overall quality of future research in the sport. To reach consensus, a systematic review and Delphi method study design was used. After a systematic search of the literature, 17 articles were used to develop the final framework that described and defined key actions and events in rugby union (rugby). Thereafter, a group of researchers and practitioners with experience and expertise in rugby video analysis formed the RUVAC group. Each member of the group examined the framework of descriptors and definitions and rated their level of agreement on a 5-point agreement Likert scale (1: strongly disagree; 2: disagree; 3: neither agree or disagree; 4: agree; 5: strongly agree). The mean rating of agreement on the five-point scale (1: strongly disagree; 5: strongly agree) was 4.6 (4.3–4.9), 4.6 (4.4–4.9), 4.7 (4.5–4.9), 4.8 (4.6–5.0) and 4.8 (4.6–5.0) for the tackle, ruck, scrum, line-out and maul, respectively. The RUVAC group recommends using this consensus as the starting framework when conducting rugby video analysis research. Which variables to use (if not all) depends on the objectives of the study. Furthermore, the intention of this consensus is to help integrate video data with other data (eg, injury surveillance).

BackgroundA negative association between injuries and team success has been demonstrated in professional football, but the nature of this association in elite Rugby Union teams is currently unclear.AimTo assess the association between injury burden measures and team success outcomes within professional Rugby Union teams.MethodsA seven-season prospective cohort design was used to record all time-loss injuries incurred by English Premiership players. Associations between team success measures (league points tally and Eurorugby Club Ranking (ECR)) and injury measures (injury burden and injury days per team-match) were modelled, both within (changes from season to season) and between (differences averaged over all seasons) teams. Thresholds for the smallest worthwhile change in league points tally and ECR were 3 points and 2.6%, respectively.ResultsData from a total of 1462 players within 15 Premiership teams were included in the analysis. We found clear negative associations between injury measures and team success (70-100% likelihood), with the exception of between-team differences for injury days per team-match and ECR, which was unclear. A reduction in injury burden of 42 days (90% CI 30 to 70) per 1000 player hours (22% of mean injury burden) was associated with the smallest worthwhile change in league points tally.ConclusionsClear negative associations were found between injury measures and team success, and moderate reductions in injury burden may have worthwhile effects on competition outcomes for professional Rugby Union teams. These findings may be useful when communicating the value of injury prevention initiatives within this elite sport setting.

Loss of muscle mass and strength are seemingly accepted as part of the ageing process, despite ultimately leading to the loss of independence. Resistance exercise is considered to be primary defence against loss of muscle function in older age, but it typically requires access to exercise equipment often in a gym environment. This pilot study aimed at examining the effect of a 28-day, unsupervised home-based exercise intervention on indices of leg strength and muscle size in healthy older adults. Twenty participants were randomly assigned to either maintain their habitual physical activity levels (Control; n=10; age, 74 (5) years; body mass, 26.3 (3.5) kg/m2) or undertake “exercise snacks” twice daily (ES; n=10; age, 70 (4) years; body mass, 25.0 (3.4) kg/m2). Both groups consumed 150 g of yogurt at their breakfast meal for the duration of the intervention. Sixty-second sit-to-stand score improved by 31% in ES, with no change in Control (p<0.01). Large effect sizes were observed for the difference in change scores between the groups for interpolated maximum leg pressing power (6% increase in ES) and thigh muscle cross-sectional area (2% increase in ES). The present pilot data suggest that exercise snacking might be a promising strategy to improve leg muscle function and size in older adults and that further investigation into zero-cost exercise strategies that allow high frequency of training is warranted.

Aim To establish the propensity for specific contact events to cause injury in rugby union. Methods Medical staff at participating English community-level rugby clubs reported any injury resulting in the absence for one match or more from the day of the injury during the 2009/2010 (n=46), 2010/2011 (n=67) and 2011/2012 (n=76) seasons. Injury severity was defined as the number of matches missed. Thirty community rugby matches were filmed and the number of contact events (tackles, collision tackles, rucks, mauls, lineouts and scrums) recorded. Results Of 370 (95% CI 364 to 378) contact events per match, 141 (137 to 145) were tackles, 115 (111 to 119) were rucks and 32 (30 to 33) were scrums. Tackles resulted in the greatest propensity for injury (2.3 (2.2 to 2.4) injuries/1000 events) and the greatest severity (16 (15 to 17) weeks missed/1000 events). Collision tackles (illegal tackles involving a shoulder charge) had a propensity for injury of 15 (12.4 to 18.3) injuries/1000 events and severity was 92 (75 to 112) weeks missed/1000 events, both of which were higher than any other event. Additional scrum analysis showed that only 5% of all scrums collapsed, but the propensity for injury was four times higher (2.9 (1.5 to 5.4) injuries/1000 events) and the severity was six times greater (22 (12 to 42) weeks missed/1000 events) than for non-collapsed scrums. Conclusions Injury prevention in the tackle should focus on technique with strict enforcement of existing laws for illegal collision tackles. The scrum is a relatively controllable event and further attempts should be made to reduce the frequency of scrum collapse.

Physical activity is considered crucial in attenuating losses in strength and power associated with ageing. However, in well-functioning, active older adults the relationship between habitual physical activity and muscle function is surprisingly unclear. Leg press velocity, force, and power, were compared between 50 older and 30 younger healthy individuals, and associations with habitual physical activity explored. An incremental power test was performed on a pneumatic leg press, with theoretical maximum velocity, force, and power calculated. Vastus lateralis muscle thickness was measured by ultrasound, and participants wore a combined accelerometer and heart rate monitor for 6-days of free-living. Older individuals produced lower absolute maximum velocity, force, and power, than younger individuals. When accounting for smaller muscle size, older individual's maximum force and power remained markedly lower. Both groups were active, however using age specific thresholds for classifying physical activity, the older individuals engaged in twice the amount of moderate-to-vigorous physical activity in comparison to the younger individuals. There were no associations between any characteristics of muscle function and physical activity. These data support that the ability to generate force and power deteriorates with age, however habitual physical activity levels do not explain inter-individual differences in muscle function in active older individuals.