E-edition: #RugbyMedicine

Dear Reader, Welcome to this special BJSM e-Edition on #RugbyMedicine. The sport of rugby union has come a long way in its quest to enhance player welfare and safety, and we hope this e-Edition provides an insight into the sport’s journey, as well as some of its more modern initiatives and advances. The e-Edition has been split into two main sections that correspond to areas within the field that have seen major advances, with then a sprinkling of other #RugbyMedicine gold-dust on top. We are hugely grateful to many people for collaborating on this project, especially those who have helped contribute new & exciting material. A huge thanks goes to Drs Martin Raftery, Eanna Falvey & Ross Tucker, Dominic Rumbles and Sir Bill Beaumont for their help in determining the scope & content, as well as Drs Simon Kemp & Keith Stokes for their support of the project. A huge thanks also to the likes of (soon to be Dr) Gautam Menon, Ania Tarazi and Jimmy Walsh for creating some of the brilliant animations/podcasts that feature so heavily. Your feedback is most welcome, please do get in touch with us via the usual social media channels if you have any queries, but in the meantime, we hope you enjoy this resource (as well as #RWC2019!) Sincerely, Dr Steffan Griffin | @SteffanGriffin BJSM Senior Associate Editor & Editorial Fellow (on behalf of the BJSM Editorial team)

As Chief Medical Officer for World Rugby I would like to welcome everyone to this rugby medicine, e-edition of the British Journal of Sports Medicine. This e-edition has been produced to coincide with our Rugby World Cup that is being held in Japan from September 19 to November 2 in 2019. Our Rugby World Cup, played every four years, is our game’s most elite competition bringing together the 20 top nations from around the world. Player welfare, as you will hear from Sir Bill Beaumont, Chairman of World Rugby, is the sport’s number 1 priority. Contributions to this e-edition come not only from World Rugby but also recognise research and welfare programs developed and introduced by some of our larger national Unions.

I would like to thank the BJSM for coordinating this new and exciting method of scientific journalism and in particular would like to recognise the enthusiasm and tireless efforts of Dr Steffan Griffin who initiated and coordinated this exciting project. Dr Martin Raftery Chief Medical Officer, World Rugby

In the first #GameChanger, we cover one of the hottest topics in Sport & Exercise Medicine, and one that’s constantly making headlines, concussion. In the section below, you will find resources covering everything from law-changes to landmark papers.

with Dr Martin Raftery and Dr Ross Tucker

As mentioned in the podcast, at #RWC2019 you will see match officials continue to use the decision making framework for high tackles. The link below takes you to a video that walks you through the issue, which is also summarised nicely in the infographic below.

The game of rugby has evolved significantly over the last few decades, and it only take a quick search of historical matches on YouTube to see this first-hand. As mentioned in the podcast, a lot of these laws have been informed by collaborative research studies from around the globe. Below are some seminal papers that informed these initiatives, and an animation of the study that led to some of the recent law changes. Risk factors for head injury events in professional rugby union: a video analysis of 464 head injury events to inform proposed injury prevention strategies Ross Tucker, Martin Raftery et al. Tackling concussion in professional rugby union: a case–control study of tackle-based risk factors and recommendations for primary prevention Matthew J Cross, Ross Tucker et al.

We have seen a huge paradigm shift in the way people view concussions over the last few years, but how have things evolved at a practical level? In this video, we hear from Associate Professor Jon Patricios about his experiences of working pitchside in rugby, and what the current state of play is.

Upset that you haven’t seen a single link to an #EpiStudy yet? You can relax. Though by no means a definitive list of studies, below is a link to some studies that have helped inform all of the above interventions & initiatives, enjoy!

A Systematic Review and Meta-Analysis of Concussion in Rugby Union Andrew J. Gardner, Grant L. Iverson et al Concussion in youth rugby union and rugby league: a systematic review Graham Kirkwood, Nikesh Parekh et al Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016 Paul McCrory, Willem Meeuwisse et al What is the physiological time to recovery after concussion? A systematic review Joshua Kamins, Erin Bigler et al What is the difference in concussion management in children as compared with adults? A systematic review Gavin A Davis, Vicki Anderson et al

Implementation of the 2017 Berlin Concussion in Sport Group Consensus Statement in contact and collision sports: a joint position statement from 11 national and international sports organisations Jon S Patricios, Clare L Ardern et al Concussed athletes walk slower than non-concussed athletes during cognitive-motor dual-task assessments but not during single-task assessments 2 months after sports concussion: a systematic review and meta-analysis using individual participant data Fionn Büttner, David R Howell et al The International Rugby Board (IRB) Pitch Side Concussion Assessment trial: a pilot test accuracy study Gordon Ward Fuller, Simon P T Kemp, Philippe Decq

We’ve tackled one of the most controversial & topical injuries, but what about injuries and their prevention in general? In this section, we hear again about the (still ongoing) journey taken by World Rugby, and we delve into some of the most recent interventions and advances, from passports to prevention programmes.

Dr Martin Raftery and Dr Ross Tucker join the BJSM to discuss World Rugby’s injury prevention journey, and most recent player welfare initiatives. We also hear from World Rugby chairman Sir Bill Beaumont on how rugby has evolved in this regard.

One of the intervention we will see rolled out this year is the Load Passport, so what exactly does this look like?

We hear a lot about load these days, but what exactly does this encompass, and how should we go about collecting this data? This podcast with Dr Stephen West PhD delves into the pitfalls of current data collection methods, and provides some golden practical tips about how to best collect load data. Below are some accompanying papers too.

Managing player load in professional rugby union: a review of current knowledge and practices #Paywall Kenneth L Quarrie, Martin Raftery, Josh Blackie et al.

Athlete Monitoring in Rugby Union: Is Heterogeneity in Data Capture Holding Us Back? Stephen W West, Sean Williams, Simon P T Kemp et al

You’ve heard of the FIFA11+ and a few other injury prevention programmes of the same ilk, but what about Activate? Activate relates to the evidence-based injury prevention programme in rugby, designed & implemented by the long-standing collaboration between the University of Bath, and the Rugby Football Union, and now adopted by World Rugby. Below you will find not only the original research papers, but some additional resources that provide some additional insight into the project.

Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial Michael D Hislop, Keith A Stokes et al.

Efficacy of a movement control injury prevention programme in adult men’s community rugby union: a cluster randomised controlled trial Matthew J Attwood, Simon P Roberts et al

Activate is the RFU’s Injury Prevention Exercise Programme.

Below you will find a number of links to key epidemiological papers, as well as some resources that detail the issue in a more interactive format, and keep your eyes peeled for more content in this area with some giants of the field.

A meta-analysis of injuries in senior men's professional Rugby Union S Williams, G Trewartha et al The Incidence of Injury in Amateur Male Rugby Union: A Systematic Review and Meta-Analysis C Yeomans, IC Kenny et al Epidemiology of adolescent rugby injuries: a systematic review C Bleakley, M Tully, S O'Connor Epidemiology of injuries in senior male rugby union sevens: a systematic review A Cruz-Ferreira, E Cruz-Ferreira et al Training volume and soft tissue injury in professional and non-professional rugby union players: a systematic review S Ball, M Halaki, R Orr

Systematic review of rugby injuries in children and adolescents under 21 years A Freitag, G Kirkwood et al. Match and Training Injuries in Women's Rugby Union: A Systematic Review of Published Studies D King, P Hume Epidemiology of injuries in a women's international rugby sevens world cup squad N Gabb, G Trewartha et al

Though we hope you enjoy the Rugby World Cup for the action on the field, if you’re wondering about anything from the medical set-up at the event, to what it must be like to prepare a team to peak in time for a unique competition, then we have you covered. Below are a list of resources that do exactly that – we hope you enjoy these as much as the matches themselves!

Preparing a team for the Rugby World Cup 2019: a medical perspective Dr Geoff Davies & Mr Prav Mathema

The Road to Rugby World Cup 2019 – A Medical Perspective Professor Mutsuo Yamada

As you get stuck into this e-Edition, we’re happy to announce that we will also be adding some additional content to this resource over the course of #RWC2019. So if you’re interested in some key SEM topics such as female athlete health and knowledge translation, keep your eyes peeled for some more cutting edge content!