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Complete compliance data were retrieved from 63 out of 83 teams intervention, 32 teams; control, 31 teams.
In teams who had provided complete compliance information, mean programme completion rate across both trial arms was close to twice per week intervention, 1. Twelve out of 63 teams maintained a mean weekly programme completion rate of three or more sessions intervention, seven teams; control, five teams. Data labels represent the per cent likelihood that each effect favours the intervention is trivial favours the control, for outcome variables that demonstrate a clear effect of trial arm allocation.
Data labels represent the per cent likelihood that each effect favours the intervention is trivial favours the control, for outcome variables which demonstrate a clear effect of trial arm allocation. CL, confidence limits. Effects of intervention programme dose were unclear for upper limb injuries, lower limb injuries and concussion. This study aimed to determine the efficacy of a movement control exercise programme for preventing injury in youth rugby players and to assess the effect of programme dose on injury measures.
Following intention-to-treat analyses, effects of the trial arm were unclear for overall match injury.
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Concussion is a priority for prevention across contact and collision sports due to potential concern over medium-term and long-term player welfare. Neck strength has been shown to be substantially lower in adolescent rugby players when compared with adult players despite similar peripheral strength profiles. Neck pain is a common physical complaint among young sportspeople participating in collision sports 34 35 and may be associated with increased concussion risk.
Little is known about the underlying risk factors and mechanisms for upper limb injuries, and examples of evidence-based upper limb injury prevention are scarce. The lack of clear substantial effects for overall match and contact-related injuries following intention-to-treat analyses should be considered in the context of dose, which may have affected these outcomes. Although mean intervention programme dose in this study was higher 1.
Greater effects of preventive exercise programmes may be realised if regularly used at least three times per week. Regularly performing a preventive exercise programme three times per week over a sustained period has been shown to improve markers for neuromuscular control and muscle strength in male soccer players. Evidence of a dose—response effect on overall and contact-related injuries in this study presents wider applications of the dose—response effect of preventive exercise programmes, and has the potential to inform subsequent implementation attempts through identifying a minimum effective dose in this population.
The collective findings from the intention-to-treat and per-protocol analyses highlight that teams involved in contact sports can obtain benefit from using preventive exercise programmes, but more importantly, regular exposure of more than three times per week can result in substantial injury risk reduction. There were several limitations to this study that should be acknowledged.
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First, the research team members that ran the pre-trial workshops and conducted pre-season visits were not blinded to the programme allocation for each school, creating potential bias between the two groups in terms of the processes followed and information disseminated at these workshops; this was mitigated through use of a unified workshop format. Second, individual player compliance was not monitored during the study.
The fidelity with which teams used the programmes is uncertain, but may actually have mediated programme efficacy along with dose and compliance. Further work is required to understand the mechanistic bases by which the intervention exercise programme reduced injury outcomes, particularly in relation to the proposed effects of the programme on neck strength and function in reducing concussion incidence, as well as kinematics and force handling capacities in the upper limb.
Although intention-to-treat results highlighted trivial effects of the intervention exercise programme on overall match injury incidence when compared with the control exercise programme, a substantial reduction in overall match injury incidence was evident from per-protocol trial arm comparisons under conditions of high programme dose three or more weekly sessions. Notable beneficial effects of the preventive programme on upper and lower extremity injuries and concussion incidence also have important implications for the reduction of these priority injury types in youth rugby.
These findings provide encouraging evidence that a pre-activity preventive exercise programme can substantially reduce injury risk in youth rugby. Notable reductions in upper extremity injuries and concussion offer promising implications for the prevention of these high-risk injury types in young rugby players. Findings also outline a minimum effective dose of three sessions a week, whereby programme efficacy can be optimised.
The authors would like to acknowledge with sincere gratitude all school coaches and medical staff for the recording of injury, exposure and compliance data during the study period. MDH analysed the data and prepared the first draft of the manuscript. All authors made substantial contributions to revision of the manuscript prior to submission. Provenance and peer review Not commissioned; externally peer reviewed.
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Article Text. Article menu. Original article. Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial. Abstract Background Injury risk in youth rugby has received much attention, highlighting the importance of establishing evidence-based injury reduction strategies.
Statistics from Altmetric. The exercise programmes being trialled The process of devising the intervention and control exercise programmes have been reported elsewhere. View this table: View inline View popup. Figure 1 Flow diagram presenting the recruitment and retention of participants through the study. Table 2 Descriptive statistics for match and training injuries across the control and intervention cohorts.
Per-protocol analyses The lack of clear substantial effects for overall match and contact-related injuries following intention-to-treat analyses should be considered in the context of dose, which may have affected these outcomes. Limitations and future directions There were several limitations to this study that should be acknowledged. What are the findings?
How might it impact on clinical practice in the future? Acknowledgments The authors would like to acknowledge with sincere gratitude all school coaches and medical staff for the recording of injury, exposure and compliance data during the study period. The unknown risks of youth rugby. BMJ ; : h Pollock AM , Kirkwood G. Removing contact from school rugby will not turn children into couch potatoes.
Br J Sports Med ; 50 : — 4. A new Rugby constituency was created, and a new constituency of Kenilworth and Southam formed to the south of Rugby, and as a result the town regained its pre status of returning its own member of parliament, albeit with the addition of the Bulkington Ward from Nuneaton.
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Jeremy Wright chose to stand for Kenilworth and Southam in the general election and was successful. Rugby is administered by two local authorities : Rugby Borough Council which covers Rugby and its surrounding countryside, and Warwickshire County Council. The two authorities are responsible for different aspects of local government.
Rugby is an unparished area and so does not have its own town council. The Borough of Rugby was created in its current form in , with the first elections held in , since then, Rugby Borough Council has spent the majority of its time under no overall control, but since it has been controlled by the Conservative Party see Rugby Borough Council elections. Rugby Town Hall pictured was built by J.
Two previous town halls existed on High Street: The first one was built in , and was mostly destroyed by a fire in , being replaced by a building which was until a Woolworths shop. The second one dated from and was for many years used as a Marks and Spencer shop.