James Tooby

The original article can be found online at https://doi.org/10.1007/s40279-023-01953-7

OBJECTIVES: The aim of this study was to examine head acceleration event (HAE) propensity and incidence during elite-level men's and women's rugby union matches. METHODS: Instrumented mouthguards (iMGs) were fitted in 92 male and 72 female players from nine elite-level clubs and three international teams. Data were collected during 406 player matches (239 male, 167 female) using iMGs and video analysis. Incidence was calculated as the number of HAEs per player hour and propensity as the proportion of contact events resulting in an HAE at a range of linear and angular thresholds. RESULTS: HAE incidence above 10 g was 22.7 and 13.2 per hour in men's forwards and backs and 11.8 and 7.2 per hour in women's forwards and backs, respectively. Propensity varied by contact event, with 35.6% and 35.4% of men's tackles and carries and 23.1% and 19.6% of women's tackles and carries producing HAEs above 1.0 krad/s2. Tackles produced significantly more HAEs than carries, and incidence was greater in forwards compared with backs for both sexes and in men compared with women. Women's forwards were 1.6 times more likely to experience a medium-magnitude HAE from a carry than women's backs. Propensity was similar from tackles and carries, and between positional groups, while significantly higher in men than women. The initial collision stage of the tackle had a higher propensity than other stages. CONCLUSION: This study quantifies HAE exposures in elite rugby union players using iMGs. Most contact events in rugby union resulted in lower-magnitude HAEs, while higher-magnitude HAEs were comparatively rare. An HAE above 40 g occurred once every 60-100 min in men and 200-300 min in women. Future research on mechanisms for HAEs may inform strategies aimed at reducing HAEs.

Head acceleration events (HAEs) are acceleration responses of the head following external short-duration collisions. The potential risk of brain injury from a single high-magnitude HAE or repeated occurrences makes them a significant concern in sport. Instrumented mouthguards (iMGs) can approximate HAEs. The distinction between sensor acceleration events, the iMG datum for approximating HAEs and HAEs themselves, which have been defined as the in vivo event, is made to highlight limitations of approximating HAEs using iMGs. This article explores the technical limitations of iMGs that constrain the approximation of HAEs and discusses important conceptual considerations for stakeholders interpreting iMG data. The approximation of HAEs by sensor acceleration events is constrained by false positives and false negatives. False positives occur when a sensor acceleration event is recorded despite no (in vivo) HAE occurring, while false negatives occur when a sensor acceleration event is not recorded after an (in vivo) HAE has occurred. Various mechanisms contribute to false positives and false negatives. Video verification and post-processing algorithms offer effective means for eradicating most false positives, but mitigation for false negatives is less comprehensive. Consequently, current iMG research is likely to underestimate HAE exposures, especially at lower magnitudes. Future research should aim to mitigate false negatives, while current iMG datasets should be interpreted with consideration for false negatives when inferring athlete HAE exposure.

Background Head acceleration events (HAEs) are an increasing concern in collision sports owing to potential negative health outcomes. Objectives The objective of this study is to describe the probabilities of HAEs in tackles of differing heights and body positions in elite men’s and women’s rugby union. Methods Instrumented mouthguards (iMGs) were worn in men’s (n = 24 teams, 508 players, 782 observations) and women’s (n = 26 teams, 350 players, 1080 observations) rugby union matches. Tackle height (i.e. point of contact on ball-carrier) and body positions of tacklers and ball-carriers were labelled for all tackles in which a player wore an iMG. HAEs from the initial impact were identified. Mean player, tackler and ball-carrier exceedance probabilities for various peak linear and angular acceleration thresholds were estimated from ordinal mixed-effects models. Results Contact with ball-carriers’ head/neck resulted in the highest mean HAE probabilities for both sexes. The probability of an HAE to the ball-carrier decreased as tackle height lowered. The highest probability for the tackler was initial contact to the ball-carriers upper leg. Body position influenced the probability of HAEs, with falling/diving ball-carriers resulting in higher mean probabilities. When a player, regardless of role, was bent-at-waist, elevated HAE probabilities were observed in men’s competitions. Women’s data demonstrated similar probabilities of an HAE for all body positions. Conclusions Initial contact to the ball-carrier’s head/neck had the highest chance of an HAE, whilst role-specific differences are apparent for different tackle heights and body positions. Future player-welfare strategies targeting contact events should therefore consider HAE mechanisms along with current literature.

Objectives Assess the validity and feasibility of current instrumented mouthguards (iMGs) and associated systems. Methods Phase I; four iMG systems (Biocore-Football Research Inc (FRI), HitIQ, ORB, Prevent) were compared against dummy headform laboratory criterion standards (25, 50, 75, 100 g). Phase II; four iMG systems were evaluated for on-field validity of iMG-triggered events against video-verification to determine true-positives, false-positives and false-negatives (20±9 player matches per iMG). Phase III; four iMG systems were evaluated by 18 rugby players, for perceptions of fit, comfort and function. Phase IV; three iMG systems (Biocore-FRI, HitIQ, Prevent) were evaluated for practical feasibility (System Usability Scale (SUS)) by four practitioners. Results Phase I; total concordance correlation coefficients were 0.986, 0.965, 0.525 and 0.984 for Biocore-FRI, HitIQ, ORB and Prevent. Phase II; different on-field kinematics were observed between iMGs. Positive predictive values were 0.98, 0.90, 0.53 and 0.94 for Biocore-FRI, HitIQ, ORB and Prevent. Sensitivity values were 0.51, 0.40, 0.71 and 0.75 for Biocore-FRI, HitIQ, ORB and Prevent. Phase III; player perceptions of fit, comfort and function were 77%, 6/10, 55% for Biocore-FRI, 88%, 8/10, 61% for HitIQ, 65%, 5/10, 43% for ORB and 85%, 8/10, 67% for Prevent. Phase IV; SUS (preparation-management) was 51.3–50.6/100, 71.3–78.8/100 and 83.8–80.0/100 for Biocore-FRI, HitIQ and Prevent. Conclusion This study shows differences between current iMG systems exist. Sporting organisations can use these findings when evaluating which iMG system is most appropriate to monitor head acceleration events in athletes, supporting player welfare initiatives related to concussion and head acceleration exposure.

Objectives The aim of this study was to describe the incidence and magnitude of head acceleration events (HAEs) during elite men’s and women’s rugby union training for different contact training levels and drill types. Method Data were collected during the 2022–23 and 2023–24 seasons from 203 men and 125 women from 13 clubs using instrumented mouthguards (iMGs) during in-season training. One author reviewed the training videos to identify the contact level and drill type. HAE incidence was calculated per player minute. Results For men’s forwards and backs, only 4.7% and 5.8% of HAEs were ≥ 25 g and ≥ 1.5 Krad/s2, and 3.4% and 4.4% for women’s forwards and backs, respectively. The incidence of ≥ 5 g and ≥ 0.4 Krad/s2 was highest during full-contact training for men’s forwards (0.20/min) and backs (0.16/min) and women’s forwards (0.10/min). HAE incidence was 2–3 times higher during repetition-based compared with game-based training drills for men’s forwards (0.25/min vs 0.09/min) and backs (0.22/min vs 0.09/min) and women’s forwards (0.09/min vs 0.04/min) and backs (0.08/min vs 0.03/min). HAE incidences were halved when repetition-based training drills used pads compared with no pads for men’s forwards (0.21/min vs 0.44/min) and backs (0.17/min vs 0.30/min), and women’s forwards (0.06/min vs 0.14/min) and backs (0.06/min vs 0.10/min). Conclusion The average HAE incidence (~ 13–20% of weekly HAEs) and magnitude during an in-season training week is very low compared with matches. Opportunities to materially reduce HAE exposure in training are likely more limited than previously assumed. Future research on HAE load and injury, and understanding players’ specific weekly training exposure, may inform effective individual player management.

The original article has been updated to add the missing Electronic Supplemental Material.

Purpose Head acceleration events (HAEs) are a growing concern in contact sports, prompting two rugby governing bodies to mandate instrumented mouthguards (iMGs). This has resulted in an influx of data imposing financial and time constraints. This study presents two computational methods that leverage a dataset of video-coded match events: cross-correlation synchronisation aligns iMG data to a video recording, by providing playback timestamps for each HAE, enabling analysts to locate them in video footage; and post-synchronisation event matching identifies the coded match event (e.g. tackles and ball carries) from a video analysis dataset for each HAE, this process is important for calculating the probability of match events resulting in HAEs. Given the professional context of iMGs in rugby, utilising commercial sources of coded match event datasets may expedite iMG analysis. Methods Accuracy and validity of the methods were assessed via video verification during 60 rugby matches. The accuracy of cross-correlation synchronisation was determined by calculating synchronisation error, whilst the validity of post-synchronisation event matching was evaluated using diagnostic accuracy measures (e.g. positive predictive value [PPV] and sensitivity). Results Cross-correlation synchronisation yielded mean synchronisation errors of 0.61–0.71 s, with all matches synchronised within 3 s’ error. Post-synchronisation event matching achieved PPVs of 0.90–0.95 and sensitivity of 0.99–1.00 for identifying correct match events for SAEs. Conclusion Both methods achieved high accuracy and validity with the data sources used in this study. Implementation depends on the availability of a dataset of video-coded match events; however, integrating commercially available video-coded datasets offers the potential to expedite iMG analysis, improve feedback timeliness, and augment research analysis.

The aim of this study was to investigate the difference in head acceleration event (HAE) incidence between training and match‐play in women's and men's players competing at the highest level of domestic rugby union globally. Players from Women's (Premiership Women's Rugby, Farah Palmer Cup) and Men's (Premiership Rugby, Currie Cup) rugby union competitions wore instrumented mouthguards during matches and training sessions during the 2022/2023 seasons. Peak linear (PLA) and angular (PAA) acceleration were calculated from each HAE and included within generalized linear mixed‐effects models. The incidence of HAEs was significantly greater in match‐play compared to training for all magnitude thresholds in both forwards and backs, despite players spending approximately 1.75–2.5 times more time in training. For all HAEs (PLA > 5 g and PAA > 400 rad/s2), incidence rate ratios (IRRs) for match versus training ranged from 2.80 (95% CI: 2.38–3.30; men's forwards) to 4.00 (3.31–4.84; women's forwards). At higher magnitude thresholds (PLA > 25 g; PAA > 2000 rad/s2), IRRs ranged from 3.64 (2.02–6.55; PAA > 2000 rad/s2 in men's backs) to 11.70 (6.50–21.08; PAA > 2000 rad/s2 in women's forwards). Similar trends were observed in each competition. Players experienced significantly more HAEs during match‐play than training, particularly at higher magnitude thresholds. Where feasible, HAE mitigation strategies may have more scope for HAE reduction if targeted at match‐play, particularly where higher magnitude HAEs are the primary concern. However, the number of HAEs associated with different training drills requires exploration to understand if HAEs can be reduced in training, alongside optimizing match performance (e.g., enhancing contact technique).

Objectives Describe head acceleration events (HAEs) experienced by professional male rugby union players during tackle, ball‐carry, and ruck events using instrumented mouthguards (iMGs). Design Prospective observational cohort. Methods Players competing in the 2023 Currie Cup (141 players) and Super Rugby (66 players) seasons wore iMGs. The iMG‐recorded peak linear acceleration (PLA) and peak angular acceleration (PAA) were used as in vivo HAE approximations and linked to contact‐event data captured using video analysis. Using the maximum PLA and PAA per contact event (HAEmax), ordinal mixed‐effects regression models estimated the probabilities of HAEmax magnitude ranges occurring, while accounting for the multilevel data structure. Results As HAEmax magnitude increased the probability of occurrence decreased. The probability of a HAEmax ≥15g was 0.461 (0.435–0.488) (approximately 1 in every 2) and ≥45g was 0.031 (0.025–0.037) (1 in every 32) during ball carries. The probability of a HAEmax >15g was 0.381 (0.360–0.404) (1 in every 3) and >45g 0.019 (0.015–0.023) (1 in every 53) during tackles. The probability of higher magnitude HAEmax occurring was greatest during ball carries, followed by tackles, defensive rucks and attacking rucks, with some ruck types having similar profiles to tackles and ball carries. No clear differences between positions were observed. Conclusion Higher magnitude HAEmax were relatively infrequent in professional men's rugby union players. Contact events appear different, but no differences were found between positions. The occurrence of HAEmax was associated with roles players performed within contact events, not their actual playing position. Defending rucks may warrant greater consideration in injury prevention research.

Abstract

ABSTRACT

This study aimed to describe the incidence of head acceleration events (HAEs) during pitch‐based in‐season training and matches in professional male rugby league. Data were recorded using instrumented mouthguards from 108 players (70 forwards and 38 backs) at nine Super League teams (2024 season), resulting in 468 player‐training sessions and 665 player‐matches included. Peak linear and angular acceleration were calculated from each HAE and analyzed using generalized linear mixed‐effects models. During the 468 player‐training sessions, 814 HAEs above the lowest magnitude threshold (5  g and 400 rad.s −2 ) were observed and the mean HAE incidence rate per player‐hour was 1.52 (95% confidence intervals; 1.34–1.70). This was substantially lower than matches (25.78 [23.28–28.27] per player‐hour) with HAE incidence being 17 times greater during matches compared to training (incidence rate ratio 16.96 [14.92–19.01]). Higher magnitude HAEs had a lower incidence in both training and matches (e.g., > 25  g 0.04 [0.02–0.06] and 2.01 [1.79–2.24] per player‐hour). Out of 468 player‐training sessions, 307 (~66%) had no HAEs > 10  g and 441 (~94%) had no HAEs > 25  g . Overall, the incidence rates of HAEs during training were low and substantially lower than match‐play. However, a small proportion of relatively high in magnitude HAEs do occur during training, which could be the target of prevention interventions in training. However, given the different HAE rates between training and matches, interventions targeting matches (e.g., law modifications or reduced exposure) would have a larger effect on reducing HAEs for players than training interventions.