Lay of the Land: Narrative Synthesis of Tackle Research in Rugby Union and Rugby Sevens

BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2019-000645 on 19 April 2020. Downloaded from Open access Review Lay of the land: narrative synthesis of tackle research in rugby union and rugby sevens Nicholas Burger ,1 Mike Lambert ,1,2 Sharief Hendricks 1,3 To cite: Burger N, Lambert M, ABSTRACT What is known Hendricks S. Lay of the land: Objectives The purpose of this review was to synthesise narrative synthesis of tackle both injury prevention and performance tackle- related research in rugby union and ► The physical and dynamic nature of rugby union and research to provide rugby stakeholders with information rugby sevens. BMJ Open rugby sevens exposes players to high risk of injury. on tackle injury epidemiology, including tackle injury risk Sport & Exercise Medicine ► The tackle is the contact event that has the highest factors and performance determinants, and to discuss 2020;6:e000645. doi:10.1136/ injury incidence. bmjsem-2019-000645 potential preventative measures. ► To effectively reduce the risk of injury and optimise Design Systematic review and narrative synthesis. performance, it is recommended a sport injury pre- ► Additional material is Data sources PubMed, Scopus and Web of Science. published online only. To view, vention or sport performance process model be Eligibility criteria Limited to peer- reviewed English- please visit the journal online followed. (http:// dx. doi. org/ 10. 1136/ only publications between January 1995 and October bmjsem- 2019- 000645). 2018. Results A total of 317 studies were identified, with 177 in rugby union and 13 were in rugby sevens. The tackle What this study adds Accepted 22 March 2020 accounted for more than 50% of all injuries in rugby union and rugby sevens, both at the professional level and at the ► Tackle injury rates are higher at the professional lev- lower levels, with the rate of tackle injuries higher at the el compared with the lower levels. by copyright. professional level (mean 32/1000 player- hours) compared ► Tackle injury frequencies are similar between the with the lower levels (mean 17/1000 player- hours). A ball carrier and tackler. player’s tackle actions and technical ability were identified ► A major risk factor for tackle injury and a key deter- as major risk factors for injury and a key determinant of minant of tackle performance is the player’s tech- performance. nical ability. Summary/conclusion Evidence- based education, ► A player’s technical ability can be improved through © Author(s) (or their progressive tackle technique training with a high potential boosting coaching competencies. An example of employer(s)) 2020. Re- use to transfer and law changes have been proposed as key such a coaching competency is how to monitor and permitted under CC BY- NC. No modifiers of player tackle actions and technical ability. commercial re- use. See rights progress tackle training to ensure optimum transfer Conceivably, all three modifiers working in unison (as to matches. and permissions. Published by http://bmjopensem.bmj.com/ BMJ. opposed to separately) will have a higher potential at 1Division of Exercise Science reducing tackle injury risk while enhancing performance. and Sports Medicine, With the guidance of tackle injury and performance has the highest incidence for the most severe Department of Human Biology, studies, as well as stakeholder engagement, experiential injuries.5 During the tackle, both the player Faculty of Health Sciences, and explorative tackle research has the potential to inspire in possession of the ball (ball carrier) and University of Cape Town, Cape innovative injury prevention and performance strategies. the player(s) attempting to contest the ball Town, Western Cape, South 6–9 Africa and territory (tacklers) are at risk of injury, 2Department of Public and although the mechanisms of injury may Occupational Health and the differ.10 11 Although the tackle is a high-injur y EMGO Institute for Health and INTRODUCTION risk contest, the ability to repeatedly win the on September 30, 2021 by guest. Protected Care Research, VU University The physical and dynamic nature of rugby contest is also a key performance indicator, Medical Center, Vrije Universiteit 12 Amsterdam, Amsterdam, The union and rugby sevens expose players to with successful teams winning more tackles. Netherlands high risk of injury. The majority of inju- To effectively reduce the risk of injury and 3Institute for Sport, Physical ries in these rugby codes, at all levels, occur optimise performance, it is recommended Activity and Leisure, Centre for during the contact events: the tackle, ruck, a sport injury prevention or sport perfor- Sport Performance, School of maul, line- out and scrums.1–4 The tackle is mance process model such as the Translating Sport, Fairfax Hall, Headingley Campus, Leeds Beckett the contact event that has the highest injury Research into Injury Prevention Practice 13 University, Leeds, UK incidence (injuries per 1000 player-hours), (TRIPP) model (involving six stages) or while the ruck and scrum have the second the Applied Research Model for the Sport 14 Correspondence to and third highest injury incidences, respec- Sciences (involving eight stages) be 1–4 Dr Sharief Hendricks; tively. Also, while the majority of spinal followed. These models outline a sequence of sharief. hendricks01@ gmail. com cord injuries occur in the scrum, the tackle stages that need to be completed to ensure Burger N, et al. BMJ Open Sp Ex Med 2020;6:e000645. doi:10.1136/bmjsem-2019-000645 1 BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2019-000645 on 19 April 2020. Downloaded from Open access the uptake and sustainability of an injury prevention or AND ‘tackle’, and ‘rugby’ AND ‘union’ OR ‘league’ OR performance initiative in the ‘real world’.13 The first stage ‘sevens’ AND ‘injur*’. proposes establishing the extent of the injury problem through injury surveillance studies. Thereafter, the aim Eligibility criteria is to understand why and how these injuries occur, that The search was limited to peer-reviewed English-only is, identifying injury risk factors (stage 2). Stage 3 seeks publications between January 1995 (the advent of profes- to develop potential preventive measures for testing in sionalism in rugby union) and October 2018. Articles ideal or controlled conditions (stage 4). Stage 5 aims to that involved quantitative data on rugby union or rugby understand the implementation context, and the final sevens (including all ages and levels of play, and male stage (stage 6) monitors the effectiveness of the preven- and female players) were included. Only studies that tive measure in the real world. included tackle- related testing protocols and match or Owing to the high risk of injury and performance training data (pertaining to tacklers and/or ball carriers) demands, the tackle has been a research focus within were included. The studies had to clearly define the rugby compared with other contact events.15 Seem- tackle or ball carry as part of their analysis and not group ingly, each of these studies have contributed to a stage the tackle into general contact/collision data. in the injury prevention or performance process models. Overall and/or time- loss tackle injury rates (only However, these studies have not been consolidated to studies reporting number of injuries per 1000 expo- determine the state of tackle- related research at each sure) and frequencies (percentages) were tabulated stage for both injury prevention and performance. For according to rugby code and level of play (tables 1–3). instance, while systematic reviews on injury rates in A time- loss injury was defined as an injury that resulted rugby union and rugby sevens have been published1–4 to in a player being absent from normal match/training/ address stage 1 of injury prevention models, and despite recreational activities for more than 24 hours or 7 days knowing the high incidence of tackle injury, no review to (depending on the specific study’s definition) after the date has synthesised tackle injury frequencies and rates by incident. Medical attention injuries were injuries that playing levels and competition, and by role (ball carrier required treatment from a doctor/healthcare profes- or tackler). Therefore, using the first three stages of the sional but resulted in no time away from normal match/ TRIPP model13 as a guide, the purpose of this review was training/recreational activities. Overall injuries included by copyright. to consolidate both injury prevention and performance both medical attention and time- loss injury events. Injury tackle- related research. The intention of this review was case studies specific to tackle events were also reviewed to synthesise both injury prevention and performance (see online supplementary appendix 1). Overall tackle tackle- related research to provide rugby stakeholders with numbers and rates (only studies reporting total number information on tackle injury epidemiology, including of tackles per match, and/or number of tackles per game tackle injury risk factors and performance determinants, or per minute) were tabulated in tables 4 and 5. Narra- and to discuss measures that may improve tackle perfor- tive literature reviews, systematic reviews, meta-analyses, mance and reduce the risk of tackle injuries. editorials, journal letters, book chapters, conference proceedings, discussions and qualitative research studies http://bmjopensem.bmj.com/ METHODS were excluded from the analysis. All other quantitative A narrative synthesis format was chosen to review and study types and case studies were accepted for review. synthesise the pool of literature. A narrative synthesis is an ‘approach to the systematic review and synthesis of find- Screening process ings from multiple studies that relies primarily on the use A five- step approach was followed to identify the final of words and texts to summarise and explain the finding group of articles that would eventually be included in the of the synthesis’.16 17 Narrative syntheses can be used to final review (figure 1).

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