The RBS Six Nations rugby tournament is almost upon us and this year will be the first time it has been contested under new rules governing the tackle zone. In short, referees will be able to use stronger sanctions in the shape of yellow and red cards to reduce reckless tackles that make contact with the head.
The rule changes are designed to help protect players from the short and long-term health consequences of concussion while building on the introduction of temporary substitutions to allow more comprehensive head injury assessment (HIA) during match play.
It is not just rugby that is taking the issue of concussion seriously; footballers who suffer a suspected head injury, such as that sustained by Ryan Mason, must be cleared to return to the field of play by a medical professional, not a member of the coaching team.
Meanwhile, a major initiative was launched last year to support players suffering from issues associated with mental health under the banner Support Within Sport. It is fair to say that when it comes to matters above the neck, players are incredibly well looked after in modern day sport. But what about injuries sustained to other body parts?
Below the neck
Despite excellent and ever improving medical support for players, we are still seeing a year-on-year increase in injuries. So how are people trying to predict and prevent injuries below the neck line?
Movement screens such as the “functional movement screen” or “landing error scoring system” are an integral part of medical support within sport. They comprise a range of exercises that allow coaches and medics to assess how individuals move in a variety of ways common to the sport they take part in. The proviso for their use is that they help to identify individuals at risk of injury.
But a recent critical review reported that movement screens have limited efficacy in the prediction of injuries. High fitness levels and the ability to tolerate high workloads have been reported to have a protective effect on injury while many teams will monitor subjective metrics associated with how the player “feels” in order to identify who may be at risk of becoming ill or injured.
The majority of techniques used to assess individuals’ preponderance for injury consider the relationship between incidence and fatigue and the tenet that increases in the latter will influence the former. Unlike concussion, which is linked to one or multiple episodes of trauma, the effect repeated exposure to fatiguing actions has is more difficult to measure.
While governing bodies are willing to make changes to the rules of their game to combat one type of injury, for example concussion, in other instances competitive schedules fail to allow sufficient recovery for players between matches.
Intensified periods of match play in youth players have been shown to decrease performance and increase markers linked to injury and illness. This is not limited to young players; a congested fixture period in rugby league players was shown to induce neuromuscular fatigue which may predispose players to a greater risk of injury.
Despite the evidence, governing bodies continue to arrange fixtures that do not allow sufficient recovery between matches. For example, Super League 2017 will see the current champions, Wigan Warriors, play five consecutive games with no more than four day’s recovery between each. Now consider that in American Football, players still felt that they were not fully recovered four days after their last match.
More worryingly, squad rotation in sports that have the resources to employ large numbers of players may not help. A recent study showed that coaches underestimate recovery time following competitive match play and as such may not recognise when players need to be rested.
Huge strides have been made in how athletes are prepared for and looked after following training and competition, testament to the hard work of medical professionals and coaches. But more work is needed. We require large scale, well-funded studies which look at a range of markers associated with injury, especially in younger athletes during the growth spurt; fixture scheduling that affords adequate recovery between matches, and a greater awareness among coaches and parents of the risk factors associated with injury and how these can be mitigated.
The changes to the tackle zone in rugby demonstrate that when provided with compelling evidence, governing bodies will move to make their game safer. What is required in the future is a better understanding of injuries that occur below the neck line, their causes – and methods for reducing their incidence.