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Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial
  1. Michael D Hislop1,
  2. Keith A Stokes1,
  3. Sean Williams1,
  4. Carly D McKay1,
  5. Mike E England2,
  6. Simon P T Kemp2,
  7. Grant Trewartha1
  1. 1 Department for Health, University of Bath, Bath, UK
  2. 2 Rugby Football Union, Twickenham, UK
  1. Correspondence to Keith A Stokes, Department for Health, University of Bath, Bath BA2 7AY, UK; k.stokes{at}


Background Injury risk in youth rugby has received much attention, highlighting the importance of establishing evidence-based injury reduction strategies.

Aim To determine the efficacy of a movement control exercise programme in reducing injuries in youth rugby players and to investigate the effect of programme dose on injury measures.

Methods In a cluster-randomised controlled trial, 40 independent schools (118 teams, 3188 players aged 14–18 years) were allocated to receive either the intervention or a reference programme, both of which were to be delivered by school coaches. The intervention comprised balance training, whole-body resistance training, plyometric training, and controlled rehearsal of landing and cutting manoeuvres. Time-loss (>24 hours) injuries arising from school rugby matches were recorded by coaches and medical staff.

Results 441 time-loss match injuries (intervention, 233; control, 208) were reported across 15 938 match exposure-hours (intervention, 9083; control, 6855). Intention-to-treat results indicated unclear effects of trial arm on overall match injury incidence (rate ratio (RR)=0.85, 90% confidence limits 0.61 to 1.17), although clear reductions were evident in the intervention arm for concussion incidence (RR=0.71, 0.48 to 1.05). When trial arm comparisons were limited to teams who had completed three or more weekly programme sessions on average, clear reductions in overall match injury incidence (RR=0.28, 0.14 to 0.51) and concussion incidence (RR=0.41, 0.17 to 0.99) were noted in the intervention group.

Conclusion A preventive movement control exercise programme can reduce match injury outcomes, including concussion, in schoolboy rugby players when compared with a standardised control exercise programme, although to realise the greatest effects players should complete the programme at least three times per week.

  • Injury prevention
  • Concussion
  • Intervention
  • Rugby

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  • Contributors GT, KAS, MEE and SK initiated the overall project. MDH, KAS, SW, CDM, MEE, SK and GT conceived and designed the study. 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.

  • Competing interests None declared.

  • Ethics approval Research Ethics Approval Committee for Health (REACH) at the University of Bath.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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