Context: Injury risks in professional and community rugby union have been extensively described; however, less is known about injury epidemiology at the schoolboy level.Objective: To investigate the injury risk in English schoolboy rugby union matches, comparing an elite competition (Achieving Academic and Sporting Excellence [AASE]) with subelite matches (non-AASE).Design: Retrospective cohort study. Setting: Rugby union academy, consisting of 16-to 19-year-old males, based at an elite sports college in England.Patients or Other Participants: A total of 132 participants (mean age ¼ 17.5 years) were included in the study; 64 athletes experienced a total of 103 time-loss injuries over a 3-season period (2012)(2013)(2014)(2015). All injuries were assessed and recorded by the team therapist using consensus statement definitions.Main Outcome Measure(s): Injury characteristics were recorded and compared between groups. Primary outcome measures were injury incidence (per 1000 h match exposure) and injury burden (days absent/1000 h), and rate ratios and 95% confidence intervals are presented throughout.Results: A total of 131 matches were played (34 AASE, 97 non-AASE) and a total of 103 injuries were recorded (47 AASE, 56 non-AASE). The injury incidence in AASE matches (77/1000 h) was greater than in non-AASE matches (34/1000 h). The concussion incidence in AASE matches (20/1000 h) was 5 times that of non-AASE matches (4/1000 h). The head/face had the highest injury incidence for a specific location, followed by the shoulder region (AASE ¼ 19/1000 h, non-AASE ¼ 5/1000 h), which had the greatest injury burden (553/1000 h and 105/1000 h, respectively) for any specific body location. More than 50% of all injuries were associated with tackles.Conclusions: A much greater incidence of all injuries occurred at the highest level of competition, and the concussion incidence was greater than that reported in any previously published study of youth rugby. Given the high incidence and burden of concussions and shoulder injuries, prevention and management deserve specific focus.Key Words: adolescents, injuries, youths, sport, upper limb, concussion Key PointsPlaying in the more elite level of competition (Achieving Academic and Sporting Excellence [AASE] matches) was associated with a greater risk of injury, with an incidence rate difference of 43/1000 player-hours. The concussion incidence was 20/1000 player-hours in AASE matches, which was 5 times greater than the rate of 4/ 1000 player-hours in non-AASE matches and those in published studies of both youth and professional rugby. Shoulder injuries constituted the largest injury burden and the second highest incidence rate in the AASE group.

The Health Action Process Approach (HAPA) is a behaviour change model showing promise in positively changing youth sport coaches’ injury prevention behaviours. This study incorporated the HAPA model into coach training workshops for Activate, an efficacious rugby injury prevention programme. Primary aims were to investigate the effect of the workshop on schoolboy rugby union coaches’ (1) perceptions towards injury risk and prevention, (2) Activate adoption and adherence. Secondary aims were to (3) assess the differences in post-season HAPA constructs between workshop attendees and non-attendees, (4) explore associations between HAPA constructs and Activate adherence. In the pre-season, all participants (n = 76) completed a baseline survey, with 41 coaches electing to attend a workshop. Participants completed a post-season survey assessing HAPA constructs and Activate adoption and adherence throughout the season. The workshop did not affect coach perceptions of injury risk and prevention. Attendees had significantly greater rates of Activate adoption (95% vs. 54% χ2 = 17.42, p < 0.01) and adherence (median = 2 sessions vs. ≤1 session per week; z = 3.45, p = 0.03) than non-attendees. At post-season, attendees had significantly greater task self-efficacy (z = −3.46, p < 0.05) and intention (z = −4.33, p < 0.05) to use Activate. These results support the delivery of coach workshops that utilise a behaviour change model to maximise programme implementation.

Injury surveillance systems seek to describe injury risk for a given sport, in order to inform preventative strategies. This often leads to comparisons between studies, although these inferences may be inappropriate, considering the range of methods adopted. This study aimed to describe the injury epidemiology of seven youth sports, enabling valid comparisons of injury risk. Consistent methods were employed across seven sports [male American football, basketball, soccer, rugby league, rugby union; female soccer and rugby union] at a high school in England. A 24-hour time-loss injury definition was adopted. Descriptive statistics and injury incidence (/1000 match-hours) are reported. In total, 322 injuries were sustained by 240 athletes (mean age=17.7±1.0) in 10 273 player-match hours. American football had a significantly greater injury incidence (86/1000 h; 95% CI 61–120) than all sports except female rugby union (54/1000 h; 95% CI 37–76). Concussion was the most common injury (incidence range 0.0–26.7/1000 h), while 59% of injuries occurred via player contact. This study employed standardized data collection methods, allowing valid and reliable comparisons of injury risk between youth sports. This is the first known study to provide epidemiological data for female rugby union, male basketball and American football in an English youth population, enabling the development of preventative strategies.