The efficacy of an iterative “sequence of prevention” approach to injury prevention by a multidisciplinary team in professional rugby union

Abstract

The range of skills required to effectively manage complex injury phenomena in professional collision sport crosses disciplinary boundaries. The evidence presented here points to the effectiveness of a multidisciplinary approach to reducing injury risk. This model will likely be applicable across a range of team and individual sports.

Sports Injury Prevention is Complex: We Need to Invest in Better Processes, Not Singular Solutions

“…In applied settings, the complex nature of injury occurrence means that practitioners will never be able to prevent all injuries and thus will never be able to 'solve' the injury problem. Instead, they assess constraints and risk factors present within their particular context, and make expertise-based judgments regarding the interventions that are most likely to be effective [43,44]. These interventions cannot be assessed as 'right or wrong' and are instead interpreted as 'better or worse' based on the contextual constraints, the level of investment required and positive and negative outcomes achieved [40].…”

“…Due to the requirement for RCTs to be rigorously controlled in their execution, RCTs are typically carried out under 'ideal conditions' so that the effect of a particular intervention can be determined. In contrast, practitioners working at the 'coalface' tend to 'overdetermine' [60] their injury prevention strategies by implementing multiple prevention approaches simultaneously (e.g., preventative exercises, training load management, squad rotation, recovery activities) [43,44,54,[61][62][63]. Furthermore, practitioners often consider multiple risk factors (age, previous injury, training load, fascicle length etc.)…”

“…Understanding injury prevention as a process requires researchers to set up iterative and ongoing feedback loops that embrace learning from previous intervention cycles. This approach (designated the team-sport injury prevention [TIP] cycle) is aligned with the actual processes that team sports medical practitioners engage in [44], and has been shown to be effective in injury reduction [43,95]. A pertinent example of this approach is the success of the RugbySmart campaign in New Zealand, which has recently noted that conducting research on program effectiveness and using this information to modify the program and responding to facilitator and participant feedback were essential to that program's success [95].…”

Evaluating the Implementation of Injury Prevention Strategies in Rugby Union and League: A Systematic Review using the RE-AIM Framework

“…Protective equipment was the most frequently investigated intervention (n = 44), followed by national injury prevention programmes (n = 9), law changes (n = 7), neuromuscular training programmes (n = 7), and law enforcement (n = 3). Other interventions included training load manipulation, stress management, injury prevention education, and a "multidisciplinary approach to reducing injury risk" in a professional team [42] (all n = 1). Of the 44 equipment studies, mouthguards were the intervention of interest in 37 studies and headgear in 12 studies.…”

‘How’ a multidisciplinary team worked effectively to reduce injury in a professional sport environment - Pre-Print

“…As such, injury occurrence is a complex(3) and context specific (4) phenomenon. Understanding, and ultimately influencing injury outcomes requires a broad range of professional skills and perspectives, resulting in the need for multidisciplinary collaboration (5)(6)(7). Accordingly, it is now common practice for professional sports teams to employ doctors, physiotherapists and sport scientists to support coaches in injury prevention (8,9), creating a unique multidisciplinary team (MDT).…”