Is a Neuromuscular Training Warm-Up Enough for Injury and Concussion Prevention in High School Girl Rugby Players?

OBJECTIVES: To evaluate the effectiveness of a rugby-specific neuromuscular training (NMT) warm-up on injury and concussion rates in Canadian high school girls’ rugby. DESIGN: Quasi-experimental study. METHODS: Two high school girls’ rugby cohorts (control seasons 2018, 2019; intervention seasons 2022, 2023) were compared using validated injury surveillance methodology. Coaches attended a rugby-specific NMT warm-up workshop before the intervention seasons. Outcomes of interest were injury and concussion. Multilevel Poisson regression analyses were used to estimate incidence rate ratios (IRRs) (95% Confidence Intervals; 95% CI) comparing intervention and control cohorts, adjusted for injury history and rugby playing experience, offset by match-hours and random effects (team and individual level). RESULTS: There were 409 player-seasons (13 teams) in control and 483 player-seasons (17 teams) in intervention seasons. Concussions accounted for 41% (62/150) of match-injuries in control seasons and 31% (70/226) in intervention seasons. Intention-to-treat (ITT) and per-protocol (PP) analyses demonstrated no differences in match-injury rates (IRR ITT : 1.06, 95% CI: 0.75-1.50; IRR PP : 0.91, 95% CI: 0.69-1.21) or match-concussions rates (IRR ITT : 0.79, 95% CI: 0.52-1.20; IRR PP : 0.74, 95% CI: 0.47-1.17) between intervention and control seasons. Head-match-injury burden (mean difference −194 days-time-loss/1000 match-hours, 95% CI: −349,-39) and all-training-injury burden (mean difference −17 days-time-loss/1000 match-hours, 95% CI: −27,-7) were lower in the intervention seasons. CONCLUSION: While no statistically significant differences were found in match-injury or concussion rates in the intervention and control seasons, regardless of adherence level, there was a clinically relevant 21% lower match-concussion rate and lower match-head-injury and all-training-injury burden with a NMT warm-up.