Abstract
OBJECTIVE: To evaluate the effectiveness of a rugby-specific neuromuscular training (NMT) warm-up on injury and concussion rates in Canadian high school girls’ rugby. U DESIGN: Quasi-experimental study. U 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 [CIs]) comparing intervention and control cohorts, adjusted for injury history and rugby playing experience, offset by match hours and random effects (team and individual level). U RESULTS: There were 409 player seasons (13 teams) in control seasons 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 of time-loss per 1000 match hours; 95% CI: −349, −39) and all-training injury burden (mean difference, −17 days of time-loss per 1000 match hours; 95% CI: −27, −7) were lower in the intervention seasons. U 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 NMT warm-up use. J Orthop Sports Phys Ther 2026;56(4):261-271. Epub 2 March 2026. doi:10.2519/jospt.2026.13373.
| Original language | English |
|---|---|
| Pages (from-to) | 261-271 |
| Number of pages | 11 |
| Journal | Journal of Orthopaedic & Sports Physical Therapy |
| Volume | 56 |
| Issue number | 4 |
| Early online date | 1 Apr 2026 |
| DOIs | |
| Publication status | Published - 30 Apr 2026 |
Funding
1Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada. 2School of Medical Sciences and Institute on Aging and Lifelong Health, Faculty of Health, University of Victoria, Victoria, Canada. 3Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada. 4UK Collaborating Centre on Injury and Illness Prevention in Sport, United Kingdom. 5Centre for Health, and Injury & Illness Prevention in Sport, Department of Health, University of Bath, Bath, United Kingdom. 6Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada. 7Hotchkiss Brain Institute, University of Calgary, Calgary, Canada. 8Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada. 9Integrative Neuromuscular Sport Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada. 10Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada. 11BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, Canada. 12Edinburgh Sports Medicine Research Centre, Institute for Sport, PE and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom. 13Rugby Football Union, Twickenham, United Kingdom. 14Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada. 15Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada. 16O’Brien Institute for Public Health, University of Calgary, Calgary, Canada. ORCID: Shill, 0000-0003-0175-2354; Pasanen, 0000-0002-0427-2877. This work was supported by funds available from a Canadian Institutes of Health Research Foundation Research Grant (Principal Investigator: C. Emery; grant 375089) and the National Football League’s Scientific Advisory Board’s Play Smart, Play Safe campaign. I.J.S. was funded through the Hotchkiss Brain Institute, Joan Snyder, and a Vanier Canadian Studentship and is funded through a Canadian Institutes of Health Research Postdoctoral Fellowship. C.A.E. holds a Canada Research Chair (Tier 1) in Concussion. S.W.W. was funded through the O’Brien Institute for Public Health and a Canadian Institutes of Health Research Postdoctoral Fellowship. K.A.S. is employed by the Rugby Football Union, the national governing body for rugby union in England. Since completion of this study, C.A.E., S.W.W., and I.J.S. have received funding from World Rugby. The other authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Carolyn A. Emery, Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary AB T2N 1N4, Canada. E-mail: [email protected] t Copyright ©2026 JOSPT ®, Inc vention Research Centre (SIPRC) is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. We acknowledge the funding from National Football League’s Scientific Advisory Board Play Smart, Play Safe campaign, Canadian Institutes of Health Research, Alberta Innovates, Hotchkiss Brain Institute, Alberta Children’s Hospital Foundation, and Joan Snyder. We acknowledge all SIPRC staff and trainees supporting this project over the 4 seasons and the school districts including all of teachers, coaches, and students involved for their time and support in completing this project. This work was supported by funds available from a Canadian Institutes of Health Research Foundation Research Grant (Principal Investigator: C. Emery; grant 375089) and the National Football League’s Scientific Advisory Board’s Play Smart, Play Safe campaign. I.J.S. was funded through the Hotchkiss Brain Institute, Joan Snyder, and a Vanier Canadian Studentship and is funded through a Canadian Institutes of Health Research Postdoctoral Fellowship. C.A.E. holds a Canada Research Chair (Tier 1) in Concussion. S.W.W. was funded through the O’Brien Institute for Public Health and a Canadian Institutes of Health Research Postdoctoral Fellowship. K.A.S. is employed by the Rugby Football Union, the national governing body for rugby union in England. Since completion of this study, C.A.E., S.W.W., and I.J.S. have received funding from World Rugby. The other authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article.
| Funders | Funder number |
|---|---|
| O’Brien institute for Public Health | |
| Alberta Children’s Hospital Foundation | |
| National Football League’s Scientific Advisory Board | |
| Hotchkiss Brain Institute | |
| Canada Research Chairs | |
| National Football League | |
| Canadian Institutes of Health Research | 375089 |
Keywords
- concussion
- girl
- injury
- injury prevention
- neuromuscular training warm-up
- rugby union
ASJC Scopus subject areas
- Physical Therapy, Sports Therapy and Rehabilitation
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