Rugby union is one of the most popular team sports in the world but, being a contact sport, also carries a high risk of injury.
England comprises the world’s largest rugby playing population in the world. Previous studies have described the incidence of injuries in the game, and a few have introduced injury prevention interventions through equipment and law changes, but until now, none have looked to reduce injury through the improvement of the players' physical preparation.
Crucially, prior to this study, injury prevention guidance and resources from the Rugby Football Union (RFU) and World Rugby was not evidence-based, and guidance regarding concussion was solely targeted on recognition.
In developing Activate, the first rugby-specific injury prevention exercise programme, the focus has shifted from injury management to injury prevention.
Understanding injury rates and risk factors
This programme of research conducted at the University of Bath is part of the Community Rugby Injury Surveillance Project (CRISP). The programme was led by Professor Keith Stokes, with Dr. Grant Trewartha, Dr. Carly McKay, Dr. Sean Williams, and Dr. Simon Roberts.
The main aims of CRISP were to:
- understand injury rates in schools and community adult rugby players
- identify the risk factors that led to these injuries during matches
- use this information to implement injury reduction interventions
Early studies by the research team during CRISP revealed that injuries were most common in the lower limb, shoulder and head (concussion) and that injury prevention strategies should target these areas. Furthermore, it was identified that players who were most proficient at performing standardised movement control tasks, incorporating balance, flexibility and strength, had a lower risk of injury during match play.
Developing an injury prevention exercise programme
To kick off the process of creating an injury prevention programme, an expert panel was convened to help develop injury prevention warm-up programmes specific to youth and adult rugby players. The panel included international research and strength and conditioning experts, including Kate Davis, RFU; Richard Mack, Bath Rugby; Dr. Mike England, RFU, Professor Carolyn Emery, University of Calgary; Professor Evert Verhagen, Amsterdam University, and Des Ryan, Arsenal Football Club.
The programmes incorporated evidence-based balance, strength and flexibility exercises from previous injury prevention studies by other research groups in team sports with additional exercises appropriate to rugby union, particularly strengthening exercises relating to the neck and shoulder areas.
This work developed into pilot randomised control trials (RCTs) during the 2014-15 rugby season assessing how well a rugby-specific movement control warm-up could be incorporated into a school and adult club environment.
Positive results from the outset
The RCTs were introduced in the 2015-16 rugby season, concentrating on participants from youth and adult rugby teams, and it became clear very quickly that the designed injury prevention warm up programmes were having an immediate positive effect.
The RCTs involved 3188 youth players in 118 teams across 40 schools and over 1500 adult players across 81 community rugby clubs.
Both the youth and adult studies demonstrated that when the warm-ups were carried out at the start of training and pre-match over the rugby season, there was a reduction in match injuries, specifically in concussions and injuries to the lower limb.
Most notably, in the youth study when the programme was carried out three times or more per week, the team saw a:
- 72% reduction in overall injuries
- 59% reduction in concussions
The adult teams saw similar positive results:
- Lower limb injuries reduced by 40%
- Incidence of concussions reduced by 60%
Activate adopted by the RFU
In 2018 the RFU, comprising the world’s largest community playing population, and the world governing body for rugby Union (World Rugby), adopted and disseminated Activate as their primary evidence-based injury prevention programme for community-level rugby. Both bodies have invested significant resources in producing online tools and trained educators to deliver face-to-face workshops that ensure the highest quality of delivery and subsequent impact on the game around the world.
'Evidence-based injury prevention is a key strategy of the Rugby Football Union and therefore providing the Activate injury prevention programme to our community playing population has been enormously significant in meeting our aims' - Rachel Faull-Brown, RFU Player welfare manager
The RFU have created dedicated a web page with links to videos and downloadable guides to the exercise programmes, situated within the RFU RugbySafe web content. And in September 2017, Activate resources and web links were provided to all registered users on the central RFU ‘Game Management System’ which includes club coaches, management and medical staff at every registered rugby union club and school in England.
All RFU community rugby coaches have also been trained to deliver an Activate workshop to school and club coaches in England. From 2017-2018, 151 free workshops were delivered across all regions in England with approximately 2700 coaches in total attending.
Benefitting rugby around the world
Building on the success of the partnership between The University of Bath and the RFU, permission has now been granted for Activate to be used by World Rugby (the World governing body for rugby union) as its core injury prevention strategy for community rugby. This has resulted in significant investment, and in September 2019 Activate was translated into eight languages for global dissemination through World Rugby’s educators and trainers benefiting rugby playing nations all over the world.
‘Activate is a significant resource for all countries but particularly developing unions which may
have limited resources to develop such a programme' - Mark Harrington, Head of Word Rugby Technical Services
In 2017, Dr. Mike Hislop was employed as World Rugby’s Technical Services Researcher with a remit to oversee the global dissemination of Activate. As of July 2020, Dr. Hislop has coordinated educator training programmes in 18 unions across Africa, North America, Oceania, Asia and Europe.
The aim is for Activate to reach approximately 9.5 million players across 104 member countries. The online content has already been accessed by approximately 4000 different users from 103 countries while a number of countries link directly to Activate on their rugby union governing body websites.