2nd International Conference on
Injury & Illness Prevention in Sport

1. Edinburgh Sports Medicine Research Centre, Institute for Sport, PE and Health Sciences, University of Edinburgh, Edinburgh, UK

2. UK Collaborating Centre on Injury and Illness Prevention in Sport, Edinburgh, UK

3. Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

4. Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom

Background

Anterior cruciate ligament (ACL) rupture is a significant injury across sporting and general populations. With a growing body of evidence regarding prevention and management, understanding the epidemiology across a range of settings is essential for adequately guiding prevention strategies.

Objective

To map and synthesise the literature on the epidemiology of primary ACL injuries.

Design

A scoping review was conducted in accordance with PRISMA guidance and included all age groups, sexes, sporting levels, community settings and geographical regions. Studies on ACL re-injury, chronic ACL deficiency, other soft-tissue knee injuries, incidence following prevention interventions and review articles were excluded. Extracted data were used to generate a descriptive summary and thematic analysis.

Results

A total of 7595 studies were identified, with 334 full texts screened and 179 included. Studies originated from 33 countries, with the majority from the United States (n=69, 39%) and 112 (63%) published within the past decade. Most were retrospective (n=110). Study demographics included male-only (n=39), female-only (n=34) and both (n=106); paediatric/adolescent (n=26), adult (n=125) and all ages (n=28). There were 83 studies exclusive to ACL injury, while 95 included multiple injury types. A total of 142 studies detailed ACL injury incidence, 29 ACL reconstruction incidence and 8 both. Most studies involved sporting populations (n=134), including professional (n=63), collegiate/high school (n=31), amateur (n=10), and mixed levels (n=36). Across 33 reporting metrics, injuries per 1000 hours was most common (n=40). Thematic analysis identified four principal patterns: contextual variability in incidence, sex- and age-specific epidemiology, evolving surgical trends, and a substantial injury burden.

Conclusion

ACL injury epidemiology is supported by a diverse and rapidly expanding evidence base across multiple populations. Findings highlight the need for targeted, population-specific prevention strategies. Future work should prioritise the development, implementation and evaluation of prevention interventions, alongside standardised reporting to enable comparison across populations.

Return to golf following anterior cruciate ligament reconstruction (ACLr): analysis of 92 amateur golfers undergoing surgery over a four-year period

Rachael Cullinan, Leo Baxendale-Smith3, Thomas Williamson3, Erin Sutherland, Lucas Watson2, Edinburgh Knee Arthroscopy Database Group, Nicholas D Clement3, Iain R Murray3, Andrew J Hall

Golden Jubilee University National Hospital, Clydebank, UK

2 NHS Greater Glasgow & Clyde, Glasgow, UK

3 Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK

NHS Ayrshire & Arran, UK

School of Medicine, University of St Andrews, St Andrews, UK

Edinburgh Knee Arthroscopy Database Group: India Daniels, Finley Dyer, Jun Min Leow, Kirsty Milne, Stefania Silvestre, Gordon Snowden, Rachel Webb, Timothy O White

Introduction

To evaluate the return to play (RTP) for golfers undergoing anterior cruciate ligament reconstruction (ACLr).

Methods

A retrospective cohort study of all patients undergoing primary ACL reconstruction (ACLr) between November 2014-2018 was conducted at a single high-volume centre in Scotland. Electronic health records were underwent multi-source validation before extraction of data including: demographics; injury and initial management; surgical management, and complications. Follow-up data were available for a minimum of 24 months. Patient-reported outcome measures (PROMs) were collected by survey (telephone and post) and included: International Knee Documentation Committee (IKDC) score; sport participation; work/life effects; satisfaction, and net promotor score.

Results

Of 512 patients, 268 (52%) completed the survey and 92/268 (34%) were golfers. Median age was 28 years (15-52 years) and 21/92 (22.8%) were female. Index procedure was ACLr in 54/92 (58.7%), ACLr + partial meniscectomy in 27/92 (29.3%), and 23/92 (25%) required further ipsilateral surgery (within 2 years), with meniscal procedure [n=6] or revision ACLr [n=6] most common. Almost half (44/92; 47.8%) returned to golf, with a median return to play (RTP) time of 39 weeks. There were more complications (16 vs 9) and more subsequent procedures (15 vs 8) among those not returning to golf. The majority of returners (35/44; 80%) were very satisfied/satisfied with their post-injury involvement in golf. Mean post-injury handicap (HCP) change for those with low handicaps (HCP 0-10) was +4 (worse), whereas handicap change in medium (HCP 11-18) and high handicappers (HCP 19+) was -3 and -4, respectively (improvement).

Conclusion

Golfers comprised 18% of patients undergoing ACLr. Around half returned to playing golf after the injury episode, with a median RTP time of 39 weeks. A lower proportion of patients experiencing postoperative complications returned to golf. The majority of those returning to golf were satisfied with their post-injury golf participation.

Rachael Cullinan: cullinanrachael@gmail.com

Leo Baxendale-Smith: leo-baxendale-smith@hotmail.co.uk

Thomas Williamson: thomas

Background: The calcaneofibular ligament (CFL) is the sole lateral ankle ligament spanning both the talocrural and subtalar joints. Combined anterior talofibular ligament (ATFL)-CFL injuries represent a substantial proportion of lateral ankle sprains, yet CFL-specific return-to-play (RTP) evidence remains limited.

Objective: To synthesis current evidence on CFL injury diagnosis, treatment, rehabilitation, and return-to-play criteria.

Design: Systematic review following PRISMA 2020 guidelines.

Setting: Electronic databases including PubMed/MEDLINE, Embase, SPORTDiscus, and Web of Science were searched through 01 April 2026.

Participants: Studies involving patients with confirmed CFL injury, isolated or combined with ATFL injury, reporting functional or RTP outcomes were included.

Interventions/assessment of risk factors: Conservative management, surgical repair (modified Broström-Gould and variants), rehabilitation protocols, and functional testing batteries were evaluated.

Main outcome measures: Return-to-play rates and timelines, recurrence of instability, validated patient-reported outcomes, and functional performance measures.

Results: Ultrasound demonstrated higher diagnostic sensitivity than standard MRI for chronic CFL injuries. Conservative management with functional bracing remains first-line for acute injuries. The modified Broström-Gould procedure is the established surgical approach for refractory chronic instability. Emerging comparative data suggests combined ATFL and CFL repair may reduce recurrence compared with ATFL-only repair in severe chronic instability. Proprioceptive and neuromuscular training programmes reduce recurrent sprain risk. No standardized, validated RTP criteria specific to CFL injury currently exist. Composite assessments incorporating hop tests, dynamic balance measures, patient-reported outcomes, and psychological readiness represent the best available approach. The evidence base remains predominantly level III-IV.

Conclusions: The CFL's contribution to ankle and subtalar stability is increasingly recognized, with growing evidence supporting direct CFL repair in severe instability. The most critical gap is the absence of CFL-specific, evidence-based RTP protocols. Prospective studies with validated RTP endpoints are needed.

Title: "For the long win" - developing a health and wellbeing measurement framework for young people enrolled in sport-related talent development environments: a mixed-methods study.

Background

Most young people (10-24 years) enrolled in talent development environments (TDEs) do not progress to elite levels, necessitating an improved understanding of the effect on health and wellbeing (H&W) and subsequent sports participation. There is evidence that there can be complex emotional, identity and adaptive effects, especially when navigating transitions in and out of TDEs. Ensuring that TDEs measure H&W alongside athletic skills and performance-based metrics has gained increasing focus.

Determining how to effectively measure and monitor these diverse experiential domains is critical. Accordingly, we aim to produce an evidence-based and co-designed evaluation framework suitable for use across multiple sports that focusses on the long-term H&W of young people enrolled in TDEs - "for the long win".

Project Methods

Patient and Public Involvement and Engagement underpins all project stages, already including representatives from three National Governing Bodies (two team-based and one individual sport), and one dance organisation.

Two interrelated projects have been initiated and will be reported in line with PRISMA-ScR and COREQ guidance: (1) a scoping review, aligned to the Joanna Briggs Institute methodology, to identify research tools and practices used to measure health and wellbeing and sustained participation outcomes in TDEs; and (2) a qualitative study, including semi-structured interviews and a "future self" letter writing task, exploring how young people reflect on their experiences of and anticipated future involvement in TDEs. Subsequent focus groups will be conducted with young people, parents/carers, TDE staff, and other key actors to inform framework co-design.

Results

The main outcome will be a co-designed evaluation framework incorporating generic TDE and sport-specific elements suitable for deployment with engaged stakeholders. This will enable measurement of young people's H&W and sustained participation, therefore supporting efforts to improve TDE

Lewis Turmeau, Paul Dijkstra, Ronan Kearney, Andrew Murray, Pieter D'Hooghe, Eva Carneiro, Stuart O'Flanagan, Rajeev Routray, Carrie McCrea, Claire-Marie Roberts, Calum Arthur, Alan Kourie, Jack Wilby, Andrea Goceva, Ciara Grant, Andrew J Hall

Poster, or Oral if combined with Turmeau et al. Performance Medicine (Scoping Review)

Background

Following identification of conceptual and structural gaps in Performance Medicine, there is a need to synthesise existing multidisciplinary knowledge into a coherent framework that can support practice, governance, service design, and future research.

Objectives

To develop a Performance Medicine framework and associated operational tools through structured multidisciplinary synthesis of scientific and applied literature.

Design

Structured narrative synthesis with thematic analysis and iterative framework development.

Setting

Peer-reviewed literature, consensus statements, organisational models, and key texts drawn from sport, medicine, psychology, and related high-performance domains.

Sources

Sources describing relevant concepts, systems, domains, professional roles, and organisational approaches to integrated health and performance support.

Outcomes

A conceptual architecture for Performance Medicine, together with applied tools to define system purpose, structure, roles, functions, and evaluation criteria.

Results

The synthesis produced a Performance Medicine Framework describing integrated domains of human performance and health, linked through system-level components including governance, team structure, decision-making, and data integration. Two applied outputs were also developed. The Performance Medicine Operational Specification defines domain-level purpose, responsibilities, and core functions across the system. The Performance Medicine Assessment Tool provides a structured method for reviewing current provision, identifying gaps, and supporting service development. Together, these outputs offer a coherent model linking conceptual structure to operational application and providing a practical basis for implementation across high-performance settings. However, the framework remains synthesis-derived and its transferability, reliability, and utility across different environments will require further testing.

Conclusions

This work addresses an important gap by presenting a unified conceptual architecture and practical tools for Performance Medicine. Together, the Performance Medicine Architecture, Operational Specification, and Assessment Tool provide an initial framework for system design, evaluation, and governance across high-performance settings, while establishing a basis for subsequent refinement, validation, and applied testing.

Wynter Bee W, Machtsiras G, Junge A3, Mountjoy M, Murray AD , Turner AP, Prosser D, Glover D, Hopley G, West SW

Institute for Sport, PE and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, United Kingdom

2 UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Edinburgh and University of Bath, United Kingdom

3 Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany

Department of Family Medicine, McMaster University, Hamilton, Canada

International Golf Federation (IGF), Lausanne, Switzerland

Medical and Science, The R&A, St Andrews, United Kingdom

Cognacity, 22 Welbeck St, London W1G 8EF, London, United Kingdom

Ladies European Tour, Denham Court Dr. Buckinghamshire, United Kingdom UB9 5PG

University College London Hospitals NHS Foundation Trust

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada

Centre for Health, and Injury and Illness Prevention in Sport, University of Bath, Bath, United Kingdom

2Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada

3Hotchkiss Brain Institute, University of Calgary, Calgary, Canada

O'Brien Institute for Public Health, University of Calgary, Calgary, Canada

Objective: (a) To assess the prevalence of mental health problems, injury and illness complaints and (b) to analyse the association between mental health problems and injury/ illness in elite female professional golfers

Design: Cross-sectional cohort study

Participants: 48 elite (professional) female golfers

Main Outcome Measures: An anonymous online questionnaire was completed by golfers during a Ladies European Tour (LET) event, the Aramco team series in July 2024. Participants' responses on mental health, illness and injury complaints were collected from a previously used structured survey which was informed by the International Golf Federation consensus on recording/reporting injury in golf, the Oslo Sports Trauma Research Questionnaire and International Olympic Committee consensus for surveillance of athlete mental health.

Results: Of the 48 golfers (45.3%) who responded to the questionnaire, 79.1% reported mental health complaints in the four weeks prior to the event, with feeling anxious (51.2%). feeling down, depressed/hopeless (37.2%) and performance anxiety (30.2%) being the most prevalent. The prevalence of injury complaints was 81.3% and illness complaints was 69.6%. The most prevalent injury locations were neck (43.8%), followed by lower back (39.6%) and wrist (22.9%). The most prevalent illness complaints were fa

Scott R Morrison, Lewis Turmeau, Ronan Kearney, Andrew D Murray, William Wynter Bee, Emma Lunan, Niall Elliott, Carrie McCrea-Routray, Rajeev McCrea-Routray, Alan Kourie,Wimpie Du Plessis, Andrew J Hall

Background

Event Medicine concerns the provision of healthcare at large events, where presentation patterns are shaped by crowd characteristics, event type, environment, and service model. Understanding these patterns is important for planning safe, proportionate, and effective services.

Objectives

To map the literature relating to healthcare presentations at large events, examine epidemiological patterns and influencing factors, and identify implications for Event Medicine service planning and future research.

Design

PRISMA-ScR scoping review with descriptive and thematic synthesis.

Setting

Peer-reviewed and grey literature from PubMed, Scopus, DOAJ, Google Scholar and citation screening.

Participants

Studies reporting on healthcare presentations among spectators and other non-participating attendees at large events.

Assessment of risk factors

Event-related and contextual factors associated with presentation patterns, including event type, venue and setting, crowd profile, environmental conditions, and service configuration.

Outcomes

Case mix, patient characteristics, influencing factors, inter-event variation, and implications for service planning.

Results

There were 119 studies, predominantly case series and expert opinion (levels III-V). The literature was heterogeneous in design, context, definitions, and reporting, and related primarily to mass gatherings in general rather than sports events specifically. While this reflects the diversity of the Event Medicine field, it currently limits direct comparison between studies and makes it difficult to draw conclusions that are robust, meaningful, and generalisable across settings. Common themes included presentation frequency and type, variation between event settings and patient groups, and the influence of environmental, crowd, and service-related factors. Overall, the literature provides useful descriptive insight but an inconsistent basis for robust service planning.

Conclusions

Current evidence in Event Medicine remains too fragmented to support strong generalisable conclusions across settings. Future research should prioritise comparable contexts, such as specific sports, groups of sports, event types, or spectator categories, to build a more robust evidence base for service planning and evaluation.

Title: Monitoring health and wellbeing in adolescent Track and Field (Athletics) athletes: a mixed-methods implementation study.

2 NIHR Applied Research Collaboration South West Peninsula, Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom

3 Podium Analytics, London, United Kingdom.

Background

Talent development environments, such as England Athletics' Youth Talent Programme (YTP), seek to better understand athlete health and wellbeing (HWB) to support long-term athletic and personal development. Athlete monitoring systems offer a means of capturing HWB information. However, research remains limited into how such systems are implemented and adopted within youth talent development environments in Athletics. The YTP provides a relevant context in which to implement such monitoring system. This study aims to identify factors influencing implementation of a monitoring system and provide insight into HWB patterns among adolescent athletes.

Study Design

This mixed-methods implementation study represents phase two of a PhD project investigating HWB among YTP athletes. Phase one involved the co-creation of a HWB monitoring system designed for YTP athletes. Phase two implements and evaluates this system within the YTP infrastructure using the PRISM/RE-AIM frameworks to guide evaluation.

Population

YTP athletes (16-18 year olds) who form the 2025-2027 cohort and YTP staff.

Measurement Approaches

The monitoring system consists of a weekly online questionnaire. Injury and illness are measured using an adapted version of the Oslo Sports Trauma Research Center questionnaire on health problems. Additional single-item scales assessed muscle soreness, mood, sleep quality, fatigue, and stress, alongside weekly training hours. Prospective monitoring (~35 weeks) will be supplemented by long-form questionnaires delivered at three time points across the YTP year, including assessment of system usability. Focus groups with YTP athletes and staff explore contextual factors influencing system use and implementation success.

Planned Analyses

Qualitative data will be analysed using inductive thematic analysis to identify key themes related to system implementation, user experiences, and contextual influences. Quantitative data will be analysed descriptively to determine the prevalence of health problems and wellbeing states within the YTP population. Group comparisons (e.g., sex and event group) will use appropriate statistical tests.

Lewis Turmeau, Paul Dijkstra, Ronan Kearney, Andrew Murray, Pieter D'Hooghe, Eva Carneiro, Stuart O'Flanagan, Rajeev Routray, Carrie McCrea, Claire-Marie Roberts, Calum Arthur, Alan Kourie, Jack Wilby, Andrea Goceva, Ciara Grant, Andrew J Hall

Poster, or Oral if combined with Turmeau et al. A Framework for Performance Medicine

Background

Performance Medicine describes the integration of health optimisation and performance enhancement across high-demand human systems. Although related models are used in elite sport, military, and other high-performance environments, the field lacks an agreed definition, conceptual structure, and governing framework.

Objectives

To map the literature relating to integrated health and performance systems, examine how such systems are described across domains, and determine whether a coherent conceptualisation of Performance Medicine currently exists.

Design

PRISMA-ScR scoping review with descriptive and thematic synthesis.

Setting

Peer-reviewed and grey literature identified through database searching, targeted web searching, and citation screening.

Sources

Empirical studies, reviews, models, frameworks, and organisational descriptions relating to integrated health and performance systems in high-performance populations.

Outcomes

Conceptual definitions, system characteristics, multidisciplinary structures, recurring domains, and evidence relevant to the existence of coherent Performance Medicine models.

Results

The literature demonstrated widespread practical implementation of integrated and multidisciplinary performance systems, particularly within elite sport and increasingly in corporate and technical settings. However, directly relevant evidence was limited, heterogeneous, and distributed across multiple disciplines and applied settings. Terminology was inconsistent, and no unified framework, taxonomy, or governance structure was identified. Existing publications described important components, including performance health, interdisciplinary teams, system coordination, and domain-specific support functions, but these were fragmented and rarely assembled into a single conceptual model. Much of the literature was descriptive or practice-led rather than theory-building, which limited comparability and reduced the strength of generalisable conclusions across contexts. Overall, the evidence suggested an active field of practice without a clearly articulated conceptual architecture.

Conclusions

Performance Medicine appears to be widely practised but insufficiently defined. The absence of a coherent conceptual architecture limits standardisation, evaluation, communication, and development of best practice. These findings support further multidisciplinary synthesis to define the field more clearly and to develop an integrated framework and practical tools for system

Background

Type 1 Diabetes (T1D) is an autoimmune condition requiring daily management of blood glucose levels through insulin, diet, and activity. An estimated 341,000 people in the UK are living with T1D. Regular physical activity is an important component of T1D management, yet many encounter barriers that limit participation - including lack of tailored guidance, and inconsistent knowledge among coaches and event organisers. National Governing Bodies (NGBs) for sport in the UK are responsible for setting standards and ensuring safe, inclusive participation for all, including people with T1D. However, no research has evaluated the prevalence or implementation of T1D policies among UK-based NGBs.

Objective

To assess the extent and quality of publicly available policy documentation provided by UK-based NGBs to support people with T1D to participate safely in sport, and to compare this to policies for other chronic health conditions (CHCs), including asthma, epilepsy, and allergies.

Design

A systematic policy audit, guided by the first five stages of a recognised methodological framework for conducting scoping reviews, as follows: (1) question identification; (2) policy document identification; (3) inclusion/exclusion criteria; (4) data charting; (5) collating, summarising, and reporting.

Setting

Publicly available policy documentation published by UK-based NGBs (n=185).

Results

Of 185 UK-based NGBs, 20 (11%) had policy documents mentioning diabetes (T1D or Type 2), 14 (7.7%) asthma, 12 (6.6%) epilepsy, and 4 (2.2%) allergies. Of the 20 NGBs with documents mentioning diabetes, only 4 had dedicated, standalone policy documents. The remaining 16 referenced diabetes in broader organisation documents.

Conclusions

Despite increasing emphasis on inclusion in sport, few NGBs have clear policies to support people living with T1D or other CHCs, including asthma, epilepsy, and allergies. We recommend the development of standardised national policies for T1D, alongside training and practical tools to enable staff and volunteers to better support people living with T1D.

Scott R Morrison, Lewis Turmeau, Ronan Kearney, Andrew D Murray, William Wynter Bee, Emma Lunan, Niall Elliott, Carrie McCrea, Rajeev Routray, Alan Kourie, Wimpie Du Plessis, Andrew J Hall

Background

Event medicine involves the provision of acute medical services at events involving spectators, performers, or the adjacent public. Sporting events form a portion of the event medicine remit, but present distinctive contextual and governance characteristics that may justify a service model aligned specifically to sport.

Objectives

Relating to medical services at sporting and non-sporting events, identify common principles and distinguishing characteristics, and evaluate the need for the development of a sporting-event specific framework for research and practice.

Design

PRISMA-ScR scoping review with descriptive and thematic analysis, expert stakeholder interpretation and framework development.

Setting

Articles relating to event medicine on PubMed, Scopus, DOAJ, Google Scholar, and relevant key literature.

Participants

Published literature relating to healthcare provision and regulation at mass-gathering events, synthesised by stakeholders experienced in sports and event medical service leadership and delivery.

Outcomes

Identification of clinical and operational domains to inform conceptual framework design.

Results

There were 119 studies, predominantly case series and expert opinion (levels III-V). The literature was heterogeneous in design, context, and reporting, and related primarily to mass gatherings rather than sports events specifically. Emergent themes were: service purpose, infrastructure, workforce, operational challenges, stakeholder interfaces, and governance. Thematic analysis and stakeholder synthesis permitted the construction of a novel sports medicine event care (SMEC) framework (Fig 1), with supporting practical tools including an operational specification and assessment tool (Fig 2). These define minimum viable service requirements, support context-sensitive adaptation, and improve consistency of design, delivery, and evaluation.

Conclusions

Sporting events represent a distinctive care context shaped by sport-specific governance, layered on-site clinical systems, operational overlap between participant and non-participant care, and the spectator-participant continuum of shared exposure. The SMEC Framework offers an evidence- and stakeholder-informed translational model to support research, service development, and quality improvement in sports event care, with future validation required in applied settings.

Table 1. Common and distinguishing features of Event Medicine in general and sports event medicine. []

.

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Figure 1. The Sports Medicine Event Care Framework

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Figure 2. Operational tools associated with the Sports Medicine Event Care Framewo

Background: Squash is a widely played racquet sport with a recognised risk of concussion. Despite growing awareness of sports-related concussion, the extent and consistency of concussion guidelines in squash across countries remain unclear. Objective: To identify and evaluate the availability and content of national concussion guidelines in leading squash-playing countries. Design: Scoping review conducted using established methodological frameworks (Arksey and O'Malley, with Levac enhancements) and reported in accordance with PRISMA-ScR guidelines. Setting: International - included countries with players ranked in the top 50 of the World Squash Federation rankings (June 2025). Participants: Twenty-one countries met inclusion criteria. Interventions: Assessment of the presence and characteristics of national and squash-specific concussion guidelines across included countries. Main Outcome Measures: Availability of concussion guidelines (general or squash-specific) and their alignment with the Amsterdam Statement. Result: Only one country (Canada) had a squash-specific concussion guideline. Seven countries had general national concussion guidelines, while fourteen had none. Overall, there was substantial variability and a notable lack of sport-specific guidance. Conclusions: The World Squash Federation and national squash organisations should produce squash specific concussion guidelines that are in line with the Amsterdam Statement and their own respective country's national guidelines. The World Squash Federation should specifically reference concussion in their rules and should strongly consider updating their self-inflicted injury time rules to allow for the suspension of play for up to fifteen minutes if there is a suspected head injury.

Beyond Knowledge: Understanding the Intention-Behaviour Gap in Concussion Reporting in Community Rugby

Steffi Studt MSc , Paul G. Mullins , Julian A. Owen PhD

Rugby Knowledge Exchange, School of Psychology and Sport Science, Bangor University, UK.

Institue for Applied Human Physiology, School of Psychology and Sport Science, Bangor University, UK.

Cognitive Neuroscience Institute, School of Psychology and Sport Science, Bangor University, UK.

Submission for oral presentation.

Background Individuals participating in rugby union are at increased risk of sports-related concussion, however many injuries remain under-reported. Current prevention strategies prioritise concussion recognition and management through educational initiatives aimed at improving player knowledge and attitudes. These approaches assume that increased knowledge translates into improved symptom-reporting behaviour, yet this assumption remains largely untested within community rugby contexts.

Objective To examine concussion knowledge, attitudes, and reporting intentions among community rugby players, and determine whether these factors predict symptom-reporting behaviour. A secondary aim is to explore the intention-behaviour gap and inform a theory-driven framework for intervention implementation.

Design Sequential explanatory mixed methods study, integrating quantitative and qualitative approaches to identify behavioural patterns and explain underlying mechanisms, informed by behaviour change theory.

Setting Community rugby union clubs in Wales.

Participants Community rugby union players, survey completion (n = 500), focus groups - to date (n= 30)

Interventions/Assessment of risk factors Concussion knowledge, attitudes, and reporting intentions were assessed using a modified RoCKAS-ST, adapted for the Welsh community rugby context.

Main Outcome Measures Self-reported concussion knowledge, attitudes, intentions, and symptom-reporting behaviour.

Results Preliminary findings indicate that while players demonstrate good concussion knowledge and generally positive attitudes, these do not consistently translate into reporting intentions or behaviour, indicating an intention-behaviour gap. To understand and explain this gap, a qualitative phase is currently underway using focus groups to explore the social, cultural, and contextual influences on reporting decisions. Questions are framed on the COM-B model, to understand players capability, opportunity and motivations to report concussions.

Conclusions These findings challenge the assumption that knowledge alone is not sufficient to change behaviour and highlight the need for theoretically informed approaches. Integrating quantitative and qualitative insights will support the development of a theory-driven framework to better understand and address concussion reporting behaviour in community rugby.

2Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford

Background

Repetitive head impacts (RHI) in contact sports have been linked to long-term neurological changes, yet objective biomarkers remain limited. Diffusion MRI (dMRI) is sensitive to microstructural alterations, with diffusion kurtosis imaging (DKI) offering enhanced sensitivity compared to conventional approaches3. Neck strength has been proposed as a modifiable protective factor, but its relationship with brain microstructure in high-impact sports such as rugby remains unclear.

Objective

To examine whether (1) concussion history and (2) neck strength are associated with white matter microstructural changes in DKI metrics in active elite rugby players, and (3) whether neck strength modulates the effects of prior concussions.

Methods

Baseline data were collected from 61 active elite rugby players (30 male, 31 female) during the preseason. Diffusion MRI data were acquired on a mobile 3T scanner and processed to derive DKI metrics, including fractional anisotropy (FA), mean diffusivity (MD), and mean kurtosis (MK). Voxel-wise analyses were performed using tract-based spatial statistics. Isometric neck strength was measured in four directions using fixed-frame dynamometry. General linear models assessed associations between imaging metrics, concussion history, neck strength, and their interaction, controlling for age and sex, with p<0.05 considered significant.

Results

Higher numbers of self-reported concussions were positively associated with mean kurtosis, while greater neck strength was positively associated with mean diffusivity in voxel-wise white matter analyses. There was no significant interaction between concussion history and neck strength.

Conclusion

These findings suggest that both concussion history and neck strength are related to brain microstructure in elite rugby players. Further work is needed to clarify the mechanisms underlying these associations, and whether neck strength represents a modifiable factor for mitigating the effects of RHI and concussion.

References

1. Koerte, I. K., Wiegand, T. L. T., Bonke, E. M., Kochsiek, J. & Shenton, M. E. Diffusion Imaging of Sport-related Repetitive Head Impacts-A Systematic Review. Neuropsychol Rev 33, 122-143 (2023).

2. Manley, G. et al. A systematic review of potential long-term effects of sport-related concussion. Br J Sports Med 51, 969-977 (2017).

3. Harritz, T., Hansen, B., Zhang, B. & Xue, R. Exploring IVIM-DKI and DKI for Assessing Microv

Gender based model comparison of computer vision methods for detecting possible head injury risk events in football using broadcast footage.

Background: Sport-related concussion and repetitive sub-concussive head impacts remain a major concern in football. Current identification methods are slow, labour-intensive, and reliant on specialist review, limiting large-scale surveillance. Existing automated approaches are further constrained by poor scalability and an overreliance on male-only datasets, despite growing evidence of sex-specific differences in head impact exposure and concussion risk.

Methods: A gender-stratified temporal action spotting (TAS) pipeline was developed to automatically detect headers, aerial duels, and possible concussive events (PCE) in broadcast football footage. Video clips were extracted from 19 matches (10 male, 9 female) at 5 fps. Frame-level spatial features were derived from a pre-trained ResNet-152 Convolutional Neural Network (2048-dimensional). Two temporal aggregation architectures were compared: NetVLAD++, aggregating features across 16 learned cluster centroids, and a lightweight single-layer Transformer encoder. Models were trained under three cohort conditions: unified, male-only, and female-only, and evaluated under both fixed match-level splits and leave-one-out cross-validation (LOO-CV). Critically, cross-sex transfer evaluations were conducted whereby male-trained models were tested on female footage and vice versa. Detection performance was assessed via mean Average Precision (mAP) at a ±5-second temporal tolerance.

Preliminary* results: Under LOO-CV, NetVLAD++ achieved an overall mAP of 0.185 (male: 0.149; female: 0.225), outperforming the Transformer baseline (overall: 0.126; male: 0.106; female: 0.147). Female clips yielded consistently higher same-sex detection performance than male clips across both architectures, contrary to the study hypothesis. Cross-sex transfer evaluation revealed that female-trained NetVLAD++ generalised better to male footage (mAP: 0.206) than male-trained models transferred to female footage (mAP: 0.172), suggesting female heading patterns may produce more generalisable visual representations.

Conclusions and Applications: A computer vision pipeline can feasibly detect head injury risk events in football broadcast footage across both sexes. The superior cross-sex transfer of female-trained models challenges assumptions about the generalisability of male-dominant training data in sports computer vision and underscores the need for sex-stratified model development in concussion surveillance systems. Full-match validation is planned to confirm and extend these preliminary findings.

2 UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, Bath, UK

3 Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK

PREM Rugby, London, UK

Rugby Football League, Etihad Campus, Manchester, UK

Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia

Rugby Football Union, London, UK

Title: Instrumented mouthguard implementation and application in elite rugby: practical considerations for research and practice

Background: Instrumented mouthguards (iMGs) provide the most accurate on-field quantification of head acceleration events (HAEs) in contact sports due to their close coupling with the upper dentition. The iMGs are increasingly being adopted in elite rugby as a player monitoring tool to inform HAE load management, and as a research tool for quantifying HAE risk. However, a main barrier to their implementation is understanding and interpreting data and consistent player iMG usage, with normative data development a research priority for practitioners.

Context: PREM Rugby, the highest level of men's rugby in England, have mandated the use of iMGs in training, the sharing of training video footage, and standardised GPS data collection. However, there remains limited applied guidance on how to implement iMGs effectively within training environments, where player behaviour, data integration requirements, and contextual variability influence data quality and interpretation.

Approach: A narrative evaluation was conducted on (1) iMG specifications; (2) iMG integration with GPS and video for temporal windowing and contextualisation of HAEs; (3) player wearing behaviours assessed through time-on-teeth logs and video verification; (4) HAE magnitude distributions in training to inform appropriate filtering thresholds.

Outcomes: Validated Prevent Biometrics iMGs demonstrate high laboratory and on-field accuracy, but implementation quality depended heavily on player adherence and practitioner workflow. iMG usage was inconsistent during modified-contact drills, yet when worn, >99% of contact events were captured. GPS and video offered essential contextual data to support accurate exposure measurement. Training HAEs were typically low magnitude, highlighting the need for thoughtful filtering and interpretation depending on the line of enquiry.

Conclusions: Effective iMG implementation requires coordinated operational planning, integration with

2 UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, Bath, UK

3 World Rugby, Dublin, Ireland

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada

Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK

PREM Rugby, London, UK

Rugby Football Union, London, UK

Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia

Rugby Football League, Etihad Campus, Manchester, UK

Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

Title: Training Concussions in Men's English Premiership Rugby Union: An Eight-Season Prospective Cohort Study of 153,243 Player-Weeks

Background: Concussion is the most common match injury in elite men's rugby union, where concussion-related risk factors have been established. However, training-related concussion incidence and risk factors are not understood.

Objectives: To describe the incidence, severity, and burden of concussion injuries in elite men's rugby union training, and associated risk factors.

Design: Prospective observational cohort study.

Setting: English Premiership training, the highest level of men's competition in England.

Participants: 1,056 players and 153,243 player-training-weeks.

Methods: Training concussions recorded as part of the Professional Rugby Injury Surveillance Project were examined between 2016/2017 and 2023/2024 seasons. Incidence rates (per 1,000 hours) were calculated with 95% confidence intervals (CIs). Poisson regression and incidence rate ratios described season-to-season changes in concussion incidence. A generalised linear mixed model assessed influence of time in season, match minutes played in previous 28 days, dominant training type, and previous concussion as fixed effects, with weekly training exposure accounted for. Random intercepts included player and team.

Results: The incidence of concussions in training was 0.23 per 1,000 hours (95% CI: 0.22-0.29). The mean severity of concussions was 18 days (95% CI: 15-21). The burden of training concussions was 4.16 days absent per 1,000 hours (95% CI: 3.57-4.85). The tackle (46%) and accidental collisions (26%) were the most common inciting events. The incidence of training-related concussions was significantly higher in 2021/202

Background Female athletes remain underrepresented in sports science research, limiting practitioners understanding of how menstrual cycle (MC) phases may influence neuromuscular performance and injury-risk.

Objective To examine changes in neuromuscular performance across MC phases in a national-level female netball athlete.

Design Single-subject repeated-measures case study.

Setting Applied performance testing in a high-performance sport environment.

Participant One 26-year-old national-level female netball athlete with a eumenorrheic MC.

Assessment of Risk Factors Using calendar tracking, symptom monitoring, and urinary luteinising hormone testing, MC phases were determined. Neuromuscular performance was assessed across three full cycles at the onset of menstruation and during ovulation. Neuromuscular performance was measured via countermovement jump (CMJ), drop jump (DJ), and isometric mid-thigh pull (IMTP). Meaningful differences were identified using non-overlapping ±2SD thresholds.

Main Outcome Measures CMJ height, DJ reactive strength and stiffness metrics, IMTP net peak vertical force, and force at 100 ms.

Results An 11% increase in IMTP net peak vertical force was observed at ovulation (+138 N), alongside a 4% reduction in force at 100 ms (−42 N). CMJ height decreased by 3% (−0.7 cm), coinciding with a 1.2% increase in body mass (+0.8 kg). No meaningful differences were observed in DJ reactive strength or stiffness measures.

Conclusions Given the single-athlete design, these findings highlight the value of case-study monitoring for capturing individual responses to MC phases. Neuromuscular performance remained largely consistent across MC phases, however, reductions in early force production may have implications for neuromuscular readiness and lower-limb injury risk. Coaches and support staff should adopt longitudinal, individualised monitoring strategies to account for potential MC-related fluctuations on injury-risk management, rather than assuming uniform effects across athletes.

Division of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa

Elite Sport UAE, Ministry of Sport, Dubai, United Arab Emirates

Department of Sport Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK

Institute of Sport, Exercise and Health, University College London, London, UK

Background: Evidence from youth sporting populations shows that variations in the rate and timing at which athletes physically mature can have implications on factors such as selection, performance and injury. To gain a greater understanding of how athlete development and health can be optimised in youth athletics (track and field), it is therefore important to investigate the role of biological maturation. By collating the existing evidence related to the influence of biological maturation on athlete selection, performance and injury in youth athletics, key concepts and knowledge gaps can be mapped and used to identify areas for future research.

Objectives: To retrieve and analyse the existing peer-reviewed literature investigating the influence of biological maturation on athlete selection, performance and injury in youth athletics, and identify knowledge gaps and opportunities for future research.

Design: Scoping review.

Inclusion criteria: Peer-reviewed articles containing the following: males and/or females participating in youth athletics; an indicator of biological maturation; and data relevant to selection, performance or injury.

Methods: Four databases (Web of Science, SPORTDiscus, Embase and PubMed) were searched from inception to February 19, 2026 using keywords such as "matur*" AND ("track and field" OR "athletics"). Two authors (BG, SC) screened articles against the inclusion/exclusion criteria, first by title and abstract, then by full text.

Planned analyses: Data will be extracted from each included article and methodological quality will be assessed by two authors (BG, AW) using the Downs and Black Scale.

Results: 1549 articles have been screened, with 54 meeting the criteria for inclusion. Included articles date from 1973 to 2026 and 67% have an exclusively female sample. Age of menarche is the most common indicator of biological maturation. Results relating to the design, findings and methodology quality

Background. Female endurance runners face injury risk profiles shaped by energy availability, bone health, and hormonal status, factors routinely collected in clinical assessment but rarely integrated into predictive models. Existing machine learning (ML) approaches to running-related injury (RRI) prediction have largely treated sex as a covariate, obscuring clinically actionable differences.

Objective. To characterise sex-specific RRI risk in competitive endurance runners using a multidisciplinary ML framework, with focus on factors central to female athlete health.

Design. Secondary analysis of a prospective 12-month cohort study.

Setting. Competitive endurance running.

Participants. 142 competitive endurance runners (64 female), contributing 6,181 weekly observations and 607 recorded injuries.

Assessment of risk factors. Sex-stratified models incorporated bone mineral density, energy availability (LEAF-Q, EDEQ), hip strength, biomechanical loading, and relevant genetic variants. Feature importance was examined using SHAP analysis.

Main outcome measures. Weekly injury occurrence. Sex-disaggregated risk profiles and relative contribution of female-specific clinical variables to injury prediction.

Results. Sex-disaggregated injury risk profiles and the relative contribution of female-specific clinical variables to weekly injury prediction are presented, with implications for individualised athlete management.

Conclusions. Integrating established female athlete health markers into ML-based injury prediction offers a pathway toward clinically meaningful, personalised risk stratification. This approach moves beyond population-level models toward decision support tools relevant to the practising sports medicine clinician.

Background

Despite the growth in ML applications for injury risk prediction in sport, relevant research into rugby union remain sparse, hampered by single team or single season analysis. Although existing machine learning approaches to sports injury prediction have reported acceptable discrimination, their clinical utility remains questionable. This emphasises the need for greater clinical relevance within sports injury risk prediction research, from definition and scope of 'injury', to model evaluation and dissemination.

Accordingly, this research intends to bridge these gaps by synthesising diverse datasets from multiple professional rugby union teams.

Objective

The aim of this study was to evaluate whether machine learning-based injury risk prediction models demonstrate sufficient practicality and clinical utility to support decision-making in elite male rugby union.

Design

Prospective cohort.

Setting

Four professional rugby union teams, one national team.

Participants

129 male rugby players.

Assessment of risk factors

Injury risk models using logistic regression, Support Vector Machine, Random Forest, XGBoost, and CatBoost.

Main outcome measures

ROC AUC, AUPRC, F1-Score, Precision, Recall. SHAP values used to interpret model output.

Results

CatBoost provided the highest statistical performance when applied to the unseen testing data, achieving values of ROC AUC (0.66), F1-Score (0.024), and AUPRC (0.008). XGBoost was the only other model to surpass a test ROC AUC of 0.6, achieving 0.61, 0.021, and 0.007 for ROC AUC, F1-Score and AUPRC respectively. Logistic regression was found to match the performance of Random Forest when applied to the test set, yet failed to outperform chance during cross-validation. Kernel-based SVM achieved the lowest ROC AUC during testing.

Conclusions

Predictive performance across the models was modest, with low precision scores highlighting each model's inability to effectively identify impending injuries. The resulting high false-positive rates underscore the restricted clinical utility of current machine learning approaches in real-world elite sport settings.

References

1. Leckey C, Van Dyk N, Doherty C, et al. Machine learning approaches to injury risk prediction in sport:a scoping review with evidence synthesis. British Journal of Sports Medicine. 2024:bjsports-2024-1.

2. Duffuler M, Bourgain M, Haddad Z, et al. Recurrent Neural Networks model for injury prevention within a professional rugby union club: a proof of concept over one season. Clinical Biomecha

Background. Lower limb muscle injuries, including hamstring, quadriceps, calf, and groin strains, are among the most prevalent and clinically consequential injuries in competitive and recreational sport. Artificial intelligence (AI) offers growing potential to augment clinical decision-making across the injury continuum, from risk stratification and diagnosis through to return-to-play. Despite rapid growth in the field, no study has systematically characterised the landscape of AI systems developed specifically for this injury group in athletes.

Objective. To map the scope, characteristics, and methodological quality of AI systems developed for lower limb muscle injury management in athletes, and to identify equity and representation gaps in the underlying data.

Design. Scoping review conducted following the Arksey and O'Malley framework, refined by Levac et al., and reported in accordance with PRISMA-ScR.

Setting. Systematic searches across MEDLINE, Embase, IEEE Xplore, and Scopus for studies published between January 2015 and December 2025.

Participants. Athletes as defined by Timpka et al. (BJSM, 2014), across studies applying AI to lower limb muscle injury management.

Assessment of risk factors. Data were extracted on AI modality, injury type, clinical application, dataset characteristics, and athlete demographics including sex reporting.

Main outcome measures. Scope and distribution of AI approaches by modality and clinical application; representation of female athletes in underlying datasets; methodological quality indicators.

Results. Machine learning applied to structured biomechanical or clinical data was the dominant modality; imaging-based and multimodal approaches were less represented. Injury prediction was the most studied application, while return-to-play decision support remained markedly underrepresented. A critical finding was the systematic underrepresentation of female athletes, fundamentally limiting the generalisability of derived models.

Conclusions. AI applications for lower limb muscle injuries in athletes are expanding but remain concentrated in injury prediction, rely predominantly on male-dominated datasets, and lack external validation. The persistent gender data gap represents a patient safety concern: models trained on skewed populations risk producing biased outputs when deployed for female athletes. Future work must prioritise inclusive data collection, rigorous external validation, and co-design with clinicians and athletes.

Title: "We can't just copy and paste what the men do into female sport": contextual experiences and perceptions of injury and injury prevention in adolescent female rugby.

Knight, Gemma

University of Bath

Background and objectives: Understanding the context in which injuries occur and how injury prevention strategies are implemented is essential for developing effective injury prevention and management strategies. Thus, the primary aim of the study was to gain an in-depth understanding of the experiences and perceptions of players, parents/guardians, and coaches regarding injuries and injury prevention strategies within adolescent female rugby in England. A secondary aim was to understand the contextual barriers and/or facilitators of injury prevention strategy implementation.

Methods: This qualitative study utilised semi-structured interviews to explore the experiences and perceptions of under-16/under-18 female rugby players, parents/guardians and coaches/team staff regarding injuries and injury prevention strategies. Reflexive thematic analysis was employed to analyse transcripts, and an inductive approach was adopted to allow themes and sub-themes to emerge naturally from the data.

Results: Twenty-four participants were recruited: twelve coaches/team staff, seven players, and five parents/guardians. Interviews ranged from 11 to 74 minutes, with a mean duration of 42±15 minutes. Four themes emerged: the female athlete, voices from the pitch, safety, and physical preparation and management. These themes and their subthemes were interlinked and shaped one another, emphasising the dynamic nature of injuries and injury prevention strategies. Communication dynamics were a consistent thread across participants' narratives, shaping their experiences of injury management and prevention, from the need for clear communication of resources and consistent inter-team dialogue to the use of age-appropriate language to help players understand their injuries.

Conclusion: Participants' experiences of injuries and injury prevention were complex and context-dependent, shaped by sociocultural factors. Communication dynamics also appeared to play a substantial role in injury management and prevention. Future research should consider involving key partners in the design and evaluation of injury prevention strategies, as their insights can help inform injury prevention and injury management to optimise their effectiveness.

Institute of Biomedical Engineering, The Podium Institute for Sports Medicine and Technology, University of Oxford, UK

Background: Athletes in equestrian and other high-risk sports are exposed to falls and high-impact events that can result in severe injury. Existing wearable protection systems are typically passive or rely on binary airbag deployment, limiting their ability to adapt mechanical response during impact. Wearable sensing technologies enable monitoring of joint motion and hazardous events but are not yet integrated with adaptive protective systems.

Objective: To develop a wearable impact attenuation system using pneumatic capsules with valve-controlled variable stiffness and to explore integration with wearable sensing for adaptive response. design: Experimental engineering study with system design and controlled impact testing.

Setting: Laboratory-based impact testing using a drop-mass setup to simulate fall conditions.

Participants: Not applicable.

Interventions/assessment of risk factors: The system consists of distributed pneumatic capsules integrated into a wearable structure, coupled with a fast-response electro-valve (~10 ms) to modulate internal pressure via controlled venting. Textile-integrated stretch sensors are incorporated to monitor joint motion and detect hazardous conditions, providing a pathway for sensor-guided valve actuation. In the current study, valve control is evaluated under predefined conditions to characterise stiffness modulation.

Main outcome measures: Peak impact force, impulse, and acceleration reduction, along with valve response time and energy dissipation behaviour. results: Preliminary findings indicate that controlled venting enables dynamic stiffness modulation and reduces peak forces compared to non-vented configurations.

Conclusions: Integrating sensing with valve-controlled pneumatic capsules enables a pathway toward adaptive, responsive impact protection. This approach supports the development of next-generation injury prevention systems in sport, with future work focusing on closed-loop sensor-driven activation and sport-specific validation.

Kloskowska, Paulina; Aliyev, Rauf2; Ibrahimov, Hakim 2; Kamilova, Zarifa 2; Staresinic, Ana 3; Mikkonen, Liis ; Oprisnaka, Anastasija ; Ursej, Eva; Crossley, Kay; Kemp, Joanne; Patterson, Brooke ; Haberfield, Melissa ; Bruder, Andrea * and Grygorowicz, Monika *

Polish Football Association (PZPN), Warsaw, Poland

2 Azerbaijan Sports Academy, Baku, Azerbaijan

3 Croatian Football Federation; Faculty of Kinesiology University of Zagreb; Karlovac County Health Center

Estonian Football Association, Tallin, Estonia

Estonian Defence Forces, Tallin, Estonia

Latvian Football Federation, Riga, Latvia

Alma Mater Europaea University, Maribor, Slovenia

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia

Rehasport Clinic, FIFA Medical Centre of Excellence, Poznan, Poland

Department of Physiotherapy, Poznan University of Medical Sciences, Poland

Background

Football is popular among women in Central and Eastern Europe (CEE), but gender-bias linked to socio-historical context excludes them from safe participation and updated strategies, increasing injury risk.

Context-specific projects including local stakeholders are essential for effective injury prevention programme (IPP) implementation. However, only 1% (2/220) of IPP-related research has been conducted in CEE, reducing the effectiveness of existing prevention approaches.

Objective

The project aimed to identify context-specific barriers and facilitators influencing IPP implementation in women's football across six CEE countries.

Design

We performed group concept mapping study. Firstly, the participants were asked to write multiple answers (statements(S)) to one question: What are the barriers and facilitators to the IPP implementation in Women's Football? Participants then rated each statement (1-5) based on importance(I) and modifiability(M), and grouped statements into meaningful clusters.

Participants

38 stakeholders from six countries (healthcare professionals, coaches, club managers, and players) participated in the idea-generation phase, and 36 in the rating and clustering phase, representing Azerbaijan, Croatia, Estonia, Latvia, Poland, and Slovenia.

Intervention/Assessment of Risk Factors

Data analysis involved multidimensional scaling, hierarchical cluster analysis, and calculation of mean ratings.

Main outcome measures

Cluster map with mean importance and modifiability were identified.

Results

9 clusters (ranked highest to lowers mean importance) were constructed from 89 unique statements: Coaching communication & leadership (S=5;I=4.41;M=3.17); Injury prevention and health management (S=12;I=4.33;M=2.63); Team communication and culture (S=12;I=4.29;M=2

Background

Marker-based systems are the gold standard for biomechanics analysis but can be expensive, time-consuming and impractical outside laboratory environments. Markerless systems such as Theia3D offer a faster, non-invasive field application but require validation, especially for youth demographic performing dynamic movements.

Objective

Evaluate the validity of the markerless motion capture system, Theia3D against a marker-based system during dynamic movements in ages 10-18.

Design

The study is a within-subject validation study conducted on a young population, with participants being assessed simultaneously by both motion capture systems.

Setting

The data collection took part in a controlled lab setting, with all cameras from both systems positioned to face 4 plates in the centre of the lab. All sessions took place at the Applied Biomechanics Suite of the University of Bath.

Participants

Forty-five participants (age: [14.2 ± 2.8 years]), (height: [135-189 cm]), (weight: [29-84 kg]) all taking part in >3 organised sport sessions per week participated in this study.

Interventions

Participants performed countermovement jumps, single-leg drop horizontal jumps and acceleration into a 180° cut, all movements captured simultaneously with both systems.

Main outcome measures

Continuous time-series data, and discrete descriptive statistics were collected from joint angles in the sagittal and frontal planes during dynamic movements. The agreement between systems was assessed using statistical measures such as statistical parametric mapping, limits of agreement and root mean square error.

Results

Data collection has been completed, and the analysis is still ongoing, it is expected that Theia will demonstrate a high level of agreement with the marker-based system, although it may encounter challenges, when analysing complex and high-speed movements.

Background Track and Field (Athletics) is a popular sport among children and young people. While participation provides substantial health benefits, it is also associated with an increased risk of injury, likely influenced by specific developmental factors, such as growth and maturation. Injuries during this period may have long-term consequences, including disrupted development, re-injury, and sport dropout. Therefore, understanding how to effectively reduce injury risk in this population is of considerable clinical and practical importance. Objective To conduct a systematic review to assess the reach, effectiveness, adoption, implementation, and maintenance of injury risk reduction interventions for children and young people taking part in Track and Field, aligned to the RE-AIM framework. Methods This systematic review will be reported in line with PRISMA guidelines and registered on PROSPERO. The PICOS framework will be used as follows: (1) Population - studies focusing on children and/or young people taking part in Track and Field across any event group (i.e., sprints, endurance, jumps, throws, and combined events) without restriction on sex or competitive level; (2) Intervention - studies implementing interventions aimed at reducing injury risk, including exercise-based and/or non-exercise strategies; (3) Comparison - studies in which the control group receives no intervention, usual training, a placebo/sham condition, or an alternative intervention; (4) Outcome - the primary outcomes include injury incidence, prevalence, and/or injury risk. Injuries are defined as any physical complaint sustained

during training or competition, including time-loss, medical attention, or modified participation; and (5) Study designs - randomised controlled trials and non-randomised studies of interventions will be included (prospective data collection). Appropriate electronic databases (e.g., SPORTDiscus) will be systematically searched. Eligible studies will include English- and Chinese-language peer-reviewed original research. Findings will inform subsequent development and/or refinement of an intervention for implementation in partnership with England Athletics.

Introduction Shoulder injuries are prevalent across sport and are associated with time-loss, recurrence, and reduced performance. Although evidence-based prevention and prehabilitation strategies are increasing in popularity (Liaghat et al., 2022), their efficacy in applied settings remains inconsistent. This research-to-practice gap highlights practitioner education as a plausible mechanism for supporting the translation of injury risk management evidence into routine practice (McKenzie, 2024). This study proposes to evaluate Armour Up, a new and not yet evaluated practitioner education programme as an implementation strategy to shoulder injury prevention.

Methods A prospective, longitudinal multi-method evaluation of the practitioner education intervention, underpinned by the RE-AIM framework is proposed (Glasgow, 1999). UK-based qualified Musculoskeletal professionals working with athletic populations across sports medicine, physiotherapy, sports therapy, strength and conditioning, and related performance domains will be invited onto the Armour Up practitioner education programme.

Preliminary data will be collected via sequential, validated online questionnaires (O'Brien and Finch, 2016) administered pre-training, post-training, and at three-month follow-up. Measures will assess perceived knowledge, attitudes, and confidence relating to shoulder injury prevention and prehabilitation, alongside implementation intention, current practice behaviours, perceived barriers and facilitators, and practitioner understanding of key injury risk factors. Outcomes are aligned to key dimensions of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) to support an implementation-focused evaluation.

Proposed Analysis

Bayesian statistical approaches will be employed to quantify evidence for change and maintenance of practitioner outcomes. Qualitative responses will be analysed using thematic analysis to provide contextual insight into adoption and implementation. Findings will be interpreted through the RE-AIM framework to evaluate both educational impact and potential for real-world adoption and sustainability.

Conclusion This study will provide an implementation-informed evaluation of a practitioner education programme targeting shoulder injury prevention, contributing to understanding how education can support the translation of evidence into practice within sport and performance settings.

References

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public He

1. Edinburgh Sports Medicine Research Centre, Institute for Sport, PE and Health Sciences, University of Edinburgh

2. UK Collaborating Centre on Injury and Illness Prevention in Sport, Edinburgh Sports Medicine Research Centre

3. University of Edinburgh Institute for Sport Physical Education and Health Sciences, Edinburgh, UK

Poster

Background: Swimming involves repetitive movements and substantial training demands, predisposing swimmers to overuse injuries, particularly affecting the shoulder, knee, and lumbar spine. Despite a rising incidence of these injuries, prevention programmes typically target isolated body regions. There is a need for a comprehensive synthesis of injury risk factors and prevention strategies across all body regions.

Objectives: To explore injury risk factors related to swimming and identify the current injury risk reduction interventions for swimmers.

Design: Scoping Review

Sources/Methods: SPORTSDiscus, (Ovid) MEDLINE, Embase, Sports Medicine & Education Index, and Scopus. Data was extracted by two independent researchers and results narratively synthesised.

Results: Fifty-eight out of 4,394 studies met the inclusion criteria, of which 46 investigated risk factors. Of these, 87.5% focused on shoulder injuries, with fewer addressing lumbar spine and knee injuries. Reported risk factors included training volume and intensity (n=22), rotator cuff muscle imbalance (n=13), biomechanical errors (n=13), glenohumeral laxity (n=9), sex (n=9), prior injury (n=9), age (n=6), fatigue deficit (n=5), hand entry position (n=2), hip kinematics (n=2), stroke specialisation (n=1), inadequate warm-up (n=1), time away from swimming (n=1), and osteoporosis (n=1). Despite this range, all intervention studies (n=12) employed exercise-based strategies targeting shoulder and back injuries, with none addressing the knee. These programmes showed some effectiveness in improving strength, with limited evidence for reducing injury rates. Interventions varied substantially, and none adopted a comprehensive approach addressing all injuries.

Conclusion: Training volume and intensity were the most examined risk factors, though they were often assessed together without clearly defined thresholds. Previous injury demonstrated the most consistent association with future injury risk, whereas findings on muscle imbalance were inconsistent, largely due to variability in measurement approaches. Interventions primarily focused on single body regions, predominantly the shoulder and lower back, underscoring the need for multicomponent, whole-body injury-prevention strategies in swimmers.

Keywords: Swimming, Risk factors, Injury, Intervention, Injury prevention, prehabilitation.

David Munn, Lewis Turmeau, Ronan Kearney, Edel Fanning, Fearghal Kerin, Mark Jackson, Stuart O'Flanagan, Pieter D'Hooghe, Andrea Goceva, Alan Kourie, Andrew J Hall

Background

High-intensity functional training (HIFT) has grown in popularity among the general population. HIFT approaches combine strength, endurance, and mixed-modality functional exercise. Despite increasing uptake, uncertainty remains regarding injury risk and the broader effects on physical and psychological health.

Objectives

Map the literature relating to HIFT and associated practices, examine injury risk and prevention strategies, and identify broader physiological, psychological, and societal health effects.

Design

PRISMA-ScR scoping review with descriptive and thematic synthesis.

Setting

Peer-reviewed literature identified from Scopus, Web of Science, PubMed, ProQuest, and Ovid, limited to publications from 2014 to 2024.

Assessment of risk factors

Training-related and contextual factors, including training load, movement quality, supervision/coaching, chronic/overuse mechanisms, and systemic physiological demands.

Outcomes

Musculoskeletal injury, prevention strategies, physiological adaptations, mental health and wellbeing outcomes.

Results

The search returned 501 articles for screening and 60 were included after full-text review. The literature was heterogeneous in design, populations, and terminology, but several themes emerged. Injury risk in HIFT did not appear uniformly greater than in traditional training approaches. Risk appeared multifactorial and was more commonly related to chronic loading/overuse than isolated events. Injury prevention was strongly influenced by coaching quality, load management, and movement competency. These modalities were also associated with favourable cardiometabolic adaptations, and evidence suggested benefits for mental health and wellbeing.

Conclusions

Hybrid and high-intensity functional training present a mixed profile of risk and benefit, but the musculoskeletal risks identified are likely substantially outweighed by the wider physical, mental, and social benefits of exercise participation. As visible, accessible, and habit-forming exercise modalities, they may reduce barriers to participation, support sustained engagement, and promote positive feedback loops around physical activity in society. Future research should prioritise clearer definitions, prospective injury surveillance, and standardised outcome reporting to better inform safe participation and athlete care.

Title: Sex-specific neuromuscular correlates of sprint deceleration performance and video-derived injury risk factors in university athletes

Background: Horizontal deceleration is a key determinant of both performance and injury risk in multidirectional sport. Previous research has linked deceleration ability with jump force-time characteristics, knee strength capacities and qualitative movement screening, yet the evidence base remains male-dominant and often unaccompanied by kinematic analysis.

Objective: To determine whether force plate and isokinetic dynamometer (IKD) variables associated with sprint deceleration differ between male and female university athletes. A secondary aim was to incorporate video-based kinematic scoring of braking technique and injury risk factors.

Design: Cross-sectional observational study with reliability analysis and sex-stratified correlational analyses.

Setting: University sport science laboratory and outdoor performance testing environment.

Participants: 36 university athletes (21 male, 15 female).

Methods: Participants completed repeated maximal sprint-deceleration trials, dual-force-plate jump and hop assessments, and IKD testing. Two-dimensional video footage was collected for planned qualitative scoring of braking mechanics and technique-related risk factors.

Main outcome measures: EarlyDecel, Decel50, selected bilateral and limb-specific force-plate variables, IKD peak torque and work per repetition, and planned kinematic scores.

Results: Reliability and correlational screening identified EarlyDecel and Decel50 as the most defensible deceleration outcomes. Preliminary findings suggest sex-specific neuromuscular profiles: male deceleration signals appear stronger for hop/force variables and extensor work measures, whereas female signals appear stronger for squat/countermovement jump impulse variables and flexor-related IKD measures. Generic variables like jump height do not appear to be the most informative monitoring variable.

Kinematic analysis is yet to be completed.

Conclusions: Male and female athletes may require different monitoring models when interpreting force-plate and IKD data in relation to deceleration performance. These findings may support more targeted screening and injury-risk management in strength and conditioning.

Background: Previous profiling studies have primarily examined single-sport cohorts, limiting understanding of whether physical characteristics differ across comparable elite sporting codes.

Objective: To establish baseline player profiles and physical characteristics of elite Irish soccer, Gaelic football, and camogie players, and compare these characteristics between sports.

Design: Cross-sectional comparative study.

Setting: Early competitive season testing within elite Irish field-sport environments.

Participants: Ninety-one elite female athletes (soccer n = 32; Gaelic football n = 32; camogie n = 27) participated.

Main outcome measures: Age, height, body mass, knee extension angle (KEA), countermovement jump height and modified reactive strength index (RSImod), dominant and non-dominant lower-limb strength and between-limb asymmetry. Between-sport differences were analysed using one-way ANOVA or Kruskal-Wallis H tests (p < .05), with η2 or ε2 effect sizes reported.

Results: Significant between-sport differences were identified for age (p = .003), height (p = .015), body mass (p = .009), dominant and non-dominant KEA (p = .003 and p = .010 respectively), RSImod (p = .047), isometric knee flexion between-limb asymmetry (p = .024), and dominant and non-dominant Nordic Hamstring Exercise relative force (p = .022 and p = .019 respectively). Predominantly moderate effect sizes (ES) were observed across significant variables (ES = .05-.14). Camogie athletes were generally older, taller, and heavier, and demonstrated greater hamstring flexibility and lower reactive jump performance, while soccer athletes demonstrated greater eccentric hamstring strength.

Conclusion: Elite Irish female field-sport athletes demonstrated distinct sport-specific physical profiles despite similar field-based demands. While many isolated lower-limb strength measures were comparable across sports, anthropometric, flexibility, reactive strength, and eccentric hamstring strength characteristics differed. Screening and performance data should therefore be interpreted within sport-specific contexts rather than using a single normative reference across female field sports.

Title: The Effects of Neuromuscular Training on Electromyography, Lower Extremity Kinematics, and Ground Reaction Force During a Sagittal Plane Hop on Recreational Female Hockey Players

Authors: Tom Johnston*, Susan J. Brown and Konstantinos Kaliarntas

Affiliations

School of Applied Sciences, Sighthill Campus, Edinburgh Napier University, Edinburgh EH11 4BN, UK

2Department of Physiotherapy, University of Patras, GR26504 Patras, Greece

Author to whom correspondence should be addressed.

Background

Female hockey players are at a high risk of noncontact injuries which could be potentially mitigated with neuromuscular training.

Objective

This study assessed the effects of a sport-specific neuromuscular training (NMT) programme on electromyography (EMG), kinematics and kinetics during a sagittal plane hop.

Design, Setting, Participants and Intervention

Female hockey recreational players performed either NMT or their usual warm-up. The intervention group (INT = 20) performed NMTP 3 x per week before training sessions or matches for 8 weeks. The control (CON = 18) group performed their normal warm-up.

Main outcome measurements

The sidecut was assessed at baseline and post-intervention with 3-D motion capture (trunk, hip, knee and ankle kinematics), force plates (peak vertical ground reaction force (vGRF), rate of force development (RFD) and posterior chain electromyography (Gluteals, Hamstrings and Gastrocnemius) at 30ms prior to initial contact (IC) and 50ms post IC.

Results

There was a non-statistically significant trend of greater muscle activation in all time points following NMT. There was greater gastrocnemius muscle activation in both groups at 30ms to IC and IC to 50ms, with a greater increase for INT. There was also an increase in hamstring (especially BF) and gluteal muscle activation (especially IC to 50ms) whereas CON decreased. There were no significant differences in hip and ankle kinematics both before and after IC. However, there was a significant reduction in maximum knee abduction (p = 0.012) and knee excursion (p = 0.019) for INT with no change for CON. There was a significant reduction in RFD for INT (p = 0.003).

Conclusions

The sports-specific NMT showed some significant alterations on the kinematics and kinetics following 8 weeks of NMT. There were greater increases in the muscle activation of the Gastrocnemius for INT groups than CON. These adaptations could have implications in reducing injury risks.

Authors: Lincoln Blandford, Alexandra Atack, Matthew Buckthorpe, Ryan Mahaffey, Jamie North, Ezio Preatoni, Charlie Quigley, Tom Sturdy

Affiliations: Faculty of Sport, Technology and Health Sciences, St Mary's University, London, UK, Department for Health, University of Bath, Bath, UK, Southampton Football Club, Long Lane, Marchwood

Poster

Title: A novel classification to capture non-contact injury patterns in U18-U21 soccer players

Background: Non-contact injuries to proximally pelvic-attached anatomy contributes substantially to time-loss injury in U18-U21 male soccer players. High-speed running is a common inciting activity for pelvic-attached anatomy including the hip adductor, hamstring, and quadricep muscles and their pelvic attachment sites (apophyses). Current diagnostic coding systems recommended for surveillance studies may underestimate running-related injury patterns in this population because pelvic-attached anatomy is segregated into regions (e. g., thigh, hip, groin), disregarding their running-specific, sagittal plane, synergistic roles. As surveillance is the foundation of aetiological research, failing to capture relevant patterns may misdirect subsequent hypotheses and investigations.

Objective: To apply a novel pelvic-attached anatomy classification within injury surveillance U18-U21 soccer players.

Design: Prospective observational surveillance study

Setting: A Category 1 English Premier League academy

Participants: Fifty-seven, male U18-U21 players

Interventions/Assessment of risk: Club staff recorded all time-loss injuries, onset characteristics, inciting activities, and days absent using standardised surveillance processes. Non-contact injuries typically coded separately as thigh, hip, groin, or pelvis, were aggregated into the novel classification.

Main outcome measures: Proportions of non-contact and running-related injuries captured by the novel proximally pelvic-attached classification.

Results: Forty-seven time-loss injuries incurred 1675 days lost. The novel classification captured 73% of the 33 non-contact injuries, including 89% of all gradual onset cases. It also captured all sudden-onset running-related injuries and 63% of the 1077 days absent attributable to non-contact injuries.

Conclusions: The novel pelvic-attached classification appears to be a useful adjunct to existing diagnostic coding frameworks for U18-U21 soccer surveillance, particularly for non-contact, running-related, and gradual-onset injuries affecting pelvic-attached anatomy. By explicitly acknowledging the synergistic roles of the involved structures during running, this approach may help direct future aetiological targeting both sudden- and gradual-onset non-contact injury of pelvic-attached anatomy in this population.

Title: Injury Epidemiology in Elite Male Youth Academy Football: A One-Season, 33 Club Prospective Cohort Study

Amy Williams

Mike Brownlow 3

Matt Green 3

Sean Cumming

Keith Stokes

Sean Williams

Centre for Health, Injury and Illness Prevention in Sport (CHi2PS), University of Bath, UK

2 UK Collaborating Centre for Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, UK

3 Football Association Premier League, London, UK

Background:

Single-club studies of injuries in youth male academy football limit generalisability, and multi-club epidemiological evidence remains scarce. A comprehensive understanding of injury patterns across age groups is needed to inform and prioritise effective prevention strategies.

Objectives:

To describe the epidemiology of injuries in U9-U21 elite male academy football players in England.

Design:

One-season (2024/25) prospective cohort.

Setting/participants:

Premier League and Category One male academy football players (33 clubs).

Interventions/assessment of risk factors:

Medical staff recorded injuries with exposure reported by sport scientists and coaches.

Main outcome measures:

Time-loss injuries, classified by the Orchard Sports Injury Classification System, with incidence, severity, and burden calculated following the IOC football consensus statement.

Results:

In total, 3,184 match and training injuries were recorded over one million exposure hours (match: 154,973 h; training: 964,723 h). Match incidence was higher than training across all age groups, ranging from 2.5/1000 hours (95% CI 1.8, 3.5) at U9 to 25.0 (95% CI 22.5, 27.7) at U21. Median severity ranged between 19 and 31 days across age groups for both match and training injuries. Match injury burden ranged from 80.8 days/1000 hours (95% CI 58.8, 111.0) at U9 to 843.2 days/1000 hours (95% CI 759.0, 936.7) at U21. The lower limb was the most common injury region across all age groups in match (63%-82%) and training (77-83%). Muscle and tendon injuries accounted for the greatest proportion in match (27%-48%) and training (38%-50%). Being tackled was the predominant match injury mechanism in U12-U21 (16-18%), while jumping/landing/falling were most common in U9-U11 (18%).

Conclusions:

Injury incidence and burden increased substantially with age, with U21 players experiencing the highest match burden. Muscle and tendon injuries were the most common type across all age groups, highlighting them as a prevention priority. These multi-club baseline values can inform targeted strategies and benchmark future interventions.

Title: Lessons learned from implementing a digital injury and concussion management app in youth tennis.

3 Lawn Tennis Association.

Background

High-quality injury surveillance is fundamental to effective injury prevention in youth sport. However, injury data collection in individual and decentralised youth sports, such as tennis, is challenging due to resource constraints and difficulties ensuring reporting standardisation/consistency. Digital tools may provide a feasible solution, but their acceptability and usability within applied performance contexts require careful evaluation.

Context

The Lawn Tennis Association (LTA) supports a network (n = 15) of Regional Player Development Centres (RPDCs). This network sits within the National Performance stage (10-14 years) of the LTA's player pathway. To supplement existing LTA-supported data collection efforts (e.g., training load) across the RPDC network, this project aimed to assess the feasibility of implementing SportSmart, a digital injury and concussion management app, to facilitate injury reporting across a select number of RPDCs.

Approach

Five RPDCs were recruited to take part, and a mixed-methods implementation approach was delivered between January and May 2025. The acceptability of SportSmart implementation was explored via a structured MS Teams meeting (March 2025) with each RPDC's self-designated project lead (i.e., 'implementation champion'). Usability was assessed via the positive System Usability Scale, completed as an online survey (May 2025) by each project lead. General reflections on project involvement were also captured via end-of-project MS Teams meetings with each project lead (May 2025).

Lessons Learned

SportSmart was perceived as acceptable, simple to use, and well aligned with player-centred coaching values at each RPDC. Implementation benefits outweighed initial set-up efforts and there was good understanding of the need for standardised injury reporting. Key implementation challenges included achieving wider organisational buy-in and ensuring timely injury reporting during busy delivery periods. Usability scores ranged from "good" to "excellent", with strong confidence reported by staff in their ability to use SportSmart. Scaled implementation of SportSmart across the RPDC network was recommended by the LTA.

Title: Methodological diversity in epidemiological research related to musculoskeletal injuries in Athletics (Track and Field): insights from a systematic review and meta-analysis.

Iowa; Service de Rhumatologie et Médecine du sport, CHIC Castres-Mazamet; Athletics Research Center, Linkoping University; Medical Committee, Swedish Athletics; Physiotherapy Department, Universitat Internacional de Catalunya; 2 Health, Medicine and Science, International Olympic Committee; 3 Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry; Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf; and Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medica School Hamburg.

If oral, would need discussion around alternative presentation formats due to speech impediment (stammer).

Background

Athletics is a popular Olympic sport that includes a range of disciplines (event groups) that challenge the limits of human performance. Therefore, Athletics participation is associated with a risk of injuries, especially related to the musculoskeletal system. Such injuries may adversely affect an athlete's health and wellbeing. To inform effective healthcare services and injury prevention strategies, it is essential to understand the overall extent of musculoskeletal injuries in Athletics. It is also important to assess typical study designs and characteristics, alongside the quality of published studies and certainty of evidence reported - providing insights to improve future research efforts.

Objective

To quantify the extent of musculoskeletal injuries in Olympic Athletics disciplines and explore the methodological characteristics of included studies.

Design

Systematic review and meta-analysis. MEDLINE, Web of Science, EMBASE, SPORTDiscus, CINAHL, and Cochrane were searched from inception to January 2025.

Eligibility Criteria

Peer-reviewed studies reporting on Athletics-related musculoskeletal injuries in Athletics disciplines included in

Background

The purpose of the URC SCRIIPT (Surveillance of Continental Rugby Injury-Illness and Performance Tracking) Project is to provide comprehensive, accurate, and reliable injury and illness surveillance, as well as benchmarking athletic performance and workload exposure, in professional rugby. We aim to provide specific insights into the burden of injury and illness, risk of injury and illness, as well as understanding the relationship between injury and performance.

Context

The SCRIIPT project was established to standardise data collection across 16 professional teams and to explore how injury, illness and performance metrics can be used effectively to support decision-making in elite rugby environments. Recognising that data alone does not drive change, the project also prioritises engagement with medical, performance, and coaching staff to encourage data use and to understand barriers and facilitators to effective surveillance. A centralised microsite was developed to share aggregated results tailored for both team-level insight and league-wide comparison. This addresses a critical gap: existing injury reporting systems often do not provide usable interpretation or actionable insight for practitioners.

Approach

A structured implementation strategy was employed, providing clear data submission guidelines, and setting up direct communication with club staff. A mixed-methods approach will utilize the quantitative injury surveillance epidemiological data as well as qualitative feedback from stakeholders on how epidemiological data is used in daily practice.

Outcomes

Early outcomes indicate improved compliance with data submission and one season of epidemiological data from a professional rugby competition. Practice lessons highlight the importance of practical translation, feedback, and building trust in shared data systems. While definitive links to injury reduction are ongoing, the project demonstrates that systematic, collaboratively developed surveillance systems can improve engagement and provide a platform for data-informed decision-making in elite sport.

Contact Details:

Greg Hawe, BSc., BSc., MSc.

Greg.hawe1@ucdconnect.ie

+353 871198098

MSK & Sports Physiotherapist

PhD Candidate

Background

Ulnar collateral ligament reconstructions (UCLR) represent one of the highest-burden injuries in Major League Baseball, with substantial implications for player availability and performance. Improved understanding of when these injuries occur may inform targeted prevention strategies.

Objective

To investigate when UCL injuries occur in professional baseball pitchers following the introduction of the pitch clock.

Design

Retrospective descriptive case series.

Setting

Professional baseball.

Participants

Professional baseball pitchers who sustained UCL injuries requiring reconstruction during the regular season between 2023 and 2025. These seasons were selected to reflect the post-pitch clock era, as changes in pitch tempo and reduced recovery intervals may alter mechanical loading and fatigue profiles in pitchers.

Interventions/assessment of risk factors

No interventions were performed. Workload exposure was quantified using publicly available data from Major League Baseball, FanGraphs, and Pro Sports Transactions. Injuries were identified via roster transactions. For each case, date of injury, pitcher role (starter vs reliever), cumulative innings pitched, and total pitches thrown during the regular season prior to injury were extracted.

Main outcome measures

Cumulative innings pitched and total number of pitches thrown at the time of UCL injury requiring reconstruction, and the proportion of injuries occurring before predefined workload thresholds.

Results

Thirteen professional pitchers (7 starting pitchers) who underwent UCLR between 2023 and 2025 were included. The median workload at the time of injury was 19.0 innings pitched (IQR: 6.5-38.7) and 361 pitches thrown (IQR: 120-691). Notably, 77% (10/13) of UCL injuries occurred before pitchers reached 40 innings pitched and 700 pitches thrown. Over half (54%) occurred even earlier, before 20 innings and 400 pitches.

Conclusions

These findings demonstrate that the majority of UCL injuries occurred early in workload accumulation rather than following prolonged exposure. This highlights the early-season period as a potential window for targeted injury prevention strategies.

UK Collaborating Centre on Injury and Illness Prevention in Sport, Universities of Bath and Edinburgh, UK

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada

Presentation type: Poster

Background: Young athletes have distinct developmental risks for sports injury and the onset of mental health problems. Research has typically focused on mental health during specific sports injury phases, such a rehabilitation, with little consideration for factors linked to adolescence.

Objective: To retrospectively explore factors influencing adolescent athletes' mental health across the injury course, emphasising developmental, social, environmental and sport-cultural contexts.

Method: A qualitative interview study with 27 athletes aged 16-21 years who had sustained a severe time-loss injury in the past six months. Participants completed a visual timeline to support reflections from injury onset to rehabilitation or return to sport. Data were analysed using reflexive thematic analysis.

Results: Five themes described factors linked to fluctuating mental health. 'Finding my inner strength' explores how injury introduced vulnerability to developing personal identities, leading to self-blame for injury-risk behaviour, training through pain and social withdrawal. 'Making sense of my emotions' describes how injury triggered overwhelming worries, amplified by unexplained pain and losing sport as a coping strategy. 'Learning to look after myself' considers how injury thwarted athletes' independence and emotional autonomy, prompting frustration and lowered self-esteem. 'Accepting peer judgement and support' explores how worries about peer evaluation and social exclusion led to concealing injury, social withdrawal, and lowered mood and self-esteem. 'Adapting to the system' describes how diagnostic uncertainty and rigid or unsupportive sport cultures caused frustration and lowered self-esteem, and prevented help-seeking. Emotion regulation skills at the individual level, and social support and mental health literacy at interpersonal and organisational levels, were positive for adolescents' mental health at challenging points during injury.

Conclusions: In addition to injury type and phase, factors linked to adolescence impact mental health during injury. Practitioners should consider supporting adolescents by developing adaptive coping strategie

Background: Sports injuries in adolescent athletes are linked to negative impacts on mental health and wellbeing. Conversely, poor mental health and wellbeing in adolescent athletes have been found to increase risk of injury, injury severity, and time taken to recover. Research has prioritised surveying adult athletes, so the adolescent experience is not well characterised. Given specific risk factors for injury and mental health problems in this demographic, this relationship warrants greater attention.

Objective: To examine the bidirectional relationship between sports injuries and mental health and wellbeing in adolescents aged 10-24 years, and potential mechanisms of this relationship.

Method: A systematic review and meta-analysis. Articles were included if they were quantitative, published between 1990-2023, focused on athletes aged 10-24 years, and measured mental health/wellbeing and all-complaints sports injury.

Results: Of 397 studies screened, 84 were included with 221,095 participants in the final sample. Narrative synthesis indicated that sports injuries were linked with worse mental health and wellbeing in the majority of studies, and vice versa. Meta-analyses revealed that sports injury incidence was significantly associated with worse mental health/wellbeing (Zr = 0.34, 95% CI [0.17, 0.50]), and concussion incidence was significantly associated with worse mental health/wellbeing (Zr = 0.19, 95% CI [0.08, 0.30]). Conversely, worse mental health/wellbeing was associated with significantly increased risk of sports injury incidence (OR = 1.54, 95% CI [1.13, 2.10]). A small number of studies revealed psychosocial factors (e.g. athletic identity, social support) that could influence this bidirectional relationship.

Conclusions: We found evidence for a bidirectional relationship between sports injuries and mental health in adolescent athletes. Longitudinal studies are required to elucidate mechanisms underlying this relationship. Interventions should focus on psychosocial mechanisms specific to adolescent athletes. Support staff should be aware of bi-directional links between sports injury and mental health.

Ends

Background: Head-to-ground contact is prevalent in women's university-level rugby union, raising concern about cervical risk. Cervical strength has been proposed as a modifiable factor in head stabilisation and injury mitigation, yet evidence regarding effective training methods and seasonal strength profiles remains limited, particularly in female players. This study aims to (1) compare the effectiveness of two neck strength training interventions in university-level female players, and (2) examine seasonal changes in neck strength and associations with injury history in elite female players.

Methods: This investigation comprises two complementary arms. The first is a systematically randomised trial with a university-level female rugby squad, in which participants are allocated to one of two intervention groups: resistance band training or a plate-loaded pulley system. Neck strength is assessed at baseline and post-intervention using isometric dynamometry, with outcomes compared between groups to determine which modality produces greater strength gains. The second arm is an observational longitudinal study conducted with an elite female rugby club, incorporating both full-time and part-time athletes. Neck strength is measured at multiple time points across a competitive season, with comparisons drawn between international and non-international players. Injury history data are collected throughout to explore potential associations between neck strength and injury incidence.

Planned Analyses: Between-group differences in strength change will be assessed using mixed-model ANOVA. Seasonal strength trajectories will be modelled using repeated-measures analysis, with subgroup comparisons by playing standard. Associations between neck strength and injury history will be examined using logistic regression. Data collection is ongoing; analyses are planned upon completion of the season and intervention period. Findings from this study are expected to inform future research on seasonal changes in neck strength and training across competitive levels in female rugby union.

Melis Atbinek, Raven Olof Huiberts2, Nivedita Bijlani, Stephan van der Zwaard3, Stefan Kluzek, Mauricio Villarroel

The Podium Institute of Sports Medicine and Technology, Department of Engineering Science, University of Oxford, Oxford, UK, 2Vrije Universiteit, Amsterdam, NL, 3Amsterdam UMC, Amsterdam, NL, Orthopaedics, Wake Forest School of Medicine, Medical Centre Boulevard, Winston-Salem, NC, USA, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.

Max:300 words.

Introduction: Monitoring training load is fundamental to reducing the risk of overuse injuries, optimising recovery, and enhancing performance. Training load comprises both external load and internal load. Accurate monitoring of internal load enables coaches to individualise training prescription and recovery strategies. However, there is currently no consensus regarding the objective metrics used to quantify internal load in elite team sports.

Method: We conducted a systematic review to identify studies reporting objective methods for monitoring internal training load in elite team sports. We categorised objective metrics according to physiological domain, collection method, sampling timing, and frequency.

Results: Heart rate-derived metrics computed from ECG (electrocardiography), PPG (Photoplethysmography), and wearable monitors are the most frequently reported (n = 236 studies). Neuromuscular fatigue assessments, primarily using force plates and surface electromyography, are also commonly applied (n = 61). Among biochemical markers, muscle damage indicators were reported in 47 studies. Hormonal markers were examined in 34 studies, and immune markers in 27 studies. Metabolic markers were reported in 39 studies, including lactate. Emerging approaches such as transcriptomics (n = 2), tissue (n = 3), and oxidative stress markers (n = 3) are under-represented. 52.45% of studies are conducted on only male athletes, and 22.70% of studies are conducted on only female athletes. Studies that have a mixed cohort constituted 2.15% of the included studies. 22.70% of the studies do not specify the sex of the cohort. Venous and capillary blood sampling is the main method for biological assessment, though wearable-derived measures are the most popular non-invasive approach, alongside saliva collection.

Conclusion: Heart rate-derived monitoring remains the most practical and widely adopted approach for internal load assessment in elite team sports. However, inconsistencies in biomarker collection and analysis limit comparability across studies. Methodological standardisation and increased inclusion of female athletes are required to improve the precision and applicability of objective internal load monitoring.

Limited joint range of motion (ROM) is commonly caused by pain, muscle tightness, and fascial restriction. These conditions often result from injury, overuse, or inactivity, leading to reduced mobility and functional limitations. Pain triggers muscle guarding, which further restricts movement. Many patients also develop fear of movement (kinesiophobia), avoiding activity and worsening stiffness, circulation, and recovery. Therefore, a safer and more patient-centered approach is needed.

From a clinical perspective, restoring ROM requires addressing both pain response and soft tissue restriction. The combination of pain-opposite movement with resisted and myofascial release provides ( 10 rep and 3 time ) an effective solution. Pain-opposite movement with resisted allows joints to move in a comfortable direction, reducing discomfort and increasing patient confidence. Meanwhile, Myofacial release applies gentle, sustained pressure to release tension in muscles and fascia, improving flexibility and circulation.

The main objective of this method is to improve joint mobility safely without increasing pain. It aims to reduce stiffness, restore functional movement, and support recovery across various rehabilitation conditions. This approach is suitable for different age groups and physical conditions due to its gentle and controlled nature.

The exercise process begins with assessment to identify limitations. Patients are guided to perform pain-free movements, followed by Myofacial Release techniques applied for 30–90 seconds. Assisted movement is then introduced to gradually increase ROM, progressing to active movement performed independently. Finally, movements are integrated into daily functional activities.

In conclusion, this combined physiotherapy approach is safe, practical, and effective. It reduces pain, improves ROM, and enhances functional mobility. By encouraging pain-free movement and releasing soft tissue restrictions, patients achieve better recovery outcomes and long-term physical function.