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Rest Days are Unrelated with Concussion Rates

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National Rugby League Match Scheduling and Rate of Concussion
Gardner AJ, Howell DR, Iverson GL. J Sci Med Sport. 2019 [Epub ahead of print]
Take Home Message: A rugby player was most likely to sustain a concussion during the first rugby match of the year compared with any other match. The number of rest days before a match was unrelated to concussions.
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Rugby athletes are at high risk of suffering a concussion during a match. Over the past 12 years in Australia, the National Rugby League (NRL) added matches on Mondays (beginning of 2007 season) and Thursdays (beginning of 2012) rather than just on weekends. The scheduling changes resulted in fewer rest days during the 24-game season. Additionally, the NRL introduced the “concussion interchange rule” at the beginning of the 2014 season to allow for proper concussion medical care. This rule allows for a brief (up to 15 minutes) sideline concussion evaluation to decide if a player has a concussion and should be removed from play or if not then to return without costing the team one of its 12 player interchanges. No one has studied if the decreased rest time is associated with a higher rate of concussion or was more likely to activate the “concussion interchange rule”. Therefore, the authors sought to determine if there was a relationship between pre-match rest days, match location, time of the season, and match outcome with diagnosed concussion and use of the “concussion interchange rule”. The authors analyzed 402 matches during the 2014 season when a concussion was diagnosed during 53 matches and the “concussion interchange rule” was implemented in 132 of the matches. The rate of concussion and rate of the use of the “concussion interchange rule” was ~9 and ~24 per 1,000 player-match hours, respectively. More concussions occurred during the first 15 weeks (34/220 matches) compared to the second 15 weeks of a season (19/182). More concussions occurred during the first match of the season compared to any other time, no matter how much rest there was in between matches. Lastly, the authors found no relationship between the activation of the “concussion interchange rule” and days of rest prior to a match, location, or match outcome.

Identifying potential injury risks and trying to intervene with rule changes is helpful in contact sports, such as rugby. The authors investigated whether rule changes that decreased rest time between matches and increased concussion evaluation efforts were associated with concussion rates or the initiation of the “concussion interchange rule”. The authors found that the decreased rest days was unrelated to the risk for concussion or the use of the ‘concussion interchange rule’ within the NRL. It was interesting to note that there was a disproportionate amount of concussions within the first half of the season. Even more noteworthy was that more athletes sustained concussions during the first game compared to any other throughout the season. This finding suggests that risk of concussion during the first game could be attributed to many risk factors such as less conditioning, medical staff having a heightened sensitivity to diagnose an injury, or due to a drastic increase in intensity from pre-season play. Moving forward it is important that medical professionals and other stakeholders are keeping sports safe, which can be done by determining risk factors, modifying rules, and identifying if rules changes that have been implemented effectively decrease risk.
Questions for Discussion: Do you note more injuries like concussions during the first game of the year? If so, how can we prevent these injuries?
Reviewed by: Jeffrey Driban
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