New England Rugby Football Union

This study investigated the change in bone and body composition characteristics of elite football players and recreationally active control participants across the course of a season. Fortysix participants (20 footballers and 26 recreationally active controls) were assessed by dual-energy x-ray absorptiometry and peripheral Quantitative Computed Tomography for a range of bone and body composition characteristics at four points over the course of a competitive season. Multilevel modelling was used to examine changes. Footballers had higher characteristics than controls for 24 out of 29 dual-energy x-ray absorptiometry and peripheral Quantitative Computed Tomography variables (all p<0.05). However, there was also significant random inter-individual variation in baseline values for all variables, for both footballers and controls (p < 0.05). Wholebody bone mineral density, leg and whole-body bone mineral content, tibial bone mass and area (38%) increased across the season in footballers (p < 0.05), and there was significant random inter-individual variation in the rate of increase of leg and whole-body bone mineral content (p<0.05). Whole-body bone mineral density, leg and whole-body bone mineral content, tibial bone mass and area (38%) increased over the course of the season in elite football players. The modelling information on expected changes in bone characteristics provides practitioners with a method of identifying those with abnormal bone response to football training and match-play.

PURPOSE: The specific aspects of exercise (e.g., distance, speed) that optimise bone characteristics are not well established. Our aim was to assess the relationship between soccer-specific loading patterns and adaptations in bone and body composition. METHODS:28 elite soccer players (age 25±5 years; height 1.82±0.07 m; body mass 80.1±7.7 kg; mean ± 1SD) gave informed consent to take part. Players’ whole body, pelvis and leg bone characteristics (bone mineral density (BMD), bone mineral content (BMC), bone area) and body composition (lean mass (kg), % body fat) was assessed using dual-energy x-ray absorptiometry (iDXA, GE Healthcare, UK). Assessments took place during the first week of pre-season training (v1), immediately following pre-season training (v2), mid-season (v3) and end of season (v4). Training load was quantified using a global positioning system (GPS, 10Hz STATsports, N. Ireland). Total distance covered (m), total high-speed running (≥5.5 m·s-1), accelerations (≥0.5 m·s-2 for ≥0.5 sec) and decelerations (≤-.5 m·s-2 for ≥.5 sec) were analysed. Changes in bone and body composition were assessed using repeated measures ANOVA. The association between GPS metrics and changes in bone characteristics and body composition were assessed using Pearson’s correlation analysis. RESULTS: Total BMD increased by 1.00% (1.41 to 1.43 g/cm2, P=0.01) and Z-score increased by 1.03% from v2-v3 (from 1.76 to 1.82; P<0.001). Total lean mass increased by 1.02% (66.1 to 67.7 kg, P=0.01) and total body fat decreased by 1.10% (14.9 to 13.5%, P< 0.001) from v1-v2. Significant positive associations occurred between changes in legs BMC and distance covered accelerating (p = 0.045, r=0.45), and decelerating (p = 0.027, r=0.49) from v2-v3. There was a significant positive association between bone area (legs) and distance covered accelerating (p = 0.049, r=0.45) from v2-v3. CONCLUSIONS: Soccer training influences bone and body composition during a competitive season, even in already well trained individuals. The positive association between accelerations and decelerations with leg BMC (v2-v3) may be due to the high magnitude of force created by these actions, causing an osteogenic effect. The association of specific training characteristics with bone adaptation may have implications for training programme design.

The COVID-19 pandemic has necessitated many novel responses in healthcare including sport and exercise medicine. The cessation of elite sport almost globally has had significant economic implications and resulted in pressure to resume sport in very controlled conditions. This includes protecting pitch-side medical staff and players from infection. The ongoing prevalence of SARS-CoV-2 and the desire to resume professional sport required urgent best practice guidelines to be developed so that sport could be resumed as safely as possible. This set of best practice recommendations assembles early evidence for managing SARS-CoV-2 and integrates expert opinion to provide a uniform and pragmatic approach to enhance on-field and pitch-side safety for the clinician and player. The nature of SARS-CoV-2 transmission creates new hazards during resuscitation and emergency care and procedures. Recommendations for the use and type of personal protective equipment during on-field or pitch-side emergency medical care is provided based on the clinical scenario and projected risk of viral transmission.

PURPOSE: To characterize cognitive change in sports related concussion injury in elite athletes. BACKGROUND: The cognitive sequelae of concussion in contact sports are still not clear. Concussion consensus guidelines recommend players be monitored clinically for resolution of symptoms and return to normal of cognitive function, before medically supervised return to play. Computerized cognitive testing has been shown more sensitive than paper and pencil tests to post-concussion cognitive decline and recovery, particularly where optimal pre-season baseline testing occurs. Such testing has now been deployed throughout the world with many thousands of elite athletes involved. Hence, more precise determination of the recovery patterns and sequelae is now possible. METHODS: Normative performance and expected rates of change in performance on the CogSport battery were computed from 49,595 tests by 5722 elite athletes tested in the UK between Jan 2002 and Oct 2007. These consisted of 2122 horse racing jockeys, 2085 rugby league and 1515 rugby union players. Data for 487 athletes who had at least one head injury with concussion during a match were identified. Standardized change from baseline scores were computed and expressed as a function of days from injury. RESULTS: Immediately post-injury cognitive performance in psychomotor, attentional and decision-making tasks remained impaired by greater than 1.65 SDs at the first after-injury assessment in only 6.8% of those concussed. Return to baseline occurred in most by day 5-6 post-injury. In the remainder, the course of resolution was variable and in some performance did not return to baseline. CONCLUSIONS: This data suggests that concussion injury is relatively mild and usually transient with resolution of cognitive changes from baseline within a week. However, some individuals require longer to recover, suggesting that return to play needs to managed on an individualized basis.