Cervical Range of Motion and Repositioning Sense in School Age Rugby Union Players

: A Cross-sectional and Longitudinal Study with mobile app-based mobility intervention.

Abstract

Rugby union players have reduced cervical range of motion (CRoM) and joint repositioning sense (JPS) and demonstrate signs of earlier articular degeneration when compared to the non-playing population. Such maladaptation can have a negative effect in terms of the longevity of playing career and quality-of-life following retirement from playing. The point at which these decreases are initiated is unknown. The aim of this thesis was to identify any changes in active CRoM and JPS across rugby union youth age groups.
The first study (Chapter 4) took a cross-sectional approach to examine the active CRoM and JPS in U8, U9, U10, U13 and U15 year-old rugby players. A secondary aim was to examine associations between years of playing experience and range of movement. Using the CRoM device, available range of motion (flexion, extension, left and right rotation, left and right lateral flexion) and head repositioning sense were assessed pre-season and end of season. With the exception of flexion, no significant differences were found between age groups. Post hoc analysis of flexion revealed a difference between the U9 and U10 age groups (F(4,54)=2.5,p=0.049, Cohen’s effect (d) = 1.3). The U10 age group showed reduced flexion (59° ± 9°) when compared to the U9 age group (71° ± 12°). However, there was a tendency for left and right lateral flexion to decrease as age group increased.
Repositioning sense accuracy revealed differences in right lateral flexion between the U8 (5 ±2°) and U15 (3 ±2°) p=0.015, and U9 (5 ±2°) and U15 (3 ±2°) age groups, p=0.045. Findings from the first study suggest that youth rugby players have less active range of motion in their cervical spine than age matched non-rugby players in the literature, and that there is a downward trend in available range of motion for left and right lateral flexion from the U9 age group.
The second study (Chapter 5) examined CRoM and JPS longitudinally over three playing seasons in U8, U9, U10, U13 and U15 age groups. Of particular interest were the transitions where tackling is introduced (U9) and where players begin to become more positionally specific (i.e., forwards and backs) with the elements of the game more closely representing that of the senior game (U13 and U15). Initial analysis examined the magnitude of change for range of motion and repositioning sense between age groups and within age group squads as they advanced through the age groups. Significant reduction in extension range of motion for the U15 squad when they reached U16 age group (-15° p=<0.01) were observed. At U17, forwards exhibited significantly less extension range of motion than backs (p=0.03). However, following enforced layoff from training and playing due to COVID19, the extension range of motion for the forwards returned to that of the backs after 18 months.
Cervical JPS showed sporadic differences between age groups, with a tendency to improve between U8 through to U12 before a pause in improved accuracy at U13. This data suggests there is a tendency for decreased active CRoM for lateral flexion between the U9 and U12 age groups that coincided with the introduction of tackling and more competitive collision aspects of the game. In addition, changes in active functional range of motion into extension were seen across the U15 to U17 age groups that are consistent in pattern to reports of senior players, all be it by a smaller magnitude. However, reductions in CRoM in forwards returned to U15 ranges following a break of 18 months of rugby training. COVID19 affected the latter parts of study two and placed restrictions on approaches to study three.
Study three (Chapter 6) aimed to assess the utility and feasibility of a mobile phone-based app which screened for movement patterns and provided exercise recommendations. The app was given to National and Championship players to obtain a range of standards where mobility dysfunction would be suspected. A focus group study was undertaken to elicit player perception of the app. The mobility screen outcomes suggested that academy age rugby union players demonstrate functional movement patterns that require attention to reduce the risk of injury and aid performance. There was a link between playing standard and mobility performance, with the higher-standard squad displaying better performance in most movement patterns within the mobility screen. Players who completed the prescribed 12 session exercise plan did show improvements in the targeted movement patterns, however, compliance was very low.
The focus group outcomes suggested that injury risk reduction was low on the player and support staff priority list. Additionally, perceptions of what injury reduction strategies were being implemented differed across players, coaches, and medical staff. Lack of context and understanding of the exercises within the mobile app led to poor compliance.
In summary, this thesis found that youth rugby players show signs of decreasing range of motion according to age and, when reaching U17 age group. A mobile phone-based app did show promise in providing screening information, but interventions need to consider integration of behaviour change concepts to be successful.

Date of Award	Jan 2025
Original language	English
Awarding Institution	Coventry University
Supervisor	Mike Price (Supervisor), Mark Noon (Supervisor) & Sheila Leddington-Wright (Supervisor)