In any sporting activity it is important to know how many injuries players might receive and also what type of injuries will be received, so that efforts can be made to reduce the risk of injury. This thesis examines the injury incidence associated with playing professional rugby league, and examines some of the risks associated with injury whilst playing the game. The first paper describes the pattern of injury incidence in professional rugby league and noted that it is higher than in other popular team sports. The second paper examines the different exposures of forward and back players and observes that forwards experience higher rates of injury. The third and fourth papers examine the effect of moving the playing calendar to summer rugby. The risk of injury has increased 67%, and it is also shown that 13% of players experience a 2-3% body mass loss in 14 of 16 games played in excess of 19°C ambient temperature. The next two papers look specifically at the number of collisions experienced by players during the course of a game. Forwards are involved in more collisions (55) than backs (29) during the course of each game. Also, backs have a significantly higher injury rate per 10,000 physical collisions compared to forwards. The next paper proposes a cyclical operational model to examine the interrelationship of a number of factors that are involved in sports injury epidemiology. The application of this proposed cyclical model may lead to greater success in understanding the multi-faceted nature of sports injuries. The final study in the series summarise the injury rates in professional rugby league football from previously published studies. The overall injury rate is 40.3 injuries per 1,000 hours (95% CI 36.9 to 43.8). The majority of injuries are to the lower half of the body (20.7 per 1,000 hours, 17.7 to 24), with the trunk receiving the least (6.7 per 1,000 hours, 5 to 8.6).

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Administration of recombinant human erythropoietin (rHuEpo) improves endurance performance. Hence rHuEpo is, allegedly, frequently subject to abuse by athletes, although rHuEpo is prohibited by the World Anti-Doping Agency. A transcriptomic-based longitudinal screening approach has the potential to improve further the performance of current detection methods. AIM: To assess the effects of rHuEpo on blood gene expression profiles in order to identify a “molecular signature” of rHuEpo doping. METHODS: 19 Caucasian trained males at sea-level (Scotland – SCO) and 20 Kenyan endurance runners at moderate altitude (~2,150 m, Kenya – KEN) received rHuEpo injections of 50 IU∙kg-1 body mass every two days for 4 weeks. Blood was obtained 2 weeks before, during and 4 weeks after administration. 3,000 m time trial performance was measured pre, post administration and at the end of the study. RNA was extracted from blood stabilized in Tempus RNA tubes, amplified, labelled and hybridized to Illumina HumanHT-12v4 Expression BeadChips. Expression data was analyzed using Rank Products with a 5% false discovery rate and an additional 1.5 fold-change threshold. A subset of target and housekeeping genes was further validated using QuantiGene Plex assay. RESULTS: Despite markedly different baseline values between SCO and KEN, as exemplified by the haematocrit (41.9 ± 1.8% vs. 45.3 ± 2.6, p < 0.001), key blood parameters significantly increased during rHuEpo in both groups (p < 0.001) to reach similar levels at the end of administration (49.2 ± 2.0% vs. 49.6 ± 2.6, p = 0.638). The relative improvements in running performance post rHuEpo (~5%) and 4 weeks post administration (~3%) compared to baseline were of similar magnitude in both groups (p > 0.188). These results confirmed that the perturbation involving rHuEpo worked effectively. Relative to baseline, the expression of hundreds of genes were found to be altered by rHuEpo. In particular, 30 transcripts were already differentially expressed two days after the first injection while 15 transcripts were profoundly up-regulated during and subsequently down-regulated up to 4 weeks post administration in both groups. Importantly, the same pattern was observed in all subjects. The functions of the discovered genes were mainly related to either the functional or structural properties of the erythrocyte or to the cell cycle and its regulation. CONCLUSION: This research successfully identified the blood “molecular signature” of rHuEpo administration and provides the strongest evidence to date that gene biomarkers have the potential to substantially improve the performance of current anti-doping methods such as the Athlete Biological Passport for rHuEpo detection.

This thesis is the culmination of a program of research which initially began in 1995. It reflects a major professional interest in the imaging of sports injuries which developed gradually over the 10 year period between 1992 to 2001, based upon previous clinical experience and expertise in the management of musculoskeletal injuries and their anatomical and pathomechanical origins. The central theme of study relates to the use of cross-sectional imaging techniques to investigate the pathoanatomical basis for groin pain in althletes with particular reference to professional soccer players with chronic groin pain. The current thesis is based around two key postulates. Firstly, that most of the commonly diagnosed causes of groin pain in professional athletes are anatomically and functionally linked and, secondly, that modern cross-sectional imaging can demonstrate both the correct diagnosis and the underlying biomechanical causes. The program of study consists of three different but linked project themes. The first investigates the scope of the problem, i.e. the differential diagnosis and prevalence of groin pain in professional soccer players. The second investigates the precise "normal" anatomy, i.e. the gross topographical anatomy of the pubic symphysis and parasymphyseal regions as actually exists rather than the regional anatomy that appears in classical anatomical texts. The third builds upon the first two projects and, investigates the underlying pathomechanical processes using magnetic resonance imaging. The study results suggest that a unifying mechanism of injury exists which partly explains the diagnostic and therapeutic difficulties that occur in athletes with groin pain. It also demonstrates that better understanding of the true pubic symphyseal anatomy allows a more accurate diagnosis to be made and that magnetic resonance imaging can demonstrate the relevant underlying pathoanatomy. The thesis adds significantly to the body of scientific knowledge related to this important sports-related, clinical condition.

Injury surveillance research has established that over 20 % of cricket injuries are related to the upper limb (Leary & White, 2000; Ranson & Gregory, 2008; Stretch, 2003), with bowlers associated altered rotational joint range of motion (Aginsky et al., 2004, BellJenje & Gray, 2005 and Stuelcken et al., 2008). As the applicability of such observations is limited, the aim of this thesis was to provide researchers with a greater understanding of the pathomechanics of shoulder injuries afflicting cricket bowlers though quantifying associated musculoskeletal adaptations and subsequently through the development and validation of a bowling specific kinematic model, establish the influence these may impart on bowling technique. The use of diagnostic ultrasound within the first experimental study in a cohort of bowlers without a history of shoulder injury, established a high prevalence of supraspinatus (45 %) and subscapularis (50 %) tendon pathology, providing insight into common musculotendinous pathology and adaptations that are indicative of the future potential of injury. Data presented within the second study aimed to first quantify the kinematics of the shoulder during the bowling delivery in relation to humerothoracic motion and, second, the influence of rotation sequence to described humerothoracic motion was investigated. Findings established that whilst the bowling delivery was associated with large variability, future research must acknowledge the contribution of the scapula to shoulder motion. As such, due to the complexity of quantifying shoulder motion during cricket bowling, the following three experimental studies evaluated and developed the CSBT shoulder model through modifying current methods. The mCAST method in conjunction with an acromion cluster, was established to not only reduce resultant RMSE associated with scapula landmarks by up to 0.016 m, but also increase the repeatability and robustness of reconstructing GHJ location using the SCoRE method. The emphasis of the final experimental study was to apply the CSBT shoulder model to establish the contribution of individual rotator cuff muscles to shoulder joint stability and, to identify phases of the bowling delivery which increases the risk of injury. This case study established that during the bowling delivery the shoulder experiences large multi-planar forces placing demand on musculature, in particular supraspinatus and Subscapularis to stabilise the joint. These findings in conjunction with those of the first experimental study, not only identify structures at risk of injury but also establish that for the effective formulation of injury prevention strategies the bowling delivery must be investigated in its entirety.

A prospective cohort study of 412 professional rugby union players registered with the English Premiership clubs was conducted during the 2002-2003 season. Injuries were diagnosed and reported by the club medics and the training practices by the club strength and conditioners. A total of 1,090 club injuries (match: 818; training: 260; unidentifiable onset: 12) and 145 international injuries (match: 97; training: 48) were reported. The incidence and risk of club match injuries was 97 injuries and 1,480 days absence per 1,000 player-hours, and the incidence and risk of international match injuries was 218 injuries and 3,076 days absence per 1,000 player-hours. The highest incidence of match injuries occurred to the thigh, however, injuries to the knee were of highest risk. The incidence of club and international training injuries was 3.1 and 6.1 injuries per 1,000 player-hours, respectively. When intrinsic risk factors were assessed, the youngest players (<21 years old) had the highest incidence and a significantly higher risk of injury. Playing position appeared to be the most influential determinate of injury profile, rather than intrinsic anthropometric risk factors alone. The match injury with the second highest incidence and risk was hamstring muscle injuries and a number of risk factors and protective training factors were identified. Results presented from this study have provided the most comprehensive study of injury incidence, aetiology and risk factors in professional rugby union to date. The data provide objective evidence on which to base both preventative interventions to reduce the probability of sustaining an injury and therapeutic interventions to reduce the severity of an injury and thereby reduce the overall risk associated with injuries.