This study investigates the cumulative effects of concussive and subconcussive mild head injury on the cognitive functioning of schoolboy rugby players. A comprehensive battery of neuropsychological tests and a self-report postconcussive questionnaire were administered to top level schoolboy rugby players (n=47), and a non-contact sport control group of top level schoolboy hockey players (n=34). Group comparisons of the percentage of individuals with cognitive deficit were carried out between i) the schoolboy rugby and the schoolboy hockey players, ii) the rugby forward and the rugby backline players; iii) the rugby forward and the schoolboy hockey players and, iv) the rugby backline and the schoolboy hockey players. Results on the neuropsychological test battery did not provide any substantial evidence of a higher level of neuropsychological impairment in the rugby players relative to the control group, or in the rugby forward players relative to the rugby backline players. Results obtained on the postconcussive symptom questionnaire provided tentative indications that the rugby players do report a greater frequency of postconcussive symptomatology. The symptoms most frequently reported were being easily angered, memory problems, clumsy speech and sleep difficulties. It was hypothesized that the absence of cognitive impairment in the schoolboy rugby players compared with that noted for professional players was due to their younger age, relatively high IQ and education level and a less intensive level of physical participation in the sport, and hence less accumulated exposure to the game, thereby decreasing their exposure to mild head injuries. From a theoretical perspective, these pre-existing conditions were considered to act as protective factors against reductions in brain reserve capacity and concomitant susceptibility to the onset of neuropsychological dysfunction.

The aim of this study was to investigate the effect of cumulative mild head injury on the cognitive functioning of professional rugby players. A comprehensive battery of neuropsychological tests was administered to 26 professional rugby players and to a comparison group of 21 professional cricket players. The group test results of the rugby, cricket, rugby forwards and rugby backline players were each compared with established normative data. Generally, the comparison of the rugby and cricket mean scores relative to the normative data did not reveal significant differences on tests known to be sensitive to the effects of mild head injury. However, the comparison of variability for each of the rugby and cricket playing groups relative to variability for the normative data, revealed a pattern of increased variability among the rugby players. This implies a bimodal distribution in which a significant number of rugby players were performing poorly across these tests whereas a significant proportion were not. This variability effect was accounted for by further mean score comparisons which revealed that, as a group, it was the forward players whose performances were disproportionately poor on tests sensitive to the effects of mild head injury. The implications of these results are developed theoretically within the context of brain reserve capacity theory and suggestions for future research are provided.

The study sought to determine whether there is evidence for the presence of residual (chronic) deleterious effects on cognition due to repetitive mild traumatic brain injury in top team university level rugby players, using ImPACT 3.0, Trail Making Test (TMT) and Digit Span. The initial sample of 48 participants was divided into groups; Rugby (n = 30) and Controls (n = 18), Rugby Forwards (n = 14) and Rugby Backs (n = 16). A reduced sample (N = 31) comprised of Rugby (n = 20) and Controls (n = 11), Rugby Forwards (n = 9) and Rugby Backs (n = 11). Comparative subgroups were equivalent for estimated IQ but not for age and educational level in the full sample; in the reduced sample there was equivalence for all three variables of age, education and estimated IQ. All cognitive test measures were subjected to independent t-test analyses between groups at the pre- and post-season, and dependent t-test analyses for Rugby and Controls at pre- versus post-season. Overall, the results implicated the presence of deleterious effects of concussive events on Rugby players in the areas of speed of information processing, working memory and impulse control. Significant practice effects were found on the TMT and Digit Span for controls, but not on ImPACT 3.0, supporting the use of this computer-based programme in the sports management context.

The present study comprises the second phase of a larger and ongoing research study investigating the brain damage effects of cumulative mild head injury in rugby. The purpose of this study was to determine whether cumulative mild head injury sustained in the game of rugby would cause brain injury as evidenced by impaired performance on sensitive neuropsychological tests. Participants were Springbok professional rugby players (n = 26), Under 21 rugby players (n = 19), and a non-contact sport control of national hockey players (n = 21). Comparisons of performance were carried out across a spectrum of neuropsychological tests for the three rugby groups (Total Rugby, Springbok Rugby, and Under 21 Rugby) versus the performance of the non-contact sport control group (Hockey Control), as well as comparisons of performance f9r the subgroups of Rugby Forwards versus Rugby Backs. Comparisons revealed a consistent pattern of poorer performance across all rugby groups relative to the performance of the controls on tests highly sensitive to the effects of diffuse brain damage. Within rugby group comparisons (Forwards versus Backs) showed significantly poorer performance for Total Rugby Forwards and Springbok Rugby Forwards relative to the performance of the respective Total Rugby Backs and Springbok Rugby Backs on sensitive, as well as on somewhat less sensitive, neuropsychological tests. The performance of Under 21 Rugby Forwards relative to Under 21 Rugby Backs demonstrated similar trends. Brain reserve capacity theory was used as a conceptual basis for discussing the implications of these findings.

A number of computerised tests have been especially developed to facilitate the medical management of the sports-related concussion. Probably the most widely used of these programmes is the ImPACT test that was developed in the USA and that is registered with the HPCSA for use in the South African context. A recent Afrikaans version of the test served as the basis of the present study with the following objectives: (i) to collect Afrikaans ImPACT normative data on a cohort of Afrikaans first language adolescent rugby players with Model C education for comparison with existing South African English first language adolescent rugby players with Private/Model C schooling, and (ii) to investigate the pre-versus postseason ImPACT neurocognitive test profiles of this cohort of Afrikaans first language adolescent rugby players versus equivalent noncontact sports controls. The results for Part 1 of the study generally demonstrate poorer performance in respect of the Afrikaans cohort, which is understood to be the result of poorer quality of education. The results for Part 2 demonstrated failure of the rugby group to benefit from practice on the ImPACT Visual Motor Speed composite score to the same extent as the control group. It is argued that this apparent cognitive vulnerability in the rugby group is due to lowered cognitive reserve capacity in association with long term exposure to concussive and sub-concussive injury.

This study investigated the cumulative effect of mild head injuries on rugby players. A comprehensive battery of neuropsychological tests was administered and subjects completed a self-report postconcussive symptom questionnaire. Data were collected for the two rugby groups, Springbok rugby players (n = 26) and Under 21 rugby players (n = 19), and for the control group, national hockey players (n = 21). Group comparisons of the percentage of individuals with deficit or self-reported symptomatology were made between: (i) the contact sport groups and the control group; (ii) the forwards and the backs within each rugby group and the rugby forwards and the control group; and (iii) the Springbok and Under 21 rugby players. Broadly speaking, comparative results on the neuropsychological tests and the self-reported postconcussive symptoms clearly distinguished between contact sport players and non-contact sport players and indicated the presence of diffuse brain damage in the contact sport players. There was also clear evidence of positional variation within the rugby groups, with the forwards (more full contact positions) most susceptible to impairment. Neuropsychological test results revealed deficit in information processing speed, attention and concentration, mental flexibility, visual memory and verbal new learning. The most significant neuropsychiatric complaints were reported in the areas of memory, social contact, sensitivity to noise, lowered frustration tolerance, anxiety and worry, and depression. The most sensitive neuropsychological test used in the present study was the Digit Symbol Substitution test. This test clearly distinguished contact sport players from non-contact sport players, and forwards from backs.

The present study comprises part of an ongoing research study investigating the effects 0 f cumulative mild head injuries 0 n Rugby Union p layers. The aim 0 f t he study was to ascertain whether there are neuropsychological effects of cumulative mild head injuries sustained during the rugby-playing careers of senior schoolboy rugby players. Participants were top-level rugby players from high schools in Grahamstown and Cape Town (n = 79) and non-contact sport controls of top-level field hockey players from the same schools (n = 58). Group mean comparisons across a battery of neuropsychological tests were carried out between the Total Rugby versus the Total Field Hockey group, and the Rugby Forwards versus the Rugby Backs group. Comparisons between Total Rugby versus Total Field Hockey revealed impaired performance by the rugby players on two tests of visuoperceptual tracking, namely Digit Symbol Substitution and Trail Making Test (Part A). For Rugby Forwards versus Rugby Backs, there were no consistent differences to support the expectation that forwards would perform worse than backs. Forwards performed more poorly than backs on WMS Associate Learning Subtest - Hard (Delayed Recall), whereas backs performed more poorly than forwards on Digits Backwards. This suggests that some individuals in the cohort were starting to exhibit verbal memory deficit, albeit not clearly in association with forward positional play. Overall, results of the present study provide tentative support for the hypothesis that school level rugby players are more susceptible to the effects of cumulative concussive and sub-concussive head injuries than are non-contact sport controls. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background Rugby union is one of South Africa’s most popular sports; it requires high levels of skill and fitness and is played at a high intensity and speed which allows for a greater risk of injury. The high risk of injury is said to be due to the nature of the physicality of rugby. It is because of this high risk of injury that several adaptations of rugby have since developed which rely more on speed and agility than physicality. These adaptations include tens or ten-a-side rugby, sevens or seven-a-side rugby and finally touch rugby, which is played with six players a-side. Each adaptation has its own set of rules and is played differently to the traditional rugby union or fifteen-a-side rugby. Hence, in these adaptations the physicality is said to decrease with a resultant increase in demand for speed and agility. The reduction of physicality and increase in the need for speed and agility would imply that the nature of injuries sustained will be different to those sustained in traditional rugby union. Objectives To develop a profile of injuries that describe the type, anatomical location and mechanism of injuries sustained in tens, sevens and touch rugby; to compare the injuries sustained between the three groups; and, to analyse management strategies utilised by chiropractic students at the 2014 Durban ‘Rugby Rush Tournament’. Additionally this study aimed to provide recommendations to the injury reporting form utilised. Method This study was a retrospective, quantitative, descriptive study based on the Chiropractic Student Sports Association’s report form in order to produce a retrospective cohort analysis of injury and treatment profiles. Participants who made use of the chiropractic treatment facility were required to complete the informed consent section of the injury reporting form. The chiropractic intern was required to complete the remainder of the form pertaining to the participant, complaint and treatment information. This study was limited to event participants to allow for subgroup analysis. The forms were then captured and analysed. Results The data collected consisted of a total of 345 individual patient forms which indicated 626 visits for a total of 733 complaints. The average participant age was 24 ± 5.58. The study found muscle strains (41.5%), SI Syndrome (17.6%) and Joint sprains (15.0%) to be the most frequent diagnoses. A history or previous injury or trauma was reported in 18.7% and 7.40% respectively. Acute injuries accounted for 64.3% and 35.7% were recorded as chronic in nature. The most frequent mechanism of injury was that of overuse (81.9%) and trauma accounted for 17.2% of injuries. The lumbar region (26.1%), thigh (20.7%) and shin/calf (15.6%) were the most commonly reported regions of complaint. Manipulation (58.8%), massage (32.0%) and stretch PNF (27.9%) were the most frequently used treatment protocols. Strapping was utilised in 21.1% of injuries of which 5.20% was applied to the muscle and 13.6% was applied to the joint. No comparison was made using the sevens subgroup as there were insufficient records, thus only tens and touch players were compared. A borderline non-significant difference (p = 0.057) was noted between the type of player and the history of previous trauma. Tens players were more likely to have a history of trauma compared to touch players. A significant difference (p = 0.001) was found between the type of athlete and mechanism of injury. Overuse was more common in touch players whereas trauma was more common in tens players. Due to statistical inconsistencies no significance tests were applicable to compare the type of player and region of complaint. Recommendations were proposed in order to avoid this in future research. Conclusion This study provides a base of knowledge regarding the injuries that were presented to the chiropractic treatment facility at the 2014 Durban ‘Rugby Rush Tournament’ and the management strategies utilised by the chiropractic interns at the event. This research provides insight into injury profiling of tens, sevens and touch rugby players. There were several recommendations proposed for future researchers in order to expand on this field of knowledge.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background Rugby union is one of South Africa’s most popular sports; it requires high levels of skill and fitness and is played at a high intensity and speed which allows for a greater risk of injury. The high risk of injury is said to be due to the nature of the physicality of rugby. It is because of this high risk of injury that several adaptations of rugby have since developed which rely more on speed and agility than physicality. These adaptations include tens or ten-a-side rugby, sevens or seven-a-side rugby and finally touch rugby, which is played with six players a-side. Each adaptation has its own set of rules and is played differently to the traditional rugby union or fifteen-a-side rugby. Hence, in these adaptations the physicality is said to decrease with a resultant increase in demand for speed and agility. The reduction of physicality and increase in the need for speed and agility would imply that the nature of injuries sustained will be different to those sustained in traditional rugby union. Objectives To develop a profile of injuries that describe the type, anatomical location and mechanism of injuries sustained in tens, sevens and touch rugby; to compare the injuries sustained between the three groups; and, to analyse management strategies utilised by chiropractic students at the 2014 Durban ‘Rugby Rush Tournament’. Additionally this study aimed to provide recommendations to the injury reporting form utilised. Method This study was a retrospective, quantitative, descriptive study based on the Chiropractic Student Sports Association’s report form in order to produce a retrospective cohort analysis of injury and treatment profiles. Participants who made use of the chiropractic treatment facility were required to complete the informed consent section of the injury reporting form. The chiropractic intern was required to complete the remainder of the form pertaining to the participant, complaint and treatment information. This study was limited to event participants to allow for subgroup analysis. The forms were then captured and analysed. Results The data collected consisted of a total of 345 individual patient forms which indicated 626 visits for a total of 733 complaints. The average participant age was 24 ± 5.58. The study found muscle strains (41.5%), SI Syndrome (17.6%) and Joint sprains (15.0%) to be the most frequent diagnoses. A history or previous injury or trauma was reported in 18.7% and 7.40% respectively. Acute injuries accounted for 64.3% and 35.7% were recorded as chronic in nature. The most frequent mechanism of injury was that of overuse (81.9%) and trauma accounted for 17.2% of injuries. The lumbar region (26.1%), thigh (20.7%) and shin/calf (15.6%) were the most commonly reported regions of complaint. Manipulation (58.8%), massage (32.0%) and stretch PNF (27.9%) were the most frequently used treatment protocols. Strapping was utilised in 21.1% of injuries of which 5.20% was applied to the muscle and 13.6% was applied to the joint. No comparison was made using the sevens subgroup as there were insufficient records, thus only tens and touch players were compared. A borderline non-significant difference (p = 0.057) was noted between the type of player and the history of previous trauma. Tens players were more likely to have a history of trauma compared to touch players. A significant difference (p = 0.001) was found between the type of athlete and mechanism of injury. Overuse was more common in touch players whereas trauma was more common in tens players. Due to statistical inconsistencies no significance tests were applicable to compare the type of player and region of complaint. Recommendations were proposed in order to avoid this in future research. Conclusion This study provides a base of knowledge regarding the injuries that were presented to the chiropractic treatment facility at the 2014 Durban ‘Rugby Rush Tournament’ and the management strategies utilised by the chiropractic interns at the event. This research provides insight into injury profiling of tens, sevens and touch rugby players. There were several recommendations proposed for future researchers in order to expand on this field of knowledge. / M

Thesis (MScPhysio)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: Groin injuries are among the top six injuries in contact sports and may lead to career ending chronic pain. Research on the role of knee kinematics in developing chronic groin pain in sport is scarce. Objective: The purpose of this study was to determine if there are differences in knee kinematics during a single-leg drop-landing in sports participants with chronic groin pain compared to asymptomatic controls. Methodology: A descriptive study was conducted. Twenty active sports’ participants were recruited from soccer and rugby clubs situated around the Cape Peninsula area, Western Cape, South Africa. The three-dimensional (3D) knee kinematics of ten cases with chronic groin pain and ten asymptomatic controls was analysed. Knee kinematics was analysed in the FNB-3D Vicon Laboratory at Stellenbosch University, using an eight camera Vicon system. A positive adductor squeeze test was used as a diagnostic test to include cases with chronic groin pain. Each participant performed six single-leg drop landings. The main outcome measure was 3D knee kinematics at initial foot contact and at the lowest vertical position of the drop landing. The following sub-groups were analysed: seven unilateral groin pain cases compared to their seven matched controls; three bilateral groin pain cases where their most painful leg and least painful leg were compared to their matched controls, respectively. Descriptive statistical techniques were used for all outcome measures; means and standard deviations (SD) were calculated, followed by a Student’s t-test to determine significant differences between the cases and controls. For all outcomes with p-values equal to or below 0.05, the effect size was calculated using the Cohen’s D. Results: The findings of this study indicated a significant difference (p=0.0001) between cases with unilateral groin pain having less knee internal rotation compared to the controls at the lowest vertical position of the drop landing in the transverse plane. Significantly less internal rotation (p<0.0001), was also noted in the cases with bilateral groin pain (in the most painful leg and the less painful leg), although this was noted at foot contact. Cases with bilateral groin pain also had significantly (p<0.001) more knee varus (adduction) during the landing phase. Conclusion: Differences in knee kinematics between sports participants with chronic groin pain and asymptomatic controls were found. These findings imply that the knee joint should be included during assessment and rehabilitation of individuals suffering with chronic groin pain. Due to the cross-sectional study design of the current study, it cannot be stated for certain whether the knee kinematics noted in the groin pain group are causative or as a result of groin pain. Future prospective studies are thus recommended; these studies should focus on the effect of contralateral knee kinematics on the hip adductors and may include exploration of the muscular components during a single-leg drop landing. / AFRIKAANSE OPSOMMING: Inleiding: Lies beserings is een van die top ses beserings in kontak sport en kan lei tot chroniese lies pyn en selfs die be-eindigging van ‘n sportloopbaan. Navorsing oor die rol van knie kinematika in die ontwikkeling van chroniese liesbeserings in sport is skaars. Doelwit: Die doel van hierdie studie was om te bepaal of daar verskille in die knie kinematika is tydens 'n enkel been val landing in sport deelnemers met chroniese lies pyn in vergelyking met gesonde kontroles. Metode: 'n Beskrywende studie was uitgevoer. Twintig aktiewe sport deelnemers is gewerf van rugby en sokker sportklubs geleë rondom die Kaapse Skiereiland, Wes-Kaap, Suid-Afrika. Die 3D knie kinematika van tien gevalle met chroniese lies pyn en tien asimptomatiese bypassende kontroles is ontleed. Knie kinematika was ontleed in die FNB-3D Vicon Laboratorium by die Universiteit van Stellenbosch, met behulp van 'n agt-kamera Vicon stelsel. 'n Positiewe Adduktor druk toets was gebruik as 'n diagnostiese toets om gevalle met chroniese lies pyn in te sluit. Om die knie kinematika te analiseer, het elke deelnemer ses enkel been val landings uitgevoer . Die belangrikste uitkomsmeting was 3D knie kinematika by die aanvanklike voet kontak en by die laagste vertikale posisie van die enkel-been val landing. Die volgende sub-groepe was ontleed: sewe unilaterale lies pyn gevalle in vergelyking met hul sewe bypassende kontroles; drie bilaterale lies pyn gevalle waar hul mees pynlike been, sowel as minder pynlike been onderskeidelik vergelyk was met hul bypassende kontroles. Beskrywende statistiese tegnieke was gebruik vir alle uitkoms maatreëls; gemiddeldes en standaardafwykings (SA) was bereken, gevolg deur 'n Studente’s t-toets om beduidende verskille tussen die gevalle en kontroles te bepaal. Vir al die uitkomste met p-waardes gelyk of onder 0.05, is die effekgrootte bereken deur die Cohen’s D. Resultate: Die bevindings van hierdie studie dui op 'n beduidende verskil (p=0,0001) tussen gevalle met unilaterale lies pyn met minder interne knie rotasie in vergelyking met die kontroles by die laagste vertikale posisie van die val landing in die dwars vlak. Aansienlik minder interne rotasie (p<0,0001), is ook opgemerk in gevalle met bilaterale lies pyn (in die mees pynlike been en die minder pynlik been), alhoewel tydens voet kontak. Gevalle met bilaterale lies pyn het ook betekenisvol (p <0.001) meer knie varus (adduksie) tydens die landingsfase gehad. Gevolgtrekking: Verskille bestaan in die knie kinematika tussen sport deelnemers met chroniese liesbesering pyn en gesonde kontroles. Hierdie bevindinge impliseer dat die knie behoort ingesluit te word tydens die assessering en rehabilitasie van individue met chroniese lies pyn. As gevolg van die deursnee-studie ontwerp van hierdie studie, kan dit nie bevestig word of die knie kinematika die oorsaak van die chroniese pyn is nie. Toekomstige voornemende studies word dus aanbeveel, hierdie studies moet fokus op die effek van die kinematika van die kontralaterale knie op die heup adduktore en kan moontlik die ondersoek van die spier kinetika tydens hierdie aktiwiteit insluit.