School of Sport and Recreation - Te Kura Hākinakina

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https://hdl.handle.net/10292/1542

Research in the School of Sport and Recreation covers sport and activity-related areas, as well as performance, nutrition, coaching and human potential. AUT is the home of New Zealand's top sport and fitness facility, AUT Millennium, and the Sports Performance Research Institute New Zealand (SPRINZ) is New Zealand’s number one sports research institute.

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Stretching: Mechanisms and Benefits for Sport Performance and Injury Prevention
(Taylor & Francis, 2004) Weerapong, P; Hume, P; Kolt, GS
Stretching is usually performed before exercise in an attempt to enhance performance and reduce the risk of injury. Most stretching techniques (static, ballistic, and proprioceptive neuromuscular facilitation) are effective in increasing static flexibility as measured by joint range of motion, but the results for dynamic flexibility as measured by active and passive stiffness, are inconclusive. The mechanisms of various stretching techniques in terms of biomechanics and neurology, the effectiveness of the combination of stretching with other therapies such as heat and cold, and the effectiveness of stretching for performance and injury prevention are reviewed. The possible mechanisms responsible for the detrimental effects of stretching on performance and the minimal effects on injury prevention are considered, with the emphasis on muscle dynamic flexibility. Further research is recommended to explore the mechanisms and effects of alternative stretching techniques on dynamic flexibility, muscle soreness, sport performance, and rate of injury.
Preventative Strategies for Exercised-Induced Muscle Damage
(Begell House Inc., 2004) Weerapong, P; Hume, PA; Kolt, GS
Eccentric exercise is part of regular rehabilitation and sports training. Unaccustomed eccentric exercise causes muscle damage that presents as delayed soreness, strength and range of motion loss, swelling, and increased passive stiffness. These symptoms reduce the ability to exercise and might be harmful if further exercise is continued. Several interventions such as warm-up, stretching, massage, acupuncture, anti-inflammatory drugs, and estrogen supplements have been researched in order to find interventions that successfully alleviate the severity of muscle damage. The results are controversial due mainly to the variety of exercise-induced muscle damage protocols, the types of intervention protocols, and the doses of application. From a practical point of view prevention strategies are preferred by practitioners because they reduce time lost from training, reduce the cost of treatment, and reduce the risk of further injury. For that reason, this article emphasizes the mechanism of initial events and the factors involving the severity of muscle damage. Research on the prevention of eccentric exercise-induced muscle damage is reviewed and discussed. Appropriate preventative strategies for muscle damage from eccentric exercise are suggested.
The Effectiveness of a Six-week Jump Shot Intervention on the Kinematics of Netball Shooting Performance
(International Society of Biomechanics in Sports, 2006) Henderson, ME; Hume, PA; Bradshaw, EJ
This study measured the kinematics of netball shooting (standing & jump technique) performance throughout a six-week training intervention. Club-class female goal shooters were allocated into three groups - experimental (stand & jump shot training, n=6), training control (standing shot training, n=6) and pure control (no training, n=6). The experimental and training control players underwent a shooting intervention of three sessions (100 shots) per week for six-weeks. All players were tested using two dimensional motion analysis at the start (0 weeks), during (3 weeks), and end (6 weeks) of the intervention programme. The mixed technique program undertaken by the goal shooters in the experimental group was the most beneficial for enhancing overall shooting performance and, therefore, is the recommended strategy from this study for off-season training.
Interim Evaluation of the Effect of a New Scrum Law on Neck and Back Injuries in Rugby Union
(BMJ Publishing, 2008) Gianotti, S; Hume, PA; Hopkins, WG; Harawira, J; Truman, R
Background: In January 2007 the International Rugby Board implemented a new law for scrum engagement aimed at improving player welfare by reducing impact force and scrum collapses. In New Zealand the new law was included in RugbySmart, an annual compulsory workshop for coaches and referees. Objective: To determine the effect of the new law on scrum-related moderate to serious neck and back injury claims in 2007. Methods: Claims filed with the Accident Compensation Corporation (the provider of no-fault injury compensation and rehabilitation in New Zealand) were combined with numbers of registered players to estimate moderate to serious scrum-related claims for players who take part in scrums (forwards). Poisson linear regression was used to compare the observed claims per 100 000 forwards for 2007 with the rate predicted from data for 2002–6. Results: The observed and predicted claims per 100 000 forwards were 52 and 76, respectively (rate ratio 0.69; 90% CI 0.42 to 1.12). The likelihoods of substantial benefit (rate ratio <0.90) and harm (rate ratio >1.1) attributable to the scrum law were 82% and 5%, respectively. Conclusion: The decline in scrum-related injury claims is consistent with a beneficial effect of the new scrum law in the first year of its implementation. Another year of monitoring should provide more evidence for the efficacy of the new law.
Pedometer-determined Physical Activity and Active Transport in Girls
(BioMed Central, 2008) Duncan, EK; Scott Duncan, J; Schofield, G
It is well established that the risk of insufficient physical activity is greater in girls than in boys, especially during the adolescent years. The promotion of active transport (AT) to and from school has been posited as a practical and convenient solution for increasing girls' total daily activity. However, there is limited information describing the associations between AT choices and girls' physical activity across a range of age, ethnic, and socioeconomic groups. The objectives of this study were to (1) investigate physical activity patterns in a large multiethnic sample of female children and adolescents, and to (2) estimate the physical activity associated with AT to and from school.
Double Sigmoid Model for Fitting Fatigue Profiles in Mouse Fast- and Slow-Twitch Muscle
(WILEY-BLACKWELL, 2008) Cairns, SP; Robinson, D; Loiselle, DS
We present a curve-fitting approach that permits quantitative comparisons of fatigue profiles obtained with different stimulation protocols in isolated slow-twitch soleus and fast-twitch extensor digitorum longus (EDL) muscles of mice. Profiles from our usual stimulation protocol (125 Hz for 500 ms, evoked once every second for 100-300 s) could be fitted by single-term functions (sigmoids or exponentials) but not by a double exponential. A clearly superior fit, as confirmed by the Akaiki Information Criterion, was achieved using a double-sigmoid function. Fitting accuracy was exceptional; mean square errors were typically <1% and r2 > 0.9995. The first sigmoid (early fatigue) involved ∼10% decline of isometric force to an intermediate plateau in both muscle types; the second sigmoid (late fatigue) involved a reduction of force to a final plateau, the decline being 83% of initial force in EDL and 63% of initial force in soleus. The maximal slope of each sigmoid was seven- to eightfold greater in EDL than in soleus. The general applicability of the model was tested by fitting profiles with a severe force loss arising from repeated tetanic stimulation evoked at different frequencies or rest periods, or with excitation via nerve terminals in soleus. Late fatigue, which was absent at 30 Hz, occurred earlier and to a greater extent at 125 than 50 Hz. The model captured small changes in rate of late fatigue for nerve terminal versus sarcolemmal stimulation. We conclude that a double-sigmoid expression is a useful and accurate model to characterize fatigue in isolated muscle preparations. © 2008 The Authors.
One year sustainability of risk factor change from a 9-week workplace intervention
(Hindawi, 2009) Rush, EC; Cumin, MB; Migriauli, L; Ferguson, LR; Plank, LD
We examined the effect of a 9-week diet and physical activity intervention provided in the workplace by a group education session where personal dietary and physical activity goals were proposed. Measurements of anthropometry, fasting blood lipids, glucose and insulin, assays for antioxidant activity (AOA) and questionnaires were completed at 0, 3, 6, 9, and 12 weeks in 50 healthy workers (50% male, mean age 46y). Followup measurements in 39 (56% male) were possible at 52 weeks. At week 3 a group dietary and physical activity "motivational seminar" was held. At week 6, half the group were supplied daily kiwifruit for 3 weeks with cross over at week 9 until week 12. Compared to baseline, lipid, glucose, insulin and AOA measurements were improved at 12 and 52 weeks. Body measurements did not change. Group diet and physical activity advice reinforced over 9 weeks is associated with a sustained improvement in cardiovascular risk factors at 52 weeks.
Understanding the Relationship Between Activity and Neighbourhoods (URBAN) Study: Research Design and Methodology
(BioMed Central Ltd., 2009) Badland, HM; Schofield, GM; Witten, K; Schluter, PJ; Mavoa, S; Kearns, RA; Hinckson, EA; Oliver, M; Kaiwai, H; Jensen, VG; Ergler, C; McGrath, L; McPhee, J
Built environment attributes are recognized as being important contributors to physical activity (PA) engagement and body size in adults and children. However, much of the existing research in this emergent public health field is hindered by methodological limitations, including: population and site homogeneity, reliance on self-report measures, aggregated measures of PA, and inadequate statistical modeling. As an integral component of multi-country collaborative research, the Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study seeks to overcome these limitations by determining the strengths of association between detailed measures of the neighborhood built environment with PA levels across multiple domains and body size measures in adults and children. This article outlines the research protocol developed for the URBAN Study.
Reliability of a Gymnastics Vaulting Feedback System
(International Society of Biomechanics in Sports, 2009) Bradshaw, E; Hume, PA; Calton, M; Aisbett, B
The current study assessed the intra- and inter-day reliability of a custom-built gymnastics vaulting feedback system. The system is a coach-friendly customized infra-red timing gate and contact timing mat system operated by the coach to augment the feedback provided to gymnasts on their vaulting performance during regular training practice. Thirteen Australian high performance gymnasts (eight males and five females) aged 11-23 years were assessed during two training sessions (Day 1 and Day 2) at their regular training centre. The approach velocity and board contact time measures were found to be reliable measures during vault training, with measures of pre-flight and table contact time less consistent. Future research should examine the validity of these measures as a tool for monitoring vault training.
Validity of the Powerline Boat Instrumentation System
(International Conference on Biomechanics in Sports, 2009) Coker, J; Hume, PA; Nolte, V
The PowerLine Boat Instrumentation System3 is comprised of instrumented oarlocks capable of measuring pin forces in the direction of boat travel and oarlock angles. The aim of this study was to determine the reliability and validity of the force and angle data from the PowerLine Boat Instrumentation System in a laboratory setting. Data were collected with the sculling oarlocks affixed to a horizontally aligned, stabilised wing rigger. For force analysis, signals were collected at 50 Hz from both the PowerLine system and a 1 kN load cell4 during 10 repetitions at a rate of approximately 30 repetitions per minute. For angular analysis, whilst recording with PowerLine, oarlocks were repositioned for a minimum of two seconds at known angles in a random order using an inclinometer accurate to one tenth of a degree over a range of -80° to +60°, in 20° increments. Linear regression analysis through the origin was used to compare the PowerLine values with known values from the load cell and the inclinometer. Laboratory testing proved the force and angle sensors to be valid throughout the testing range (0 N to 554.8 + 20.4 N, and -80° to +60° respectively) when fully functioning. The PowerLine Boat Instrumentation System appears to be appropriate for measuring biomechanical variables in an elite sculling programme. On-water reliability testing is still required to fully evaluate their application in quantifying the effect of interventions made to technique or boat set-up.
Holism in sports coaching: beyond humanistic psychology: a commentary
(Multi-Science Publishing, 2010) Kidman, L
No abstract.
Effect of Intermittent Sitting Time on Postprandial Lipemia in Children
(Elsevier, 2010) Faithfull, K; Hinckson, E; Zynn, C
Objective To investigate the effect of interrupting sitting time with intermittent moderate exercise on acute postprandial plasma triglyceride (TG) in healthy children following high-fat meal consumption. Methods Twelve participants (8 girls; 4 boys), aged 12 ± 2 years (mean ± SD), completed two trials in the laboratory. On Day 1 (d1), sitting was interrupted with moderate intensity exercise every 30 min, and compared with day 2, (d2), where participants remained sedentary. On each testing day, participants consumed four high fat meals. Blood was sampled in a fasted state and 2-hourly for 6 h with the last sample taken on the 7th hour. Results Overall, there were no significant differences in the area under the concentration–time curve between day 1 and day 2, for the 12 participants combined ( p = 0.98). However, in eight of the 12 participants, triglyceride concentrations remained high on d2 at two, four and 6 h after baseline compared with d1 ( p = 0.03). Conclusion When sitting was interrupted by short bouts of moderate intensity exercise there was a reduction in triglyceride concentrations in eight out of 12 participants. Possible reasons to account for the difference in response may include sexual maturation, gender differences, genetic conditions, or the rate of digestion and intestinal absorption.
Video Analysis of Tackles in Professional Rugby League by Player Position, Tackle Height and Tackle Location
(Taylor & Francis, 2010) King, D; Hume, PA; Clark, T
This paper describes the nature, height, site and direction of tackles seen in professional rugby league. Retrospective observational analysis was conducted using videos of 80 rugby league matches from 2008. There were 50,019 tackles recorded representing 701 ±64 tackles per match. Nearly 50% of tackles involved tacklers from behind the visual fields of the ball carrier, most tackles involved either two or three tacklers and most tackles involved contact with the mid-torso and hip-thigh region of the ball carrier. Significantly more players were involved in the tackle in the first, than the second half of matches (χ2=4.3, df=1, p=0.038). Significantly more tackles were recorded in the defence than the attack side of the field. Forwards were more commonly involved in the tackle than backs. Forwards were significantly more involved in tackle events than backs but when viewed in player groups, adjustables were involved in significantly more tackle events than outside backs and hit-up forwards. Coaches should focus on getting players to practice correct tackle technique during tackling with two or more players involved in the tackle and especially, when making a tackle in the ball carriers blind vision area.
Strength and coordination training are both effective in reducing the postural tremor amplitude of older adults
(Human Kinetics, 2010) Keogh, JWL; Morrison, S; Barrett, R
The current study investigated the effect of 2 different types of unilateral resistance training on the postural tremor output of 19 neurologically healthy men age 70–80 yr. The strength- (n = 7) and coordination-training (n = 7) groups trained twice a week for 6 wk, performing dumbbell biceps curls, wrist flexions, and wrist extensions, while the control group (n = 5) maintained their normal activities. Changes in index-finger tremor (RMS amplitude, peak, and proportional power) and upper limb muscle coactivation were assessed during 4 postural conditions that were performed separately with the trained and untrained limbs. The 2 training groups experienced significantly greater reductions in mean RMS tremor amplitude, peak, and proportional tremor power 8–12 Hz and upper limb muscle coactivation, as well as greater increases in strength, than the control group. These results further demonstrate the benefits of resistance training for improving function in older adults.
First-aid and Concussion Knowledge of Rugby League Team Management, Administrators and Officials in New Zealand
(Sports Medicine New Zealand, 2010) King, D; Hume, PA; Clark, T
Objective: To assess rugby league team management, administrators and officials’ knowledge of first-aid, concussion recognition and management and injury prevention. Methods: A descriptive study was conducted using a first-aid and concussion knowledge questionnaire consisting of two parts: (1) Thirty six multi-choice questions on first-aid assessment and knowledge incorporating five constructs (injury prevention, identification and management, cardiopulmonary resuscitation, and wound care) and, (2) Thirty eight closed- and open-ended questions on concussion recognition, management and prevention knowledge. Results: Ninety five people from the Wellington district rugby league community completed the questionnaire. Fifty two (55%) of respondents had a current up-to-date first-aid certificate which included cardiopulmonary resuscitation. Only two (2%) participants achieved the 80% passing score in the first-aid and concussion knowledge questionnaire. The mean ±SD percentages for the first-aid knowledge questions was 56 ±13% and for the 16 symptom recognition of concussion questions was 33 ±14%. Overall sports-related concussion knowledge was low (42 ±20%). Loss of consciousness was reported to be incorrectly required for a concussion to have occurred by 39% of respondents. Nearly half the respondents identified that all concussions recover at the same rate. All referees had a refereeing qualification while only 24% of coaches, 7% of managers and 2% of trainer/medics had a rugby league specific qualification. Conclusion: The first-aid and concussion knowledge results highlighted a lower understanding of sports-related first-aid and concussion than previously reported. Injury prevention and care programs in rugby league at the amateur level in New Zealand should stress first-aid and concussion injury knowledge management to enable knowledge empowerment.
Predictors of physical activity and quality of life in New Zealand prostate cancer survivors undergoing androgen-deprivation therapy
(New Zealand Medical Association (NZMA), 2010-11-05) Keogh, JW; Shepherd, D; Krägeloh, CU; Ryan, C; Masters, J; Shepherd, G; MacLeod, R
Aims The aims of this study were to: quantify the levels and predictors of physical activity in prostate cancer survivors on androgen deprivation therapy (ADT); gain some insight into the effect of physical activity on the quality of life of prostate cancer survivors on ADT; and compare the quality of life of prostate cancer survivors on ADT with matched controls. Methods A sample of 84 prostate cancer survivors on ADT were recruited from a register held by the Auckland District Health Board. Participants were mailed a collection of self-report surveys probing quality of life, physical activity and determinants of physical activity. Result Less than half the prostate cancer sample were categorised as physically active, and there was no relationship between physical activity and age, PSA levels, or time on ADT. Compared to a matched control group the sample had lower scores for global quality of life, as well as on the physical and environmental quality of life domains. Results also showed that those prostate cancer survivors classified as active had higher levels of quality of life on average than those classified as insufficiently active. Attitude towards physical activity was the dominant predictor of the intention to be physically active, while perceived behavioural control was the dominant predictor of actual behaviour. Conclusions Our findings describe a positive relationship between physical activity and quality of life in men with prostate cancer currently undergoing ADT. However, only half the sample was physically active, indicating that physical activity interventions aimed at prostate cancer survivors are of utility. Our data suggests targeting both attitudes and factors related to the ability to perform physical activity will be fruitful approaches.
How Many Steps/Day are Enough? for Children and Adolescents
(BioMed Central, 2011) Tudor Locke, C; Craig, CL; Beets, MW; Belton, S; Cardon, GM; Duncan, S; Hatano, Y; Lubans, DR; Olds, TS; Raustorp, A; Rowe, DA; Spence, JC; Tanaka, S; Blair, SN
Worldwide, public health physical activity guidelines include special emphasis on populations of children (typically 6-11 years) and adolescents (typically 12-19 years). Existing guidelines are commonly expressed in terms of frequency, time, and intensity of behaviour. However, the simple step output from both accelerometers and pedometers is gaining increased credibility in research and practice as a reasonable approximation of daily ambulatory physical activity volume. Therefore, the purpose of this article is to review existing child and adolescent objectively monitored step-defined physical activity literature to provide researchers, practitioners, and lay people who use accelerometers and pedometers with evidence-based translations of these public health guidelines in terms of steps/day. In terms of normative data (i.e., expected values), the updated international literature indicates that we can expect 1) among children, boys to average 12,000 to 16,000 steps/day and girls to average 10,000 to 13,000 steps/day; and, 2) adolescents to steadily decrease steps/day until approximately 8,000-9,000 steps/day are observed in 18-year olds. Controlled studies of cadence show that continuous MVPA walking produces 3,300-3,500 steps in 30 minutes or 6,600-7,000 steps in 60 minutes in 10-15 year olds. Limited evidence suggests that a total daily physical activity volume of 10,000-14,000 steps/day is associated with 60-100 minutes of MVPA in preschool children (approximately 4-6 years of age). Across studies, 60 minutes of MVPA in primary/elementary school children appears to be achieved, on average, within a total volume of 13,000 to 15,000 steps/day in boys and 11,000 to 12,000 steps/day in girls. For adolescents (both boys and girls), 10,000 to 11,700 may be associated with 60 minutes of MVPA. Translations of time- and intensity-based guidelines may be higher than existing normative data (e.g., in adolescents) and therefore will be more difficult to achieve (but not impossible nor contraindicated). Recommendations are preliminary and further research is needed to confirm and extend values for measured cadences, associated speeds, and MET values in young people; continue to accumulate normative data (expected values) for both steps/day and MVPA across ages and populations; and, conduct longitudinal and intervention studies in children and adolescents required to inform the shape of step-defined physical activity dose-response curves associated with various health parameters.
The Effect of Player Positional Groups on the Nature of Tackles That Result in Tackle-Related Injuries in Professional Rugby League Matches
(Edizioni Minerva Medica, 2011) King, DA; Hume, PA; Clark, T
AIM: The aim of this study was to describe the effect of player positional groups on the nature of tackles that result in tackle-related injuries in professional rugby league matches. METHODS: Prospective observational epidemiology analyses for tackle-related injuries and video analyses for the nature of tackles were conducted for a single team in the National Rugby League (NRL) throughout the 2007 and 2008 competitions for a total of 48 games. Risk ratios (RR) were calculated for comparisons between positional groups (adjustable, hit-up forwards or outside backs). RESULTS: The total missed match tackle-related injury rate was 57.8 per 1 000 player hours. Hit-up forwards recorded significantly more total tackle-related injuries than outside backs (RR: 1.3; P=0.049), but not more than adjustables (RR: 1.0; P=0.922). Hit-up forwards recorded significantly more chest-back tackle-related injuries than adjustables (RR: 6.0; P=0.008). Outside backs recorded significantly more tackle injuries as the ball carrier than the tackler (RR: 2.4; P=0.015) while adjustables recorded significantly more tackle injuries as the tackler than the ball carrier (RR: 1.8; P<0.001). Hit-up forwards had a higher incidence of contusions, and sprains while adjustables had a higher incidence of fracture/dislocations. There were no differences in injury severity between the positional groups. CONCLUSION: Player positional group had an effect on tackle-related injury type and injury site. Hit-up forwards and outside backs recorded more tackle-related injuries as a ball carrier than as a tackler, while in contrast, adjustables recorded more tackle-related injuries as the tackler than the ball carrier.
Mechanisms of Quadriceps Muscle Weakness in Knee Joint Osteoarthritis: The Effects of Prolonged Vibration on Torque and Muscle Activation in Osteoarthritic and Healthy Control Subjects
(BioMed Central (BMC), 2011) Rice, DA; McNair, PJ; Lewis, GN
Introduction: A consequence of knee joint osteoarthritis (OA) is an inability to fully activate the quadriceps muscles, a problem termed arthrogenic muscle inhibition (AMI). AMI leads to marked quadriceps weakness that impairs physical function and may hasten disease progression. The purpose of the present study was to determine whether g-loop dysfunction contributes to AMI in people with knee joint OA. Methods: Fifteen subjects with knee joint OA and 15 controls with no history of knee joint pathology participated in this study. Quadriceps and hamstrings peak isometric torque (Nm) and electromyography (EMG) amplitude were collected before and after 20 minutes of 50 Hz vibration applied to the infrapatellar tendon. Between-group differences in pre-vibration torque were analysed using a one-way analysis of covariance, with age, gender and body mass (kg) as the covariates. If the g-loop is intact, vibration should decrease torque and EMG levels in the target muscle; if dysfunctional, then torque and EMG levels should not change following vibration. One-sample t tests were thus undertaken to analyse whether percentage changes in torque and EMG differed from zero after vibration in each group. In addition, analyses of covariance were utilised to analyse between-group differences in the percentage changes in torque and EMG following vibration. Results: Pre-vibration quadriceps torque was significantly lower in the OA group compared with the control group (P = 0.005). Following tendon vibration, quadriceps torque (P < 0.001) and EMG amplitude (P ≤0.001) decreased significantly in the control group but did not change in the OA group (all P > 0.299). Hamstrings torque and EMG amplitude were unchanged in both groups (all P > 0.204). The vibration-induced changes in quadriceps torque and EMG were significantly different between the OA and control groups (all P < 0.011). No between-group differences were observed for the change in hamstrings torque or EMG (all P > 0.554). Conclusions: g-loop dysfunction may contribute to AMI in individuals with knee joint OA, partially explaining the marked quadriceps weakness and atrophy that is often observed in this population.
A Retrospective Review Over 1999 to 2007 of Head, Shoulder and Knee Soft Tissue and Fracture Dislocation Injuries and Associated Costs for Rugby League in New Zealand
(Thieme Gruppe, 2011) King, D; Hume, PA; Gianotti, S; Clark, T
King et al. reported that of 5 941 moderate to serious claims resulting in medical treatment for rugby league injuries, the knee, shoulder, and head and neck body sites and soft tissue and fracture-dislocation injuries were most frequent and costly in the New Zealand national no-fault injury compensation corporation database during 1999 to 2007. However, additional analyses of knee, shoulder and head and neck body sites by soft tissue and fracture-dislocation injury types was required to enable a greater understanding of the nature of injuries most likely to be seen by sports medical personnel dealing with rugby league players. From 1999 to 2007 the injury claims and costs for head and neck soft tissue, fracture-dislocations, shoulders soft tissue significantly increased. Knee soft tissue injury claims and costs significantly decreased from 1999 to 2007. There was no significant difference in knee fracture-dislocation injury claims but there was a significant increase in knee fracture-dislocation injury costs from 1999 to 2007. Changes in the nature of injuries may be related to changes in defensive techniques employed in rugby league during this time. Sports medical personnel dealing with rugby league players should focus their injury prevention strategies on reducing musculoskeletal injuries to the head and shoulder. There should be a focus on increasing awareness of correct tackling technique, head injury awareness and management of suspected cervical spine injuries.

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