Is a Neuromuscular Training Warm-up Enough for Injury and Concussion Prevention in High School Girl Rugby Players?

OBJECTIVE

To evaluate the effectiveness of a rugby-specific neuromuscular training (NMT) warm-up on injury and concussion rates in Canadian high school girls' rugby.

DESIGN

Quasi-experimental study.

METHODS

Two high school girls' rugby cohorts (control seasons 2018, 2019; intervention seasons 2022, 2023) were compared using validated injury surveillance methodology. Coaches attended a rugby-specific NMT warm-up workshop before the intervention seasons. Outcomes of interest were injury and concussion. Multilevel Poisson regression analyses were used to estimate incidence rate ratios (IRRs) (95% confidence intervals [CIs]) comparing intervention and control cohorts, adjusted for injury history and rugby playing experience, offset by match hours and random effects (team and individual level).

RESULTS

There were 409 player seasons (13 teams) in control seasons and 483 player seasons (17 teams) in intervention seasons. Concussions accounted for 41% (62/150) of match injuries in control seasons and 31% (70/226) in intervention seasons. Intention-to-treat (ITT) and per-protocol (PP) analyses demonstrated no differences in match injury rates (IRRITT: 1.06; 95% CI: 0.75, 1.50; IRRPP: 0.91; 95% CI: 0.69, 1.21) or match concussions rates (IRRITT: 0.79; 95% CI: 0.52, 1.20; IRRPP: 0.74; 95% CI: 0.47, 1.17) between intervention and control seasons. Head-match injury burden (mean difference, -194 days of time-loss per 1000 match hours; 95% CI: -349, -39) and all-training injury burden (mean difference, -17 days of time-loss per 1000 match hours; 95% CI: -27, -7) were lower in the intervention seasons.

CONCLUSION

While no statistically significant differences were found in match injury or concussion rates in the intervention and control seasons, regardless of adherence level, there was a clinically relevant 21% lower match concussion rate and lower match-head injury and all-training injury burden with NMT warm-up use. J Orthop Sports Phys Ther 2026;56(4):261-271. Epub 2 March 2026. doi:10.2519/jospt.2026.13373.