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 (IRR_ITT: 1.06; 95% CI: 0.75, 1.50; IRR_PP: 0.91; 95% CI: 0.69, 1.21) or match concussions rates (IRR_ITT: 0.79; 95% CI: 0.52, 1.20; IRR_PP: 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.