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INTRODUCTION
The injury risk in youth rugby has received attention in the mainstream public and sports medicine literature 1 2 and has prioritised the formulation of appropriate preventive measures. 3 Musculoskeletal injuries and concussion are prominent reasons for time loss from sport for adolescent rugby players, 4 5 and significant youth sports injuries, in general, have been implicated in long-term disability and compromised quality of later life. 6 7 Conditioning the musculoskeletal system to tolerate external forces, through enhancing strength and movement control, has been advocated as means of reducing musculoskeletal injury risk, as indicated by a growing evidence base that supports using multifaceted preventive exercise programmes to reduce musculoskeletal injury risk across male sports such as basketball 8 and soccer. 9-11 Moreover, cross-sectional associations between neck strength measures with concussion risk in young athletes invite the possibility that interventions to enhance neck strength may reduce concussion risk. 12 The injury patterns in rugby differ from other team sports, owing to a greater frequency of concussion, upper body and contact-related injuries, 13 14 and so it is uncertain if introducing a targeted exercise programme can reduce musculoskeletal injuries and/or concussion in youth rugby players.
The efficacy of preventive exercise programmes is dependent on several factors, of which the frequency of programme use (ie, dose) may be one such factor. 15 Dose-response relationships have typically been identified between programme use and reductions in knee ligament injury incidence in female sportspeople. 16 17 Assessing the effects of programme dose can be useful in reinforcing the outcomes of intervention research and informing subsequent implementation attempts. 18
The aims of this study were to assess the efficacy of a pre-activity movement control exercise intervention to reduce the incidence and burden of rugby-related injuries in a schoolboy population and to assess the influences of programme dose and compliance on injury outcomes.
METHODS
Study design and recruitment
A cluster-randomised controlled trial was conducted across independent school rugby teams over one playing season (August to December 2015). The study design was in accordance with the Consolidated Standards of Reporting Trials statement, 19 and the trial was registered before recruitment (trial registration number: ISRCTN13422001 ). Study procedures were approved by the Research Ethics Approval Committee for Health at the University of Bath.
Each...