If you’re like me, you’ll have been glued to the TV over the past few weeks following the Rugby World Cup. England’s early exit has obviously been a low point, but it will no doubt still be a compelling story to follow as we head into the knockout stage.
As an amateur player, the sport is one which is close to my heart. But even after all these years of playing, I still cringe at the sight of some of the more painful injuries which players encounter on the pitch.
Over recent years, other sports like football have become relatively safer, with new rules contributing towards a minimisation of physical contact. However, this isn’t the case with rugby. In fact, changes in the way the game has been played over recent years have resulted in the occurrence of even more injuries; there were more tournament-ending injuries in this year’s world cup after just 19 games than there were in the whole tournament in 2011.
French site Rugbyrama recently published an article detailing how the average run of active play, which in matches in 1987 was around 20 minutes, had risen by 2011 to 35 minutes. Now, matches which exceed 40 minutes of running play have become even more common.
This has had direct ramifications on the health of players.
Firstly, this has contributed towards an increase in ‘overuse’ injuries. Players now are much more likely to wear down ligaments and weather joints over the course of a game, because they’re using these parts of their body for longer.
Secondly, the chances of receiving a traumatic injury have risen as well, as players are obviously much more likely to have collisions when the ball is in play.
In 2013, the Australian Rugby Union published figures which indicated that between 2004 and 2008: 31% of injuries sustained at all levels came as a result of being tackled; 18% occurred from overexertion; and 15% occurred to those players performing tackles. Of these, a whopping 59% were strains and sprains.
This week on the blog, we decided to delve a little deeper into the subject of rugby injuries; by identifying some of the more common injuries, how these are treated and, perhaps most importantly for those who play the sport on any level, how these can be avoided and prevented.
Injuries to the knee can occur in a variety of forms, but among the more damaging types are those which affect the ligaments. Anterior cruciate ligament (ACL) and other knee ligament injuries often occur as a result of the physical demands of the sport.
ACL tears can occur when someone stops running and suddenly changes direction, or jumps and lands awkwardly on their knee. These actions are commonplace occurrences in rugby.
Twisting your knee with your foot dug into the ground, such as in a scrum, can also damage the ligaments; as can quickly shifting weight from one leg on to the other, which is an action often performed by backs trying to stop a forward.
Symptoms of a torn ACL include swelling, restricted movement and severe pain.
First aid should be the most immediate course of action when any of the ligaments become damaged. Using ice to limit swelling and pain, placing the leg in an elevated position and using an elastic bandage to apply a small amount of pressure to the affected region are all measures which can help.
Paracetamol and NSAIDs can be used, provided no medical restrictions exist in the patient, to reduce pain. A doctor may also advise the use of crutches or splints for a short time after injury, but they will also encourage making small movements to help the patient prevent further muscle stiffness and aid mobility.
In more severe cases, surgery may be necessary to reconstruct the torn ligament.
There are a few ways you can limit your risk of a knee injury or ligament damage both before and during your game:
- Warming up prior to your match and warming down afterwards is obviously important, but it’s crucial to follow a more general regime of exercise which helps to improve flexibility in the joints.
- Use the recommended technique if you’re in the scrum, or going for a tackle. During the scrum, follow the referee’s instructions.
- It’s a lot easier than it sounds, but the better you position yourself during play, the less likely you are to have to change direction and put extra pressure on your knee.
- Make sure you compete at a level you’re comfortable with. If you’re playing against a team with a significantly higher skill level, you’re more likely to overextend yourself making a tackle thus increasing your risk of injury.
Injuries to the thigh can take many forms, and it would be impossible to cover every possible type. However, two which may occur more regularly than others in rugby are a haematoma or an injured hamstring.
A haematoma is a severe bruise caused by a blood clot in the tissue. It occurs when blood vessels become damaged, usually through trauma, and blood leaks out to form a clot outside the vessel.
Hamstring injuries are another common problem for rugby players. The hamstring is a muscle at the back of the thigh, which can become strained through overuse or overexertion.
Kickers are thought to be more susceptible to this type of injury than other players, due to the motion involved in taking a penalty.
For haematomas, treatment usually depends on the severity. Those which are less severe will require the patient to rest with the leg raised, to help drain the area of blood. If the clot is a large one, it may need to be surgically drained, particularly if it persists after a few days.
Hamstring injuries and other types of muscle strains can mostly be treated through something known as the RICE technique.
This is an acronym for:
Rest - Ice - Compression - Elevation
- Resting the area means taking all the pressure you can off the affected thigh, so that you do not risk causing further damage.
- Ice packs (wrapped in a towel) applied to the injured area during the first couple of days can help to limit inflammation. Try to do this for 20 minutes at a time every two to three hours.
- Compression bandages can be used to limit further swelling.
- Elevating the injured region by, for instance, lying down and raising the leg up on a pillow, will also help to offset swelling.
Severe hamstring injuries, however, may require surgical intervention.
Avoiding haematoma injuries is easier said than done, as they are primarily the result of a tackle or collision. However, you may not be as likely to be taken by surprise by a harsh tackle if you play at your own skill level.
There are a variety of measures you can take to lower your risk of acquiring a strained thigh muscle:
- Warm up. The aim of your pre-game routine is to ideally raise the temperature of the muscle by one to two degrees; so try to exercise for around 20 minutes to half an hour.
- Stretches before and after the game will help to prepare the muscle and help it recover after a period of heavy exertion.
- Thigh supports can help to keep the area warm, thus reducing the likelihood of a strain, and act as protection.
- Perform strength exercises on a regular basis off the pitch to keep your muscles healthy.
- Keep a balanced diet to help muscles stay strong.
The above study by the Australian Rugby Union found that 18% of all injuries recorded in the sport between 2004 and 2008 were to the shoulder region.
When you consider, as Lennard Funk points out in his article published by shoulderdoc, that the average weight of players is increasing, as is the speed at which they move on the field, then it’s more than likely that shoulder injuries will steadily rise in the sport over the coming years. This is an inevitable symptom of collisions occurring with increased force.
Dislocations are the most common shoulder injuries in rugby. This is where the joint slips or ‘pops’ out of the socket. A dislocated shoulder is immediately noticeable, as it causes intense pain and mobility in the arm will be virtually non-existent.
The appearance of the shoulder may also be different, displaying an angled as opposed to a round corner; and a lump under the skin may also be present.
Immediate medical attention will be required. In A&E, staff will usually perform an X-ray to determine whether or not there are any breaks or fractures present. If there are, further analysis and referral, and potentially surgery, may be required.
Where there are no breaks present, the shoulder will be gently managed back into the socket. This process is called reduction, and will typically undertaken at the A&E department by a doctor. Sedation will be applied beforehand, and a doctor will move the arm around to ease it back into position. A further X-ray will then be undertaken, to make sure that the joint has been successfully put back in the socket.
Afterwards, it will be necessary to wear the arm in a sling and rest it for a specified period. Pain relief, exercises and follow-up appointments with an orthopaedic specialist will usually be recommended. The recovery time for dislocated shoulders according to the NHS is around three to four months. Normal everyday activities can often be resumed sooner, but it may be necessary to avoid playing sports and doing any heavy lifting until a full recovery has been made.
Once again, you should always make sure you’re playing rugby at a level which suits you and your performance capacities. If you’re lighter than most of the other players on the field, then a shoulder dislocation is a bigger risk for you.
If you’ve dislocated your shoulder once, you’re also at significantly increased risk of doing so again. Making sure you follow your treatment plan after dislocating your shoulder for the first time will help the area to heal more effectively, and reduce this reinjury risk.
Old-fashioned purists might consider ‘pads’ to be a dirty word, but in truth, many pros and amateurs alike use them to protect the shoulders, arms, ribs, and solar plexus. Pads are certainly worth considering if you want to protect a vulnerable region which has experienced an injury before.
Many of the actions in a rugby game which can cause a torn ACL can also lead to a twisted or sprained ankle, such as landing awkwardly after a jump or twisting your leg in a scrum with your studs locked into the ground. Typically, symptoms include tenderness, swelling and sometimes bruising. The affected ankle will often not be able to support the weight of the injured person.
As with a pulled hamstring, a doctor may advise the RICE technique to reduce inflammation and swelling. One of the most important things to keep in mind for the majority of people during rehab from a sprained ankle, is to make sure you move the joint regularly; however, in severe cases, a doctor may decide that immobilisation is a better option, and place the injured joint in a cast.
This movement will not generally involve putting weight on the injured ankle early on, but rather the performance of certain exercises, such as writing the alphabet with your foot, to improve flexibility and range of movement.
Warming up properly before your game can help to reduce the likelihood of a sprain, as can wearing proper footwear.
These sorts of injuries are the result of high impact play, and are unfortunately a common fixture in rugby. Last year, New Zealand-born English International Shontayne Hape revealed just how rife concussions are in the sport, and the pressures that sadly some players feel to essentially ignore them and carry on playing.
Concussions do however present a very real long term health risk if they are left untreated. Symptoms may include a short loss of consciousness after the impact to the head (but not always), impaired vision, confusion, and memory loss.
First of all, a paramedic or an official will examine the patient to see if there are any indications of a serious head injury, by measuring breathing and checking to see if the ears are bleeding.
They will then ask a series of questions to determine if there is any memory loss present, or ask the patient to perform a simple task to determine if there is any loss of coordination.
If there are signs to suggest a brain injury, then further tests such as a CT scan may be required.
Recovering from a concussion will usually involve getting rest and avoiding situations which could potentially be distressing. Alcohol is to be avoided at all costs, as are any form of recreational drugs. Pain medicine, such as paracetamol, may be advised, and applying an ice pack wrapped in a towel to the area affected may help to soothe swelling.
There is no consensus regarding a specific time of rest a patient must observe following a concussion prior to returning to play, however, it is vital to get clearance from a doctor beforehand.
Wearing the appropriate clothing, such as a protective cap, can help to prevent the extent of a head injury.
It can be tempting, especially for the super-competitive, to try and downplay the extent of head symptoms after a knock so that you can get back to the game as soon as possible, but this is probably the most dangerous thing you can do. Repeated undiagnosed concussions can be hugely detrimental to your long term health, so take every hard knock on the head seriously.
My Pre- and Post-Game Exercise Routine
What you do during your warmup, like just about everything else when it comes to sports and exercise, is down to you, your coach and your teammates. Everyone has a different opinion on how long you should do it for and which exercises are most beneficial.
I’m not saying that my routine is the most definitive and perfect warmup routine. However, it has served me pretty well during my twenty plus years playing rugby:
- I perform certain exercises almost every day. These include hamstring, thigh, back and groin stretches, and I’ll usually do these after I've been jogging or circuit training.
- On a match day our team goes through some basic handling exercises before doing some dynamic exercises to make sure the muscles are warm before our static stretching starts.
- We perform a warm down after the game, which is a gentle jog around the pitch followed by some gentle general stretches.