Rugby is well known for a high injury rate and this is mostly due to the physicality and contact nature of the sport, coupled with a lack of protective equipment! In most cases, the only protection a rugby player wears is shin pads and a gum shield, although shoulder padding and padded scrum caps are also available and permitted.
Common injuries include impact injuries such as AC joint separations and contusions. Injuries similar to other field sports such as soccer and hockey are also common. These include hamstring strains and ankle sprains due to bursts of speed and rapid changes in direction.
AC joint separations
AC joint separation or AC joint sprain is an injury to the ligament that holds the acromioclavicular joint together at the top of the shoulder. It is usually caused by fall onto an outstretched arm. A grade 1 sprain is very mild and a grade 6 injury would be very severe. Getting early treatment and support through taping is important to avoid long-term problems or shoulder deformity. The Symptoms include pain right at the end of the collarbone on the top of the shoulder. Initially, the pain may be widespread throughout the shoulder but become more localized to a bony point on the top of the shoulder later on. Read more on treatment for AC joint separation.
Shoulder dislocations are traumatic and painful, they are often caused in contact sports or from falling. The upper arm bone dislocates out of its normal position with significant damage to the surrounding soft tissues (muscles, tendons, and ligaments) If you suspect a shoulder dislocation you may require immediate medical attention. Rehabilitation is essential if the athlete is to avoid re-injuring the shoulder. Read more on treatment and rehabilitation for a dislocated shoulder.
A hamstring strain commonly knows as a pulled hamstring is a sudden sharp pain at the back of the thigh. Treatment for this injury involves immediate first aid of rest, ice, and compression followed by a full rehabilitation and exercise program. Symptoms of a hamstring strain include pains whilst sprinting or a fast stretching movement or high kick. The strains are graded 1, 2 or 3 depending on how bad they are. A grade 1 injury may only be a slight twinge whilst a grade 3 can result in the athlete being unable to walk with swelling and bruising developing soon after. Read more on treatment and rehabilitation for hamstring strains.
A sprained ankle is one of the most common sports injuries and is also the most frequently re-injured. In the majority of cases, the ankle rolls inwards (inversion) under the weight of the rest of the body, resulting in damage to the ligaments on the outside of the ankle. Pain is usually felt around the ankle joint itself although more specifically on the outside of the ankle where the damaged ligaments are located. Swelling or bruising may present immediately or may take up to 48 hours to develop (depending on the types of structures damaged and the severity of the sprain). Read more on sprained ankle treatment.
Should I seek professional treatment?
If you have any of the following symptoms you should seek further medical assistance.
- Severe pain, especially on walking
- Severe swelling (oedema)
- Altered sensation in the foot – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anaesthesia).
- Unable to complete normal daily activities after the initial 72 hours.
Further medical assistance can be sought through either your local GP or a private clinician such as a podiatrist, physiotherapist, sports therapist, osteopath or chiropractor. If you have followed the P.R.I.C.E. principles (see below) and are still unable to walk after 72 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment.
Secondly, if you have applied for P.R.I.C.E. principles and still have weakness that lasts a long time (more than 2 weeks) or have ongoing discomfort in your foot or heel, you are highly recommended to seek advice from a specialist expert - such as a podiatrist or physiotherapist, osteopath, or chiropractor - who can provide you with advice and an appropriate and effective recovery and rehabilitation program.
Immediate first aid for acute injuries
The PRICE principles are the gold standard set for treating acute sports injuries. The acronym stands for Protection, Rest, Ice, Compression and Elevation and should be applied as early as possible and continued for at least the first 24-72 hours.
Protection of the damaged tissue is vital to prevent further damage and enable the healing process to start efficiently and effectively. There are a number of ways to protect the injured area all with the same aim of limiting further movement and use of the joint/muscle/ligament/tendon. One way this can be achieved is by using a support or splint.
In the early stages, rest is one of the most important components of the P.R.I.C.E principle but is often neglected or ignored. It does not only refer to the prolonged period of time that the athlete will be out of action but also to the immediate period after the injury.
An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.
If an injury is sustained during sporting activity some athletes have a tendency to 'run it off'. This implies that by continuing to participate in the exercise, the injury will simply go away. In fact, in the majority of cases, this is not true and is not advisable.
Ice therapy, also known as cryotherapy, is one of the most widely known and used treatment modalities for acute sports injuries. It is cheap, easy to use and requires very little time to or expertise to prepare.
The application of ice to an injury, in the acute phase, can substantially decrease the extent of the damage. It achieves this in a number of different ways:
Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction).
Reduces pain (pain gate theory)
Reduces muscle spasm
Reduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism
Ice is usually applied to the injured site by means of a bag filled with crushed ice which is wrapped in a damp towel. The damp towel is essential as it forms a barrier between the bag of ice and the skin and reduces the risk of an “ice burn”. DO NOT leave the ice on for more than 15 minutes as you could cause an “ice burn”.
There are a small number of areas that you should not apply ice to which include the neck, the outside bone of the elbow, the collarbone (upper end), the front of the hip (bony part) and the outer bone of the knee. The reason for this is there is a superficial nerve just below the skin in these areas that can be damaged by applying ice to it. Always check for contraindications.
Applying compression to an injured area minimises the amount of swelling that forms after an injury in two ways and should be applied for the first 24 to 72 hours from the onset of injury. Compression can be applied through a number of methods. The most effective of these is by using a compression bandage which is an elasticated bandage that simply fits around the affected limb.
Elevation of the injured limb is the final principle of PRICE but is equally as important as the other 4. Elevation allows gravity to drain the fluid away from the injured site. This aids in decreasing the swelling which in turn may decrease the pain associated with the oedema (swelling).
Read more on PRICE principles
Preventing Rugby injuries
Due to the contact and aggressive style of rugby, many injuries are acute, traumatic injuries and as such are difficult to prevent. Other injuries such as hamstring strains can be prevented by ensuring correct warm-up, strengthening and flexibility programs are followed.
Warming up is often overlooked but should be part of your injury prevention routine. A good warm will:
- Increase the temperature of muscles - they work better at a temperature of 40 degrees.
- Increase blood flow and oxygen to muscles.
- Increase the speed of nerve impulses - making you faster.
- Increase range of motion at joints reducing the risk of tearing muscles and ligaments
Warm up will not only help avoid injury but will also improve performance.
A warm-up should consist of:
- A gentle pulse raiser for 5-10 minutes to circulate blood and oxygen supplying the muscles with more energy to work with. Jogging, skipping and cycling are all acceptable forms of warm-up.
- Stretching to increase the range of motion at joints. Emphasis should be placed on stretching the muscles of the legs and lower back and shoulders.
This is also often overlooked in favor of sitting down and resting, or even heading to the bar! However, it can help avoid injuries and boost performance. The aim of the cooldown is to:
- Gradually lower heart rate.
- Circulate blood and oxygen to muscles, restoring them to the condition they were in before exercise.
- Remove waste products such as lactic acid.
- Reduce the risk of muscle soreness.
The cooldown should consist of a period of light cardio work, such as jogging or walking, followed by stretching.
There are many types of protective clothing which can be worn for rugby. These include:
- Gum shields (mouth guards)
- Scrum caps
- Shoulder pads
- Shin pads (guards)
Each player has their preferences as to which equipment they wear and this is also position dependent. For example, those involved in a scrum are more likely to wear a scrum cap to help prevent concussion and to reduce the 'cauliflower ear' effect!
Getting a regular sports massage can flush the muscles of waste products and release tight knots, lumps, and bumps in muscles that if left may cause strains and tears. It is possible for a good sports massage therapist to identify potential trouble spots long before they become injuries.
Nutrition, Hydration Injury
Proper nutrition is important. A bad diet will prevent you from recovering from training sessions making you more prone to injury. A balanced diet is what you should aim for:
- Carbohydrate is important for refueling muscles.
- Protein rebuilds muscles.
- If you become dehydrated then less blood will flow through muscles. The muscles will be more prone to injury.
- Vitamins and minerals are required for a number of reasons related to recovery.
Much of what is discussed above should be part of your sporting routine. A biomechanical analysis can help identify possible injury risks. Assessment from a sports therapist or specialist can identify weak areas and possible injury risks. A course of exercises specific to your needs can give you the best chance of avoiding injury.
Not allowing your body to recover properly from training will eventually result in injury. Your body needs time to rebuild itself stronger before the next training session. Remember - you are not training when you are training, you are training when you recover! Sleep is also an important part of your training. If you are not getting enough, get it sorted.
In the event that a sports injury does occur, having a sports insurance policy will mean you are covered for costs of treatment and lost earning!