It’s common knowledge that with rugby comes injuries. This is due to its inherently physical nature of play. This blog covers common injuries, injury prevention and safe play, injury recovery and delves deeper into concussion looking at causes, how to recognise it and signs to look out for.
Common rugby injuries
The list of common injuries is long, however below lists the most common ones:
- Concussions: these are very frequent in rugby due to the games’ high impact nature. Research shows that concussions are particularly prevalent, with them being one of the highest incidence rates among team sports.
- “Stingers”: these are an intense and painful neurological event that is usually one sided due to an acute traumatic nerve compression to the upper roots or trunk of the brachial plexus.
- Muscle Strains: hamstring and calf in the lower body and biceps along with pec strains are the most common in rugby, due to explosive movements, abrupt stops and sprinting during the game.
- Ligament Sprains: these happen regularly- especially to the knees and ankles as they are constantly under a lot of load.
- Dislocations and Fractures: most common are shoulder dislocations, along with clavicle and rib fractures (or rib injuries in general). This again is due to the rough nature of rugby. Recovery periods are long, and some may require surgery.
- Lacerations: due to the physical nature of rugby, cuts and lacerations are very common- and even though not as serious as other injuries, some may require a hospital visit due to the size/depth of the cut.
- Overuse injuries: tendinopathies can occur in rugby due to the repetitive nature of the sport, along with some adhering to a grueling schedule of training and games.
- Acromioclavicular Joint injuries: these can range from minor sprains to severe separations. Due to falling/being tackled to the ground and either falling onto the shoulder or being hit on the shoulder itself.
Injury prevention strategies and promoting safe play
Although not a lot can be done to prevent injuries in rugby due to the physical nature of the game, some things can be done. The main ones are wearing protective gear and education. Protective gear includes mouthguards, shoulder pads and scrum hats, plus any strapping/ taping to required areas. Education starts with technique. Educating the players on not only the correct techniques on how to tackle or for scrummaging, but also how to fall correctly- although not always controllable. Education on the importance of how the players’ bodies feel too. If injuries are ignored and not treated properly then this can lead to long term injuries/ retirement from the game. Activation and warmup techniques are also highly important prior to a game of rugby. Activation of the muscles to get them firing and ready to work aids in helping reduce the risk of injuries as everything is ready to go.
Injury Recovery and Reducing the risk of injury
The risk of injury is ever-present and affects all players at all levels. Recovering from injury fully and taking the time to recover/ treat said injury is as important if not more important than anything. If not, then the risk of re-injury or lingering injuries is high. Here are some tips in reducing this risk:
- Understanding common injuries: the list of common injuries is long, however with having a clear understanding of what the common injuries are then reduction and recovery strategies are clear.
- Technique: tackling, falling, scrummaging or even ball handling skills are crucial in aiding reduction of injuries.
- Gym work:
- Strength and Conditioning: rugby players are only getting bigger and stronger, therefore, building muscle and maintaining strength through S&C will help with the challenges of a bigger opposition. Weight training as well as impact work and mimicking movement patterns of your position will help on the pitch.
- Flexibility and Mobility: no matter what your size, age, weight or standard, F&M are a crucial part of rugby due to some of the unnatural positions you may find yourselves in. The stretchier you can be, the easier it is for your muscles to adapt to excess movement and help prevent injury.
- Rest and Recovery: rest and recovery are highly important in preventing injuries. The more rest and good sleep you have along with recovery techniques like foam rolling/ massage or a hot bath the better.
- Nutrition and Hydration: due to the guiling load the body undertakes during a game, adequate energy through hydration and nutrition restoration is important in recovery.
- Protective gear: while the gear is not full protection, it still aids in the reduction of injury as it will add a protective layer and absorb some of the force that has been put on the body.
- Communication: this is key. Building a good report with coaches/ staff through communication helps players voice their concerns/ their injuries. In return early intervention of an injury helps tackle it head on and aids in reducing recovery time.
- Concussion management: the education and understanding signs and symptoms of a concussion and knowing what to do when a suspected concussion occurs.
Concussion
At all levels of rugby, concussion is a heavy but highly important topic. Most head injuries are mild and non-serious; however, concussions should be treated as a serious head injury and you should always take the approach of ‘if in doubt, sit them out’.
What is a concussion?
Concussion is a traumatic brain injury resulting in a disruption of brain function. It affects players in different ways but mainly affects the way players think, feel and remembering things. It can also be very hard to differentiate between a concussion and a more serious injury- such as bleeding on the brain.
Causes
It can be caused by a direct blow to the head or from when other parts of the body have been hit by a high force causing rapid movement of the neck/head- e.g. whiplash type motion.
How to recognise it
Noticing a head impact or visible clues of a concussion can be difficult in a fast moving and high impact sport such as rugby. Responsibility falls on everyone at the game- referee, coaches, players, spectators- to recognise or look out for players with suspected concussion and should be removed from the pitch immediately. If continuation of play is made with a suspected concussion, then it may lead to worsening the concussion which leads to longer recovery periods or worst-case scenario death- known as second impact syndrome.
Signs and symptoms
Although not all concussions are visible, signs and symptoms linked to it are categorised into four main areas. The four main areas that concussion affects player in are;
- Physical; e.g. headaches, dizziness or vision changes
- Mental processing; e.g. no clear thoughts or the feeling of slowed down
- Mood; e.g. emotional, short tempered, sad or just ‘not them selves’
- Sleep; e.g. not being able to sleep or sleeping more than usual.
The loss of consciousness only occurs in less than 10% of concussions and is not required to be diagnosed with concussion. However, it is important to note that if any player has had any loss of consciousness because of a head injury then they have had a concussion.
The onset of symptoms varies. They typically occur immediately or within minutes of the head injury, but some may experience delayed symptoms and appear 24-48 hours following the head injury. Additional symptoms may also occur several days after the incident too.
If any signs or symptoms are reported or detected, then urgent intervention should be taken place. This is by either an appropriate onsite health care professional or in a hospital accident and emergency department.
Visible signs include:
- Loss of consciousness or loss of responsiveness
- Lying motionless/slow to get up
- Loss of balance, coordination or unsteady on their feet
- Dazed, blank or vacant look
- Slow to respond to commands/questions
- Confused
- Holding their head
- Tonic posture: lying rigid, motionless due to muscle spasm
- More emotional or irritable for that player
- Vomiting
- Severe neck pain
Symptoms of concussion after the event:
- Disorientated
- Amnesia
- Headache
- Dizziness/loss of balance
- Confusion/slowed down/mental clouding
- Drowsy/feeling like in a ‘fog’/difficulty concentrating
- Visual problems
- Nausea
- Fatigue
- Pressure in head
- Sensitivity to light or sound
- More emotional
What to do if concussion is suspected:
- Immediate remove from play – ‘If in doubt, sit them out’. Once the player has been removed from play then a return to the pitch should not be taken place until the player has been seen by an appropriate health care professional and completed a Scat 6/return to play protocol. If an onsite healthcare professional is not available, then call NHS on 111 within the first 24 hrs. of the incident and they will advise.
- Rest and Sleep: as much as needed is good within the first 24-48 hours as it is good for recovery. However, players should not be left alone for the first 24 hours post injury.
- Limiting screen time – phones, TV or computers – for at least 48 hours post injury.
- No driving or operating motor vehicles for the first 24 hours as it increases brain activity.
- No consuming alcohol for the first 24 hours and/or symptoms persists
- Informing work/school or other sports clubs
Return to play protocol:
- Stage 1: Recovery and Rest – 24-48 hours
- Stage 2: Return to life activities – 48 hours – day 7
- Stage 3: Return to light aerobic exercise – from day 8
- Stage 4: Return to non-contact training – from day 10
- Stage 5: Return to contact training – from day 15
- Stage 6: Return to match play – from day 21
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