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RUGBY INJURIES: INITIAL MANAGEMENT

Rugby union is fast, exciting, and brutal. A contact sport which has frequent high impact collisions involving multiple players each game. These high impact collisions often lead to player injuries and time off in rehab, away from the field(1).

About 50% of players at the elite level in super rugby can be expected to miss time on the rugby field in each season. With almost a third of players expected to have an injury resulting in more than 8 days of time loss, and 1 in 8 players will miss more than 28 days of rugby with a severe injury(1). Player injuries negatively impact the player but also reduce a team’s chance of success(2).

So, it is important to know how to manage injuries as soon as they occur. Effective rehab starts from the first hour after an injury. Players and their medical staff can reduce the number of days a player is out injured by managing the first 72 hours of a player’s injury properly.

The first step to recovering from an injury is to first show it PEACE & LOVE(3).

PEACE

Protect the site of pain from further injury:

  • Let the injury site settle for 48-72 hours. This is the inflammatory window, which is a good thing! Inflammation is how the body heals; we do not want to stop it!

Elevate the limb above the heart:

  • After injuries to the extremities especially e.g., hands and feet, we need to elevate the limb above the heart so that the limb can drain unwanted swelling.
  • Do this every hour if possible, to reduce pain and swelling.

Anti-Inflammatories stop taking them early on:

  • Do not take anti-inflammatory soon after an injury, paracetamol is a much better option which provides the same amount of pain relief.
  • Ice…. ice in theory stops inflammation which, as we covered, is a good thing. If you however feel quite sore and paracetamol is not helping as much as you would like. Ice, for most joint sprain and muscle strains, can be a good source of pain relief(4).

Compression does no harm, may reduce swelling:

  • Compression can help reduce swelling and does no harm to the body, a good option for any acute injury.

Educate Trust the body, it knows what it is doing:

  • Everyone is somewhat of an expert with their own body. But do not over medicate yourself and use every tool proposed to you on the internet. E.g., tens, Thera gun, shakti matts, crystals…. The human body has survived for a long time without help, it for the most part knows what it is doing.

LOVE

Load it/ Use it: Start moving as your body allows you to, but do not overdo it.

  • During the first 48-72 hours and beyond, keep moving and keep using your body. Let your symptoms i.e., pain guide you in what is good and what is not. You can also train around your injury. Take a leg injury for example; you can still use your upper body and your opposite leg. Doing nothing will lead to the rest of your body de-training.
  • Keep walking on it/using it as much as you are able. Only use it as your symptoms allow. I suggest pain that settles quickly less than <1hr is ok.

Optimism: Pain is not just physical, stay mentally stimulated and in a positive mindset, be positive, have a good relationship with your injury.

  • Injuries are a chance to work on strength weaknesses, skills, hobbies etc. your body is taking a time out, do not let the brain think negatively. ALL pain is an experience and if we let it be a very nasty experience it is likely to be a rough time out mentally and physically for an athlete.

Vascularization: Blood flow is good, do cardio that does not affect the limb to promote more of it.

  • Blood flow is GOOD! Pain free cardio will promote blood flow to the injured tissues and help with healing.

Exercise: When able we need to start actively rehabilitating the injured body part as symptoms allow.

  • When your symptoms allow start to restore mobility, strength, and proprioception to the area. Be active in your recovery, lying on the couch for the entirety of an injury is NOT the way to get back on the field faster.

In short, we need to be more active in our own rehab after an injury and we need to give our body more credit, it knows what it is doing. Once the pain is gone however the injury is not ‘over’. As the biggest predictor of a future injury is a previous injury(5). Athletes need to strengthen the injury back pre-injury status and, in most cases, STRONGER than before they were injured to protect themselves from further injury.

By Alex Holland (M.Phty, B.Phty)

APA Sports & Exercise Physiotherapist

Axe Physio Director

References

  1.  Schwellnus MP, Jordaan E, Janse Van Rensburg C, et al. Match injury incidence during the Super Rugby tournament is high: A prospective cohort study over five seasons involving 93 641 player-hours. Br J Sports Med. 2019;53(10). doi:10.1136/bjsports-2018-099105
  2.  Drew MK, Raysmith BP, Charlton PC. Injuries impair the chance of successful performance by sportspeople: A systematic review. Br J Sports Med. 2017;51(16). doi:10.1136/bjsports-2016-096731
  3.  Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2). doi:10.1136/bjsports-2019-101253
  4.  Hung KKC, Graham CA, Lo RSL, et al. Oral paracetamol and/or ibuprofen for treating pain after soft tissue injuries: Single centre double-blind, randomised controlled clinical trial. PLoS One. 2018;13(2). doi:10.1371/journal.pone.0192043
  5.  Hewett TE. Prediction of future injury in sport: Primary and secondary anterior cruciate ligament injury risk and return to sport as a model. J Orthop Sports Phys Ther. 2017;47(4). doi:10.2519/jospt.2017.0603