Snap, Crackle & Pop! No, this is not a blog endorsing Kellogg’s Rice Krispies, but in fact the words every Sports Physiotherapist fear hearing when one of the team describes their injury! It’s a tough old sport Rugby, but no doubt about it, every man and his dog will be gripped by what promises to be another stellar Rugby World Cup this Autumn. What should make this tournament particularly mystical is the host country of Japan, with plenty of wasabi, cherry blossom and geisha’s on show.
Whether you are a rugby stalwart, just a fan of big tournaments or (like my wife) only watches because of the muscular thighs and unapologetically tight shorts, this RWC promises to be a cracker! For me, I’m hooked when the first Haka’s issued by the mighty New Zealand All Blacks, “Ka ma-te! Ka ma-te Ka ora! Ka ora” to sum up the translation: “It is death! It is death! It is life! It is life!
Let’s consider what potentially awaits the RWC 2019 Players and, as the un-quintessentially rugby looking men PJ & Duncan said, “Let’s get ready to rumble!”
With big hits, full speed collisions and rather muscular players diving for each other, concussion is a challenging area of the game to regulate! Protocols in recent years have become much more stringent to reduce the long-term effects of head injuries, including the chance for medical staff to watch pitch-side replays of head injuries retrospectively and pull a player off to complete an assessment. For me it’s not about taking risks or pretending that bravery is admirable with this type of injury. If a 20 stone prop has just landed on your head, let’s get you off the pitch, into the changing room and work with the Sports Doctors to assess whether it’s safe to continue.
This World Cup has issued concussion guidance, stating any player that demonstrates “behavioral changes”, appears “Unsteady of feet” or has been “Lying motionless on ground” needs a formal assessment. To be fair, most people who enjoy a beer or ten in club house, appear like this anyway! In all seriousness, the frustrating short-term outcome of concussion is that it can be two weeks before a player is fit to return and, in a tournament, this could be 3 – 4 games out!
1. Menezes, J. (2019). Six Nations: Tom Curry brushes aside his Terry Butcher- like war wounds to give England its bite back
Well Brian Habana, the former Springbok winger, once raced against a Jet at Manston Airport in Kent — and won! The quick players, typically wingers, are known less for their studious pre-match preparation but more for ensuring their leg hair is waxed, the fade is fresh and the boots are fluorescent! So, with the speedsters of the games out to carve up tired defences in the hot & humid environment of Japan, one thing is for sure, some poor soul will go down mid sprint like a sniper has shot him in the back of leg!
From a diagnostic point of view hamstring injuries, getting a player off the field as soon as possible is essential, quick imaging (typically MRI) is a must but sadly a twanged hammy is notoriously difficult to clear up quickly. A bad strain can take 6 – 12 weeks to resolve. This can instantly cause a player to be sent home enabling a healthy replacement to get integrated into the squad quickly. For this, my top tips are: always stay hydrated with plenty of fluid and electrolytes, use a post-match Game Ready (ice machine) and maintain general mobility.
2. Stafford, I, (2008). Jason Robinson: I played in the World Cup final despite the pain from my secret injury.
Micky “the Munch” Skinner, who’s favourite phrase “BOOOSH!” alongside some big tackles made him a legend in the 1980’s. Those big tackles are often what draws so many new fans to rugby.
Sadly, when the players get shirty, the big hits start arriving and terrible bone injuries can occur! It’s not hard to see a player who has fractured something like an ankle, hand or nose; they can’t move it, don’t like putting weight on the region, it is often accompanied by severe swelling and, in the case of the nose, is gushing claret everywhere.
If it’s a nose, cheekbone, eye socket players will likely play on but with something like an ankle it’s time for them to sink a cold beer because they will play no further part for 4 – 8 weeks! As a sports physio, the most important thing is: stabilise the affected area quickly. Then let them enjoy the green whistle (pain relief), arrange medical imaging & search your phone for the best orthopaedic surgeon you can find.
3. Noone,R. (2014) Sam Burgess was brave but playing on in NRL Grand Final victory posed little risk of further damage.
#4 Anterior Cruciate Ligament (ACL) rupture.
Any player that has done their ACL will know just how painful this injury can be. It has a prolonged recovery period with evidence showing that those who unfortunately suffer this injury will be lucky to return between 6 – 12 months.
It’s the athletes that show a bit of flare, a goose-step, pivoting, darting through defensive gaps that will often hear the dulcet tones of an ACL snapping. Some of the literature that looks at why rupture rates are more prevalent in different populations is interesting; including stating that higher rates of rupture are found in professional female athletes when menstruating. Elite female tandem cyclist are often placed on the contraceptive pill to synchronise the athlete’s menstrual cycle around key events/competitions.
The early phases of ACL rehab are all about restoring range, reducing swelling and controlling pain but the big milestones are returning to running, change of direction and progressing back to contact. For most Physiotherapists it’s about slowing the athlete down and keeping them chipper during a long period of rehabilitation. One thing is for sure, if people don’t incorporate change of direction into their training in general are more likely to be injured.
4. Hansen (2019) Steve Hansen stated on Sport 24 that “He could be out for eight to nine months”
#5 Rib cartilage
This is one of those injuries that doesn’t sound like much but are incredibly painful. The rib cage of a professional rugby player can look like a dodgy xylophone and, when an opposition player is hit hard enough, can create as many noises. Tackling rules have changed in recent years to reduce the volume of head injuries, however it is still perfectly legal to deliver a direct blow with a shoulder (as long as arms look like they are attempting to wrap) into someone else’s ribcage – ouch!
Breathing becomes strained, the pain is initially searing and trying to exercise for a few days after is quite a challenge. The general rules, if the ribs aren’t broken, are plenty of pain relief before the game, create a padding that protects the region and clench your teeth when you sneeze or cough, because it’s going to hurt!
5. Bidwell, H. (2016) Hurricanes coaches unable to confirm severity of Dane Coles’ rib injury.
Here at Pure Sports Medicine you don’t have to look far to find rugby expertise at anyone of our practices. Whether you want Sports Doctor, Dr James Thing (Matchday physio for Harlequins) to ultra sound your dodgy tendon, Andy Reay Strength & Conditioning coach (Head of S&C at PSM and formerly of Rosslyn Park R.F.C) to plan your pre-season preparation, Hayley Hopkins a Soft Tissue Therapist of ours (Canada Men’s Rugby Team) to soothe your twanged hammy or Dr Simon Lack, Physiotherapist (Otago rugby 7’s) to approximate your bad shoulder, we got it covered!
My personal area of enjoyment is, returning injured patients to play by creating rehabilitation programs that delve into fixing movement-based anxieties; so feel free to get in touch with any of our clinics or clinicians, to aid your rugby needs.