Injury prevention in Rugby has become much more important as the collisions get bigger and harder. At some point in our life, we will spend time away from work for approximately two to six months nursing a serious injury. We can imagine what the statistics say about Rugby players; many players will spend a good part of their career on the side-lines. Sometimes we are considered unlucky or lucky. Often it is our own negligence of doing the prehab/rehab work. As rugby players, we often leave out the smaller more difficult exercises to compensate for the lack of time, energy and inability to complete the exercise.
We managed to catch up with our friend and physiotherapist Damian Banks to ask him some key questions around medical negligence and injury prevention. We got to understand a new perspective of care and for that we are grateful.
What are the most common injuries in Rugby?
There is always a slight variance year by year, and team by team but there are still injuries you see every year.
Ankle sprains would still be number one overall. We see more high ankle sprains now than we used to about 5-10 years ago. This can be due to several factors. For example, changes in footwear, changes in playing surface, changes in game plan/tackling technique, more footwork pre-contact of the attacking player. Bigger players who are more powerful = greater forces on ligaments and joints. Better awareness from medical staff and greater diagnostic abilities.
A concussion is an interesting injury which is a lot higher on the list now than it used to be. Probably because everyone is more aware of it, particularly players and coaches. The nature of the game and the increasing forces at play.
Shoulders are often injured, but there are a lot of different injuries that occur. Rotator cuff sprains, internal impingement, labral tears and AC joint sprains (a common one).
Soft tissue strains are one you need to know how to deal with, but to be honest we don’t have too many of these anymore as these are the one area where you can have real effect with injury prevention and monitoring.
How does this change according to playing position?
Loose Head Prop – Cervical disc & nerve root injuries
Hooker – Rotator cuff injuries in the shoulder
Tight Head Prop – Achilles tendon injuries & Lumbar Spine/disc injuries
Locks – Lateral Ligament ankle sprains
Flanker – Hamstring injuries and ankle injuries
Number 8 – Bicep and Wrist injuries
Scrum-half – lumbar disc injuries and soft tissue injuries
Fly-half – Hamstring and groin injuries
Centre – Concussion, dislocations and lower leg fractures
Winger – Thigh Hematomas
Fullback – Groins Injuries, chest and sternum injuries
What are the best exercises for injury prevention in Rugby?
Single leg standing with eyes shut. Hands down the best drill for ankle sprains and preventing occurrences. Build up from 20 seconds to one-minute holds. To progress use a Bosu half swiss ball or wobble board/cushion.
The second-best exercise at the moment is a banded lunge. Using an elastic band just above the ankle joint pulling backward. Then lunge forward over the foot to help to regain dorsi-flexion range after stiffness which can be caused by surgery or wearing moon boots etc.
Single leg exercises (leg press, squat, lunge). Following injury, strengthening up again using two legs often just causes your good leg to get stronger – so you need to work the one leg by itself. In terms of prevention, with UNINJURED KNEES then bounding drills are good for stability.
Isometric squeeze with a ball between knees and again with a ball between ankles. 30 second holds, 5 to 6 of each. Hip mobility exercises and stretches are extremely important as well.
Scapula stability exercises – mostly retraction type exercises. If unsure where to go from here – just start with seated row and lat pull down type activities to try and get the balance back from everything that causes rounded shoulders. This can be caused by players doing too much bench press but in general everything in life is done in front of us. We reach for things, keyboards, phones, tablets etc – so all this time our pecs are shortened and our scap retractors are stretched.
Core strength and ability to activate your core is important. Start with static drills like the plank but progress to more functional exercises with movement and rotation as this is what happens in the game. We try to avoid general sit ups as it works mostly the rectus abdominous (the six-pack muscle). This looks good but is poor for spinal stability as it is a “global muscle” rather than a local muscle. This basically means that when it contracts it causes uncontrolled movement of the spine, whereas the smaller fiddlier muscles attach to each individual spinal segment so when they work, they stabilise the spinal column.
Too many sit-ups mean you become dominant in the global muscles and de-trained in the stabilisers – as a generalisation.
What are the common mistakes made by Rugby players?
From a physiotherapist’s perspective, there is too much emphasis on traditional exercises such as bench press and squats. These are good exercises but there is not enough time spent on the little fiddly difficult drills. Sometimes we forget or just do not do the exercises that help with multi-directional movements and performance on the field. We often forget these exercises are important to keep our bodies performing at the highest level and decrease the risk of injury.
What happens at the end of the season with regards to Injury Prevention and Screening?
During our end of season review, we asked players how much time they spent on the prehab/movement prep movements. Almost all our players responded with: “definitely not enough” or “I knew I should but just didn’t”. A lot of players moan about the lack of time. If they have 60 minutes for a gym session, they will feel like that isn’t long enough to do it all. So the main lifts are prioritized. The fact is prehab and rehab exercises can often be done at home while watching television or after training.
Where are we weak or vulnerable to the risk of injury?
Hip stiffness is a very common issue that can raise its head as back pain while squatting. Or we see players are unable to complete tasks through the full range (squat, or scrum).
To be honest this is not necessarily dangerous – often needed to reduce range of squat if bony impingement is causing pain in deeper ranges. Often this stiffness is muscular and this may increase load into other areas, knees/ patella tendons, ankle/Achilles tendon and probably most likely, back and discs.
Active Recovery and Injury Prevention for Rugby
Going for a swim in the pool, walking in the pool and stretching in the pool. A good active recovery method to benefit your rugby. Simply getting on a spin bike and rolling the legs over can have massive benefits. Going for an easy walk can also be a no-brainer. When you have had a massive game sometimes you are so broken the pool is the only option.
What one piece of advice would you give to aspiring young Rugby players?
I’ve been involved in a lot of teams now. Almost all players want to make it to the next level. Whether that is a representative team or on their way to their ultimate goal of national team representation.
The few that succeed all have one thing in common. They aren’t the most talented or the best athlete (although that certainly helps) but they are the most professional. They are professional in everything they do.