RUGBY INJURIES Tackles are

responsible for 58% of all

rugby injuries, mostly strains and sprains (41%) and haematomas (26%)

injury rate in tackler and ball carrier. The differential in speed appears as one of the decisive factors in determining which play- er is injured with the slower moving player being the more likely to come off worst from the encounter.

Rucking and mauling When a player has been tackled it is not uncommon for either a ruck or a maul to form. Clearly in this situation there is great potential for contact injuries to occur. Because of the dynamic and variable nature of the ruck and maul there is relatively little scientific data available to describe the loading involved.

Physiologically it is clear that these activities represent periods of high intensity, relatively static muscular contraction and thus will inevitably lead to the accumulation of lactic acid and muscular fatigue. Blood lactate levels, recorded during breaks in play, have been seen to be as high as 9.8mmol. As a consequence, when the play demands the repeated formation of rucks and mauls over sev- eral phases of play, in close sequence, there will be an inevitable decrease in the ability of the muscle to sustain high levels of force. Therefore the resistance to destabilising forces will be reduced and injury more likely.

Open play/running Analysis of the work rates in rugby indicate that the game is made up from intermittent periods of high intensity efforts lasting between 5 and 15 seconds followed by recovery periods of less than 40 seconds. During the course of a game players may cover between 5 and 10 km with about a third each made up from walk- ing, jogging and sprinting.

Running in rugby is rarely in straight lines as players make rapid changes in direction and speed to avoid tackles and to support other players. Therefore players require great strength and power in the abductor and rotator muscles of the hip to facilitate such changes. There is also a greater demand for joint stabilisation in the lower limb with large rotational forces transmitted through the knee and ankle joints. Non-contact injuries to the ankle and knee ligaments are not uncommon, particularly if the grip between the studded boot and the ground is excessive.

Kicking The ball may be kicked either from hand in open play or from the ground in set pieces. Kicking involves the sequential recruitment of the trunk, hip and then knee joints in a ballistic, open chain movement. To start the motion the kicking leg is drawn backwards with exter- nal rotation of the supporting leg, hip extension and external rotation and knee flexion in the kicking limb. The initial drawing

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back of the leg sets up the stretch-shortening cycle (SSC) and facilitates the achievement of greater muscular forces in the for- ward swing of the limb.

As the leg starts to swing forwards the supporting leg starts to internally rotate pulling the pelvis forwards on the kicking side. This motion is accompanied by the rapid flexion of the hip whilst the knee remains flexed. As the thigh reaches maximum velocity the knee starts to extend, initially with a concentric contraction of the quadriceps but, towards the end of the motion, it is con- trolled by eccentric action in the hamstrings. After contact the hip continues to flex with the knee relatively extended placing the hamstrings and lower back under strain. Eccentric action of ham- strings and gluteals is necessary to control this motion and return the limb to a less stressful position.

This gives us an overview of the key aspects of the game and the likely risk factors for injury. What then can be done to protect players from injury and ensure that after injury they are ready to return to play as soon as possible?

THE PHYSIOTHERAPIST’S ROLE Before we can focus on specific injuries in any sport it is important to reflect on the available resources and the management strategies employed. In an ideal world the best doctors, physiotherapists and massage practitioners would be readily available. However, in our less than ideal world we must consider how best to treat, manage and support the individual on limited equipment and budgets.

The management of resources, whether human or material, relies on information gathered over a period of time. It is by using this data that strategies can be designed to deal with those injuries that occur regularly and plan for the more serious injuries which present only occasionally. In any sport, collecting and or having access to relevant information, collected over a period of time can greatly assist in the decision making process. This helps focus on prevention of injury.

Detailed information relating to an individual’s, health and fitness status prior to injury can greatly assist in the rehabilitation of an individual post injury. Detailed questionnaires given at the time a player joins a club, together with basic fitness tests and skill assessment, can identify early potential problems. If resources allow, further biomechanical assessment and movement analysis can provide an invaluable profile of an individual. By identifying early an individual area of weakness, training can be tailored to include specific exercise needed to address the problems. Regular testing could then be used to monitor changes in a person’s fit-

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