INJURY PREVENTION

ness status allowing training/competitive phases to be adjusted to avoid the preventable problems. In many sports the information or accepted norms already exist allowing players at all levels to understand the requirements of a particular position at every stage of development and ‘age’ in relation to sports specific experience.

Once there is a clear understanding of the sport, position and individuals’s needs then the right ‘person(s)’ can be identified. In many cases the expertise lies within the rugby club’s network of coaches and medical personnel. It is important that each practi- tioner recognises their limitations and adheres to their scope of practise. Working closely with others allows not only information and expertise to be shared but a co-ordinated strategy to be developed. This will lead to an individual receiving the best treat- ment, management and advice.

It should also be appreciated that however prepared an individual is, accidents and injuries will still occur. In my experience, the management in the period immediately after an injury occurs, very often determines the long-term outcome. The more serious an injury is, often the better it is managed, while injuries of a less severe nature have poorer management which as a consequence impinges on the individual for longer. This quite often then leads to time not only away from training and competition but also from the work place.

There are five main skills/actions in rugby, which present the potential for injury. They are: ■ Scrummaging ■ Tackling ■ Rucking/mauling ■ Open play/running ■ Kicking

It is usually the rugby club physiotherapist who is expected to orchestrate the other practitioners or appear in the ‘all singing all dancing’ role. Recognising the worst and best scenarios of any structural/soft tissue injury/problem (no inflammatory process but recognisable imbalance issues) allows us to manage both the human and disposable resources more effectively. ‘Prevention is better than the cure’ is a well known phrase to us all and rolls off the tongue. In reality the balance of care deals with those who have sustained an injury (inflammatory process present) and only looks to address the issues of muscle imbalance and lack of core stability afterwards.

The most common injuries associated with scrummaging include spinal compressions and degenerative changes; in tackling the injuries tend to include skin lacerations, haematomas, sprains and strains while in open play, problems include muscle fatigue, cramp, and muscle strains.

The expertise with which each of the above is dealt with relies on the experience of the practitioner(s) involved. Continuing profes- sional development is essential not necessarily for the purpose of acquiring evidence-based practice but for the reality of practice- based evidence. For example the PRICE pneumonic is known to all in sport and for the majority of minor soft tissue injuries is the management undertaken. How this is applied varies dramatically - often the role of ice (finding it and applying it) becomes such a

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40% of injuries occur in the last quarter of the match, indicating the importance of fatigue as a predisposing factor.

focus that in my opinion, the application of compression is either delayed or overlooked. This then results in a greater effusion and the potential for more scar tissue which in turn leads to a greater chance of the remodelling process being delayed and/or inappropriate.

Another example might be the expertise required managing par- tial thickness lacerations. Many individuals wish to continue therefore, cleaning the area and use of butterfly dressings, steri- strips and or suturing is a skilled job if infection, poor union or unnecessary scarring is to be avoided. The management of cramp often leads to muscle fibre damage when inappropriate stretching is applied instead of inducing ‘letting go’ through appropriate application of compressions/pressure techniques. The above are all common problems, the management of which should constant- ly be revisited to hone skills which will result in the individuals returning to their activities in a shorter time frame.

As stated before more serious injuries such as spinal and fracture dislocations type injuries are often managed more appropriately as training in the use of spinal boards and inflatable splints are revisited on a regular basis.

In conclusion, as practitioners in the field of sport, it is our duty to constantly look at what constitutes best practice within the resource restraints placed upon us.

THE AUTHORS ■ Dr Neil Fowler, principal lecturer in sport and exercise biome- chanics at Manchester Metropolitan University and lecturer to University of Bath’s MSc in Sport and Exercise Medicine for Doctors.

Viv Lancey is a chartered physiotherapist and author of diploma in sports massage OCR award. Viv has been physiotherapist to many sports over the last 20 years including athletics, netball and rugby. Until February 2003 she was the provider of sports medicine services to the Sports Council for Wales.

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