Rugby – Most Common Injuries seen by Physiotherapists
Rugby is a contact team sport, renowned for its action-packed and tough nature. The impacts that the bodies of rugby players are exposed to are immense. Powerful bodily contact is made during tackles, mauling, rucks and scrums, and players frequently collide with each other or with the ground. Not only do the players have to be able to withstand these hard blows, rugby also demands running and endurance ability. It is not surprising then, that injuries are very common in the sport of rugby.
What type of injuries can you get?
Most rugby injuries are traumatic on-field injuries. However, overuse injuries are also prevalent. Probably the most serious traumatic injury in rugby is a concussion.
Concussions usually happen when a player takes a blow to the head. The typical immediate indication that a player might have a concussion is confusion or disorientation. The player may also present with strange behaviour, unclear speech, reduced performance, and poor co-ordination. In severe cases, the player can lose consciousness. Other symptoms of concussion may only develop some time after the actual injury and include headache, dizziness, nausea, unsteadiness, vision problems, and ringing in the ears (tinnitus).
What should you do if you have a concussion?
A player suspected of having a concussion must be removed from the field immediately. They must be assessed by a qualified medical professional and monitored closely over the next 24 hours. The player should then remain out of play for a few days even a week and then gradually return to their sporting activities.
Most schools and professional rugby clubs in South Africa sent their players for the BoksSmart program in the beginning of the season. Players do cognitive tests pre-season. Whenever a player gets a concussion he or she needs to pass the cognitive test before they are aloud to play again. This system has proven to be very effective and it ensure safety of players.
Soft tissue injuries
Other common traumatic injuries that occur in the sport of rugby include soft tissue injuries, joint dislocations, fractures and lacerations. Soft tissue injuries can be muscle strains, tears and contusions, as well as ligament sprains or ruptures. All acute traumatic injuries need to be assessed immediately by the medical team, who will determine the severity of the injury and provide the appropriate immediate treatment. If the player’s injury necessitates further investigation, the team will refer them to a specialist. Once medical treatment has been provided, it is crucial that the player undergoes a comprehensive rehabilitation program.
Overuse injuries occur as a result of repetitive stresses and strains on various body structures. These repetitive minor stresses gradually damage or weaken the affected structures, increasing your risk of an acute injury in future. Pain caused by overuse injuries will come on gradually, and players often try to ignore it and “play it off” initially. However, if left untreated, overuse injuries can cause long-term problems. Failing to address overuse injuries early-on will mean longer recovery time and time out of play, and will put you at risk for recurring injury.
Below we will discuss some of the most common rugby injuries and how Just Physio can help you manage them.
The Rugby Shoulder
Rugby players take heavy blows to their shoulders. Tackling and landing manoeuvres account for most shoulder injuries.
A player can dislocate their shoulder, resulting in damage to the muscles and ligaments. A dislocated shoulder should be reduced, i.e. put back in place, as soon as possible to prevent further damage. Recurring shoulder instability is very common after a dislocation, and therefore optimal rehabilitation is crucial. Once your shoulder has been reduced, we will be able to provide you with pain relieving treatment if necessary. Then we will work through a comprehensive, personalised rehabilitation program with you to regain your shoulder stability and strength.
The rotator cuff consist of four muscles which work together to provide stability to your shoulder. These muscles can be strained or torn in acute events, but can also become dysfunctional over time (i.e. overuse injury) when subjected to repetitive, forceful movements.
Similarly, labrum injuries can be traumatic, causing sudden severe shoulder pain with an inability to move your shoulder through its full range, or it can develop over time with repetitive minor incidents tucking at it. Pain from a rotator cuff or labrum injury will present as deep shoulder pain that is worse when you try to use your arm. You may not be able to sleep on your shoulder and have pain at night.
Labrum and rotator cuff lesions may need to be repaired surgically but some may also respond well to conservative management through a progressive physiotherapy program. Recovery from these injuries takes time, and your commitment to your rehabilitation program will determine the success thereof. Shoulder stability training is key in the rehabilitation of shoulder injuries and we will tailor a program specifically for you to ensure that you achieve the best outcome.
Traction or compression nerve injuries
Traction or compression injuries to the shoulder can damage the nerves running from your neck into your arm. This typically happens during a tackle or making contact with the ground, where the player’s arm is outstretched and their head is forced in the opposite direction. This injury is often referred to as a “burner” or “stinger” because of the immediate electrical pain sensation that is felt down your arm. This sensation is only transient but your arm can feel numb, tingly and weak thereafter, the typical “dead arm”. In most cases, symptoms disappear quickly. However, in more severe injuries, it can take days. Treatment for nerve injuries will focus on symptom relief and regaining nerve integrity, as well as shoulder and neck mobility and strength.
AC Joint injuries
The small acromioclavicular (AC) joint at the tip of your shoulder is also often injured during rugby. Acute joint strains can occur, but repetitive strain can result in an overuse type injury. Pain will be felt at the tip of the shoulder with extreme overhead movements, or when the player’s arm is crossed over their chest. AC joint problems can be managed with physiotherapy treatment consisting of pain management, supportive taping, advice on activity modification and rest, as well as rehabilitation. In severe cases, the player may need to undergo surgery or immobilise their arm in a sling for a period of time after which the rehabilitation is crucial.
The Rugby Knee
Acute knee injuries typically happen when the player’s knee twists or takes a blow from the side while their foot remains fixed to the ground.
ACL and PCL Injuries
The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are located deep within the knee joint, and are crucial for knee stability. ACL injuries are much more common than PCL injuries. With an acute ACL injury, there will be a pop and the player will have severe knee pain. Because of the ACL’s location and very good blood supply, the knee will start to swell almost immediately. There will be marked instability of the knee, making it difficult to walk on the affected leg.
The PRICE protocol of injury management, which stands for Protection, Rest, Ice, Compression and Elevation, should be administered as soon as possible. This will help reduce the amount of bleeding into the joint, and control swelling and pain. Surgery is recommended for most acute ACL or PCL tears. Physiotherapy can help with the management of pain and swelling prior to surgery. It is critical that the player then follows a proper rehabilitation program, usually for 6 to 9 months, to ensure optimal recovery and safe return to sport.
The ACL or PCL can also be torn over time with repeated turning and twisting forces from playing rugby. Pain and swelling will build up gradually, and you might start to notice that your knee is less stable than before. Overuse injuries like this, or other minor incomplete tears, can repair without surgery as long as a highly structured rehabilitation program is followed. At Just Physio, we develop a personalised program for you, and guide you every step of the way to ensure optimal recovery.
MCL and LCL injuries
The other ligaments of the knee can also be sprained or torn. The medial collateral ligament (MCL) is located on the inner aspect of the knee, and the lateral collateral ligament (LCL) is on the outside. The MCL and LCL are smaller ligaments and can often recover without surgery. Our physiotherapy treatment will initially help reduce symptoms of pain and swelling, assist with protecting and resting the knee, and then follow a step-by-step mobility and strengthening program to regain your knee function.
Meniscus injuries often involve a twisting motion where the knee is bent. The knee has two menisci, which are C-shaped cartilage discs laying on the top part of the shin bone (tibia). The menisci cushion the knee joint as you walk or run and help to disperse the weight to protect your knee joint. Injury to the meniscus might not be very painful or cause swelling, since the menisci do not have very good blood supply. You may only notice some vague pain and a gradual build-up of swelling. Other symptoms of meniscus injury include tenderness over the joint line, knee stiffness, locking or instability. You may also hear a clunking sound when moving your knee or walking up and down stairs.
Severe acute meniscus injuries can be surgically repaired. However, others recover well with a structured rehabilitation program. Meniscus damage can also occur over time with the repeated stresses applied to the knee during the game, causing wear and tear of the joint. Physiotherapy treatment of such injuries involve the management of pain and swelling, regaining knee mobility and then improving muscle strength and knee stability. At Just Physio we will assess the extent of your injury and develop a treatment program specifically for you. We continuously monitor your symptoms and progress as necessary to ensure that we always achieve the best results.
The Rugby Thigh
Rugby players take a lot of strain on their legs. They are tackled and stepped on by other players. Rugby players also power through their leg muscles during scrums, rucks and kicking actions.
The quadriceps muscles, which are the muscles at the front of the thigh, are prone to muscle strains and contusions. Similarly, the hamstring muscle group at the back of the thigh can be injured.
A muscle strain happens when the force applied to the muscle is greater than what it can withstand, resulting in torn muscle fibres. An acute strain typically happens when the muscle contracts while being in an overstretched position such as when kicking, quickly stopping or changing direction.
Muscle strains are graded from 1 to 3.
- Grade 1 strains are when minimal muscle fibres are damaged, causing mild pain or discomfort. The player will most likely be able to continue playing but start experiencing a mild ache and tightness in the thigh after the game.
- Grade 2 strains involve more muscle fibres and will cause sudden, sharp pain that stops the player from continuing play. There will be swelling and bruising in the area of the muscle strain. Moving the affected leg through full range will be painful and the player might struggle to walk.
- Grade 3 strains involve severe muscle fibre damage causing intense pain, immediate swelling and the inability to walk on the affected leg. There will be considerable bruising and limited leg movement within a few hours after the time of injury.
Acute muscle strains require immediate medical attention to prevent further muscle damage. Immediate management should follow the PRICE protocol of protection, rest, ice, compression and elevation. This will reduce the amount of bleeding and inflammation and thus relieve pain and control the swelling.
Physiotherapy treatment for pain and swelling can be commenced immediately. Following a short period of rest, an active rehabilitation program needs to be followed to regain mobility and strength of the injured area. Depending on the severity of the muscle strain, we will start with stretching and strengthening exercises as part of your program. Over time, as healing occurs, we will introduce balance and sport-specific training into your routine.
Repetitive muscle overload can also result in muscle strain over time. Treatment for overuse type muscle strains will also focus on symptom relief initially, but then include active rehabilitation. This will include full body conditioning.
Hard blows to the thigh can also rupture the muscle fibres and cause deep muscle bruising known as a contusion. Contusions cause bleeding in and around the muscle. If a contusion is not treated timeously, it can result in complications such as compartment syndrome or myositis ossificans.
Muscle contusions are graded as mild, moderate or severe. Symptoms are sometimes negligible initially but pain, swelling, bruising and stiffness will develop over time.
Non-steroidal anti-inflammatory medications are often prescribed to control the inflammation and bleeding within the muscle tissue. Physiotherapy treatment including cold therapy, soft tissue massage, ultrasound and electrical stimulation will also help. As healing occurs, we will also progress to more active therapy including range-of-motion and strengthening exercises, stretches, balance and sport-specific exercises.
Of course, ankle sprains and injuries to the calf or other muscles also occur often in rugby. Please see our website for more information on how we treat these areas.
If you suffered a rugby injury, please give us a call to help you recover to your best ability!
Written By: Marelize Grobler