Rugby injuries from the perspective of a Sports Chiropractor
Match play injuries – By injury and position part 2
This article is a follow up to the previous match play injury article looking at. Those who thought lower back pain, calf pain, shoulder pain, knee pain, neck pain and hamstring injuries would feature heavily in the literature were right. Sciatica, Hip pain and heel pain, not so much. Lets pick up where we left off in looking at injury tendencies by position and location.
During matches, lower limb injuries sustained by backs were significantly more likely to occur to their non-dominant side as was the case with upper limb match injuries (Fuller, Laborde et al. 2008) and an early season bias was identified with lower limb injuries (Alsop, Morrison et al. 2005). The rate of lower limb fractures was reported as being higher on firm or hard pitches than on heavy or slippery pitches (Lee and Garraway 2000).
Brooks et al, 2005 and Bleakley et al, 2011 reported a significantly higher severity for upper limb injuries when compared to trunk and head or neck pain complaints, (Brooks, Fuller et al. 2005, Bleakley, Tully et al. 2011). Severity of fractures and/or bone stress injuries was significantly higher than that of all other pathologies (Brooks, Fuller et al. 2005) (Fuller, Taylor et al. 2010). The highest incidence of concussion was 3.3 concussions in 1000 playing hours with no catastrophic injuries reported. (Bleakley, Tully et al. 2011)
Injuries leading to retirement included neck pain from cervical disc prolapse, often resulting from a collapsed scrum or maul and cervical nerve root compression (England Rugby Premiership Injury and Training Audit Steering group 2012).
Contact mechanisms account for 72% of rugby injuries, (Brooks, Fuller et al. 2005) (Fuller and Taylor 2011) with non-contact injuries accounting for 27.2% (Fuller and Taylor 2011). Collisions were 70% more likely to result in an injury than a tackle, and scrums carried a 60% greater risk of injury than a tackle (Fuller, Brooks et al. 2007). The majority of match injuries were acute (93%) and resulted from contact (78%) events, being tackled (34%) or running (22%) mechanisms (Fuller, Taylor et al. 2010).
The Tackle is the most common contact event throughout the course of a rugby match and is responsible for the highest number of injuries and the greatest loss of time through injury (Fuller, Brooks et al. 2007). Most injuries are sustained in the tackle during matches or in full-contact skills activities during a training session (Fuller, Laborde et al. 2008) (Fuller, Raftery et al. 2009). This is consistent with my experiences as a sports chiropractor.
Takarada suggested serious structural damage was done to the muscles of the neck and shoulders during tackling, the extent of damage being dependent on number of tackles completed during a match (Takarada 2003). I see and feel this in the rugby players I see that present with neck pain, mid back pain and/or shoulder pain. The treatment tools I use as a sports chiropractor are well equipped to help minimize the permanent damage to the soft tissue that can be caused by repeated contact in rugby.
Most injuries sustained from being tackled were from side on and head on tackles (Brooks, Fuller et al. 2005). High or middle tackles from the front or side were largely responsible for injury while being tackled, but rate of injury per tackle was higher for tackles from behind (Quarrie and Hopkins 2008). Most injuries sustained from tackling were caused by head on and side on tackles (Brooks, Fuller et al. 2005).
Foul play was only implicated in 6% of injuries. (Brooks, Fuller et al. 2005) however was associated with an 87% higher risk in injury (Chalmers, Samaranayaka et al. 2012).
Incidence for contact injuries was higher for forwards when compared to backs. The ruck and maul being responsible for the most injuries to forwards whereas being tackled caused the most injuries to backs (Brooks, Fuller et al. 2005). Scrummaging injuries accounted for 11% of injuries to forwards, but only a small proportion of these were caused by a collapsed scrum (Brooks, Fuller et al. 2005, Fuller, Brooks et al. 2007).
Again, being aware of the injuries sustained during match play and positional susceptibilities helps me in my role as a sports chiropractor but is also useful for players and coaches to focus more attention on training for prevention. The next few articles in this rugby injuries from the perspective of a sports chiropractor series will look at injuries sustained at training.
Alsop, J. C., et al. (2005). “Playing conditions, player preparation and rugby injury: a case-control study.” Journal of Science and Medicine in Sport 8(2): 171-180.
Bleakley, C., et al. (2011). “Epidemiology of Adolescent Rugby Injuries: A Systematic Review.” Journal of Athletic Training 46(5): 555-565
Brooks, J. H. M., et al. (2005). “Epidemiology of injuries in English professional rugby union: part 1 match injuries.” British Journal of Sports Medicine 39(10): 757-766.
Chalmers, D. J., et al. (2012). “Risk factors for injury in rugby union football in New Zealand: a cohort study.” British Journal of Sports Medicine 46(2): 95-102.
England Rugby Premiership Injury and Training Audit Steering group (2012). England Rugby Premiership injury and Training audit 2010-2011 season Report, England Rugby Union.
Fuller, C. and A. Taylor (2011). IRB Injury Surveillance Study, HSBC Sevens World Series 2010/11, International Rugby Board.
Fuller, C. W., et al. (2007). “Contact events in rugby union and their propensity to cause injury.” British Journal of Sports Medicine 41(12): 862-867.
Fuller, C. W., et al. (2008). “International Rugby Board Rugby World Cup 2007 injury surveillance study.” British Journal of Sports Medicine 42(6): 452-459.
Fuller, C. W., et al. (2009). “Match injuries in Southern Hemisphere professional rugby union: Impact of the International Rugby Board’s Experimental Law Variations.” South African Medical Journal 99(4).
Fuller, C. W., et al. (2010). “Epidemiological Study of Injuries in International Rugby Sevens.” Clinical Journal of Sport Medicine 20(3): 179-184 110.1097/JSM.1090b1013e3181df1091eea.
Lee, A. J. and W. M. Garraway (2000). “The influence of environmental factors on rugby football injuries. / Influence des facteurs environnementaux sur les blessures en rugby.” Journal of Sports Sciences 18(2): 91-95.
Quarrie, K. L. and W. G. Hopkins (2008). “Tackle Injuries in Professional Rugby Union.” The American Journal of Sports Medicine 36(9): 1705-1716
Takarada, Y. (2003). “Evaluation of muscle damage after a rugby match with special reference to tackle plays.” British Journal of Sports Medicine 37(5): 416-419.