Rugby injuries from the perspective of a Sports Chiropractor
Match play injuries – By injury and position
I hope your enjoying this series of articles on rugby from the perspective of a sports chiropractor. This article will specifically look at match play injuries by injury and position. So are you still sticking with your top 5 complaints of Lower back pain, Calf pain, Shoulder pain, Knee pain or Neck pain? Perhaps heel pain or sciatica are starting to creep into your top 5. The most common injury within rugby union may surprise you, its not the first one that came to my mind but makes sense.
The nature of rugby injury is somewhat consistent throughout the literature. The most common areas of injury in order of frequency are the lower limb, the head, face or neck, the torso and the upper limb, with the majority of injuries consisting of sprains, strains or contusions (Fuller and Taylor 2011, Chalmers, Samaranayaka et al. 2012) (Yard and Comstock 2006). This is consistent with what I see I see in my sports chiropractic practice.
Contact at the tackle was the most common cause of injury, with the head being the most common site (Quarrie and Hopkins 2008, Bleakley, Tully et al. 2011). Ball carriers were at most risk with tackles to the head-neck region, whereas tacklers were most at risk when making low tackles (Quarrie and Hopkins 2008).
With collision events during match play, head or facial fracture were common; at lineout time neck pain and lower back pain complaints were common; around the maul, knee pain and foot/ankle ligament injury were common and at ruck time calf muscle haematoma and foot/ankle ligament injury were common. Scrum injuries often resulted in calf muscle strain or lower back pain involving the lumbar discs, and at the tackle, shoulder pain from ligament injury, concussion, thigh muscle haematoma and knee pain from ligament injury were common (Fuller, Brooks et al. 2007) (Fuller, Raftery et al. 2009).
The lower limb, joint and/or ligamentous injury were the most common site and type of match injury (Fuller, Taylor et al. 2010) (Fuller, Clarke et al. 2010) of which joint and/or ligamentous injury had a significantly higher severity (Brooks, Fuller et al. 2005).
Thigh haematomas were the most common injury for forwards and backs followed by hamstring strains, knee pain from ligament injury, ankle pain from lateral ligament injury, concussion and calf muscle injuries (Brooks, Fuller et al. 2005) (England Rugby Premiership Injury and Training Audit Steering group 2012) (Fuller and Taylor 2011).
Hamstring injuries for backs caused the greatest number of days absence (Brooks, Fuller et al. 2005) and was amongst the most common recurrent match injuries alongside knee cartilage, cervical root injury, calf injury and ankle sprain (Fuller, Laborde et al. 2008). This was consistent throughout provincial, super rugby and international levels (Fuller, Raftery et al. 2009). Quarrie and Hopkins, 2008 identified an important mechanism of lower limb injuries was loading of weight of another player immediately prior to injury (Quarrie and Hopkins 2008). Sports chiropractors can be very effective in the treatment of hamstring injuries both recurrent and acute. The unique treatment approach is focused on unloading the hamstring muscles by treating surrounding areas and locally treating the site of injury to promote effective healing of damaged tissue.
Knee pain for forwards often involved anterior cruciate ligament injuries (Brooks, Fuller et al. 2005) which can result in more than 84 days absence from play (England Rugby Premiership Injury and Training Audit Steering group 2012). Orchard found a strong relationship between ACL injuries and playing on hard surfaces and suggested a focus on modification of the playing surface rather than the athletes shoe or boot (Orchard 2002). Fuller et al, 2010 found that the incidence of anterior cruciate ligament injuries was nearly four times higher on artificial turf than grass (Fuller, Clarke et al. 2010).
To make this article a little easier to digest, I will continue the rest of my findings around match play injuries in the next article.
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. (2010). “Risk of injury associated with rugby union played on artificial turf.” Journal of Sports Sciences 28(5): 563-570.
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. and A. Taylor (2011). IRB Injury Surveillance Study: U-20 Tournaments: JWC and JWRT 2011, International Rugby Board.
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.
Orchard, J. (2002). “Is There a Relationship Between Ground and Climatic Conditions and Injuries in Football?” Sports Medicine 32(7): 419-432.
Quarrie, K. L. and W. G. Hopkins (2008). “Tackle Injuries in Professional Rugby Union.” The American Journal of Sports Medicine 36(9): 1705-1716.
Yard, E. E. and R. D. Comstock (2006). “Injuries Sustained by Rugby Players Presenting to United States Emergency Departments, 1978 Through 2004.” Journal of Athletic Training 41(3): 325-331.