Common Rugby Injuries and how to tackle them

Rugby is one of the most physically demanding sports, the intense physical requirements including speed, strength and contact make injuries inevitable to occur. Understanding how they happen is crucial for ensuring they receive optimal recovery and a safe return to play. The type of injuries seen varies across the different positions throughout a team. For example, a rugby team is split between forwards and backs, within these there are multiple different positions. Shoulder injuries and concussions are more often seen in forward positions, due to the nature of their position of being involved in tackles, mauls and scrums, whereas back positions such as scrum half and winger tend to have more lower limb injuries such as hamstring tears or ankle/knee ligament issues. Improper management of these injuries can set players back and prolong their recovery.

Concussions 

In the 2022/23 championship rugby season, concussions were the most common match injury sustained by professional rugby union players in England, with an incidence rate of 15.8 per 1,000 hours of playtime. When concussions aren’t managed properly, they can lead to a range of short and long-term issues, e.g., headaches, migraines, vision problems or pain in the upper neck (ref here). 

If you sustain a concussion, following a proper concussion protocol will ensure you are returning to activity at a safe pace and give you the best chance at not having recurrent symptoms. This protocol usually consists of a 12 day return in rugby, however this can be extended if symptoms persist. The protocol would be as follows;

Phase 1 (Days 1+2) Relative Rest -No activity within the first 48 hours -Try limit screen ime-keep bright lights and loud noises to a minimum

Phase 2 (Days 3+4) Aerobic Activity  2A- Light aerobic exercise up to 55% max HR , stationary cycling and walking (Day 3) 2B- Moderate activity up to 70% max HR, stationary cycling and walking (Day 4)

Phase 3 (Days 5+7) Sports Specific Exercise  -Running and change of direction can begin  -Individual training skills away from the team environment

Phase 4 (Days 8-10) Non contact training drills  -Non contact training in a team environment  -Can begin return to contact prep

Phase 5 (Day 11) Full contact -Player can complete full contact training

Phase 6 (Day 12) -Player can be available for selection

Shoulder Injuries 

The most relevant shoulder injuries in rugby consist of dislocations and acromioclavicular joint (ACJ) injuries. 

Dislocations- These can occur from a fall, tackling or a direct hit to the shoulder. Dislocations may be partial (sublaxation) or a full dislocation of the humeral head. In these cases, if a lot of force was involved, injury to the labrum may also occur

If you sustain a shoulder dislocation, ensuring the relocation of the shoulder is managed by healthcare professionals. The rehabilitation of this injury may include wearing a sling to support the shoulder joint. After this, rehabilitation that strengthens the shoulder should begin, there will be some limitations as to which position you put your shoulder, in order to project the joint as well as looking after it. Engaging in proper scapular mechanics and performing exercises aiding glenohumeral rhythm will help aid the recovery of the shoulder. 

ACJ– Injury to the AC joint usually results from a direct hit to the shoulder on or near the joint. Due to the location of the joint at the top of the shoulder, it is slightly more susceptible to injury. A fall on an outstretched arm can also cause injury to the AC. There can be various degrees of separation of the joint. 

Depending on the severity of the separation, the initial focus of your early rehabilitation should be regaining range of motion. Once this has reached a good level (determined by the supervising clinician), isometric strengthening can begin, there should be an initial focus on the internal and external rotational strength , then proceeding to posterior shoulder strength and eventually weight-bearing strength. When adequate strength has been achieved, early exposure to neuromuscular and plyometric exercises can challenge the athlete and ensure the shoulder is being sufficiently prepared for sport. At Nottingham physio, we can guide you through the entire rehabilitation process and give you full confidence that your shoulder is ready for sport. 

Knee Injuries 

In a sport that consists of so many fast paced movements with sharp cuts and turns, your knees are at risk for injury, specifically your ligaments. Injury to your cruciate (ACL+PCL) and collateral ligaments (MCL+LCL) and meniscus as well as your quad and patella tendons can occur. In rugby, the most commonly injured knee structure is the medial collateral ligament (MCL). 

MCL Injuries- The mechanism for an MCL injury can result from side tackles, where there is direct stress placed on the inside of the knee. A fall generated by force where the knee is in an exaggerated bent position can also result in injury to the ligament. The severity of the injury can range from a grade 1 injury where there is minimal disruption to the ligament, a few fibres may be torn, to a grade 3 where the ligament is fully ruptured and there is complete anatomical disruption. Luckily, the MCL has a greater blood supply compared to other ligaments, such as the ACL, therefore its capacity to deal with injury is much higher. Depending on the portion of the ligament injured, initial rehabilitation should include restoring quadriceps function and range of motion, especially knee flexion. Ensuring mobility is kept up alongside the knee exercises will help aid the recovery. As range of motion progresses, strengthening of the knee and restoring function can begin. Your rehabilitation should continually progress until you are back to full function with no pain or instability. Our knees carry us through our days; we should be doing everything we can to ensure they are functioning optimally. 

Hamstring Injuries  

Sustaining a hamstring injury can be due to a gradual stress on the muscle, decelerating at high speeds or extending the leg beyond its anatomical limits. These are relatively common in rugby, accounting for 15% of all injuries in rugby union. 

The rehabilitation process may look slightly different depending on which hamstring is injured and how severe the injury is. However, the recovery process is very similar and can be applied to most hamstring injuries. Once weight-bearing is allowed (advised by the supervising clinician), the initial goal should be restoring range of motion in a safe way. The slider and glider method is often used for early strengthening and allows you to develop the concentric and eccentric strength in the hamstring in a controlled manner. Once strength is restored, building endurance back into the muscle is extremely important, ensuring that the muscle tissue is not only strong but it can perform for longer periods of time and allows you to last longer on the pitch before fatigue sets in. 

Getting back to it

No matter what the sport, if you have sustained an injury, whether it’s playing rugby or any other sport. Getting a full assessment and a detailed well-structured rehabilitation plan will allow you to get back on track doing what you love, and we are here to support you every step of the way.

References 

World Rugby (2023). Concussion Guidance | World Rugby. [online] http://www.world.rugby. Available at: https://www.world.rugby/the-game/player-welfare/medical/concussion/concussion-guidelines.

Khan, A. (2020). Shoulder injuries in rugby. [online] @topdoctors_uk. Available at: https://www.topdoctors.co.uk/medical-articles/shoulder-injuries-in-rugby-treatment-to-get-you-playing-again/

http://www.nurokor.com. (n.d.). The most common rugby injuries, recovery time, treatment and tips | NuroKor BioElectronics. [online] Available at: https://www.nurokor.com/blog/most-common-rugby-injuries-recovery-time-treatment-and-tips.

Bangor University. (2023). Rugby World Cup: why hamstring injuries are so prevalent in the sport. [online] Available at: https://www.bangor.ac.uk/news/2023-09-06-rugby-world-cup-why-hamstring-injuries-are-so-prevalent-in-the-sport.