Injury prevention and rugby

"We had a lot of bad luck this season, without so many injuries we had won the title". How wrong such an approach is. Rugby is a collision sport and injuries are a part of it. However, there is now more focus on preventing injuries (read this news flash on injuries). It is our task as coaches to prepare players physically and technically in order to prevent injuries. Some of the points I focus on:

• Make players fitter, like strong core muscles provide protection against back injuries (Core Stability).
• A good technique beats any protective shoulder pad, reach out before contact and the shoulder muscles will move on top of your shoulder .
• Make players more mobile and increase their flexibility.
• Have real ‘live’ training sessions, there is a place for contact pads / suits, but also do without.
• Finish sessions with little, close contact games. Three team, play two min. games and rotate.
• Keep a close eye on your players, give them a rest if they seem tired.
• Pay attention to your players, injuries might be a negative way of getting attention.
• Have some ground rules on how you handle injured players. Injured on Friday, no game on Sunday (don't believe in miraculous recoveries). When is an injured player declared "recovered"?

Don de Winter has a good article on injury prevention. I have summarized his views below. You can also download his article in .pdf format.

I have found that the mental aspects of the recovering process are equally important. Karlene Sugarman, Sport Psychologist, wrote an article on this aspect.

Because the focus it received Don has added a special article on concussions. Again, with lots of practical tips for us coaches with (too) little medical background.

Injury Prevention

The Don de Winter article focuses on the following topics:

• The concept of injury prevention
• How to avoid injuries
• Warming-up and cooling-down
• Overview of preventive measurements

The concept of injury prevention

Avoid injuries, it can be divided on three levels :

• Avoid the possibility that injuries occur (primary prevention).
• Treat a injury the best possible way (secondary prevention), so that permanent damage does not occur.
• As good as possible after treatment of the injury (tertiary prevention), in such a way that an injury does not repeat itself.

The rugby trainer has the most important task concerning the primary prevention.   First aid is essential. The trainer must be aware that he could put the treated player too soon into the match.

When one wants to avoid injuries, one should know how injuries occur. The factors that create injuries can be divided into two groups: individual bound factors and environmental bound factors.

How To Avoid Injuries

Measurements are:

• Medical Sport tests
• Warming-up and cooling-down
• Technique, have a look at my rugby tackle page
• Revalidation
• Taping
• Rules
• The playing field
• Sports gear
• Education
• First aid

Warming-up

The warming-up has 3 functions.

1. The rugby player performs better after a warming-up because of the elasticity of his muscles is higher.
2. He prepares himself physiologically AND mentally for the training or the game.
3. A good warming-up reduces the risks of injuries.

An active warming-up can be divided in 3 stages :

1. Getting on temperature,
2. Muscle loosening and dynamic stretching exercises, (I use the Dynamic Flex method from SAQ)
3. Specific rugby warming-up is with coordination exercises, for 5 - 10 minutes.

I have set up a special page on warming up and included some running technique drills.

Cooling down

Cooling-down is in fact the opposite to the warming-up: like the body adjusts slowly from a rest position into a strained position, so it gradually needs to return from a strained position into a rest position. A cooling-down should consists of :

• Easy run in a slower pace, a calm jog, varied with hopping passes. The SAQ Dynamic Flex routines
• Sway with the legs calmly. Do this for 3 - 5 minutes.
• Quiet and easy exercises at the spot. This is in principle in motion with gravity.
• For instance bending forwards with the torso (trunk) and dangling the Shaking the legs or let the legs be shaken.
• Stretching exercises.
• Warm shower followed by a short, cold shower.
• (Books tell me: "Eventually a massage", yeah right! Not at the clubs I trained......)

Motorial characteristics and youth

The age of the boys and girls determines the topics that make up your training.

Overview of preventive measures

Summarized from an article from Don de Winter, M.D. sport physician and formerly involved with the Dutch Rugby Union. You can download the article in pdf format.

ACC Sport Smart Injury Prevention Program

Ken Quarrie, Injury Prevention Manager with the NZRFU brought the ACC website to my attention. It has a large amount of injury prevention material for rugby. "It's all about lifting team performance by ensuring players are physically and technically at their peak before they put their bodies on the line."

"Rugby Smart is based around ACC Sport Smart, the 10-point plan for sports injury prevention. It's a comprehensive approach that is about keeping players where coaches and supporters want them on the field!"

The programs 10 points look a lot at the points Don made above and cover:

1. Screening
2. Warm-up/cool-down and stretch
3. Physical conditioning
4. Technique
5. Fair play
6. Protective equipment
7. Hydration and nutrition
8. Injury surveillance
9. Environmental factors
10. Injury management

Check the program out on their ACC Think Safe website.

Rehabilitation

Your player has treated his injury, doctor and physio told him he is fit but is he ready to play .......? No, most medical organizations set up their rehab programs for patient to take part in normal daily life. Not players take part in rugby matches!
You need to close that gap and perhaps work with a physio to make the players ready. If your club has a physio, try to get him involved into this. Things to remember while setting up a recovery program for rugby is:

• Reduced intensity
• In contact situation, have as much control on the situation. Take another player with a sound tackle technique, etc.
• The player needs to learn to concentrate again
• He will have lost his leg speed and agility
• A returning player will have had a lot of attention, suddenly he is one of the team again. You should be aware of this happening!

This is one of the main reasons for doing regular fitness testing. You can evaluate the return to fitness of an individual player and decide if he is fit enough to play.