Injuries in Contact Sports: Rugby and the FMS Approach
This past week I have seen 3 Rugby players of all ages, with all very unique goals and strengths stream into our clinic at Fit to Train Human Performance Systems. Each player shows some signs of dysfunction in movement that could potentially cause serious injury if not addressed, assessed and cleaned up. What I love about working with athletes is their drive and dedication to learn more about how to fine tune their mechanics for improved performance. More importantly, they are prepared with the mental fortitude to not look at weakness in the body as a negative, but to see it as an opportunity to mold, re pattern and adapt – to be stronger, fitter and more in tune with their surroundings.
Before, we move on to positional injuries, prevention and key pointers, let’s look at what’s happening on the fields of one of the world’s most sought after sports.
Rugby Canada Sevens and Canadian U20 Men’s Team Tryouts:
Perhaps it’s the anticipation of our very own Rugby Canada Team playing in round 5 next week in the Sevens World series against Kenya, or perhaps it’s the anticipation of who will play for our Canadian U20 Men’s Team. Whichever, it may be, fans are in a tizzy, eagerly waiting.
First round of try outs for the U20 team were held on January 24th, in Shawnigan Lake, at the Canadian Rugby Centre of Excellence. 44 players from across the country were asked to come out, and only 26 – 30 players will make the team.
Completing a large selection makes for difficult decisions by Head Coach Mike Shelley and his selection team. “We’re working towards cutting it down to the 26 players that we’ll be taking to Chile for the Junior World Trophy in Chile in late May, early June” said Shelley.
Rugby is one of the most popular sports in the world alongside soccer and cricket. Yes, it’s true now soccer in some countries is also considered football. So let’s say Rugby is one of the most popular sports in the world alongside, soccer, football and cricket and has been gaining popularity, with more than 80,000 players registered with USA Rugby, 20,000 of these players are high school age. In Canada over 73,000 players of all ages, with over 55,000 of those athletes in high school as well.
With so many young athletes; it makes sense to focus our attention on injury prevention before an injury occurs, does it not? Yet, so many teams still treat, rather than prevent. When a team mate has to sit on the sidelines – the whole team suffers.
Do Not Sit on the Sidelines:
Due to the high numbers of physical collisions and tackles, musculoskeletal injuries are common. Fractured bones, dislocated fingers and elbows, cuts, sprained ligaments and strained tendons or muscles and deep muscle bruises. Let us not forget to mention elbows to the nose, cracked ribs, torn ACL/ MCL and of course bruised egos.
In a literature review for the BokSmart Program of SA Rugby, Murphy (2009) (Rugby Safety Program in South Africa) mentions that the lower limb is most prone to injury in the professional leagues. The National Center for Biotechnology Information (2004) mentions that the majority of studies have shown that the head and neck is the most common site of match injuries in senior rugby league players, while knee injuries are the most common site of injury in junior rugby league players.
The review goes on to cite a fairly recent South African based study done where the hip and pelvis accounted for 19% of all injuries and the knee followed as the second most commonly injured area, at 13 %.
Positions Play a Factor:
From a positional perspective it seems that its dependant on the country we look at for review. In Australia, Murphy (2009), mentions that the scrumhalf is least at risk of injury overall, even though The locks are at greatest risk of facial cuts and cauliflower ear (external deformity to the ear caused by repeated blows).
A study conducted in Scotland in 2012 found that the majority of injuries were in the backline, with the wing sustaining most of the injuries at 21.6% and the centre next at 18.9%. In Argentina, the flanker, at 16%, is injured the most. They also found that 53.3% of all injuries sustained by the forwards were specifically to the front row forwards. Forwards are more frequently injured than backs because of their greater involvement in physical collisions and tackles.
These studies didn’t showcase players in rucks and mauls, but these injuries commonly occur to fingers and thumbs as well as abrasions and lacerations from cleats.
Stages of Injury: Pre-Season vs In-Season
The majority of training injuries occur in the early stages of the season, while match injuries occur in the latter stages of the season, suggesting that changes in training and playing intensity may influence the incidence of injury in rugby league.
Rugby demands the running and endurance of soccer combined with the contact and tackling that is similar to football. With running and fast cutting there is the potential for overuse injuries like tendinitis and bursitis. More common, however are traumatic injuries sustained during collisions with other players and/or the ground during scrumming, rucking, and tackling.
Prevention is Key:
Speaking of the U20, there is no one better to talk with than Coach Chamberlain. A UBC Thunderbird Alumni, and CFL vet, Mr. Bill Chamberlain coaches (and teachers) with Saint Georges High School in Vancouver; one of the most prestigious private schools known for cultivating and grooming leaders in our athletic community (Rugby being one of them).
Coach Chambo (as he’s called by his players) says, “Common injuries tend to be shoulders, hamstring pulls, knees, but lately its been hip stuff, “ says Coach Chamberlain.
When asked about the gaps in conditioning that may lead to injury he says; “the gap for me (as a Coach) is that the kids are working out more now and earlier on now. They have access to more then we ever did as far as how to get bigger, faster, and stronger but the gap for me seems to be in the flexibility area. Flexibility needs to be emphasized way more. But I am certainly not and expert. Try convincing teenagers to put down the biceps curls and squats and do more yoga…… That’s the tough part.”
Coach Chamberlain is right! Flexibility ….more so mobility… needs to play a larger part in our young players up and comers success.
Let’s Narrow the Playing Field to the Hips and the Spine:
After researching most common injuries and prevention techniques on how to prevent hip and spinal injuries, I found that the majority of articles out there was focused on traditional strength training and isolation exercises to..let’s say… “strengthening the lower back.” If it’s tight or hurts that must mean it’s weak right? Wrong!
One of the benefits to coaching the FMS systems and using this approach of screening, assessment and corrective intervention is that we focus on training movement patterns to not only identify dysfunctional movement and compensation in the body, but to also address the compensation patterns to “why” the injury occurred, what else has shifted in the body and how to clean up the pain and structural trauma, but also ensure the injury is not repeated.
When we look at the statistics of what positions have higher rates of injury we can also deduce how the injury most likely occurred. If the player can recollect the incident then we can also simulate and take into account the approximate angle, velocity, torque, and to a degree determine the undue stress placed upon the other structures and surrounding tissue. This, in its own right will have a compensation pattern that needs to be taken into account when treating a player for an acute injury.
Let’s review the “strength the lower back” again..
Training Isolation vs. Movement:
When I come across articles mentioning: “to reduce back injuries in Rugby and contact sports: strengthen the lower back,” I immediately ask why and how? I also ask what is the state of the other joints? The hips? The knees? How about the T spine? What about core stability? Yes, I said it – Core Stability.
Most Rugby players that are fit can plank for an hour. I could do push-ups on their back for an hour and they will plank like a champ, but does this mean that when they stand up, brace when running at top speed, cutting in and out, and then rotate to block (or take a block) of an opponent that their core will fire appropriately and be able to take on the rotational load without straining their back? My point is – we are not just talking about the back. We need to take a step back from the Kinesiology 101 class and see the body as a moving machine, not an isolated series of nuts, bolts and chains.
Isolating the lower back will not always deter injury. If it isn’t weak and you strengthen it more, you reduce the mobility and the joints above and below it will also have to either become more mobile and thus unstable. We must ensure we look at the whole picture.
Prevention of Back and Spinal Injuries in Rugby:
The lumbo-pelvic region of the hip complex sits at the cross roads of mechanical stress. Lack of motor control and instability can be replaced by generalized stiffness as a survival strategy, giving it the feeling of “weakness.”
Moving farther down the Rugby rabbit hole; ribs, vertebrae, and lots of muscle and fascia crisscrossing the front and the back of the thorax cause thoracic stiffness. Now, we don’t necessarily need a lot of mobility there, but in contact sports we want as much as we can get so that we have the elasticity of tissue to take on force. The low back or thoracolumbar fascia need to be stiff because it protects our organs. The back body most often takes the hit, as the anterior body braces for impact or pushing through.
Apart from your thoraco-lumbar fascia, this also connects to your lower limb mechanics, via the glutes and hamstrings. The hamstrings are called bi-articular muscles because they cross both the hip and knee joints. This is an important consideration because a hamstring injury can affect your hips, low back, knees, and the motion patterns of the entire lower extremity. Adductor pulls and groin pulls are also common in rotational injuries. If we consider fascial connections (posterior line), we will see that a hamstring injury can affect a very large area and vice versa. If you have a back injury it can pull on this entire line and place undue stress on your anterior line AND your spiral line (one of the lines that support rotation).
This is why, I say strengthening the back or isolated exercises will not allow the athlete to properly prevent injuries from re occurring, and it rarely fixes the problem. What I do, is look at the most asymmetrical movements and apply that to the acute injury.
In our case we are talking about the spine and lower back. Therefore, when I assess my clients who specifically play contact sports, I pay close attention to the following:
1. ASLR, and ask if it’s asymmetrical (1/3 or even even 2’s) I then break it down, is it a mobility issue or is it motor control? We are talking hamstring, hip flexors and quads, femoral movement in the hip socket, lumbo pelvic stability and trunk engagement.
2. Shoulder Mobility, most often there will be an asymmetry because of ball handling, bracing, protecting and repeated game dependent movement patterns
3. Core stability in movement and assess breathing mechanics in a range of positions. Notice I did not say the Trunk Stability Push Up Test (TSPU), primitive position (prone) showcases just the trunk in a “plank” variation. This does not always show true weakness. When we apply the load of gravity in standing and in movement, start to notice if the athlete can properly engage and balance intra abdominal pressure. Do they understand the mechanics of breath and integration of the nervous system etc?
Contact sports will incur injuries – that’s a fact, and we ladies love a good scrimmage. Ensuring you prevent injuries means taking a preventative approach and learning as much as you can about your own unique mechanics before injury occurs. If you are at the high school level, you are in the prime time developmental stages of grooming your performance, so hit all the angles, not just the heavy loads and pushing weight. Understanding that muscle length, muscle and fascia tensegrity and elasticity will help you absorb force and re bound out of tackle quicker and more safely. Any type of “flexibility training” or “mobility” training needs to be unique for you. Yoga for Contact Sports… I may even start a class.
If you are currently treating an injury, ensure your health professional is not just treating the pain, but also taking into account compensations and screening for dysfunction.
The best way to prevent an injury is to be pro active:
- Practice a balanced and structured training regimen involving strength, flexibility and endurance not just in season, but post season.
- Seek advice on corrective movement and get screened pre, during and post season.
- Always use proper technique when tackling, rucking and scrumming.
- Learn proper positioning during game play to minimize risky moves and anticipate your opponent.
- Use a quality, properly fitted mouth guard.
- Participate at a level consistent with ability.
- Adhering to the rules for the formation of the scrum, no showboating.
- Ask your athletic trainer/coach or other sports medicine professional about any training or injury questions. We like to give you lots of freebie information.
Watch the next Rugby Canada Sevens game Feb 08th in Las Vegas against Kenya. Happy Scrumming!
- Rugby Canada – www.rugbycanada.ca
- Saint Georges High School – Rugby