The most common injuries in Rugby Union involve the soft tissues.  These include the ligaments that hold joints together, tendons that attach muscles onto bones and the muscles themselves.  There are many ways they can be injured, especially in contact sports and the degree of injury is often considered as mild, moderate or severe.  A direct knock or bang on a muscle may cause mild damage where the muscle will still contract and support weight or a moderate problem where there would be some loss of power and difficulties weight bearing.  If a muscle were to be over stretched or strained this may also result in mild or moderate damage or there may be complete rupture within the muscle belly or tendon in severe cases.  With these it is not possible to bring about any movement in the direction the muscle would normally move a joint.  There are specific tests that a qualified medical practitioner would initially carry out but confirmation would need tests such as ultrasound or MRI scan.

Mild ligament sprains might cause some limping initially or soreness at the end of a movement and there may be some swelling but moderate injuries would restrict what the joint normally does and there will be significant swelling and possibly some bruising.  In severe cases the joint will be unstable if a ligament is ruptured and again diagnostic tests from hospital would be necessary.

What should we do if there is a bang or a sprain that is causing some pain and swelling?

The PRICE  regime should be followed for mild to moderate injuries. 

P – Protection

R – Rest

I – Ice

C – Compression

E – Elevation

Bandages or tape can be used to protect the injury from further damage, although not always necessary.  Rest may limit the pain and swelling but it is a good idea to keep the joint moving as much as pain allows.  Ice can be as simple as a bag of frozen peas wrapped in a damp cloth to avoid an ice burn.  The skin under an ice pack should go evenly red and not have white patches in it and certainly no ice formation!  This can be applied for up to 20 minutes but lifted up every five minutes to check the skin.  Crepe, cohesive or elasticated bandages will apply Compression.   The bandage should reach from the joint below to the joint above the injured area, not just around the joint itself as this will just restrict blood flow and congest the swelling.

To assist with PRICE clubs can invest in a small amount of wool and crepe bandage (the roll of wool goes under the crepe to provide padded compression.  More common now is the use of cohesive bandages, which are slightly elastic and stick to themselves but not to the skin.  These are better than tubular bandages which are the same size top to bottom, unlike the average rugby player’s leg.

Ice has always been most cheaply applied by ice cubes in a food bag and often held in place with cling film wrap.  Sealed gel packs that can be frozen before a game and taken in a cool box can be used if access to ice cubes is a problem.  The cold from these is better than the instant packs you “crack” to activate and much cheaper as they can be reused once they have had a wash.  As with all ice applications the skin should be protected from the ice pack burning. 

More effective are cold compression units where there is a bucket you fill up with iced water and a cuff to wrap around the joint which is then filled with the iced water by elevating the bucket.  This is kept cold by running the water back out of the cuff and refilling every so often.  The pressure from the water also applies a nice even pressure around the injured area  but they are more expensive as the cuffs are for individual joints.  The results however are worth the investment even if a club just had the common joint cuffs such as the ankle and knee (You only need one bucket as it clips off from the cuff).  There are now versions where you chill the cuff liner and inflate the cuff.  Although the liner will eventually warm up they are quite cold even out of the fridge!  These are particularly good for home use if you have got an injury.

All this matters because in the first 48 hours you are trying to control the amount of swelling and bleeding that is going on around the injury.  Mild swelling is actually delivering the ingredients the body needs to repair the injury but you can have too much of a good thing!  The positive side of swelling is one of the reasons  why research is suggesting that anti-inflammatories such as Ibuprofen are not given in the first 3 days.  Pain relief from paracetamol (if there is no sensitivity or allergy) will not hinder this process in these first couple of days.

Once the “stuff” is delivered the body sets to over the next few days, trying to lay down new fibres to repair the damage.  The body needs reminding at this stage which direction it is best to lay these fibres in so moving and weight bearing through the injured joint will create forces in the direction which the repairs should be made.  

Once these fibres are in place the speed and loading of the joint or muscle can increase, then skill drills added and return to play.

The full soft tissue healing process always takes at least six weeks but how long away from training and playing will depend on the extent of the injury. 

Finally if you are unsure of how much damage has been sustained consulting a physio or other medical practitioner is essential.  These guidelines will help you understand the advice you may be given but cannot replace their assessment.  

 Lisa