Rugby Smart
Injury Management
Get yourself in working order
Injury management involves identifying, treating and recovering from an injury. Players who return to play before they have fully recovered end up missing about three times as much play as they would have if they had completely healed before resuming play.
Phases of injury management:
Sideline Concussion Check
Ask your coach or RDO for this great little resource that fits into your wallet.
Who takes responsibility in your team if there’s a serious injury?
Each team needs to appoint a person, present at the match, who is responsible for the immediate management of injured players. Preferably the same person should complete and return any serious injury report forms to their Provincial Union.
Phase 1 – Acute
There are a few basic things that you can make sure happen immediately after an injury has occurred - this is called the immediate phase. Coaches and players should be 100% familiar with these procedures.
Suspected spinal injury
In the event of a suspected spinal or other serious injury:
GET HELP FIRST, and GET IT FAST
1) Call 111 for an Ambulance
Don’t move the player until qualified medical personnel arrive! A player may have suffered a severe neck injury, and yet still be able to move. If the spine is unstable, and they are moved, they run the risk of permanent paralysis. Referees and coaches should err on the side of caution and seek medical assistance in the event of any potentially serious injury.
Concussion
- Concussion is the most common head injury in rugby and is caused by a temporary disturbance in brain function due to trauma.
- Concussion can occur following sudden violent movement of the head, usually in a tackle or collision. Most damage is caused by rotation and acceleration (e.g., spinning of the head caused by a blow to the side of the head).
- Concussion may occur with or without loss of consciousness.
- The IRB have regulated that a player who is concussed must not play or practise for a period of three weeks after they were concussed. After this period the player may only resume participation when they are symptom free and have received a medical clearance. The coach should sight the medical clearance before permitting the player to take part in training and play.
- Concussion is under-reported in rugby – players, coaches (and parents) are often either unaware of the serious nature of concussion, or unwilling to allow players enough time to properly recover.
Concussion is a process not an event. Not all head injuries that occur in rugby are concussions.
If you suspect a concussion has occurred remove the player from the field immediately. Have the player medically assessed. Do not permit them to return if they exhibit any of the following signs or symptoms.
Symptoms of concussion
Does the player show any of these signs?
- Appears to be dazed or stunned
- Is confused
- Forgets team moves
- Is unsure of game, score or opponent
- Moves clumsily
- Answers questions slowly
- Loses consciousness (even temporarily)
- Shows behaviour or personality change
- Forgets events prior to impact
- Forgets events after impact
Does the player report any of these symptoms?
- Headache, nausea
- Balance problems or dizziness
- Double or fuzzy vision
- Pupils appear different in size
- Sensitivity to light or noise
- Felling sluggish, groggy or dizzy
- Ringing in the ears
- Concentration on memory problems
If a player reports any of these symptoms, they should not return to play.
FOR ALL OTHER INJURIES
If the injury disrupts play, get the player assessed on the field so you can decide whether to keep the player on or take them off.
Assessing the injury
For effective assessment of an injury, remember T.O.T.A.P.S.
Talk
Ask the player what happened
Where does it hurt?
What kind of pain is it?
Observe
Look at the affected area for redness or swelling
Is the injured side different from the other side?
Touch
Touch will indicate warmth for inflammation – touch also assesses pain.
Active movement
Ask the injured player to move the injured part without any help.
Passive movement
If the player can move the injured part, carefully try to move it yourself through its full range of motion.
Skill test
Did the active and passive movement produce pain? If no, can the player stand and demonstrate some of the skills from the game? If an injury is identified, remove the player from the activity immediately.
Treating the injury R.I.C.E.D.
A soft tissue injury such as a sprain, strain, or bruise should immediately be treated with the R.I.C.E.D. procedure:
Rest
Rest reduces further damage.
Avoid as much movement of the injured part as possible to limit further injury. Don’t put any weight on the injured part.
Ice
Ice cools the tissue and reduces pain, swelling and bleeding.
Place ice wrapped in a damp towel onto the injured area.
Apply ice for 20 minutes every two hours for the first 48 hours.
Compression
Firm bandaging helps to reduce bleeding and swelling. Ensure that bandaging is not so tight that it cuts off circulation or causes tingling or pain past the bandage. Bandage the injury between ice treatments.
Elevation
Elevate the injured area to stop bleeding and swelling.
Raise the injured area on a pillow for comfort and support.
Diagnosis
Consult a medical professional such as a doctor or physiotherapist especially if you are worried about the injury, or if the pain or swelling gets worse. If the pain or swelling has not gone down significantly within 48 hours, also seek treatment.
Avoid H.A.R.M.-ful factors
Once the injury has been diagnosed and treated, avoid the H.A.R.M.-ful factors for 72 hours:
Heat
Heat increases the bleeding in the injured tissues. Avoid hot baths and showers, saunas, hot water bottles, heat packs and liniments.
Alcohol
Avoid alcohol as it increases the bleeding and swelling around soft tissue injuries and delays healing. It can also mask the injury’s pain and possible severity, which may result in the player not seeking treatment as early as they should. If a player has a suspected head injury alcohol MUST be avoided.
Running
Running, or exercise of the injured part, will cause further damage. Do not resume exercise within 72 hours of the injury unless a medical professional clears the player.
Massage
Massage causes an increase in bleeding and swelling and will prolong the rehabilitation process when done within 72 hours of the injury.
Phase 2 – rehabilitation
Rehabilitation focuses on restoring the player’s full functions and rugby-specific abilities to prevent re-injury and encourage their best possible performance. In this phase the player should be building up muscle strength around the injured area, working towards getting the full movement back in the joint, getting their balance back and keeping fit through activities like swimming and cycling. Once they are ready they need to gradually build in light rugby-specific skills and drills, extending themselves at training only as much as the injury allows.
The player needs support to:
- Restore strength
- Restore range of motion
- Restore co-ordination and control
- Restore balance
- Maintain fitness
- Build confidence
- Restore their rugby-specific ability
Phase 3 – Demonstration of pre-injury - Performance level followed by return to play
This is when the coach, doctor or physiotherapist puts a player through a set of tests to see if they are ready to get back out on the field.
These tests should be a combination of those you used for the fitness tests at the start of the season and rugby skills and moves that the player will have to make during a game – like side stepping and tackling.
You can use the Player Profiling information you recorded earlier in the year to see whether a player is ready to return to play based on a comparison of performance.
Remember – if your players continue playing with an injury they increase the chance of a further, more severe injury.
- Restore rugby-specific skills and techniques e.g. jumping, throwing, kicking
- When the rugby-specific skills are done at the same level as they were before the injury, the player can return to the activity
- Don’t play hurt!
The coach’s first aid kit
- Surgical gloves
- Small towel
- Compression bandages
- Adhesive tape
- Band-aids, plasters
- Antiseptic solutions, eg Savlon.
- Eye wash
- Scissors (not with sharp points)
- A sling bandage
- Sterile gauze dressing
- Ice should be available as well