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Injuries to lower limbs common in rugby

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In rugby the lower limb is the most commonly injured area of the body. For example, the lower limb accounted for 42% of all injuries at the 1995 Rugby World Cup in South Africa.  

A study of South African Super 12 players in 2005 showed that the pelvis and hip were the most commonly injured area (19%) followed by the knee (13%) and that ligament sprains accounted for 25% and muscle tears and strains 24% of injuries 35.

During matches the knee joint accounted for 12% of injuries, the thigh 8% and the ankle 5%. However, during practice sessions the injury profile was slightly different with the ankle being the most injured part of the body (14%), followed by the thigh at 13% and the hamstring at 11%.

There is evidence to suggest that the numbers of injuries increase in relation to an increasing proficiency level of play. Reasons for this could include player size, more physicality in the tackle area, and the fact that the ball is in play for a longer period at an elite level.

Mechanism of injury

To implement an effective injury prevention programme it is necessary to examine the aspects of playing and training that are associated with a high risk of injury.

Phase of play:

Tackles, rucks and mauls appear to be the phase of play where most injuries occur. In a study of South African rugby players it was found that 40% of injuries occurred during tackling and 11% during mauls.

In the 1995 Rugby World Cup 37, 56% of injuries occurred during the tackle phase of play, 23% during rucks and mauls, 11% during open play and 9% as a result of foul play.

A study of the Australian team (1994-2000), 3 showed that most (59%) injuries occurred during a tackle and 20% occurring during open play. This was slightly lower than the study on Argentinean rugby players which showed that 33% of injuries occurred in open play. Foul play is also responsible for causing injuries.

Injuries by position:

This varies from study to study. Some studies have found that there is no difference in injury rate between the backs and forwards.

However, an Argentinean study showed that the flanker appears to the most injured player (16%).

An Australian study showed that the lock was the most injured forward whilst the fly half number 10 was the most injured back.

Time during match when most injuries occur:

Fatigue contributes to injuries as most injuries occur in the second half of the match, specifically the third quarter (40%).

 Previous injury:

A previous injury appears to be a high risk factor for another injury. Interestingly, in a review of injured players it was found that a majority of players completed the full match in which they were injured and 39% of players played against medical advice at some time in their careers.

Conclusion

 The lower limb accounts for a high proportion of injuries in rugby. Much time and money is spent on getting players back on the field.  

Preventative training for the lower leg reduces the rate of injury of injuries and speeds up recovery. This training should be well planned so that the player is not over-trained, and should be continued through all the phases of a rugby season for best results.

Preventative intervention should be comprehensive and include warm-up, hamstring eccentric training and proprioceptive and balance training.

 Sources: Literature Review on Preventative Rehabilitation for Rugby injuries to the Lower Limb, SA Rugby

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