21 April 2009

Rugby players and warriors

Rugby is a popular - and dangerous - sport. How can you let your child experience the joy of playing while protecting him from life-threatening injury?

They’re warriors and their war is rugby – which means battle scars are part of the game. But how can you let your child experience the joy of playing while protecting him from life-threatening injury? By ELISE-MARIE TANCRED for YOU Pulse magazine.

It’s bull against bull: brute force, tactics, courage and speed. Human battering rams going for one another with power and skill in scrums and lineout's, flattening the guy with the ball. Every moment of the game counts, as does each hour, day, month and year of fanatical preparation.

Then comes the glory of victory in front of hundreds or thousands of cheering fans – sometimes in front of the entire world.

They walk off the field as heroes. Some are carried shoulder- high: the golden boys and gods of the game.

But there’s also another reality. Not all the men always walk off the field intact. And sometimes the rugby field becomes a field of death.

As exciting as it is, rugby has a dark side – there’s always the risk of injury, paralysis and even loss of life. Just as thousands before them, many young boys today have grand rugby dreams.

They’re up and in the gym by 5am even though some of them are barely 13. They take supplements and protein powders, say no to fatty foods and go to bed early. There’s nothing they don’t know about anabolic steroids; some even put them to the test.

Some also suffer broken bones, torn ligaments, concussion or neck injuries. They’re prepared to risk everything – because they’re warriors and their war is rugby.

One mistake can change a life forever
It takes a strong, hard player with a powerful neck to take on 800 kg of muscle and bone in a scrum or to clash with a 120-kg body without breaking or tearing something.

If things go wrong and a head, arm or leg is contacted at just the wrong angle or a little too hard – like when super flank Schalk Burger suffered a serious neck injury in 2006 – the body can give way, with serious consequences.

Just one single inadmissible high tackle that cracks the neck sideways and backwards, a scrum that collapses or a ruck that forces a player’s head onto his chest or whips it backwards can change a life forever.

If even a seasoned player who trains correctly and prepares thoroughly can be seriously injured in this way it stands to reason that a schoolboy, whose muscles and bones are still developing, can be badly hurt.

Lots of pressure on boys to play rugby
If your son plays rugby you have a huge responsibility, the World Cup Springbok team’s conditioning expert Dr Derik Coetzee says. And right now there’s no shortage of boys who’re passionate about playing the game.

"There’s enormous pressure on boys to play rugby in certain SA schools," says Jannie Putter, the Bulls' sports psychologist and author of Winning is for Kids and Parents. "For many people rugby is our national sport and your status and popularity rise instantly if you play. Playing is good for a child's self-esteem – he’s 'in'."

More and mroe pressure is being put on young boys t play rugby.

Given the right coaching, playing rugby has many positive elements. It builds character, teaches kids to work together and develops leadership qualities. Kids learn to set goals and be motivated – all of which will help them later in life.

But the game also involves huge emotional and physical risks. "Children start playing rugby too early," Putter says. "In general they’re not ready for this kind of contact sport. At the age of seven or eight they don’t really have a clue what it’s all about.

Only by about 12 do they start to grasp the concept of team sport. "It takes just one vicious tackle for a seven year- old to develop a fear of the game that’ll stay with him for the rest of his life. It also humiliates him and damages his self-image – and this could lead to a fear of failure following him into adulthood."

And that’s even before we get to physical injury. There’s barely a body part that doesn’t take strain and though knee and ankle injuries can keep a player off the field for ages they don’t come close to the risks of concussion or a broken neck.

A damaged spine can end in paralysis or even death and a light blow to the head soon after a first concussion can cause brain damage.

Incorrect exercise programmes and eating patterns, unnecessary or dangerous supplements and the desire to win at all costs add to the danger of this sport.

Training intelligently
The desire of many young boys to build muscle and be big and strong drives them to train with weights that are far too heavy for their muscles and frames. Teen boys on their backs at the gym, training with heavy weights – the worrying bench press craze – has become all too common.

Boys’ skeletons and muscles develop rapidly between the ages of 12 and 17 and teenagers often complain of cramps and pains in their legs. Excessive or incorrect exercise puts them at risk of two types of serious injury: growth plate fractures and avulsion fractures.

Growth plate refers to bone growth in the bone itself. If a child breaks an arm or leg in the growth plate it constitutes a serious, irreversible injury that never heals. Further bone growth will not be normal and the child could develop a deformity – for example, one leg could be longer than the other.

Incorrect exercise, such as resistance exercises, can cause avulsion fractures. This is when the muscles develop faster than they can attach to the bone and a bit of the bone is literally torn away because the muscles haven’t attached properly.

Proper training is essential to prevent injuries.

Specific training programmes needed
An injury such as this is serious enough to end a child’s sports career for good. Training programmes for kids should match the sport in which they wish to improve. Most gym instructors don’t have the necessary expertise and children should be evaluated by a biokineticist to prevent them from embarking on a programme that could hurt them.

A biokineticist first establishes your child’s strong and weak points, then works out a specialised training programme with the correct exercises for speed, explosive power and muscle mass, Coetzee says.

Of course larger, stronger muscles also have their use. "They can help reduce the risk of injury because they protect the ligaments and joints. But muscle-building should happen incrementally over a long period and under the supervision of a trained instructor – or the risk of injury could actually be higher," he emphasises.

Eating correctly
Another danger which rugby-mad teens are exposed to – especially in gyms – is the use of anabolic steroids.

It’s shockingly common among schoolboys, Free State University research has shown. Steroids are popular because they shorten the rest period needed between workouts. Kids can therefore train more and build muscle faster.

Last year it was reported that primary school boys were even injecting them - selves with equine hormones to build larger muscles.

"Muscle growth is fast and dramatic but it makes me shudder to think about it," Coetzee says. Steroids can be life-threatening if used incorrectly.

If you notice your son’s skin has suddenly deteriorated and become pimply, his muscles have grown quickly and his testes have shrunk you should be extremely concerned – he could be at risk of a heart attack, stroke or liver damage.

Parents should also watch out for certain diets and food supplements. "For kids not to eat any red meat because the fat content is too high is nonsense,"

Coetzee says. "I’m also sceptical about the value of protein supplements. They can cause kidney damage. Teenagers are in a fast-growth phase and damage to certain organs can’t be fixed later. Ask yourself if you want to see your son hooked up to a dialysis machine when he’s 20."

There’s no scientific proof that food and vitamin supplements are of any real value, Coetzee says. "About 95% of the population don’t need supplements at all and will remain fit and healthy simply by eating properly – by which I mean a diet that consists of about 55% carbohydrates, 20 to 30% fats and 15% protein."

"It’s a combination of the right nutrition and the right exercise that will help kids become better rugby players – not steroids and excessive training."

A dangerous game
Rugby has changed a lot over the past few decades. Not only is the season longer, the rules have been adjusted to make the game flow better. Players now play longer without a break – which increases the risk of injury as it’s easier for them to overtax themselves.

These changes increase the possibility of a serious injury that could leave players crippled, paralysed or mentally shattered.

Greater expertise and medical research is needed to make the game safe. It takes just one serious tackle to destroy a life, Dr Ansa Erasmus of Groote Schuur Hospital’s acute spinal injury unit confirms. The unit handled six serious rugby injuries in a single season last year.

Five of the young patients are now quadriplegics, with total paralysis of all four limbs.

The full extent of serious rugby injuries hits you when you look at countrywide statistics: over the past seven years 46 boys and 106 men have sustained serious neck injuries – of whom 21 died and 35 will never walk again, according to the Chris Burger/Petro Jackson Players’ Fund.

Tackles and scrums most dangerous
High tackles, scrums and loose scrums are the most dangerous aspects of the game as far as injury is concerned – but any movement that causes the neck to bend or turn unnaturally can be fatal.

"Any flexion (forward movement) or extension (backward movement) with or without rotation is enough to shift or squash your cervical vertebrae," Erasmus says. "If a big guy tackles a little guy in this way the action has enough impact to break his neck."

In addition some people have a congenital predisposition to weak vertebrae or brittle bones and shouldn’t ever participate in a contact sport. "We had a young patient whose cervical vertebrae were so delicate he should never have been allowed near a rugby field. It didn’t take much to crush them."

Any neck injury sustained while playing rugby should be taken seriously and X-rays should always be taken, she says. A stiff neck, pins and needles in the limbs and other signs of paralysis should immediately be investigated by an expert.

Children, especially fast-growing teenagers, are exposed to great risk because the small bones in their neck and back are still soft.

One in four injuries is to the head
Almost all rugby injuries can be prevented, doctors say. Players should make sure they don’t play again before their injuries have fully healed and referees should be stricter, especially at club level where play tends to be more violent and can get out of hand faster.

Emergency treatment and equipment should be available next to the field – if players get the right treatment in time it can prevent possible paralysis. Parents are responsible for checking that coaches conform to the necessary standards and that children do exercises to strengthen their neck muscles.

One in every four rugby injuries is to the head and of those concussion and skull fractures are by far the most serious. The latter can result in bits of bone piercing the brain or bruising brain tissue – which may cause a brain bleed and even death.

Concussion occurs when a player takes a hard knock to the head or jaw, when two players run into one another or when the head is snapped sideways.

"The brain is a soft mass inside a hard shell," Dr Jon Patricios of Sports Concussion South Africa explains.

Protect your head
One in every four rugby injuries is to the head and of those concussion and skull fractures are by far the most serious. The latter can result in bits of bone piercing the brain or bruising brain tissue – which may cause a brain bleed and even death.

Concussion occurs when a player takes a hard knock to the head or jaw, when two players run into one another or when the head is snapped sideways.

"The brain is a soft mass inside a hard shell," Dr Jon Patricios of Sports Concussion South Africa explains.

"A hard blow causes the brain to slam against the skull. It then bounces back and hits the other side of the skull. It’s shaken around almost like jelly in a tin and this can make nerve cells tear and cause damage to blood vessels.

"This causes a chain reaction in the brain: the damaged bits need more nutrients such as glucose but because blood flow decreases there’s actually less oxygen and nutrients. The result is swelling and further damage."

A player doesn’t have to fall to sustain a concussion. He also doesn’t have to be knocked unconscious. Typical symptoms include disorientation, memory loss, headache, dizziness, nausea, drowsiness, loss of balance, ringing in the ears and seeing stars or double vision.

The dangers of concussion
Players with even a mild concussion should rest for at least three weeks before playing again. This gives the extremely vulnerable brain a chance to heal.

If a player sustains concussion twice in one season he shouldn’t play again that season – and if it happens three times the brain must rest for an entire year, even if a CT or MRI scan doesn’t show any damage.

These scans can sometimes be misleading and show things to be in order when there’s already serious brain damage. If a player already has concussion and subsequently suffers even a light blow to the head it could mean death.

This is known as secondary impact syndrome. Children’s developing brains are more vulnerable and they’re more prone to sustaining concussion than adults.

Although the rugby community now sees concussion in a more serious light than it did three years ago it’s still not serious enough, Patricios says. In 2006 a centre for sports concussion treated 158 schoolboys for concussion – and that’s just in Johannesburg in a single season!

"I’m a rugby fan," he says, "but we urgently need to give more attention to the causes of serious injury in this sport."

Winners, winners, winners!
The drive to win is instilled in kids from a young age. Add rugby coaches who aren’t always up to scratch and primary school learners who don’t all grow and develop muscle power at the same rate and you have a recipe for injuries.

The pressure on schoolboys to achieve is where things start going wrong in rugby. The player himself, his parents or his coach may push him to return to the game too soon after an injury.

He may also over-train and even start using anabolic steroids – kids will often do anything they can in an attempt not to disappoint their parents.

Coaches can do much to change this. There’s a shortage of competent coaches at primary school level and unfortunately some of them motivate their teams the wrong way.

"They try to encourage kids by shouting at them but this just promotes aggression and frustration," Putter says. "Aggression is praised by the coach but the result is often that primary school players are so badly injured on the field they look as though they’ve been in a car accident."

Pushy parents can be dangerous
Parents need to take a hard look at themselves too. Some do really stupid things, such as the Pretoria father who tried to bribe a doctor to declare his son fit for Craven Week – despite the boy’s skull fracture.

There are even those who encourage their kids to use steroids. But you don’t have to go to such extremes to make your kids feel the pressure – your disappointed face when your son isn’t the top scorer may show you think winning is everything.

"Don’t forget the players are just children," says Theo Kleynhans, who is the head of junior rugby in the Western Province and has been involved in the game for 27 years.

It’s no wonder there’s now talk of official codes of behaviour for parents watching matches. "We need to teach our kids to simply enjoy the game," Jannie Putter says.

We could even consider scrapping leagues and tournaments at school level, as has happened in Australia and New Zealand.

Other suggestions for school rugby include:

  • Informing parents about the risks of steroids, too many protein shakes and over-training.
  • Classifying primary school teams according to size not age – some 10-year-olds are the size of high-school boys while others are the size of eight-year-olds.
  • Substantially improving coaching at school level. Kids should first learn skills and strengthen their bodies. Wrestling is an ideal sport for youngsters who want to play rugby – it exposes them to physical contact in a controlled way while allowing them to develop self-confidence and build strength.

Making the game safer for kids
The South African Rugby Football Union has already set the ball rolling and last year announced a comprehensive programme to make rugby safer. It includes improved training of referees and coaches and allowing only coaches with the necessary training to take on school teams.

First aid at schools will also have to be improved and all serious injuries reported to the rugby unions. The carrot dangled in front of every rugby-mad boy’s nose is of course the financial rewards enjoyed by top players.

Rugby is big money. International agents descend on senior players at Craven Week, one of the biggest school rugby tournaments in the world, in order to tap new talent.

Schools try to hijack one another’s top players and bursaries and contracts are handed out like sweets. If promising players and parents keep their wits about them it can mean the difference between a long, famed rugby career and one cut short by injury.

'Everyone must work together'
Dreams of green and gold and World Cup glory cause top provincial and national players to put their bodies on the line. But is it worth all the blood, sweat and tears?

"Absolutely!" a well-known Super 14 player says. "Nothing can compare with sitting in the locker room with the manne after a good match, knowing you gave your best and helped your team to win. There’s a brotherhood; a feeling that’s hard to describe. That’s when every twinge of pain is worth the effort."

Rugby is and remains a fantastic game, Coetzee says, but everyone must work together to make it as safe as possible. "In South Africa we’ve seen what a unifying force rugby can be. We can do so much more to responsibly develop the game."

But this will happen only if we don’t look for shortcuts to fame and do the right things to ensure our kids walk off the field unscathed, every time. The same goes for one day when they’re our country’s Bok heroes . . .

Making the grade
Modern rugby makes huge physical demands on players. It’s a completely different game from the one played in Mannetjies Roux’s day – it’s now a dangerous contact sport in which muscle power and aggression are used to exert pressure and intimidate opponents.

The days of overweight forwards and skinny backs are over – for good. Jake White’s fitness requirements for his World Cup team makes one realise how much the game has changed.

Not only should a prop be able to take off like an Olympic sprinter and do 40 m in 5,56 seconds, he also has to be strong enough to lift 180 kg from a crouch – not to mention being as light-footed as a ballerina and able to leap 55 cm into the air.

The most dangerous positions
Eighty minutes as a wing is completely different to 80 minutes as a forward, Conrad Booysen, biokineticist on Health24, says.

The most dangerous position is eighth man – they sustain between 12 and 14% of all injuries. Scrumhalf is the 'safest' with a 6-8% chance of injury.

Hooker, flank, lock and wing (10-12%) share the second most dangerous position while fullback, prop and centre (8-10%) share third place.

A flyhalf’s risk of injury is 8-9% and his position is, after scrumhalf, the safest.

The is a 24-hour emergency number for information on concussion – call 084-272-4624 if you suspect your child has concussion.

[This is an edited version of an article that originally appeared in the Summer 2008/2009 edition of YOU Pulse / Huisgenoot-POLS. The current edition is on sale now.]

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