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Sports Injuries

Updated 30 June 2016

How a physiotherapist would manage muscle injuries

The South African Society of Physiotherapy prescribes two methods to manage acute sport injuries: 'PRICE' (protect, rest ice, compress and elevate) and 'MEAT' (movement, exercise, analgesics and treatment).

A muscle strain/pulled muscle during a rugby match should be treated following the PRICE principles: Protect, Rest, Ice, Compression and Elevation. If the player, doctor or physio suspect that a muscle is torn, the player should be removed from the field to prevent further damage.

It is not always immediately apparent how severe the injury is, so it is important to try and protect the area as much as possible. There appears to be some benefit in icing the area to reduce swelling, for around 15 mins, every couple of hours.

Read: Preventing injuries on the rugby field

Strapping may help to support the area, and if the tear appears to be severe, the player should be put on crutches or in a sling to offload the area. A minor muscle strain could recover in a week to 10 days, but severe strains could take up to 6 weeks or even require surgical reattachment occasionally.

This is how a physiotherapist would treat dislocation at a rugby match:

Remove player from field
When a player is injured it is recommended that they stop playing and is removed from the field. Although the player may still be able to play, changes in his motor planning and neuro-muscular control to protect the painful area, makes him more susceptible to injuries at other sites as well. 

Evaluation of muscle or joint
If there is medical assistance available, the muscle should be evaluated via muscle testing and palpation for possible injury. This can either clear the patient for return to play or suggest further evaluation.
To return to play, the patient must be able to mimic the actions needed for play either sprinting, scrummaging etc. Strapping may be applied to provide additional support to the muscle. 

PRICE regime
P – Protect the area e.g. strapping to assist movement and lessen the strain on the muscle
R – Rest the area (refrain from painful activities) for 10 days, but stay active. Movement increases blood flow, which is essential for healing to take place.
I – Ice the affected area 12-20 minutes every 2 hours for the first 4 days after the initial injury
C – Compress the area to limit excessive swelling and support the muscle. 
E – Elevate the affect area to horizontal level, preferable to a level above your heart. This helps with limiting swelling in the area.

Read: Preventing injuries on the rugby field

Medication
The use of pain killers is recommended e.g. Codeine, Paracetamol. If pain is controlled initially, the chance of chronic pain developing is decreased.  Do not use anti-inflammatories in the first 72 hours after injury, as inflammation is part of the healing process.

Physiotherapy
The biggest risk factor for re-injury is a previous injury. When a muscle or ligament is injured, it is more than a few ruptured muscle fibres. In most cases the torn muscle is only the symptom of another problem that puts excessive strain on the specific structure. 
Your physiotherapist will be able to assist you in sorting out other factors contributing to the injury, as well as re-educate the injured structures through movement retraining, proprioceptive exercises and mobilisations.

Read more:

The Springboks' training tricks

8 recovery techniques the Springboks use to prevent injuries

Rugby injuries: new approach recommended

Image: Playing through the pain from iStock

 

Ask the Expert

Sports Injuries Expert

Adrian Rotunno is a medical doctor in the Sports & Exercise Medicine fellowship at the Sports Science Institute of South Africa, and qualified physiotherapist. Team physician for Dimension Data pro-cycling, and Boland Rugby. Special interests include endurance sport, in particular cycling, as well as contact sports.

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