'Acute’ refers to those injuries that occur very suddenly, usually as a result of a sudden hard tackle to the body or a twist or side step that tears a ligament or tendon or breaks or fractures a bone structure. ‘Chronic’ injuries, also known as overuse injuries, develop over a few days, weeks or even months with a gradual increase in pain.

Injury prevention is divided into two forms, but both follow the same principles of prevention. The two forms of injury prevention are:

• Primary Prevention = prevention of the occurrence of an injury
• Secondary Prevention = prevention of the re-occurrence of an injury

Warming-up consists of players performing low intensity physical activity before participating in more strenuous activity. The scientific literature indicates that warming up may enhance rugby performance and plays a major role in reducing the risk of injury during training or in a match situation.

The purpose of a warm-up is to increase local muscle and/or core body temperature. A general warm-up is the more common used. This is a very common form of warm up routine and not necessarily specific to rugby. Jogging, running, or any other activity which increases the core and muscle temperature, increases heart rate, blood flow, deep muscle temperature, respiratory rate, joint fluid viscosity and perspiration is suitable.

A specific warm-up involves activities that are relevant to the event. Meaning that the actual activity is performed at a reduced intensity. For example: Start off by doing cross over ball handling drills and incorporate this as a warm-up – this drill can be done slowly and can be interspersed by stretches.

Specific warm-ups are effective as they:

• increase the temperature of the muscles that are recruited during the activity
• act as preparation in activities requiring neuro-muscular coordination
• form a rehearsal of the event and allow for psychological preparation

The precise intensity and duration of the warm-up will vary with the state of training of the rugby player, the ambient conditions and the game.

Adequate Stretching

The purpose of a stretching routine is to improve the range of movement in a joint or a group of joints. The implementation of a stretching programme will decrease the risk of injuries by:

• Improving flexibility, which leads to a reduction in injuries.

There are three methods of stretching that can be utilised:

• Static stretching – involves stretching slowly to the point of discomfort and is then held for prolonged period of time. Between 30-40 seconds, repeated 3-4 times
• Ballistic stretching – involves repetitive bouncing movements. Ballistic stretches are effective, but do have an increased risk of developing an injury.
• Proprioceptive neuromuscular facilitation (PNF) – All PNF stretches involve some combination of contraction and relaxation of agonist and antagonist muscles, usually a 10-second contraction phase followed by a 10-second relaxation phase. PNF stretching techniques are more effective than static or ballistic stretching, but the disadvantage is that a partner is required to perform the technique: this is always practical to perform.

Guidelines for Stretching:

The optimal stretching programme should consist of:

• 3-4 daily stretching sessions (results in increased range of motion between days 7-9 after starting a stretching programme).
• Static stretching to be held for approximately 30 seconds.
• Stretch to be repeated 3 times.

For example: Important areas to be stretched include the major muscle groups of the legs and upper body including the neck. These stretches can be performed between the skills training.

Adequate Training

Comprising endurance training, high-intensity intervals, skeletal muscle strengthening, flexibility, agility, visual skills training and cross training. (To develop a greater understanding of rugby specific training - review the article on periodization for rugby.)

Adequate Recovery

Adequate recovery after heavy training and competition is essential if injury is to be prevented. This encompasses a cool down period after exercise, massage, sufficient rest and sleep, psychological relaxation and optimal nutrition in the post exercise period.

Adequate Psychological Preparation

Prevention of sports injuries may be achieved by ensuring that the player is neither over nor under aroused.

Excessive arousal may lead to a loss of concentration and therefore predispose the rugby player to an injury. Furthermore, the excessively aroused athlete might ignore a minor, but significant injury, or ignore optimal nutrition during performance, leading to further injuries.

Under arousal may lead to a decrease in concentration during warm up and stretching or the rugby player may react and make decisions slower than normal, further increasing the risk of injury.

If you feel that you are under prepared mentally it is important that you considering contacting a sports psychologist.

Adequate Nutrition

Optimal nutrition prior to and after an athletic event not only insures optimal performance and recovery, but also aids in preventing injuries. Sub-optimal nutrition may indirectly lead to injury due to the fact that the rugby players are not able to recover from game to game. Adequate intake of protein, carbohydrate, fat, water, calcium, vitamins, antioxidants and other micronutrients should be ingested by the rugby player according to the particular demands of the sport, to achieve peak performance and to aid in injury prevention.

Injury prevention should not be taken lightly. It is very important to be fully prepared for all the physical and mental pressures placed on any rugby player. Any weaknesses place the rugby player at a higher risk of injury. Preparation is the key to an injury free season.

What do you do if you have an injury

A simple method to follow in the event of an injury is the P.R.I.C.E principle. P.R.I.C.E stands for:

Protection
Rest
Ice
Compression
Elevation

This principle is applied as it reduces: The bleeding and the swelling

Protection:
- The injured area should be protected from additional injuries by applying the appropriate splints, braces, pads
- Use crutches where necessary and don’t weight bear on the injured area

• Rest (restricted activity)
  - Rest implies that you rest the injured part and not the entire body
  - Reduce the stress imposed on that part
• Ice:
  - Ice acts as an analgesic (pain killer)
  - Promotes local vasoconstriction- reducing the bleeding and reducing the oedema (swelling)
  - Used for at least 72 hrs after an acute injury and up to any length of time as long as the swelling is noticeable.
  - Apply for approximately 15 minutes. (Too long an application can lead to burning of the skin)
  - Ice should be applied numerous times a day
  - Ice should not be applied directly to the skin
  - Frozen vegetables act as a great ice pack and can be molded around the injured area
  - Ice should also be compressed against the injured area.
• Compression:
  - Controls the initial swelling
  - Mechanically reduces the amount of intracellular space in which swelling may occur.
  - An elastic wrap or tubigrip an effective way to compress the injured area.
  - Can be left in place continuously for 72hrs after an acute injury, provided it is not too tight.
  - If pain due to the swelling arises keep the wrap applied keeping the swelling at a minimum. (NB. Make sure that there is still circulation to the appropriate body parts)
• Elevation:
  - The injured part should be elevated, this aids in draining the excess inflammation away from the injured site
  - The greater the degree of elevation the more effective is the reduction of swelling
  - Should be elevated as much as possible in the first 72 hours
  - Elevation can also be done while sleeping by placing your foot on a pillow or by raising your bed slightly.

  An important factor to remember is that any injuries that persist for more than a 24-hour period then you consult a qualified person, a doctor, physiotherapist or a biokineticist. Remember any injuries that occur should be fully healed and rehabilitated prior to the persons returning to rugby.