Injury prevention with physio Damian Banks
Injury prevention in Rugby has become much more important as the collisions get bigger and harder. At some point in our life, we will spend time away from work for approximately two to six months nursing a serious injury. We can imagine what the statistics say about Rugby players.
Many players will spend a good part of their career on the sidelines. Sometimes we are considered unlucky or lucky. Often it is our own negligence of doing the prehab/rehab work.
As rugby players, we often leave out the smaller more difficult exercises to compensate for the lack of time, energy and inability to complete the exercise.
We managed to catch up with our friend and physiotherapist Damian Banks to ask him some key questions around injury prevention.
Damian is a fantastic physiotherapist with a lot of experience specific to Rugby. He always gives a throughout diagnosis of our injury and with his expert knowledge can help us make the best call on moving forward. Damian knows the difference between managing an injury to play and managing an injury to return to play in a few weeks or months. His current roles involve the head Bay of Plenty Rugby Physio (2011 – current) and the New Zealand under 20s physiotherapist (2015 – current).
Damian has worked with the Waikato Chiefs Development (2011-2014). With his expert knowledge, Damian has found himself covering physiotherapy duties for the New Zealand All Blacks Sevens when needed.
What are the most common injuries in Rugby?
There is always a slight variance year by year, and team by team but there are still injuries you see every year.
Ankle sprains would still be number one overall. We see more high ankle sprains now than we used to about 5-10 years ago. This can be due to a number of factors. For example, changes in footwear, changes in playing surface, changes in game plan/tackling technique, more footwork pre-contact of the attacking player. Bigger players who are more powerful = greater forces on ligaments and joints. Better awareness of medical staff and greater diagnostic abilities.
A concussion is an interesting injury which is a lot higher on the list now than it used to be. Probably because everyone is more aware of it, particularly players and coaches. The nature of the game and the increasing forces at play. More on Concussion here.
Shoulders are often injured, but there are a lot of different injuries that occur. Rotator cuff sprains, internal impingement, labral tears and AC joint sprains.
Soft tissue strains are one you need to know how to deal with, but to be honest we don’t have too many of these anymore as these are the one area where you can have real effect with injury prevention and monitoring.
How does this change according to playing position? (Study by Brooks & Kemp 2011)
- Loosehead Props – Cervical disc & nerve root injuries
- Hookers – Rotator cuff injuries in the shoulder
- Tight Head Props – Achilles tendon injuries & Lumbar Spine/disc injuries
- Locks – Lateral Ligament ankle sprains
- Flankers – Hamstring injuries and ankle injuries
- Number 8 – Bicep and Wrist injuries
- Halfbacks – lumbar disc injuries and soft tissue injuries
- Flyhalfs – Hamstring and groin injuries
- Centers – Concussion, dislocations and lower leg fractures
- Wings – Thigh Hematomas
- Fullbacks – Groins Injuries, chest and sternum injuries
What are the best exercises for injury prevention in Rugby?
Single leg standing with eyes shut. Hands down the best drill for ankle sprains and preventing occurrences. Build up from 20 seconds to one minute holds. To progress use a Bosu half swiss ball or wobble board/cushion.
The second best exercise at the moment is a banded lunge. Using an elastic band just above the ankle joint pulling backward. Then lunge forward over the foot to help to regain dorsi-flexion range after stiffness which can be caused by surgery or wearing moon boots etc. Ankles are the most commonly injured joints for ruggers.
Single leg exercises (leg press, squat, lunge). Following injury, strengthening up again using two legs often just causes your good leg to get stronger – so you need to work the one leg by itself. In terms of prevention, with UNINJURED KNEES then bounding drills are good for stability.
Isometric squeeze with a ball between knees and again with a ball between ankles. 30 second holds, 5 to 6 of each. Hip mobility exercises and stretches are extremely important as well.
Scapula stability exercises – mostly retraction type exercises. If unsure where to go from here – just start with seated row and lat pull down type activities to try and get the balance back from everything that causes rounded shoulders. This can be caused by players doing too much bench press but in general everything in life is done in front of us. We reach for things, keyboards, phones, tablets etc – so all this time our pecs are shortened and our scap retractors are stretched.
Simple yet effective are isometric holds of the neck in all directions for strength.
Core strength and ability to activate your core is important. Start with static drills like the good old plank but progress to more functional exercises with movement and rotation as this is what happens in the game. We try to avoid general sit ups as it works mostly the rectus abdominous (the six-pack muscle).
This looks good but is poor for spinal stability as it is a “global muscle” rather than a local muscle. This basically means that when it contracts it causes uncontrolled movement of the spine, whereas the smaller fiddlier muscles attach to each individual spinal segment so when they work they stabilize the spinal column.
Too many sit-ups mean you become dominant in the global muscles and de-trained in the stabilizers – as a generalization. We have seen this in many amateur players. Some can not even do basic core movements and have no idea how to active their core. If you have awesome stability, then you will cope with sit ups. Please avoid sit-ups if you already have back/buttock pain from the instability of your spine.
Incorporate these exercises into warm up:
- Single Leg Deadlift – awesome.
- Pistol Squat – good if you can do it (eg no knee pain/injury)
- Try a banded monster walk, or the multi-hip machine in the gym to abduct – or just lie on your stomach and hold your leg up straight for max hold.
- Single Leg glute bridge – again good, progress to from a swiss ball.
- Deadbug + progressions
- Turkish Getup – We also like a variation of the farmers walk where you carry a kettle bell over one shoulder.
Incorporate these stretches into warm down for Injury Prevention:
- Pec stretch
- Shoulder stretch
- Banded Hamstring and Quadricep stretches
What are the common mistakes made by Rugby players?
From a physiotherapist’s perspective, there is too much emphasis on traditional exercises such as bench press and squats. These are good exercises but there is not enough time spent on the little fiddly difficult drills. Sometimes we forget or just do not do the exercises that help with multi-directional movements and performance on the field. We often forget these exercises are important to keep our bodies performing at the highest level and decrease the risk of injury.
What happens at the end of the season with regards to Injury Prevention and Screening?
During our end of season review, we asked players how much time they spent on the prehab/movement prep movements. Almost all of our players responded with: “definitely not enough” or “I knew I should but just didn’t”. A lot of players moan about the lack of time.
If they have 60 minutes for a gym session they will feel like that isn’t long enough to do it all. So the main lifts are prioritized. The fact is prehab and rehab exercises can often be done at home while watching television or after training.
Where are we weak or vulnerable to the risk of injury?
Hip stiffness is a very common issue that can raise its head as back pain while squatting. Or we see players are unable to complete tasks through the full range (squat, or scrum).
To be honest this is not necessarily dangerous – often needed to reduce range of squat if bony impingement is causing pain in deeper ranges. Often this stiffness is muscular and this may increase load into other areas, knees/ patella tendons, ankle/Achilles tendon and probably most likely, back and discs.
Shoulders – because of being really protracted these get susceptible to significant contact injuries such as dislocations, and labral injuries.
The main exercise is pretty boring but extremely effective – Pec stretches, 3 x 20 seconds every day. The next best thing to do is working scapular muscles in retraction, and variations of this.
Best recovery methods for Rugby and why?
Sleep is the best and most under-rated recovery method of all. This is especially important for those in our academy systems who get up early to train, and get home late from training. Those that need to organize food for the next day and unwind before settling down for the night.
Good tips for improving sleep:
- Prioritize it.
- Don’t use your phone in the last 60 mins before planned bedtime.
- Avoid caffeine after a certain time in the day – test this as each person is different.
- Nap if you can throughout the day. A power nap of 30 mins or less will help you avoid feeling drowsy.
Active recovery methods are generally better than passive – so going for a walk, or a moderate bike the day after a game is better than getting a massage or something else done to you. Hydrotherapy is a great way of achieving active recovery and you can also control temperature.
After training, using contrast baths or hot colds will be beneficial to a player. They are a great option if there has been no contact component. Some players will suffer from soft tissue injuries and hot may not be the best option. After contact and games, we would recommend cold/ice water immersion and avoid a heat option.
Hot cold contrast
By using the ice bath for just a minute and then transferring to a hot shower then repeating the process 3 – 4 times can be very beneficial for the body and recovery. If you do not have access to a bath or ice bin you can use a very cold shower and a hot shower to almost replicate the same.
Stretching and warm down
Often overlooked by Rugby players as we tend to finish the game and head straight into the changing rooms for a beer. Just a small amount of exercises and stretching can have a massive impact on your body and its ability to recover.
Active Recovery and Injury Prevention
Going for a swim in the pool, walking in the pool and stretching in the pool. A good active recovery method to benefit your rugby. Simply getting on a spin bike and rolling the legs over can have massive benefits. Going for an easy walk can also be a no-brainer. When you have had a massive game sometimes you are so broken the pool is the only option. Try these recovery programs too.
What one piece of advice would you give to aspiring young Rugby players?
I’ve been involved in a lot of teams now. Almost all players want to make it to the next level. Whether that is a representative team or on their way to their ultimate goal of national team representation.
The few that succeed all have one thing in common. They aren’t the most talented or the best athlete (although that certainly helps) but they are the most professional. They are professional in everything they do.
So I would say to aspiring rugby players:
If you want to make a living out of playing rugby, then treat it like a real-life job. Each team you play for is a job interview for the next team you want to play for. That means you work hard, you put in the hours and work late if you have to. Be punctual and on time to work or your training session. Never be late or miss a session as it is an opportunity to improve. It is another chance to prove to your boss you are capable. To do the required work that your boss has asked.
“Bosses” whether that be coaches, managers, trainers or physiotherapists. Communicate clearly and early when an issue arises. Invest in your career like a tradesman buying tools (rollers, ice packs, compression clothes etc). Continue to work on your strengths and what sets you apart from the next player.
Work hard on your weaknesses. Physically your body is your main asset. Invest in your asset for the future returns by spending time doing injury prevention exercises and rehab. Invest in your asset on a technical, tactical, nutritional, and psychological level and in the future, you will get the return on that investment.
Be professional in your approach to the game and you may make the game a profession.