It was a day shy of exactly 6 months since I had suffered a catastrophic compound fracture of my tibia and fibula in a rugby match. And the moment had finally come for me to take the pitch once more. It had been an arduous journey. One that would with certainty prove my innermost resolve.
If one definition of grit is, a positive, non-cognitive trait based on an individual’s passion for a particular long- term goal or end state, coupled with a powerful motivation to achieve their respective objective, then my return to rugby would certainly be the grittiest accomplishment of my life.
I will conclude my 4 part series with the Re-entry Phase, by identifying the psychological and physiological hurdles that must still be overcome in the final push for a full and productive return to the rugby pitch.
For every amateur athlete, the timeline of progression will vary, but the steps themselves are universal. If there is any consolation to an injured rugby player it’s found in what my orthopedic surgeon told me, that “80% of your recovery was accomplished prior to your injury”. What he meant was, the fact that I was already in ideal physical shape and condition would prove to be the catalyst itself for a full and quick recovery.
For me, the barometer for transition from the Mobilization Phase to the Re-Entry phase was when I was able to sustain a run at pace, pain free, with symmetrical gait. This represented a physical return of baseline mobility and stability. I now was ready to transition to more acute abilities such agility, power and speed.
As my running capabilities began to return, I became physically able to pursue other facets of mobility. I discovered that supplemental support bracing was essential for growing my confidence and functionality. During all training activity, I wore a medium strength compression sock that ran from my ankle up past my knee and a velcro knee brace to keep it taught and securely in position.
My personal experience coincided with a number of studies suggesting that the use of local compression can speed recovery and reduce soreness following strenuous activity. In the event that I exerted physical activity without compression support, I not only noticed an immediate effect on my performance capability, but also the longevity of my training recovery. Compression support became essential.
When deciding on the right fit, it is important to follow the manufacture’s guidelines. Most current studies recommend ideal compression to be 15-25 mmHg of pressure. This pressure should be graduated however, with a slight degrease in compression tension as you move from the ankle to the knee. This prevents any over restriction of blood flow to the lower extremity. 1
A successful return to rugby is probably better stated as the successful return of all the athletic abilities necessary to play rugby. And if there is any performance attribute most essential to the game, its agility. Agility is the ability of the athlete to explosively stop, change direction and accelerate again. Anyone with rugby experience knows, the player who can change speed and direction in a controlled fashion, more effectively than the opposition, will usually win the 1 on 1 battle on both sides of the ball.
If I was going to return to the pitch and compete, I had to redevelop my fast speed strength in all movement directions and rework the neuro-muscular coordination of my new muscle tissue. 2 To accomplish this stage of development, I started playing racquetball 2 times a week.
Most days I had an opponent (which definitely helped the monotony of the exercise), but I found that even if I was going solo, I could still generate the necessary start/stop activity I desired. I began to see steady growth and improvement nearly every week and the more I could exert physically, the more anaerobic conditioning came online as well.
From the very beginning of the mobilization phase, I had been doing solo leg work to rebuild my lost muscle tissue. And despite massive progress (as evident in my before and after pictures), it is unlikely that I will likely ever reach musculo-symmetry again. As I transitioned away from rebuilding strength, I shifted focus to restoring power. So I drew back to my Track & Field days as a triple jumper and dusted off some of my old training routines.
A typical session would involve:
(beginning with both, then emphasizing my recovery leg)
One significant benefit to these sessions was that all my progress was measurable in both physical comfort and distance/duration. The closer I came to being able to duplicate an exercise with my recovery leg, indicated that my capacity to return to rugby was coming into view.
Regardless of your physical size or rugby position, speed can be an invaluable asset. Every amateur athlete has their limitations of course, but to neglect your speed potential only limits your on-field contribution.
I utilized these 3 workouts to regain my speed performance:
Depending on where you live, access to stairs can vary. Since I do a fair bit of traveling I always took advantage of the stair cases in the hotels I was staying in. I found that anywhere between 5 to 10 flights at a time worked best.
Start by jogging to the top and walking down. Repeat this process of jogging without rest until you are unable to do more than a brisk walk to the top. Keep pushing for a 20 minute session.
When determining a running hill, choose a location of steady incline that is challenging and that you can reach the summit in 15-20 seconds (at sprint pace). Alternate between sprinting and jogging to the top and always walking down.
I found that I could maintain an alternating sprint throughout the 20 minute session if I would break for rest between every 5 climbs. Do not overwhelm your body, you want to maintain the High Intensity Interval for a full session.
The great thing about lunges is that you can do them anywhere! The specific benefit of this great exercise as it relates to speed is that it engages the kinetic chain of muscle and tendons necessary for running from the back and core, through the groin and butt, down the legs, to the ankles and feet. The strength of this chain will enhance the stride and cadence of your run, resulting in greater speed.
Proper form will maximize the routine, so ensure in the lunge position that your front knee does not extend beyond your front toes. Both legs should be flexed at 90 degrees, with your back knee nearly touching the floor. There are multiple variations of this move including stepping forward and returning to your back foot, alternating legs walking forward, stepping back into a lunge and returning forward, or adding pulses when engaged.
Complete 3 sets of 25 alternating lunges in a session. (3)
Doing all of this isolated personal work does not negate the necessity of being present and participating in regular rugby training sessions. Begin by doing what you can in warm up, fitness, light drills and make every effort to assist with set up and tear down. Be an asset to your club, not a spectator.
Allowing your teammates to be involved in your progressive improvement can also be a real boost to morale. When you allow others to see your limitations, you are more motivated to overcome them. This will also give your mates a chance to rally around your effort and witnessing your personal dedication can enhance the heart and culture of the team.
Being active in training will be the final litmus test to know how ready you are physically to make the transition to full contact. But don’t be surprised when you discover that this moment has more to do more with your mind than it does your body.
A traumatic injury, such as a bone fracture not only affects the physical wellbeing of the athlete, but likewise can have a significant impact on the athletes mental health as well. According to experts,
a common psychological response to sports injury is fear of reinjury. Other potential psychological responses of an injured athlete include anxiety, depression, frustration, tension, and decreased self-esteem. These psychological responses are generally greatest immediately after sports injury and lessen during the rehabilitation process. However, they often rebound prior to return to sports, consistent with a “U pattern of recovery.” If unaddressed and unresolved, these elevated psychological responses to the injury can slow rehabilitation progress and delay return to sports. (4)
I found that as the time drew nearer for myself to return to full contact, I became more and more anxious about the reality of putting my body at risk once more. I began to experience intense dreams of breaking my leg again and would wake up in a cold sweat. For the most part I had successfully compartmentalized the memory of my leg break, but when I allowed myself to retrieve and relive it in my mind, I found I would quickly become nauseous.
Unfortunately for many athletes, and I can only assume even more so for the adult amateur athlete, it is the fear of re-injury that keeps many from returning to the sport that injured them, rather than the physical ability to do so.
In a meta-analysis study, 63% of athletes returned to play after ACL reconstruction at their pre-injury level, and fear of re-injury is the most frequently cited reason for reduction in sports participation. However, over 85% of athletes achieved clinically satisfactory outcomes in terms of knee laxity, muscle strength, and single-leg hop distance. As physical and psychological readiness to return to sports after an injury do not always coincide, fear of re-injury may prevent return to sports even with resolved symptoms and physical impairments. (4)
Being injured in April and the way the Fall schedule worked out, I felt the drive to return to play sooner, rather that waiting until the following Spring. Unknowingly to me at the time, this was a very advantageous strategy. At the beginning of the Fall season, weeks prior to being able to go full contact, I would do the complete pregame warm up and then run the touchline during matches. This allowed me to engage the game mentally and gauge my running speed against the opposition.
Finally, midway through the Fall season and despite not being back to 100% pre-injury condition, I made the decision to take the leap and get back in the game. I dressed as a reserve and went on with about 10 minutes remaining in a tight game. We scored quickly after I came on and without hesitation I called for the tee and kicked through the conversion. I was not going to be denied scoring points in my first match back!
For my mental closure, I needed to kick for goal, make a tackle, and take a hit. I accomplished all 3. It wasn’t pretty and I was still weak in some areas, but the fear was gone. I finished the remainder of the season steadily increasing my playing time from 10 minutes to a complete half by seasons end. Now I had the Winter to fully prepare my body for 100% physical performance, assured that the mental battle had already been won.
By Spring, I was ready. My fitness, strength, power and agility had all returned. The needs of club had changed in the offseason, so I made the move from Fullback and returned to the forward pack, taking over the 8 Man position. For whatever reason, perhaps it was all the tenacious work in weight room or simply the fact that after crushing my fear and anxiety, I became a battering ram. The physicality of my game reached a whole new level and I wasn’t taking any prisoners. The grittiness of my recovery had added massive grit to my game.
My journey of returning to rugby was rewarded that season as I was named Team Captain for the first time. The incredible honor I’m sure would have never been possible without the crucible of my recovery experience. My body had been rebuilt, and I had been reborn.
A catastrophic injury playing the game of rugby can be an overwhelming experience, but with hard work and an unwavering focus through every phase of recovery playing again (even at a high level) is entirely possible. As one who has walked this path, I commend all my brothers and sisters who have gone before me and earnestly cheer on those on the journey!
1 – Quinn, Elizabeth Compression Socks for Sports: Does wearing compression socks to actually improve recovery? October 2017 https://www.verywellfit.com/compression-socks-for-sports-3120084
2 – Rugby fitness training – agility http://www.rugbyfitnesstraining.com/rugby-fitness-information/rugby-fitness-training-agility/
3 – Five Workouts To Increase Your Running Speed May 2017 http://runpals.com/speed-workouts.html
4 – Chao-Jung Hsu, PT, PhD, Adam Meierbachtol, PT, DPT, SCS, ATC, Steven Z. George, PT, PhD, and Terese L. Chmielewski, PT, PhD Fear of Reinjury in Athletes: Implications for Rehabilitation September 2016 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349388/