Elite rugby is suffering an unprecedented injury crisis. What does this mean for the players... and for you?

January 27, 2015

A tight hamstring, painful ankles, a sore shoulder or a slightly inflamed knee. We’ve all had these symptoms after exercise, but with sensible rest and management, you can – 
to an extent – ensure those niggles don’t become 
a serious injury. But, unlike average fit guys, elite athletes don’t have the luxury of skipping a gym session because of a minor ache. After all, pain is the constant companion of the pro sportsman. And no sport inflicts it like rugby. Former Springbok coach Jake White once said that after a Test match, players demonstrate the same symptoms as someone who’d been involved in a 60km/h car crash. And those were the uninjured players. At the top level, players repeat that cycle 30 times a year. It’s no wonder then that current Springbok coach Heyneke Meyer wore a worried expression after his side’s narrow 31-30 win over Wales in Nelspruit last June.

Meyer hadn’t liked what he’d seen, and not just because the Boks had needed a controversial last-minute penalty try to win the match. He was mostly anxious because
the performance had been flatter than a platteland vowel. The players were lethargic, slow on their feet and slow in thought. They showed all the signs of fatigue, yet the international season was just beginning.

“I am worried about the state of the players because at this time of year I’ve never seen players so tired and over-played,” Meyer said.

The reality is that the players don’t really have a season. Pro rugby has become one 
continuous stream of training and matches, for all but two weeks around Christmas. 
Pinpointing the end of one season and the beginning of another is virtually impossible.

And given the nature of the sport there
is one guarantee in rugby: an elite player will suffer at least one massive injury at some point in his career.

“Injuries in rugby are difficult to predict and explain because rugby is a contact sport,” says Bulls and Springbok No 8 Pierre Spies. “But without doubt players are bigger, stronger and faster and there are more games.As a result
we’ll see more and more injuries.”

“Conditioning coaches prepare us as well as they can but because of the nature of the collisions there is no way to prevent massive injuries from happening. We’re seeing that guys are even suffering severe injuries, especially knee injuries, when they aren’t touched.

Statistically speaking, rugby is the world’s most dangerous sport at an elite level. It’s a tough game. Several studies conclude that rugby has between 80 to 82 player injuries
per 1 000 playing hours. European soccer’s governing body, UEFA, did an exhaustive study of football injuries over eight years and concluded that the ratio of injuries was eight per 1 000 playing hours. That’s a massive 
10 times less than rugby.

In a Super Rugby game a backline player will experience an average of 120 “impacts” – defined as a tackle, attending a ruck or maul or a collision – and a forward 300. Within the game there are also numerous changes of 
acceleration and direction, which puts 
extreme pressure on the body’s active and passive stabilisers, the tendons and muscles.

But that’s only part of the story, because playing time is minimal compared to time on the training ground, which is where the real fatigue sets in even – if contact and collisions are kept to a minimum.

In the Rugby Football Union’s annual injury report for the 2012/13 English Premier League season, the most common training ground injuries were ankle sprains and medial knee ligament damage. Concussion was the most frequent match day ailment. Not unsurprisingly their study also found that teams with less injuries had a greater league points return.

“The nature of the game is that it is a high-paced collision sport played by very fit, strong and relatively big players, and injuries
are inevitable,” says Clint Readhead of the South African Rugby Union’s (SARU)
medical department.

“Currently the research data that we have with regards to the incidence of injury in the Super Rugby competition is very similar to research data from around the world, and other South African studies.”

Readhead’s 2013 international findings recorded an incident rate of 81 injuries per 
1 000 player match hours. This translates roughly into 1.6 time loss injuries per match, 
or one time loss injury every 12.3 player match exposure hours. “To put that into perspective, it equates to 1.64 injures per match or one time loss injury every 12.2 player match hours,” Readhead says.

“So potentially teams can have three players suffer a time loss injury every two games.”

Put it this way: on average a player will suffer three injuries that keep him out of the game in a two-year period. And most of those injuries are picked up in matches. An injury will occur every 10.7 hours in a match environment, and every 500 hours in training.
But considering that training takes up much more time than matches, statistically one player will be injured for every 11 days of training. So over the course of an average
season, 12 players will be ruled out through training-ground injuries.

Questions must be asked about whether professional rugby can sustain this kind of player attrition while maintaining high standards. As fans, are we really seeing the best product? At one stage in the 2014 season,
the Stormers had 16 players out of action.

“I remember coming to training and guys would be popping Myprodols (powerful painkillers) just to get through, to demonstrate they were fit to play,” says one former Springbok Test player. Another current Super Rugby player revealed that he played on knowingly, despite having a painful injury. “Ag, I’m just going to play until it goes again because I don’t want to sit out now,” he told Men’s Health.
“I have no cartilage there so it’s only a matter of time before it goes again.”

It did.

The professional game might have brought wealth and comfort to some players, but 
missing games almost always translates to 
a loss of income, which for the average
professional is difficult.

A study of Aussie Rules Footballers 
published in the Journal of Sports Sciences in 2010 found that players were motivated by ego and money to return and were less concerned about the possibility of a recurrence of the same injury. The authors also found that players who made the call to return after self-assessment and regulation were less resentful than those forced back into the game through the advice of medical experts. Rugby players have a similar attitude and motivation to return.

“Injuries are a part of the game that make you mentally tougher,” says Spies. He suffered a recurrence of a torn bicep earlier this year, which ruled him out for a full season in 2014. He also missed most of the 2013 campaign with the same injury.

“Not being able to play comes with its own frustrations,” Spies says. “Obviously you’re missing a lot of games and as a consequence I’ve taken quite a financial knock as well.” 
No kidding. Springbok players currently 
earn R100 000 per game.

“It’s been tough and frustrating, but there is always an upside in that I get some family time and can look at my life and plan a little bit,” he says. “The injury offers a perspective on your career that you might not be able to understand when you’re playing all the time. Bizarrely, injuries like this can extend your career because they give your body a break. That’s the way I’ve chosen to look at it.”

Leading medical experts and coaches 
generally agree that a player at the top level has a career expectancy of between five and seven years, which is among the shortest in professional sports.

“This particular injury recurrence was simply a case of bad luck,” says Spies. “I 
approached rehab conservatively, but my body rejected the screw that had been put in my bone. The tendon partially tore bit by bit 
before it eventually went completely.”

For Spies, that’s where “if onlys” come into the picture. Ordinarily eight months off would’ve
been plenty of recovery time for Spies’ injury. But once doctors opened him up months later, they discovered his body had rejected the screw.

“What made this setback difficult was that I’d approached the year well, trained hard, lived healthily and got my body into the best physical shape it could be,” Spies says. “You have to know your body well and be in tune with it. That can be a negative because you can become worried about warning signs, which is not ideal in a game like rugby. All a player can do ultimately, is to be as well conditioned as possible to avoid certain types of injuries. But a lot of the time it comes down to bad luck.”

Injuries are common, even for the recreational sports enthusiast or the weekend warrior. But science is moving into exciting – and affordable – new spheres which will allow you to take rehabilitative and preventative steps to avoid and recover from injuries.

Respected Cape Town-based biokineticist James Raaff, who has worked with various amateur and professional amateur sports teams (including the Springbok), has a 
modern outlook on training. “There are 
a range of injuries that are out of your control – acute traumatic injuries. Let’s call them ‘accidents’,” he says. “In surfing you could
get whacked in the face by the board. The
only way to reduce them is through a better cognitive understanding of your sport.
Broadly speaking, being better conditioned
to play at the level you’re comfortable with
is important, so that you are more able
to handle those ‘accidents’ with less
catastrophic consequences.”

“The second and far more common 
category of injuries are not life threatening 
or massively traumatic but generally occur 
in the lower extremities – ankle and knee 
ligament and muscle damage. What can you 
to prevent these? We call it pre-habilitation, which is conditioning yourself to be appropriately fit for the demands of your chosen sport, in addition to a base fitness.

“At a modest level one way of fine-tuning your fitness is to play/do your sport as much as possible so that you get used to the various forces, bumps and knocks of the game itself. You can spend time in a gym, or doing Cross-Fit, which is all well and good, but it doesn’t necessarily prepare you for a specific sport.”

Although more and More time and money is being invested in injury research,
data collection and prevention, it’s still unclear whether the current trend in rugby of more matches of higher intensity can continue unchecked.
“If you take a calendar year, in the amateur days they used to divide it into four or five cycles,” says Professor Derik Coetzee, the former Springbok conditioning coach and respected sports scientist at the University 
of the Free State.

“The first cycle was the base strength phase. After that was the power phase where the players did more speed work. That was then followed by the pre-season phase 
where you spent most of the time on 
structure, then an active rest period which was at least six weeks.

“But now all your base strength, power phase and your pre-season or pre-competition phase is crammed into something like two weeks. It really becomes ridiculous, 
and I think it’s inhuman to expect any player tobe able to reload his battery, not just physiologically but psychologically as well.

“Yet every year the powers that be are looking to increase the number of games.”

Current Springbok captain Jean de 
Villiers – a player who’s had more than his fair share of injuries – has just completed nine weeks on the sidelines with a knee injury after nearly three seasons of non-stop rugby. He has often shrugged at a situation that sees him playing Currie Cup matches a week 
before leading the Boks on their traditional end- of-year tour to Europe.

“There will come a time when my body won’t be able to take it anymore, or a time when I’m asked to leave,” De Villiers said 
philosophically during a rare quiet moment on last year’s Springbok tour.

“I accept that.”

By Craig Ray