| Catastrophic injury (serious head and neck injuries resulting in death or paralysis), the scourge of rugby have again been highlighted in the press and televised media. Slightly more tongue-in-cheek, a recent survey on this website asked whether ballet classes might be an option for rugby players in order to improve flexibility and hence help prevent injury.
The topic of injury in sport is ever-present, nowhere more so than in rugby circles. Although it appears that mothers in particular appear concerned for the safety of their sons and daughters, I am sure that all of us involved in sport are unhappy with the incidence of catastrophic injury in South Africa as well as the negative publicity it brings to collision sport.
There is no magic formula for injury prevention. In my opinion there are several important role players each of whom is responsible for facilitating safety on sport, in particular, rugby. I will touch on the areas I believe to be important and then dwell a little on some positive and evolving trends in preventative sports medicine.
The Player
The days of arriving at practice, jogging twice around the pitch and then performing a few rudimentary stretches are gone. A rugby player of any age should assess his strengths and weaknesses and, perhaps with the assistance of a medical professional, fitness trainer or coach, determine a strategy to address any weak areas. These may be as obvious as muscle strength and flexibility, or more subtle such as poor balance sense. Moreover, ensuring adequate preseason preparation will help to prevent injury, as will the early treatment of injuries and niggles using the simple RICE protocol, and the reporting of any potentially more serious injury to a doctor or physiotherapist.
The Coach
Coaches need to appreciate the importance of preseason and maintenance conditioning, allow for periods of higher and lower intensity training as well as incorporate adequate recovery or rest periods. Determining whether to play a player who has a “niggle” or potential injury is often difficult. As much as I am against exacerbating a player’s condition by exposing an injury to risk (as indicated in a recent “Reader’s viewpoint” posted on this site), I also fully understand a coach’s frustration at over-enthusiastic paramedics hauling a player off the field or excessively conservative practitioners resting players for long periods. Part of my sports medicine philosophy is to keep players on the field and perhaps the best way of facilitating this together with the age-old physician’s maxim of “first do no harm”, is to build up a relationship of trusted medical personnel who have sports medicine experience and are accessible to the school.
The School
In a previous article I have referred to the need to establish a medical network that can manage most medical situations, sporting and otherwise. This includes match day planning, transport to hospitals, doctors on call and medical personnel on-site. Not only does this have medico-legal implication, but allows all involved in contact and collision sports to play safe in the knowledge that, should an injury occur, the structures are in place to allow for optimal care.
Referees
The laws of the game, in particular the scrum and tackle laws, have been changed over the years to improve safety. Implementing these laws will significantly decrease the incidence of serious injury. It is incumbent upon referees to ensure this consistently form the first whistle.
Administrators
I believe this to be the most contentious issue with regards to catastrophic injury prevention in particular. Support bodies such as the Chris Burger Petro Jackson Fund do outstanding hands-on work but are really picking up the pieces of a dire situation. Stringent preventative measures are required and South African Rugby requires leadership in this regard. Leadership by an individual who will take overall responsibility and a “buck stops here!” attitude towards a reduction in the number and severity of injuries. Resources and money need to be directed towards this urgently, a strategy determined and the public informed. This way we will know that it is a priority and can monitor the efficacy of these endeavours.
Medical Trends In Injury Prevention
On 2 recent trips to congresses abroad, it has become apparent that there is a big trend towards injury prevention through specific, scientifically validated exercise programmes. These routines are designed to address weaknesses and are functional, meaning that they can be incorporated into training and practice sessions.
In 2 articles to follow in the coming months I will elaborate on programmes to help prevent knee injuries and, of particular importance to South Africa, head and neck injuries. A group of sports medicine practitioners is currently working on strategies to adapt overseas technology and protocols to South African sports settings. The first MCU (Multi-Cervical Unit) designed to assess neck range of motion and strength and accurately guide pre and re-habilitation will be operated by a biokineticist at a sports medicine centre in Johannesburg within the next 2 months.
In conclusion, leave the dancing to the ballerinas! It’s time all of us involved in rugby from sports medicine practitioners to coaches, parents and players, looked at our role in reducing injuries. Should we all play our part, the rewards at community level will be gratifying. Nationally, we require leadership to place our injury statistics in a better light. Who will stand up? | 
