Rugby health expert reveals top injures ahead of the Six Nations Final

Ulrik Sandstrøm, chiropractor and BCA Board Member, has been involved in elite level sports chiropractic for over two decades and is passionate about delivering the highest quality care to athletes by working together as an integrated medical team. As chiropractor to Leicester Tigers Rugby and chiropractic consultant to England Rugby, he has worked closely with many England Rugby Union stars, developing an evidence, patient-centred approach to their care.  

 Comment on when the most injuries happen during a match

Generally, most injuries occur in the game rather than training and particularly in the first part of the second half. So, between 40 and 60 minutes is when we are likely to see the highest peak in injuries. We often put this down to the fact that players are fatigued because they’ve had a full first half and then 15 minutes of cooling down and then they’re straight back out, playing at full intensity again. Many players will sit on static bikes keeping warm during half time to keep their legs ticking over as a preventative measure. 

What’s also interesting to note is that in game time, backs players tend to get more injuries than forwards. Whereas in training, forwards tend to get more injuries than backs. In training, the backs generally don’t get hit as hard as they would during a game, but forwards do get involved with live scrums, lineouts etc. which carry more risk. 

Comment on hamstring and groin injuries 

Because rugby is a running sport, you tend to see a lot more hamstring and groin injuries than you would in other sports. Hamstring injuries can take anywhere from a few days to a few months to heal properly, depending on the severity of the injury, and groin injuries can take six to eight weeks to fully recover from, leading to time out of training and a slow return to play. When a player is injured, it’s important to work with the player to develop an individual evidence-based treatment plan that reduces their pain as soon as possible and supports them throughout their recovery period.   

Hamstring and groin injuries usually occur from sudden changes of direction or high speed when running, so players can limit the occurrences of these kinds of injuries by making sure their muscles are thoroughly warmed-up before matches. Warm up drills are usually very individual and designed by the strength and conditioning team to fit the particular tasks and injury profile of each player. As chiropractor and member of the BCA we always take an evidence, patient-centred approach to care – and create bespoke care packages for all patients. 

Comment on hip Injuries 

You see a lot of high impact injuries in rugby due to the nature of the game – it’s not uncommon for a player to make 10 or more tackles per match in a Six Nations clash. Hip injuries, known as hip pointers, occur after direct impact to the front of the hip and are very common in rugby due to tackles. The usual recovery time is one to three weeks, depending on the severity of the condition, but severe injuries can take closer to eight weeks to properly heal. When treating an injured player in a sporting competition like the Six Nations it is often the case that other healthcare professionals will be present. Working collaboratively and communicating effectively with the other clinicians within the team is paramount to ensure the athlete gets the best treatment and guidance from the whole medical team. 

Comment on concussion and neck injuries

Mild head and spine injuries are common in rugby, especially during high contact play like scrums, tackles, and rucks, but can be very painful so need to be looked at carefully. I see a several ‘stingers’ in rugby – stingers are essentially traction injuries of the nerve bundle coming from the neck and are usually caused by tackling someone. Depending on how severe the injury is, a stinger will cause an electric-stinging pain which usually doesn’t last long, but can continue for hours or even days in bad cases. They can take anywhere from two weeks, to a few months to recover from and can sometimes be associated with a marked weakness of the arm muscles. These injuries are very often co-managed by the team chiropractor to make sure the athlete is on the right course of treatment. As a BCA chiropractor, we always take an evidence, patient-centred approach to care – and create bespoke care packages for all my patients. Stingers were certainly one of those conditions often waiting for me on Monday mornings at Leicester Tigers. 

Concussion is clearly a potentially serious injury – especially if players get them repeatedly. We are seeing a number of neurological conditions, such as MND and Parkinson’s, now being linked to concussions, which is why the RFU are making changes to tackle laws to reduce the risk of head injuries”.