Pain game: how an Irish tech firm is helping to reduce injuries in rugby

Rugby is mangling its players. So much so that an Irish tech company is producing enough preventative measures to journey deep down into Silicon Valley.

Officially, the sport is not suffering an injury epidemic. According to World Rugby, global injury rates and their severity have plateaued since 2003.

All we are seeing, they tell us, are inevitable “fluctuations” following a British and Irish Lions tour.

This "Lions Spike" has little to do with England and Scotland being almost propless. Nor does it account for battered English number eights, Billy Vunipola and Nathan Hughes, and can't fully explain why Wales are without 10 probable starters for the Six Nations.

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Ireland are doing better than most. Seán O’Brien, Rhys Ruddock, Jamie Heaslip could be the established national backrow but for hip, hamstring, back problems while Jared Payne hasn’t played since last summer due to migraines.

This is not just about concussion even if 40 per cent of injuries happen in the tackle. It is everywhere: soft tissue, shoulder reconstructions, exploding knees and the Leinster special, syndesmosis – an ankle operation requiring six weeks’ rehab and Josh van der Flier, Dan Leavy, Barry Daly, Isa Nacewa and eventually Garry Ringrose will be right with you.

Joe Schmidt's squad is also shorn of two hookers, Niall Scannell and James Tracy, but the Irish system is clearly working. This can be attributed to the control of minutes on the pitch combined with the expertise of Nick Winkleman – recruited from the elite end of American sport as Irish rugby's recently invented head of athletic performance and science.

Tipping point

Rugby appears to be at a tipping point despite highly skilled professionals laying out effective methods to keep players on the battlefield for longer.

“I had about seven or eight operations on my left knee alone,” said Kevin McLaughlin (33), the former Ireland flanker who was forced to retire in 2015 due to concussion. “Two reconstructions and several cartilage cleanouts. I had my right shoulder reconstructed once, my left shoulder reconstructed twice and all the other contact injuries – rib, concussion – along the way as well.

“Out of a 10-year career I spent just under half of it injured.”

Strangely, McLaughlin doesn’t look like Robocop. In fact, he’s carving out a career in a growing industry: injury prevention.

Imagine waking up in varying states of recovery from surgery or, on the good days, pounding discomfort. In your 20s. This is rugby today. This is what players do to themselves for our entertainment.

Insurance has become an enormously costly issue.

“The IRFU has every player covered on a blanket policy so there is no issue there but in terms of private insurance – you can have a body part excluded,” McLaughlin explained. “So, for instance, my left knee was excluded from my private insurance policy because I had so many issues with it that they didn’t want to insure it. That can happen.”

It’s common for players to have private insurance?

“Some players do it.”

Kitman Labs, where McLaughlin is head of operations, is contracted by the IRFU to collate data that identifies injury patterns and recommends methods to reduce them. Their remit covers the Ireland women's squads, provinces and underage systems. All under the watchful eye of Winkleman.

“Nick has come in and done a great job streamlining the provinces so by the time a player is 23 and winning his first international cap, they will have a passport of seven, eight years of data,” McLaughlin explained. “That allows them make the best possible decisions for the individual’s optimal training programme.”

Other Kitman rugby clients include three English Premiership clubs – Bordeaux Bégles, the Hurricanes in New Zealand and Natal Sharks in South Africa.

They have discovered that most athletes can reduce soft tissue injuries by training at comparable velocity to how they play games.

"Our philosophy is that you should collect your data and link it to your injuries to understand how they are happening so that you can make better decisions," said Stephen Smith, founder and CEO (now based in northern California) who in a previous lifetime was Leinster's head of rehab.

McLaughlin said: “For instance, a prop – Cian Healy – doesn’t need to do the same high-speed running in training camp as Rob Kearney but maybe he needs to do more contact work to build up his resistance. One of the trends we are seeing is actually doing more in training has a preventative effect and a protective effect over players when they play the games.”

Makes sense.

Donncha O’Callaghan recently provided his perspective from behind the scenes at the Worcester Warriors.

“You wouldn’t believe the contact level at training now,” said O’Callaghan on Newstalk. “You chat with the other guys in the Premiership; physicality in training is probably where you pick up most of your bangs and knocks. It’s probably two concussions a week . . . It’s also other fractures and breaks due to training. The players’ union needs to look at the training loads.”

Smith said: “If a club was having two players a week concussed from doing either too much contact or specific contact-related drill, our system would help to identify that and showcase that as high risk, thus allowing coaches to make informed decisions as to the appropriate amount of contact.

“Determining the sweet spot for training is a real balancing act, to totally prevent injuries in training you could jog around and do no contact but then the risk of game injuries would skyrocket by under-preparing athletes.”

World Rugby states that at least 75 per cent of a player's activity is on the training field, with chief medical officer Dr Martin Raftery saying "players should be managed on an individual basis as the data suggests players returning from injury and players exposed to sudden changes in training appear to be at a higher risk of injury".

Kitman Labs agrees. “I think the use of all this data and technology is part of the problem,” said Smith. “Zoom back to 2007 at Leinster. We didn’t have GPS technology. We had a stopwatch and were clocking the time somebody would spend on the training field and games. We’d calculate very simple workloads from that.

A contact is exposure. It's a higher chance of someone getting injured. So, every time a player goes into contact it increases the risk of injury

“Now, we have every single step they take, every twist and turn, every time they bump into each other or take a collision, every time they jump and land. We measure everything. What has that led to? It means teams have hundreds of data points on their athletes every day.

“I think we are over-decisioning on our athletes. Coaches see somebody [via the data] doing more than last week and, fearing fatigue, might reduce his workload.

“They are assuming doing more increases risk. What we are finding from the analysis is that athletes hitting higher scores in training actually leads to less injuries.

“Because the game is so fast these guys need a certain stimulus from how they train all week, they need to do a certain amount of work to be able to cope with the demands of the game.

“We are arming people with facts not opinions because, you are right, injuries are getting worse in certain teams,” Smith continued. “We see it now with Wales and England – the Six Nations might be a completely different experience for them because of injuries and that would be a shame. The teams that win should be the best teams with the best strategy and attack game. Not the teams that aren’t broken the most.”

Pain games

“CARNAGE!” screamed the Sports Illustrated cover in December: “Inside the NFL Season Of Pain.”

In American Football this season, 54 players suffered torn anterior cruciate ligaments. “That’s across 30 teams that only play from September to January,” said Smith. “Rugby suffers a fraction of that.”

Also, from the 281 reported concussions – a record since the NFL started sharing such data in 2012 – 56 happened at practice. Similar rugby data is not in the public domain.

Meanwhile, in Europe, the governing body is “closely monitoring” the situation. They state that new rules and the rising ball-in-play minutes since 2015 have not impacted injury rates.

“Guys are so much bigger now,” said O’Callaghan. “I’ll be honest, it’s gone to the point where nearly every game you come off and you’re okay, you’re thankful.”

The club game in England has seen an increase in the severity of injuries.

“There seems to be a lots of talk in the English Premiership about collision-based injuries and there has definitely been an increase based on looking at the stats,” said McLaughlin.

“When I first started playing [in 2007] if you hit 20 rucks, made 10 tackles and five carries that would be standard for a backrower. Now, look at Josh [van der Flier]’s stats: 36 tackles in a game and he probably hit about 40 rucks and carried the ball about 10 times as well.”

McLaughlin simplifies the issue: “A contact is exposure. It’s a higher chance of someone getting injured. So, every time a player goes into contact it increases the risk of injury. That has definitely changed over the last 10 years. Without a shadow of a doubt.”

More risks

The Sunday Times printed 11 letters in their sports section last weekend. Seven were in reaction to a Stephen Jones article on rugby injuries. "It is inevitable that a player will be killed on the field," wrote one reader. "Injury levels will become epidemic and long term, chronic injury will become the norm."

Smith, working at the coalface, states that World Rugby has been proactive when it comes to injury prevention: “I don’t know if I would say there is a massive epidemic in rugby today. Certainly there are rule aspects that mean there is more risks.”

Smith mentions Seán O’Brien’s shoulder dislocation – presumably against Ulster in December 2013 – at the breakdown. “His arms are extended and completely exposed so when someone comes in and hits him at a 45 degree angle it is the perfect way to dislocate a shoulder. But, at the same time, that’s rucking.”

World Rugby says less than eight per cent of injuries are ruck related. So no problem there either.

The ultimate goal of professional sport will never change.

“The only thing I ever cared about in Leinster was winning,” McLaughlin added. “What we are trying to do is provide objective data to back up decisions coaches are making. Sometimes the right thing to do is to take risk and the player and coach will agree to that. It is the best thing for the team as it gives them the best chance of winning because that’s what is most important. ”

Injured Six Nations (players recently selected by country):

Ireland

Niall Scannell – hooker

James Tracy – hooker

Dave Kilcoyne – prop

Rhys Ruddock – flanker

Sean O’Brien – flanker

Jamie Heaslip – number eight

Garry Ringrose – centre

Jared Payne – centre/fullback

Italy

Ornel Gega – hooker

Marco Fuser – lock

Angelo Esposito – wing

Leonardo Sarto – wing

Michele Campagnaro – centre

England

Matt Mullan – prop

Beno Obano – prop

Kyle Sinclair – prop

Ellis Genge – prop

Tom Curry – flanker

Nathan Hughes – number eight

Billy Vunipola – number eight

Elliot Daly – wing/centre

Henry Slade – centre

Semesa Rokoduguni – wing

Wales

Jake Ball – lock

Sam Warburton – flanker

Dan Lydiate – flanker

Toby Faletau –number eight

Rhys Webb - scrumhalf

Jonathan Davies – centre

Hallam Amos – wing

George North - wing

Liam Williams – fullback/wing

Dan Biggar - outhalf

Rhys Priestland – outhalf

Scotland

Richie Gray – lock

Ross Ford – hooker

Fraser Brown – hooker

George Turner – hooker

Zander Ferguson – prop

WP Nel – prop

Darryl Marfo – prop

Allan Dell – prop

Al Dickinson –prop

Alex Dunbar – centre

France

Fabien Sanconnie – flanker

Loann Goujon – flanker

Judicaël Cancoriet - flanker

Morgan Parra – scrumhalf

Camille Lopez – outhalf

Wesley Fofana – centre

Damian Penaud – centre

Noa Nakaitaci – wing

Gabriel Lacroix – wing

Brice Dulin – fullback