Keeping track of health matters


Players' fitness and injuries: Johnny Watterson assesses the increasingly important role played by the people who monitor the fitness of professional rugby players

When Brian O'Driscoll resisted the overtures of Biarritz and all the other French and English suitors to remain faithful to the less glamorous Heineken European Cup sister, Leinster, the usual number of considerations, as in the case of a contract of any kind, would have run through his head: the salary; the lifestyle; the prosperity and cost of living outside Dublin; the tax issues; the team-mates; the language and, at the heart of it all, his prize possession and the thing that makes him exclusively Brian O'Driscoll: his body.

The number of games expected from O'Driscoll may not have been the crucial factor in his decision to stay with Michael Cheika and his Leinster colleagues but, from his side of the negotiations and given that his dislocated shoulder had not been fully road tested at the time of the contract discussions, it would have been a hugely important point of consideration.

O'Driscoll and the backroom staff in Leinster are keenly aware of the study conducted by Brooks, Fuller, Kemp and Reddin in 2003, which, at its most simplified, says that the more games played and the more collisions between players the greater are the chances of sustaining injury.

Published in the Journal of Sports Medicine, the study looks at the England 2003 Rugby World Cup squad's training for a 63-week period and the injuries sustained and while some of the conclusions amount to what you would expect, the devil is in the detail. There are more complex factors involved than the bald, simple equation that more matches equals more injuries.

In a second study, which is ongoing, the Rugby Football Union in England in partnership with Premier Rugby Limited and the Professional Rugby Players' Association are carrying out an injury and training audit, to find out and address the risk of injury in rugby union and what can be done to minimise the frequency and severity of injuries rugby players suffer. Since the game has turned professional, the players' welfare has become not only a health issue but also a corporate imperative.

Healthy bodies equals stronger sides and better results, which translates into turnstile revenue and television time for sponsors. In essence, injuries indirectly relate to and influence money issues in the sport. The question of whether Leinster would have beaten Bath at the RDS or Bourgoin a few weeks ago in Stade Pierre Rajon with a fit O'Driscoll, which would have turned their European Cup campaign into an altogether more positive journey, needs asking.

Both studies were extensive with the first concentrating on international players within the England squad in the run up to and including the last World Cup, while the current and ongoing study covers international and club matches in the 2002/'03 and 2003/'04 seasons. An important definition in both papers is they defined an injury as something that prevented a player from taking part in all training activities and match play for more than 24 hours. Blood injuries, where a player left the pitch and then returned, were discounted.

Both studies arrived at some very clear conclusions. The latter investigation, involving English Premiership club sides, recorded over 2,000 injuries to players over the two seasons up to the end of 2004, which translated into an average of 92 injuries per team per season. It went on to quantify just what sort of risk players take when playing in both club games and international matches.

Players had a one in eight chance of sustaining injury in a club match resulting in an average 18 days' absence. But at international level their chances of injury doubled to a one in four chance, resulting in an average two-week absence. It reported that, on average, nine players at every club required treatment and rehabilitation each day for the injuries reported and critically, most of the injuries, 72 per cent, occurred during contact, 51 per cent of them in a tackle situation.

Fitness and injury prevention gurus such as the IRFU's Liam Hennessy have been looking at Irish players and their pattern of injuries for a number of years. The answer to preventing injury and presenting the country's best players in good condition is known but the reality is the game of rugby and how the seasons operate militates against repeatedly putting the strongest players on the field.

Rugby, the game, has been much slower in adapting to the professional era and all of its requirements than the players have. The people who are picking up the tab are those same players and those who pay their wages.

"It is a dilemma," says Hennessy, the IRFU director of fitness "Years ago when we looked at the system that operated, we could see that it was convoluted. We looked at the extent of the season, which is September to June, depending on the player. That leaves a very small period of preparation. That is the foundation on which we are able to manage a system. The season is very long and preparation is very short. It's a dilemma.

"We use 30 games a season as a definitive figure for the players. If a player is coming close to that figure then we watch him very closely. The consequences of playing more than that is that the players then begin to break down and they don't progress. We've been pretty happy. Some come up very close and some will step over it but sometimes they don't play enough games, particularly the players who are not frontline and that's an issue we are aware of."

Connacht are able to rotate players over three games on one-off system. That can be done with a complete squad but when the national players from Leinster, Ulster and Munster are put in the mix it begins to pose a problem. There is no difficulty in playing all the games, the question is where do you then pencil in the critical recovery time.

"The number 30 comes from a pragmatic analysis of the length of the season. The most games you could expect them to play is 30," says Hennessy. "It's not ideal. Ideal would be a "double periodised" year. That would break down into something like prepare-play-break-prepare-play again. New Zealand plays in discreet blocks through the season with the Super 14, the NPC and November tours. We don't get those periods where we can get players out."

Last week the IRFU tried to get players "out" for a week-long national squad session scheduled to take place after the new year. But Eddie O'Sullivan cancelled the session because of pressure on the players to compete in a succession of Celtic League and European Cup fixtures. In short, the most successful players are those hardest done by if their management is not monitored carefully. While frontline international players such as Gordon D'Arcy, Shane Horgan, Paul O'Connell and Ronan O'Gara are required by province and country whenever fit, they open themselves up to more injuries.

But as the year progresses and end of season matches become more intense, those players are in greater demand. Their risk of injury then increases due to the intensity and because the matches come at the end of a long season. It also cuts back on their time away from the game to recuperate and reduces the preparation time for the following season. The cumulative effect is to put the players most in demand under the greatest stress and in a high-risk category with regard to injury.

"We monitor the players every week," says Hennessy. "We also count the time in minutes as a player may have played in 10 games but not 10 full games. We know how many minutes every player has played. But they will tell you that the step up from Celtic League to European Cup is significant in terms of the tackle count, the intensity and physicality of the matches.

"Then, if you put those matches at the end of a long season, the fact that you are still playing is another risk factor. These players are also hardest done by pre-season. So year in, you get less time to prepare for the base. Add that up year to year and there is always a pay back. Guys at the top are the ones we have to be most careful with."

What Brooks, Fuller, Kemp and Reddin concluded was the incidence of match injuries at international level was higher than previously believed. The tackle, ruck and maul elements of play, the endurance running and contact elements of training presented the highest risk of injury for all players.

Hennessy is aware of the risk areas. Forwards, for example were found to pick up more injuries undertaking endurance running. Because of their size and bulk, the stress on muscles and joints was more severe than with backline players.

The backline players have a greater incidence of injury being tackled. Now the backline players work hard on skills such as being tackled and tackling while forwards don't do the type of endurance training that they once used to, which begs the question of how they become fit enough to last more than 80 minutes of an international match.

"We have always been aware of the non-contact injury," says Hennessy. "Big guys running and the impact on joints. We've said they'll do cross-training instead. Methods and progression are important. We screen them as individuals and work in the training by seeing their weaknesses. It is a trade off."

The role of the fitness team involved in rugby is not just to prevent and manage injury but to get players in the best possible condition to play to their ability consistently. A rule of thumb in Ireland used for speed is that if an international player cannot run 10 metres in 1.70 seconds or less then he is going to struggle in a game. If he is a secondrow like Paul O'Connell, it means he can't get to the break down quick enough or, if he's involved in a backline move, he will be out of synch with the other faster players.

Crucially it means he will be caught more often and tackled more frequently. All in all, bad news. But there are certain physical qualities needed to run 1.70 seconds for 10 metres. O'Connell's initial best was 1.78 seconds, a little slow for his immense ability. With personalised training, his time was brought down to 1.67 seconds - well within the acceptable levels for a frontline player.

Recently an application was made to the IRB for funding for detailed research over an 18-month period into injuries relating to the tackle, which may shed more light on the area of greatest attrition. Teams also now recognise there must be defined industry standards for injury prevention and management.

Stationary bikes at the side of the pitch at Twickenham for England's autumn game against the All Blacks has been one such noticeable but simple innovation to enable players to correctly warm-up before being thrown into the middle of a high-intensity match.

"Based on specific findings of this report Premier League Rugby (PRL) has already raised the minimum standards required for medical facilities at club grounds and minimum qualifications for club medics. As employers we have a duty of care to our players," said Phil Winstanley, rugby manager for PRL.

There are always going to be injuries to players as contact becomes increasingly faster between larger body mass players. O'Connell, O'Driscoll and Denis Hickie have shown over the past several months, that even with strict regimes of preparation and diligence, few are immune.

Looking at it from a corporate point of view, the whole issue is of immense importance. From the England study (England, England A, under-21s and sevens) we know that 263 injuries accounted for 5,161 days' absence, or, the equivalent number of days off work. That's quite a lot for an industry to absorb.

"We are mindful of injury but we also want them bigger and stronger and you have to push to get development," says Hennessy. "It is a tightrope."