Ireland Injuries: Science is coming into play

Report does not support theories that there is a rising trend of injuries in rugby

Ireland’s Dave Kearney is left grounded after Guilhem Guirado of France’s tackle during the Six Nations game in Paris. Photograph: James Crombie/Inpho

Ireland’s Dave Kearney is left grounded after Guilhem Guirado of France’s tackle during the Six Nations game in Paris. Photograph: James Crombie/Inpho

 

At face value it looks like carnage. For the opener against Wales, Ireland had nine frontline players ruled out through injury, a figure which rose to 10 for the French game and will be circa eight to 10 for the forthcoming rendezvous with England in Twickenham. Yet that is about the going rate nowadays.

List the catalogue of injuries to Dr Eanna Falvey, who has just finished a six-year stint as the Irish team doctor, and he cites the latest RFU Injury Surveillance Report from last year. Produced annually since 2002 and based on research amongst all 12 Premiership clubs and the English senior team, it is the most comprehensive injury dataset in professional rugby union.

“If you look at the RFU report, which is the only thing we can really quote in terms of Northern Hemisphere participation rates for professional rugby, their figures are just short of 30 per cent in all squads at all times. That’s a very high figure,” Falvey admits.

The current Irish casualty list is also a snapshot, containing players at the end or start of longer-term injuries.

“In some ways the national squad can be either under or over reflective of injury trends. Looking at provincial squads is probably a more accurate reflection of what’s happening. In an international squad, guys are probably playing at a higher intensity than anybody else but then are protected in other ways.”

Indeed Simon Kemp, the RFU’s chief medical officer said on foot of their latest survey: “The 2013/’14 season report does not support the theory that there is a rising injury trend in the professional game.”

What has changed is that injuries are longer term. In total 739 injuries were sustained during matches in the 2012/’13 season, and the average injury caused a player to miss 26 days. In 2002, when the project began, the average severity was 16 days.

Last year’s RFU report generated alarm when finding that reported incidents of concussion increased by 59 per cent on the figures published for the the 2012/’13 season, rising from 54 instances to 86.

Kemp forecast that “reported concussion will continue to rise with greater awareness and focus”. He added: “Our figures are reported figures when historically there has been an under-reporting of concussion across all sports.”

Worrying rise

Falvey concurs that the worrying rise can be attributed in part to improved diagnosis and reporting of concussions, and there’s a heightened awareness amongst players and the media.

“I’ve always supported the process of HIA (Head Injury Assessment) for all of its foibles and deficits. It has definitely increased the accuracy of diagnosis of concussion. It has also increased not only public awareness but physician and player awareness around this.

“Back in the day when it was a 21-day blanket rest for concussion, very few concussions were reported because of that. Before the process of proper HIA and a graduated return to play you also had under reporting of what was going on. The stakes are a good deal higher for everyone involved, for the athletes, the physicians and the coaches. The higher rate probably does reflect the reality of the situation. The lower one probably did not.”

The RFU report showed hamstring injuries have come down yet, judging by the current Irish snapshot, may fit into the category of longer-term injuries; ie in Paul O’Connell’s case, career-ending, or in Iain Henderson’s, season ending.

Some hamstring injuries, says Falvey, are related to collisions, others not so. Some are load related, be it new work in the gym, on the pitch or just a higher workload.

“The hamstring tendon problem, where it’s pulled off the bone, in rugby that’s almost exclusively in a ruck position,” he adds. “You have a guy trying to get into a jackal position to win turnover ball. His trunk is flexed, his knee is extended or straight, and he’s bent at the hip. He is stretching his hamstring at full-length, and then somebody tries to clear him out by driving him backwards and the hamstring is pulled through supraphysiological range, and the weak link between muscle tendon and bone is usually the musclo-tendinous junction, where it rips.”

O’Connell’s fateful injury near the end of the first-half in the Ireland-France World Cup game springs most readily to mind. “You can actually see it on the video,” says Falvey. “It was pretty graphic.”

The players who suffer these injuries are primarily “groundhogs” or forwards.

There also appears to be a high rate of knee injuries, and long-term ones to Tommy Bowe and Peter O’Mahony. Falvey recalls hearing someone on television claiming “Peter O’Mahony’s knee couldn’t stand the pressure or force of the tackle. His cruciate was torn before he made contact. That was a non-contact injury. The vast majority of anterior cruciate ligament injuries occur when you put your foot in the ground and you twist, and your neuro-muscular control isn’t as good as it should be, and your ACL ruptures.”

Falvey says: “From that perspective, a girl playing rugby is six times more likely to tear her ACL than a man playing rugby because they have issues around their neuro-muscular controls. So an injury like Peter O’Mahony’s has nothing to do with contact, whereas Tommy Bowe’s injury, which was his posterior cruciate ligament, was because he had his foot in the ground, and somebody made a chop tackle and posteriorly translated his tibia and ruptured his posterior cruciate ligament. That is a contact injury.”

These knee injuries, like the shorter-term ones, are “part of the bread and butter of a season unfortunately,” adds Falvey.

Other factors which can come into play, says Falvey, are the age profile of players and of squads, adding: “One of the significantly biggest predictors for injury is previous injuries.”

Tendon injuries tend to be more age related, says Falvey. “If you look at the shoulder tendons of a 50-year-old compared to a 20-year-old, they’re markedly different in terms of structure and integrity. So halfway between those two points you are going to be seeing a difference.”

Looking back on last week’s casualties in Paris, that Guilhem Guirado received no sanction whatsoever, either at the time or subsequently, for his dangerously high tackle on Dave Kearney beggared belief, and was in stark contrast to the vigilance of the authorities at the World Cup.

“I thought that the measures taken at the World Cup were a real positive for the game,” says Falvey, “and I’m really disappointed that they don’t seem to have followed through on it at the moment.”

Six-day turnarounds, all the more so between full-on Six Nations matches, don’t help. “No doubt about it,” says Falvey.

Falvey now works two days per week in a sports surgery clinic in Santry along with clinics in Cork and and a job as a senior lecturer in sports and exercise medicine in UCC, which has allowed him to concentrate more on his “passion” for research.

For example, they have just conducted research in Santry on groin pain, which was published in the British Journal of Sports Medicine last month. “In Ireland we get an awful lot of groin pain, because we’ve got soccer, rugby and Gaelic football. The research group we have in Santry would be among the world leaders in the use of biomechanics for treating groin pain.”

There is always scope for improved research, with which laws can be changed based on science. Falvey cites research and ensuing law changes to the scrum: “Ten years ago collapsed scrums were a major cause of neck injuries for props. The depowering of the scrum hasn’t affected the game, but has significantly decreased the cervical injuries in props.”

This followed a study in South African into cervical spine injuries in rugby players over a period of time, and laws depowering the scrum which were trialled in Stellenbosch University. “This showed the depowered scrums didn’t affect the integrity of the game but were a lot safer, and now we’re seeing the fruition of that in the last 10 years.”

Game-making decisions

To that end, the IRFU are committed to conducting research into injuries at schools and AIL level, while the RFU are conducting a survey with retired players, all of which can lead to the game-making decisions based on science.

“It’s a really exciting area for us to try and apply a little science on what direction the game can go.”

More research equals more knowledge, equals more law changes. It’s not exactly rocket science.

IRELAND’S CASUALTY WARD

Frontliners:

Seán O’Brien

Suffered a grade two hamstring tear against France and will definitely miss the rest of Ireland’s games in the Six Nations.

Mike McCarthy

The secondrow suffered concussion against France and following a visit to a specialist, has now been ruled out for the rest of this season.

Dave Kearney

The Leinster winger sustained an AC shoulder injury against France and , according to Joe Schmidt, is “likely to miss the rest of the Six Nations”.

Cian Healy

After recovering from neck, hamstring and ankle injuries, Healy’s right knee required an elective procedure which ruled him out of Ireland’s opening two games against Wales and France. Returned for Leinster last Friday.

Marty Moore

Suffered a torn hamstring in the defeat to Wasps in January which will sideline him for six to eight weeks in total.

Luke Fitzgerald

Suffered a medial knee ligament injury in the Irish squad’s open session at the Aviva nine days before the tournament opener, sidelining him for up to eight weeks.

Mike Ross

Sustained a knee injury against Toulon in December which sidelined him for seven weeks until returning last week against Zebre, thus also ruling him out of the Wales and France matches.

Jared Payne

Suffered a grade one hamstring injury against France and is in doubt for Twickenham.

Iain Henderson

Tore hamstring in Ulster’s home win over Edinburgh in early December, sidelining for the rest of the season or, at best, a return in March/April.

Tommy Bowe

Suffered cruciate knee ligament injury in World Cup quarter-final defeat to Argentina. May return for Ulster before end of the season.

Peter O’Mahony

Suffered a serious cruciate ligament injury in the World Cup win over France and is targeting a return in April or May.

Keith Earls

Suffered concussion against Wales, ruling him out of the French game, but should be fit for Twickenham clash.

Simon Zebo

Suffered a knee injury against Wales, ruling him out of the French game, but should be fit for Twickenham.

The Provinces:

ULSTER

Peter Nelson

Dislocated his left midfoot in the Pro12 defeat of Edinburgh last December, which effectively ended his season.

Dan Tuohy

Sidelined since early December when fracturing his right ankle and suffering ligament damage against Edinburgh.

LEINSTER

Hayden Triggs

Recently returned after a two months’ absence since injuring his ankle against Bath in November, subsequently requiring surgery.

Jack Conan

The backrow returns to Leinster action away to Cardiff on Saturday after suffering a broken foot last November.

Ed Byrne

Ruptured his patellar tendon in the first of Leinster’s pre-season friendlies, requiring an operation, and hasn’t played since. This was unconnected with the ACL injury to the same knee which kept him out for the second half of last season.

Royce Burke Flynn

The prop is currently out for four months after undergoing an operation on his neck last month.

Isaac Boss

Should be back in contention next week from a calf injury.

CONNACHT

Ben Marshall

Just recovered from a fractured arm sustained in December.

Jack Carty

Underwent splenectomy in Dubai last week. Sidelined indefinitely.

Shane Delahunt

(ankle)

Andrew Browne

(shoulder)

Quinn Roux

(ankle)

Nepia Fox-Matamua

(knee)

John Cooney

(shoulder)

Dave McSharry

(concussion)

Rory Parata

(knee)

Darragh Leader

(wrist)

MUNSTER

BJ Botha

Sustained an ACL injury during the Stade Francais game in January. Expected to be sidelined for the remainder of the season. Tyler Bleyendaal A quadriceps tendon setback has ruled out him for 12 weeks from the middle of last month. Will be rehabilitating his leg injury until April.

Duncan Casey

Sustained a pectoral muscle injury while playing in the Champions Cup defeat of Benetton Treviso in November and will continue rehabbing until March.

Stephen Archer

Sustained a neck injury in the Pro12 victory over Glasgow Warriors at Thomond Park in September. Has advanced to modified training and will continue to be monitored for next few weeks

Dave O’Callaghan

Sustained a rib injury during training in February. Is being reviewed and managed on an ongoing basis.

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