League: Injuries add up to a lifetime of pain

By Peter Jessup

The NRL league season hasn't started yet and already 50 players are sidelined by injury.

Rugby is no better. All Blacks Ali Williams, Mils Muliaina, Brad Thorn, Corey Flynn, Conrad Smith, Sione Lauaki, Piri Weepu and Jimmy Cowan are among a host of Super 14 players who have had to watch their teams from the sidelines in the first three rounds or will do so this weekend.

New Zealand's two professional contact sports now spend so much time concentrating on gathering scientific data, weights and gym work, sprint training, wrestling and so on that players are continually getting bigger, faster and stronger.

The result is that the injuries sustained both in collision and by over-exertion are increasing in both number and severity.

And when you hear the probable long-term prognosis for most of these players after sustaining repeat injuries to the ankle, knee, shoulder or back, it puts the big wages they earn over a relatively short playing career into some perspective.

Most will suffer osteo-arthritis, particularly if they have had artorscopic operations to remove cartilage, in their lower limbs, due to both evasive manoeuvres and to the burden of carrying tacklers when attacking, and to the forces involved in tackle collisions.

Those who have had repeat concussive incidents are likely to be slower than their peers in processing information and a high percentage will suffer depressive illness and other mental problems.

The increase in speed of players and their acceleration has increased the forces involved in tackles and gang-tackling systems used in both sports add extra load to the ball-carrying player, multiplying those forces exponentially.

The collisions in tackles and in contest for the ball are happening at greater speeds.

Little work has been done to quantify the forces involved in rugby and league but the NFL, which has been professional for far longer, has maintained a sports science programme since the 1970s.

It is as a result of its findings and recommendations that the players' protective body armour and headgear are redesigned and improved and law changes are to be implemented with the aim of reducing the risk of injury.

A University of Nebraska study of the physics of tackles and collisions in the NFL found that players can be subjected to a force of as much as 150G to the head when they collide at high speed or when a tackle is made which throws a player backwards so his head hits the ground and he is unable to control his fall.

Concussion can result from a force of 100G, a jet fighter pilot undergoes about 11G in a tight roll and the bottom swoop on a roller-coaster hits 5G.

The protective gear distributes the force of hits via a visco elastic foam invented by Nasa to protect the astronauts during space shuttle launch. The G-forces there are just 3G.

The Nebraska study, measuring collisions involving defensive backs and running backs, found that bodies can be subjected to up to 226 a sq cm of pressure. The players were all around 101kg and could sprint 36m in around 4.6 seconds.

One in six injuries in the NFL is to knees. The study found that the anterior cruciate ligament can take up to 226kg of pressure in straight-on force.

But it can sustain far less in sideways movement and strain. It was also that American study that identified a higher rate of depressive illness among players who had suffered concussion.

And after it was completed the NFL banned the "horse-collar" tackle whereby players are caught by the clothing and dragged down from behind because it was found to be a cause of frequent serious injury.

Of the 50 players on the NRL casualty list, 17 have knee-related problems. The other big ones are ankles (9) and shoulders (7). Then come facial injuries (4), hamstrings (3), back, pectoral muscle and rib injuries (2 each) and hip and Achilles (1 each).

The majority of lower-limb injuries are suffered when legs buckle under the strain of too much weight or collision force, usually when two or more players are involved against the ball-carrier.

Hookers run the most metres and suffer the most injuries because they also tend to make most tackles. The props suffer the most over-exertion injuries due to the heavy contact in gang tackles and there is thought that this is also related to fatigue.

A study of league in Australia found that 27.3 per cent of injuries were sustained while being tackled and 25.2 per cent were sustained when tackling. The five-eighths position has a high incidence of slipping, falling and stumbling injuries.

The overall injury rate of 68 incidents per 1000 playing hours (one game being around 17 hours across 34 players) is far higher than that for Australian Rules (24) and soccer (18).

Players with a slow 10-metre speed are involved in more injury incidents than others. And while the rule makers want to speed the game up by eliminating tactics designed to slow the play-the-ball, the medical experts say injuries would decrease if players had more time to retreat the 10 metre and prepare themselves for the next defensive contact.

As compromise, teams have been advised to improve the line-speed of players in making the 10 metre gap then retreating after a tackle. A study found more time should be spent on proper tackling technique, and how to fall in a tackle.

In rugby, the most frequent serious injuries are caused to mid-field backs, because of the high speeds at which they contact. A study on injuries in the Super 12 competition found that when tacklers go low they are the most likely to be injured; when they go high it is the ball-carrier most likely to be injured.

If rule changes are designed to bring tackles down, will that mean more injuries? The NZRU has an injury-prevention study, research and advice project looking at how and when injury happens, to which players and what might be done to prevent injury by tackling or ball-carrying technique, physiological change to players' strength and fitness and so on.

A study of the English Premiership rugby clubs that involved 13 of 14 teams and 434 players over two seasons showed that the number of contact events was increasing. A total 760 injuries were reported, 497 due to contact. There were 54 scrum injuries, 21 from mauls.

Forwards were more likely to sustain an injury, backs more likely to sustain a serious one. The most serious injuries are sustained in collisions (not tackles) when two players are contesting the ball and in scrums.

The study published through the University of Nottingham showed that knocking down or charging an opponent without trying to grasp the player also caused dangerous injury. Head injury incidents involving concussion were recorded at 4.1 every 1000 playing hours.

The Nottingham study stated that "the structure of the game was similar at the professional club and international level and the higher incidence of injury at international level may therefore reflect the greater power of international players."

There are around 230 tackles per game in rugby and 500 or more in a league match and as the tackle is where most injury is caused, it is where most work is being down in injury prevention.

Recommendations from the Aussie and British studies include (1) improved coaching of defensive skills; (2) instilling in players the correct tackling technique;

(3) teaching correct techniques for falling; (4) use of methods to minimise the absorption of collision forces;

(5) the practising of defensive drills when fatigued so they are instinctive and players make the right decisions when they are fatigued during a game.

Dr Paul Marshall, director of the Academy of Exercise Rehabilitation in the Department of Sport and Exercise Science at Auckland University, sees the players coming out the back end of their rugby and league careers, frequently hobbling, usually suffering other medical problems and often overweight too.

"They stop playing, have increased family commitments and they often don't do enough to look after themselves and the injuries they have sustained in their career. If you've had cartilage ripped off you're stuffed, you're going to have problems probably with osteo-arthritis. You have to exercise to strengthen the muscles around the joint so they can help ease the strain."

He's aware of the US study that shows an increase in depressive illness among those who suffer repeat head impacts and concussions and wonders what will follow here.

"Maybe they don't want to go the way of the NFL but maybe they are going to have to start looking at some form of protective gear here."

STACEY JONES ONE OF MANY HURTING ON THE SIDELINES AS ROUND 1 KICKS OFF

Warriors veteran Stacey Jones is one of many players who will sit out round one of the NRL competition this weekend.

Jones has injured a calf muscle in training and, although he could play at a pinch and in the past would have played, now he will be given time to recover properly.

Jones broke his arm playing in a test "warm-up" against Tonga before the 1999 Tri Nations and missed time in 2000 and, in 2004, he carried a bad groin injury.

Broncos, Queensland and Australian captain Darren Lockyer will be keenly watched as he makes what is another in a long line of attempts to come back from reconstruction surgery on his knee.

Lockyer, dubbed "the most influential player in the game", ripped his anterior cruciate ligament in the first half of the Broncos' contest with North Queensland in 2007, went back on in the second half and aggravated the injury. He missed the rest of that season.

He was desperate to make the first State of Origin game in June last year and returned for the Broncos the week before but left the field early and subsequently couldn't make the state side. He played 17 of 26 games but left the field early in five.

The Storm's Kiwis, Jeff Lima and Sika Manu, return in round one after knee surgery as does Will Chambers, who is rated as the next Greg Inglis.

Manly wing David Williams was ruled out this week with a knee tear that will sideline him until round six.

Sharks captain Paul Gallen will miss the first round at least - and possibly more - after sustaining a knee injury in pre-season, while Cronulla's new signing Reni Maitua is out until round six with an ankle ligament strain.

The Warriors 2008 season suffered badly after the outing of elusive attacking fullback Wade McKinnon with a knee tear suffered in pre-season against Newcastle and then the loss of skipper Steve Price, who did his hamstring in round one and returned mid-year.

Price has had a great career that might have been greater - he missed the 2004 grand final when the Bulldogs beat the Roosters after suffering a calf tear and was ruled out of last year's World Cup final with a similar injury.

His brother-in-law, Brent Tate, spent nine months on the sideline after a knee reconstruction in 2007 and missed the Cup final in 2008 with a hip flexor injury.

- NZ Herald

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