Shouldering the load in codes' high-impact zone

Troy Flavell went down with a shoulder injury during last week's Super 14 match. Picture / Dean Purcell

Shoulder injuries have become a growing pain for Super 14 teams and given the All Black selectors a few headaches to boot.

Not that it is a rugby problem alone, not by a long stretch.

League superstar Benji Marshall is the most famous shoulder injury sports victim right now.

He is so disaster prone in this area that you would wince at the sight of him leaning against a lamppost.

He's had five dislocations and reconstructive surgery on both shoulders in his brief first-grade career and has just delayed going under the knife again in an effort to see out the 2006 season.

It puts a cloud on the brilliant New Zealander's career. As top Aussie sports doctor Nathan Gibbs reckoned: "After each operation, the risk of dislocation becomes greater. When someone dislocates their shoulder, invariably in the future the other one goes as well, which means there is usually some inherent weakness in the ligaments that stabilise the joint."

But shoulder injuries have suddenly leaped up the list of rugby problems. James Ryan (remedial surgery), Sione Lauaki (torn pectoral muscles), Troy Flavell (ruptured tendon) and Nick Evans (broken collarbone) head the list and require long-term layoffs.

In Ryan's case, the Highlanders' medics decided to operate on an unstable joint before an inevitable dislocation arrived - a "stitch in time saves nine" philosophy which will sideline Ryan for six months.

Highlanders doctor Sandy Webb says there have been a "whole bunch" of shoulder problems - far more than in the past - among the Otago and Highlanders, leading her to seek injury statistics from the New Zealand Rugby Union this week.

She didn't want to comment on the theory put to her by the Herald that the changing nature of rugby, with more high-impact collisions, might be causing more shoulder injuries.

"It might just be a statistical blip," she said. "Rugby is a game with a whole lot of big blokes charging into a whole lot of big blokes, and the shoulder is inherently unstable."

Shoulder injuries vary. Sometimes the shoulder can dislocate and relocate with minimal extra damage, allowing players to return within weeks. But with other damage, such as rotator cuff tendons, biceps tendon or axillary nerve, recovery can take months.

So are shoulder breakdowns a sign of the times, a symbol of rugby transformation into a high-impact game?

Tune into an old rugby test and it looks like handbags at 10 paces compared with the relentlessly smashing time the modern professional rugby player endures.

The Herald went head-to-head on the shoulders subject with new All Black doctor Deb Robinson, who too was reluctant to stick her neck out.

Robinson, the Canterbury/Crusaders doctor who has held many other top-level sports posts, said the rash of shoulder problems might be coincidence. Then again, it might not.

Herald: With all these shoulder shudders, footballers might think twice about putting this body part to the grindstone?
Deb Robinson: I think one of our jobs is to actually explain injuries to the public and the thing with shoulders is that they have a very shallow socket. It has always been a high-risk joint, especially when the arm is away from the body doing things like catching the ball above the head and stretching out in lineouts etc.

(The Blues should be pretty safe then ... ) So the shoulder has been dodgy since the beginning of time?
There are lever forces at work ... You're only relying on some soft tissue to keep it in place. The shoulder is inherently unstable.

(I could slip in another line about the Blues there, I suppose, but I won't). Has it struck you as odd that there are a lot of high-profile shoulder injury problems at the moment?
I've noticed we've had a few but you really have to wait until the end of the season to see if it is a blip or a trend. Even though rugby is the national sport, the number of [professional] players is actually quite low and three or four high-profile cases can skew the picture. And there are different types of injuries involved. It's a bit like the road toll. You have two or three multiple fatalities on Queen's Birthday Weekend and suddenly it looks much worse than it is. But worldwide in rugby we are concerned about shoulder problems, especially as they put guys out for so long.

In Benji Marshall's case, you wonder just how long he can go on?
It's hard to comment and I don't know the details of his case. The last time it happened his arm was just down by his side. He's clearly a special case and you'd have suspicions something else is going on there. He might have joint laxity ...

And Benji is little. Does size matter?
Generally in rugby all the players are bigger and stronger than before so you would think that things should even themselves out and there wouldn't be any more problems than previously.

Speaking of which, your Crusaders don't have any shoulder problems right now. Could it be that highly organised winning teams suffer less than teams who are forever trying to dig their way out of trouble with excessive arm extension?
As the All Black doctor I really can't comment on the form of various teams. But there are always likely to be less problems if you are in a balanced position moving forward.

Geez Deb. Is Chris Moller writing your lines? Just kidding. So to summarise then, shoulders face a potentially more comfortable time in a decent team rather than in one where they hurtle all over the place in dishevelled defensive lines, throwing arms out left, right and centre in the forlorn hope of bringing down rampaging Mose Tuiali'i-types.
I just don't know for sure if that is true. But guys will always tell you that their bodies are under less stress when their team is going forward. They are better balanced and positioned at collision points. They will even say that it is easier to get over niggles in teams going forward, when you are not under so much pressure and in a good bio-mechanical positions. It is better if you are not flailing your arms around in desperation.

(I'll remember that advice at my next rugby press conference). So what, if anything, needs to be done?
We are looking at strength and conditioning programmes for shoulders. We are always balancing power with endurance, and the power guys will tell you that the game is in more and more of a power phase right now.

And the players are so strong nowadays. I suppose a lot of them play on anyway, especially when you're in a top team.
In the old days players probably managed their way through these things more. You can play on niggles, but in the end form tells the story. Coaches will always tell us when they can see a player is not using the shoulder properly any more.

The moral being that you can shrug off a shoulder injury for a while, but it's a lot harder to shrug off Robbie Deans. Cheers Deb, and all the best with the All Blacks. And please, look after that Richie McCaw. There's a lot resting on those shoulders.