It is safe to say that 2015 is going to be a fantastic year if you are a rugby fan. The Six Nations starts this week, then in the summer, England will be flooded with fans from all over the world as it plays host to the Rugby World Cup.

Due to the physical nature of the sport and with so many of the English International team currently side lined through injury, we thought it would be interesting to pull together a graphic showing the most common types of injuries that occurred at the last Rugby World Cup in New Zealand, 2011. We will also discuss the specific injuries for some of the key players in the injury stricken England team.

Upper Body Injuries

Head and neck injuries are common in rugby, often due to the high impact collisions occurring during tackles and contact situations.  Concussions and neck pain can occur following collisions and are common in forwards due to their increased presence in scrums and mauls.

England second-rowJoe Launchbury has been suffering from a neck problem since the autumn.  He was reported to have a nerve irritation which caused some weakness in his arm. Nerve irritation is sometimes caused by a bulging disc in the neck which can interfere with the nerve signals and result in causing pain and weakness.  They often improve with a combination of rest and physiotherapy and it usually takes between 4-8 weeks.  Unfortunately in Joe’s case, failure to improve meant that he had a surgical procedure known as a discectomy to trim the disc that’s causing the problem. Since then, he will have been working on rehabilitation exercises to improve his movement and stability and is hoping to return from injury in April.

Shoulder and upper limb injuries regularly occur in rugby.  Normally in the tackle situation, trying to fend off defenders or making the tackle itself. The most common injury of the shoulder complex found in rugby players is injury to the gleno-humeral labrum (soft cartilage) or rotator cuff tendons.  This is because of the mechanism of injury of the arm out to the side during a tackle (abducted/externally rotated) is an inherently unstable position for this joint, which causes tears in the cartilage and small tendons in the shoulder.

Depending on the extent of the tears, these sometimes need to be surgically repaired. Following this, an accelerated rehabilitation programme designed to progress players back to full fitness would commence. The focus will be on on joint stability exercises that gradually progress to more functional and sport specific activities, depending on the surgery and players’ progress.  It is thought that the large musculature of professional rugby players for stabilising the shoulder joint is the reason why there are less dislocations than possibly expected. Kyle Eastmond took “a knock” to his shoulder in a recent game and was taken off as a precautionary measure. The extent of his injury was not reported but he is likely to be back playing in the next couple of weeks.

Lower Limb Injuries

Rugby players are always at risk of knee and other lower limb injuries, not only from contact situations but from the constant cutting and explosive change in directions needed in both attack and defence. Owen Farrell is out of the whole Six Nations following his recent awkward knee injury.  He required surgery but is set to return by end of April. However, Northampton Saints full back Ben Foden is set to miss the remainder of the 2014/15 season with a knee injury sustained in the club’s Champions Cup win at Ospreys. He left the field early on in the match and subsequent scans revealed a rupture of the anterior cruciate ligament (ACL) in his left leg.

ACL injuries are common in high level sports. They normally occur during a valgus and pivoting movement on a planted leg.  The ACL is very important at providing feedback and some stability to the knee joint.  It is sometimes not essential and the knee can function well without it providing the muscles are working efficiently to control the knee.  Due to the high level of activity Ben Foden needs to return to, he will undergo ACL reconstruction surgery with a view to rehabilitating for the start of the 2015/16 season.

The post-operative rehabilitation process normally takes between 6-9 months and will be focused initially on regaining full movements and stability in the knee joint. Then, gradually the physiotherapy team will progress to high level stability/strengthening exercises and sport specific drills including cutting and jumping manoeuvres that are prevalent in his game.  The muscles have an important role in providing stability to the joint and preventing injury in the future.

As can be seen from the infographic, lower limb injuries contribute hugely to the overall injuries in rugby players.  This is especially true in the backs due to the explosive running speeds and changes in direction in open play. These range from muscle strains and minor ligament sprains such as Geoff Parling and Brad Barritt have suffered, which often only take a few weeks to recover from, to chronic recurring injuries that take much longer to shake.

Manu Tuilagi is likely to miss the entire Six Nations with his groin injury. Groin strains are difficult and timely to recover from due to their complexity and involvement in high level sporting activity.  Depending on the severity, treatment in the acute phase might include rest ice and compression.  Then a rehabilitation programme including stretching and some graded strengthening.

Tuilagi has opted for a series of “sugar” injections over surgery to aid his recovery. Also known as prolotherapy, is said to aid the production of repair tissue in the muscle. He is hoping to return to club rugby in the next couple of months.

Broken bones are an uncommon appearance in rugby. England’s No.8 hopeful, Ben Morgan was unfortunately subjected to a broken leg prior to Six Nations selection. He required surgery to fix the issue and is now out for the rest of the season.  He will require lots of physiotherapy to regain full movements and power in his ankle and leg.  He will hopefully be back in the mix for World Cup selections.

On a more positive note, Courtney Lawes’ ankle injury is set to recover in time for the clash with Ireland next month.  Lawes was said to have a “chipped bone” in his ankle which require keyhole surgery to clear out.  He is optimistic of his return by next month which will surely lessen the worries in Stuart Lancaster’s injury stricken side.