Background and Local Rugby Clubs
Rugby union and Rugby league are fast-moving, high-intensity contact team sports. Both forms of the sport demand the running and endurance of soccer combined with the contact and tackling of American football. As a result, rugby has become one of the most popular professional team sports in the world. Both Rugby Union and League require the completion of sprinting, tackling, pushing and kicking. These mechanisms can elicit a range of health benefits. These include:
- Cardiovascular fitness and endurance
- Strength in upper and lower body
- Team skills
- Social interaction
- Communication skills
There are some fantastic local clubs as well as teams for beginners in the surrounding area. Rugby is all inclusive and allows for all shapes, sizes, ages and genders. Local ametuer clubs include; Blackheath, Millwall and Southwark Rugby club. Local professional teams can range from the premiership (Harlequins, London Wasps and Saracens) to the Championship (London Scottish and Ealing Trailfinders). Additionally, London Broncos are a well established Rugby League team in the local area.
Rugby World Cup 2019
In 2019, England and South Africa competed in the Rugby World Cup final’s held in Japan. Fans across the world tuned with great interest to witness this sporting spectacle. According to the TV viewing statistics, a staggering 12.8 million people were watching this match (The Guardian).
This therefore became the most-watched sports programme on any channel since the 2018 football World Cup final. Upon reflection, some England fans may still feel the ‘pain’ of watching a ruthless South Africa team dominate the game and secure a 32–12 win. However, this pain can manifest and present far more severely in the form of rugby related injuries. Throughout the rugby world cup, all the players are under pressure to maintain peak performance at all times, with hardly any rest periods in between. This In tandem with the physical demands of the sport itself can result in a variety of injuries.
These injuries are not only a serious concern for a number of professional players but amateur rugby players as well.
Rugby Injury Incidence Rate
Despite the action of health practitioners, coaches, doctors and physios, rugby still has one of the highest reported incidences of injury, irrespective of the injury definition used. This may be due to the demands of the sport.
- Per 1000 player-hours a total of 91 injuries occur
- Each injury resulted on average in 18 days lost time
- A more recent study has shown probability of injury occurs as high as 57.2% per 1000 player-hours
This means that in the time it takes a player to perform 1000 hours of rugby, the chance of them getting injured is over 50%!
Common Rugby Injuries and Mechanisms
Soft muscle injuries have been identified as the most common injuries. Rugby players are also especially prone to hamstring strains. This is due to the sprinting demands of the sport.
- Running activities account for ~68% of hamstring muscle injuries
- Injuries resulting from kicking present as the most severe hamstring strains (~36 days lost)
- Running was the most common non-contact injury event, of which 56% were hamstring injuries.
Rugby Positions Most Prone to Injury
According to the British Journal of Sports Medicine:
- Thigh haematomas were identified as the most common injury for forwards and backs
- Anterior cruciate ligament injuries appeared to be more common among forwards
- Hamstring injuries caused the greatest number of days absence for backs
- The number 2 and outside centre were the playing positions at greatest risk of injury
Match Components Resulting in Injury
- The incidence of injury is greater when tackling than when being tackled
- The incidence rate of injury in senior male amateur rugby union players appears to be lower than that in professional players
- The ruck and maul elements of the game caused most injuries to forwards
- Being tackled caused most injuries to backs
- Contact events accounted for 80% of all injuries and tackles accounted for 50%
- Foul play (e.g. high tackles) was only implicated in 6% of injuries
Moreover, through the mechanism of sprinting and running for prolonged periods of time, there is the potential for overuse injuries like:
- Medial tibial stress syndrome (shin splints)
This tendinitis usually occurs in the knee and/or ankle. The knee was the most commonly injured joint. This was followed by the shoulder and thigh.
These injuries can have an adverse effect upon performance and sequentially lead to more complicated conditions if not properly addressed by a qualified sports medicine professional.
Benefits of Sports Massage
As with most sports, regaining strength and flexibility after an injury are important to a successful rehabilitation. Neck, shoulder, hip and core strength, as well as flexibility of the hamstrings and hip flexors are important for overall conditioning and can minimize the chances of an athlete sustaining a secondary injury. For any athlete, Sports Massage helps to speed up recovery by:
Increasing Blood Flow
- Massage has been reported to increase muscle mass temperature and blood flow.
- This in turn helps to increase muscle compliance and minimise muscle stiffness.
- Massage increases skin temperature. This enhances blood flow in local regions.
- Upon review of the visual analogue scale (provides score for patients regarding cardiovascular health and cardiovascular disease), a significant positive difference has been reported following massage compared to rest alone.
Improving Oxygen Delivery
When muscles are tense, there is increased pressure in muscle compartments leading to inhibited circulation in the muscles and joints. However, sports massage techniques have been proven to elicit positive effects in respect of oxygen delivery.
- The pumping effects of massage measurably improves total blood flow.
- This blood is rich with oxygen and other substances vital for the repair and growth. Therefore, massage can be essential to restore normal tissue condition.
Removal of Lactic Acid
It has been reported that massage can increase blood flow to the muscles being massaged, and blood flow is suggested to be an important factor in the removal of lactate following exercise through enhanced oxidation and diffusion out of the muscles.
- Blood lactate has been shown to be significantly lower after 25 and 35 minutes of recovery following muscle compressions. Therefore, muscle compressions during recovery may be a viable alternative when inactive recovery is desirable.
- Post exercise blood lactate levels are reportedly significantly lower following a massage compared with a passive rest condition.
Delayed Onset of Muscle Soreness (DOMS)
- There is strong overall evidence for the effect of sports massage in promoting muscle recovery and alleviating DOMS after exercise.
- Therapeutic massage also attenuates early soreness associated with DOMS.
- The Intensity of muscle soreness has been reported to be significantly lower 48 hours after exercise following massage.
- Lower limb compression combined with manual massage has been shown to be an effective recovery strategy following exercise induced muscle damage.
- Sports massage significantly reduces creatine kinase levels and symptoms of delayed onset of muscle fatigue (DOMS) when used 2 hours After Exercise.
Targeting Scar Tissue
After joint sprains, damaged ligaments repair by forming new fibrous tissue. This can be hard, inelastic and less resilient, especially if the joint has been immobilised. Deep friction is a technique applied by sports massage therapists and has been shown to be effective at targeting and breaking down this scar tissue.
- Deep friction breaks down scar tissue which is inelastic and restricts movement of tendons as well as efficient muscle contraction.
- By applying deep friction massage, one hinders this build-up of tissue and promotes the formation of more tolerable elastic fibrous tissue.
A sports massage may be painful when treating certain injuries, but it will help to reduce pain in the long run, speed up the rate at which a player recovers from injury and stop the injuries from becoming more serious problems.
- By altering the signalling pathways involved in the inflammatory process, massage is reported to decrease secondary injury and reduce nerve sensitisation.
- This results in the reduction or prevention of pain and increased recovery from tissue damage
- Sports massage reduces the risk of secondary injuries associated with intense exercise.
The lymph system is part of your body’s immune system and helps fight infection. Manual lymphatic drainage is a massage technique which can be applied by sport massage therapists. This technique requires the use of very light pressure and long, gentle, rhythmic strokes to increase the flow of lymph to reduce toxins in the body. Lymphatic massage can also aid in the prevention of swelling after injury or surgery.
- Manual or electro-stimulation and deep oscillation, improve post-exercise regeneration of the forearm muscles of athletes.
- The methods can be an important element of therapeutic management focused on optimizing training effects and reducing the risk of injuries.
Changes in heart rate, blood pressure, heart rate variability and hormonal levels (cortisol levels) following massage can also elicit a psychological response.
- Massage can promote a feeling of well-being through decreased arousal levels.
- Massage reportedly improved mood state in a group of amateur boxers under-going intensive training when compared with passive rest and touching control conditions.
- Perceived recovery has also been found to increase with the use of massage following athletic performance as well as following training sessions.
- A reduction in anxiety and an improvement in mood state also cause relaxation (psychological mechanisms) after massage.
Improvement in Performance
It is well accepted that over-load is necessary for improvement. Progressive overload is the gradual increase of stress placed upon the body during exercise training. Progressive overload is one of the fundamental ingredients for muscle growth and development. Whether this be through lifting weights, running, or performing bodyweight activities such as push ups.
However, overtraining results in a breakdown of muscle fibre in order to build stronger fibres (hypertrophy) and/or and increased number of muscle fibres (hyperplasia). Therefore, impairment or regression of performance rather than improvement become the norm. Nevertheless sports massage can be beneficial in this process. Sports massage/soft tissue therapy has been reported to be more beneficial compared to exercise, non-massaged controls at:
- Reducing muscle oedema (swelling)
- Decreasing the number of damaged muscle fibres
- Sports massage can reduce tissue damage and accelerate recovery
- If the recovery rate can be improved greater training volumes would be possible without incurring the negative consequences of overtraining
These benefits have been reported immediately after and 48 hours following exercise.
- Massage after exercise fatigue significantly improved individual leg extension ability and performance compared to rest.
- Massage during isokinetic exercise intervals had an enhancing effect on knee extensors strength.
Sports massage provides a wide range of benefits eliciting significant positive effects. Sports massage improves blood flow and circulation, oxygen delivery to muscles, and reduces lactic acid accumulation following exercise; this has been proven to reduce muscle soreness. Furthermore, specific techniques such as deep friction can assist and prevent the build up of inelastic scar tissue which results from injury.
Lymphatic massage techniques have been reported to aid in the prevention of swelling after injury or surgery. In regard to improvements in performance, sports massage can improve flexibility not only improving performance but prevent further injury or reinjury. Studies have also reported improvements in lower limb extension ability and strength. This occurs as a result of a reduction in tissue damage and acceleration in recovery.
Through improved recovery rate, greater training volumes can then ensue. Lastly, sports massage not only provides benefits physiologically, but psychologically through reductions in anxiety and stress, as well as improved perception of recovery and mood state.
- Astin JA. Why patients use alternative medicine: results of a national study. (1998) JAMA, 279(19), pp. 1548–1553.
- Azman, M.A.A.M., Lan, N.C., Azmi, S.H. and Sulaiman, N., 2016, November. A Systematic Review of Type of Injury Among Rugby Union Players. In International Colloquium on Sport Science, Exercise, Engineering and Technology (pp. 35-42). Springer, Singapore.
- Best, T. M., Hunter, R., Wilcox, A., & Haq, F. (2008). Effectiveness of sports massage for recovery of skeletal muscle from strenuous exercise. Clinical Journal of Sport Medicine. https://doi.org/10.1097/JSM.0b013e31818837a1
- Brooks, J. H.M., Fuller, C. W., Kemp, S. P. T., & Reddin, D. B. (2005). Epidemiology of injuries in English professional rugby union: Part 1 match injuries. British Journal of Sports Medicine. https://doi.org/10.1136/bjsm.2005.018135
- Brooks, John H.M., Fuller, C. W., Kemp, S. P. T., & Reddin, D. B. (2006). Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. American Journal of Sports Medicine. https://doi.org/10.1177/0363546505286022
- Dursley, B., 2012. The Effects of Sports Massage Effleurage On Hamstring Flexibility In Rugby Players (Doctoral dissertation, University of Wales Institute Cardiff).
- Farr, T., Nottle, C., Nosaka, K., & Sacco, P. (2002). The effects of therapeutic massage on delayed onset muscle soreness and muscle function following downhill walking. Journal of Science and Medicine in Sport. https://doi.org/10.1016/S1440-2440(02)80018-4
- Gasibat, Q., & Suwehli, W. (2017). Determining the Benefits of Massage Mechanisms: A Review of Literature. Article in Journal of Rehabilitation Sciences. https://doi.org/10.11648/j.rs.20170203.12
- Hemmings, B. J. (2001). Physiological, psychological and performance effects of massage therapy in sport: A review of the literature. Physical Therapy in Sport. https://doi.org/10.1054/ptsp.2001.0070
- Hemmings, B., Smith, M., Graydon, J., & Dyson, R. (2000). Effects of massage on physiological restoration, perceived recovery, and repeated sports performance. British Journal of Sports Medicine. https://doi.org/10.1136/bjsm.34.2.109
- Hilbert, J. E., Sforzo, G. A., & Swensen, T. (2003). The effects of massage on delayed onset muscle soreness. British Journal of Sports Medicine. https://doi.org/10.1136/bjsm.37.1.72
- Jakeman, J. R., Byrne, C., & Eston, R. G. (2010). Efficacy of lower limb compression and combined treatment of manual massage and lower limb compression on symptoms of exercise-induced muscle damage in women. Journal of Strength and Conditioning Research. https://doi.org/10.1519/JSC.0b013e3181e4f80c
- Longworth, J. C. (1982). Psychophysiological effects of slow stroke back massage in normotensive females. ANS. Advances in Nursing Science. https://doi.org/10.1097/00012272-198207000-00006
- Martin, J. S., Friedenreich, Z. D., Borges, A. R., & Roberts, M. D. (2015). Acute effects of peristaltic pneumatic compression on repeated anaerobic exercise performance and blood lactate clearance. Journal of Strength and Conditioning Research. https://doi.org/10.1519/JSC.0000000000000928
- Mori, H., Ohsawa, H., Tanaka, T. H., Taniwaki, E., Leisman, G., & Nishijo, K. (2004). Effect of massage on blood flow and muscle fatigue following isometric lumbar exercise. Medical Science Monitor.
- Phillip A. Bishop, Eric Jones, Krista Woods. (2008) Recovery from training: A brief review, Journal of Strength and Conditioning Research, 22 (3), pp. 1015-1024.
- Rinder, A. N., & Sutherland, C. J. (1995). An investigation of the effects of massage on quadriceps performance after exercise fatigue. Complementary Therapies in Nursing and Midwifery. https://doi.org/10.1016/S1353-6117(05)80048-4
- Roberts, S. P., Trewartha, G., England, M., Shaddick, G., & Stokes, K. A. (2013). Epidemiology of time-loss injuries in English community-level rugby union. BMJ Open. https://doi.org/10.1136/bmjopen-2013-003998
- Smith, L. L., Keating, M. N., Holbert, D., Spratt, D. J., McCammon, M. R., Smith, S. S., & Israel, R. G. (1994). The effects of athletic massage on delayed onset muscle soreness, creatine kinase, and neutrophil count: A preliminary report. Journal of Orthopaedic and Sports Physical Therapy. https://doi.org/10.2519/jospt.19188.8.131.52
- Sykaras, E., Mylonas, A., Malliaropoulos, N., Zakas, A., & Papacostas, E. T. (2003). Manual massage effect in knee extensors peak torque during short-term intense continuous concentric-eccentric isokinetic exercise in female elite athletes. Isokinetics and Exercise Science. https://doi.org/10.3233/ies-2003-0142
- Tanaka, T. H., Leisman, G., Mori, H., & Nishijo, K. (2002). The effect of massage on localized lumbar muscle fatigue. BMC Complementary and Alternative Medicine. https://doi.org/10.1186/1472-6882-2-9
- Weerapong, P., Hume, P. A., & Kolt, G. S. (2005). The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Medicine. https://doi.org/10.2165/00007256-200535030-00004
- Yeomans, C., Kenny, I. C., Cahalan, R., Warrington, G. D., Harrison, A. J., Hayes, K., … Comyns, T. M. (2018). The Incidence of Injury in Amateur Male Rugby Union: A Systematic Review and Meta-Analysis. Sports Medicine. https://doi.org/10.1007/s40279-017-0838-4
- Ylinen, J. and Cash, M., 2011. Sports massage. Random House.