Benefits of Sports Massage on Rugby Related Injuries

Written by Chris Bradley

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:

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.

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.

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%!

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.

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

• 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:

• Tendinitis
• Bursitis
• 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.

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:

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.

MLD / LDM Manual 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.

1. Astin JA. Why patients use alternative medicine: results of a national study. (1998) JAMA, 279(19), pp. 1548–1553.
2. 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.
3. 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
4. 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
5. 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
6. Dursley, B., 2012. The Effects of Sports Massage Effleurage On Hamstring Flexibility In Rugby Players (Doctoral dissertation, University of Wales Institute Cardiff).
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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
15. 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.
16. 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.
17. 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
18. 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
19. 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.1994.19.2.93
20. 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
21. 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
22. 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
23. 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
24. Ylinen, J. and Cash, M., 2011. Sports massage. Random House.