Injury management

Injuries are a part of any contact sport. Serious or life threatening injury in Rugby is, however, rare. The outcome of many injuries can often be improved by very simple first aid skills until emergency help arrives. For the majority of the Rugby-playing world, there is little qualified medical support available pitch side. Thus, first aid responsibility may fall to club officials, coaches, players, parents, or referees.

Often when faced with an injury, the issue is what not to do rather than what to do, i.e., ‘do no further harm’. Many things improve with a little bit of time and, commonly, taking control of a situation and preventing panic is all that is needed until the player improves or more experienced help arrives. In certain circumstances, simple measures such as protecting the head and neck, ensuring an open airway or supporting an injured limb are often all that is needed in the immediate stages of injury management.

There are, of course, some conditions where the idea of simply supporting the player and waiting will be the wrong thing to do, e.g. cardiac arrest. These, while rare, do occur and are one reason for ensuring there is trained first aid support available at games and training.

World Rugby recommends that there is an appropriate level of first aid cover at every game and training session. World Rugby provides different levels of training and more details can be found at https://passport.world.rugby/player-welfare/first-aid-in-rugby/ 

The general principles of looking after an injured player are:

1. Do no further harm
2. Take control
3. Avoid unnecessary movement
4. Speak to the player
5. Call for help if needed
6. Ensure more experienced help is on the way
7. Recognise when you need to do more which may include calling an ambulance

Take control of the situation.

Preventing panic until the player improves or more experienced help arrives is fundamental to looking after an injured player.

First Aid in Rugby

https://passport.world.rugby/player-welfare/first-aid-in-rugby/ 

All stakeholders - coaches, referees, parents, and anyone else involved in the Game - should undertake at least basic first aid training

For non-life-threatening and non-limb-threatening injuries

Assess the player on the field of play using the TOTAPS system.

Steps	Assessment	Action
Talk	What happened? Where does it hurt?
Observe	Look at the injured area. Is it different from the other side (swollen, a different colour, etc.)?	If swollen or there is a deformity, call first aider.
Touch	Feel for swelling, tenderness and pain.	If tender to touch, call first aider.
Active movement	Ask the player to move the injured part without assistance.	If unable to move or painful to move, call first aider, and remove from the field (non weight-bearing).
Passive movement	If the player moves the injured part actively, then carefully move it through a full range of movement.	If unable to do so or painful, the player should be removed from the field (non weight-bearing).
Skill test	If the active and passive movements did not produce pain, ask the player to stand and see if lower limb is fully weight-bearing and he/she can walk. If unable to do so, the player should be removed from the field (non weight-bearing for lower limb injuries).	If unable to do so, the player should be removed from the field (non weight-bearing).

Bleeding

When treating a bleeding player, gloves should be worn to protect the player and the first-aider from possible transmission of blood-borne diseases such as HIV and hepatitis. Blood must not be transferred from one player to another. Any items that have been contaminated by blood must be sealed in a plastic bag and discarded appropriately.

Major bleeding must be treated as soon as possible to reduce the flow of blood, as this may be enough to preserve a life. Apply direct pressure to a wound first and only apply indirect pressure if this is not possible. Arrange urgent transport to a hospital or doctor’s surgery.

Soft tissue injuries

Soft tissue injuries are typically ligament sprains and muscle strains, tears and bruises. They should be treated using the method known as PRICED.

Protect	Once an injury has occurred, it is of vital importance that the injured area and the player are protected from further injury. Failure to do so can exacerbate the problem and delay healing. Abrasions / lacerations should be covered The injured joint should be supported by taping or bracing Weight-bearing should be avoided
Rest	Adequate rest to enable tissue healing and repair is vital for any injury. Remember - if it hurts, it is probably not good for the injury. Don’t put any weight on the injured part of the body.
Ice	Application of ice to an injury helps prevent bleeding and further swelling. Regular use of crushed ice in a damp towel is helpful in shortening recovery time and decreasing pain in the interim. Apply ice to the injury for 20 minutes every 2 hours for the first 48 hours. Protection of the skin with petroleum jelly or oil avoids unnecessary thermal injury.
Compression	Compression of a soft tissue injury prevents swelling and shortens recovery time. Compression using a firm bandage is effective. Ensure that bandaging is not so tight that it cuts off circulation or causes tingling or pain past the bandage. Bandage the area between ice treatments.
Elevation	Elevation of the affected area decreases swelling and pain.
Diagnosis	Early diagnosis by an appropriately qualified health professional and correct management are the fastest route to recovery. Consult a medical professional, especially if you are worried about the injury, the pain or swelling gets worse or the pain or swelling has not gone down within 48 hours.

Ice helps to prevent bleeding and further swelling

Elevation decreases swelling and pain

Once the injury has been diagnosed, avoid any element of HARM for 72 hours.

Heat	Can increase bleeding and swelling and worsen pain and stiffness.
Alcohol	Can increase bleeding and swelling as well as masking pain and the severity of the injury.
Running	Rest is essential.
Massage	Best avoided as it can increase bleeding and swelling, thereby delaying recovery.

Concussion

Concussion must be taken extremely seriously to safeguard the short and long-term welfare of players. Although commonly caused by a blow to the head, it can come from a blow to the body where the force of the collision is transmitted up to the brain. It is not always associated with loss of consciousness.

Concussion has many different symptoms or signs and many of these can be found in the World Rugby Concussion Guidelines at https://www.world.rugby/the-game/player-welfare/medical/concussion/concussion-guidelines 

Common symptoms include poor concentration, memory loss and balance difficulties. The Pocket Concussion Recognition Tool (shown below) may help with the recognition of concussion.

If an athlete has a suspected concussion, he/she should be removed from the field of play and not allowed to return.

If a concussed player continues to play, they will put themselves at risk of greater injury and they will also let the team down because they will have difficulty processing the game happening around them.

Young players are more susceptible to rare and dangerous neurological complications, including death, caused by a second impact in an already concussed or not fully recovered individual.

Anyone removed due to suspected concussion should be assessed by a health care professional. They should not be allowed to drive a motor vehicle. Return to play should follow a graduated approach as described in the World Rugby Concussion Guidelines.

Download the Pocket Concussion Recognition Tool as an Adobe PDF file.

Rehabilitation