Knee injuries are, without doubt, the most common, potentially career-ending injury in rugby, especially ACL tears. And when we say ‘rugby’, we’re talking Union: the biggest areas of risk in League are shoulder injuries.
Why do the knees take so much punishment? It’s the nature of the sport. In comparison to other football codes, rugby is a succession of grind-it-out, stop-and-start plays which put huge amount of stress on the knees not to mention the fact that tackles usually happen lower on the body compared to other contact sports.
Although knee braces are allowed nowadays, they’re nowhere near as sturdy as the braces allowed in other sports. Factor in the increasing length of the club season these days – especially in the highest levels – and the stubbornness of the average player to attempt to walk off injuries, and it’s not surprising that the knee area goes through a hell of a lot of punishment in the game.
There are a lot of factors inherent in the sport that can bring on a knee injury: instant injuries can be brought on by another player landing on your leg in a ruck, or being shoulder-tackled low from the side. The more gradual wear-and-tear injuries come from simply playing the game, especially during scrum situations. As the game gets faster and the players get bigger, the risk of knee injury grows larger.
Here is a list of some of the most common rugby knee injuries:
Anterior Cruciate Ligament Tear
Situated deep within the knee joint, the ACL is a crucial component in maintaining joint stability. In layperson’s terms, it stops your knee from rotating too much and helps keep the shin in place. It can be torn over time by repetitive turning and changing direction, but it can also be instantly damaged by any violent impact on the knee during a game.
Symptoms of an ACL tear include mild to severe instability, painful swelling and a long layoff from playing and exercising. Solutions depend on the severity of the tear: in extreme cases (or high-level players) ACL reconstruction surgery will be recommended. This involves using a strip of the patella tendon as a replacement graft, and, if enough care and expense is deployed, a professional athlete can be match fit again in less than six months.
However, surgery isn’t always the answer: there’s a school of thought that claims that unless a return to full fitness is absolutely crucial, a period of highly structured rehabilitation can repair the damage without surgery. But this obviously a horses-for-courses situation, and like many injuries, ACL tears need to be treated on a case-by-case basis.
Medial Collateral Ligament Tear
Situated on the inside of the knee, the MCL does a similar job to the ACL, but is more susceptible to damage when the knee is twisted. There are three medical degrees of tear: a first-degree tear affects merely a few muscle fibres, a second-degree tear damages a majority of muscle fibres while leaving the ligament intact, while a third-degree tear is a complete rupture of the ligament, resulting in an inability to walk on it comfortably.
First and second degree tears can be treated with RICE. Third-degree tears can be treated with reconstructive surgery.
Lateral Collateral Ligament Tear
Situated on the outside of the knee, LCL tears are very similar to MCL tears. Again, RICE is recommended for first and second degree tears, and surgery for third degree tears.
Meniscal Tear
The meniscus is a rubbery, crescent-shaped disc which cushions the stress caused as you walk or run, and help steady the knee by balancing the weight you put on it. Damage can be caused by extreme stress caused by planting the foot or twisting the knee. Symptoms vary, from slight pain and swelling from a minor tear to pieces of the meniscus getting lodged in joint space, in which case surgical intervention may be required.
Mr Jonathan Webb combined his medical training with a top-level rugby career, representing England 33 times and being voted Rothmans Rugby Player of the Year in 1992. His experience has given him an invaluable insight into the pressures faced by athletes in the field of rugby and all other sports.
To arrange a consultation, call 08450 60 44 99 for his Bristol clinic or 020 3195 2443 for his London clinics.