England will go into their Autumn international test series without their first choice front row and a batch of other injuries keeping Martin Johnson busy with his selection.  In recent weeks it seems that players are being sidelined with alarming regularity.  In particular it is the shoulder that is the current fad for injury with 5 potential English starters out due to issues with the joint.

The Times (http://www.timesonline.co.uk/tol/sport/rugby_union/article6881917.ece) recently reported on the RFU’s use of GPS accelerometer units being used to collect data on the velocities, accelerations and decelerations at the tackle for use in injury prevention.  The shoulder joint itself, while being very versatile and mobile, is also very vulnerable particularly when at end of range and relies heavily on the conditioning of the surrounding musculature for its’ stability. Factor in the forces at the point of contact and you have a recipe for injury.

Rugby Union probably has a greater risk of collision injury than any other contact sports.  Rugby League tends to have a fairly ritual contact situation lacking the same variety than those seen on a union field and American Football doesn’t have the same fatigue (a major factor in maintaining joint stability) levels.  The RFU findings may lead to more recommendations on player conditioning perhaps to increase emphasis on improving the proprioceptive ability of the joint and its’ ability to work under fatigue.

One aspect that I hope will be covered will be the player management issue mentioned by Dr James Robson, the British Lions doctor on their summer tour. He has spoken about more need for better player management (http://www.guardian.co.uk/sport/2009/jul/05/lions-doctor-james-robson-physical-tour) to help reduce the incidence of injury.  Teams currently play 22 games in the premiership season, add on European cup, anglo-welsh cup , international matches (higher intensity) and playoff games and you see the high demands placed on players.  Playing careers and livelihoods are being placed at risk and the monetary bottom line is the primary reason.  Teams in the NFL each play 16 games in their regular season…in total.  I’d like to see some data on their injury rates!

In this months’ NSCA strength and conditioning journal, one piece caught my eye because it discussed an injury I’ve heard self diagnosed by more people than any other.  I am of course talking about shin splints, or medial tibial stress syndrome (MTSS) to give it’s full name.  Below I’ll give you the highlights from Tolbert & Binkley’s article (reference below).

The condition will usually present with a dull ache following training/competition from the middle to the distal (bottom) of the posteromedial (rear/inside) border of the tibia.  Rest will usually alleviate pain but with continued training it will become more severe.  Hamstring and heel cord tightness as well as very high or very low foot arches have been shown to be predictors of MTSS.  Other associated causes include change in footwear or worn out footwear, training continually on very hard surfaces, progression to too high an exercise intensity, muscle imbalance and an over-pronated foot position.

The paper suggests static stretching as a rehabilitative and preventative measure.  The muscles targeted should include the hamstrings and gastrocnemius and soleus, or calf muscles.  Originally tibialis posterior was thought to be the site of pain and injury with MTSS but the irritation is now thought to be consistent with the medial soleus (the inside portion of the deeper calf muscle) hence the inclusion of the calf muscles in the prescribed stretching program.  As usual, the inclusion of certain targeted exercises and a well structured periodised training program can limit the chances of developing the syndrome…consult your strength and conditioning coach for details.

• Tolbert, T.A. & Binkley, H.M. (2009).  Treatment and prevention of shin splints.  Strength and conditioning Journal, 31(5) pp. 69-72.