The Rugby World Cup (RWC) kicked off last weekend in Japan with wins for England, Ireland and Wales in their opening matches!
Scotland suffered a 'double blow' - a disappointing performance saw them lose to Ireland 27-3 and flanker, Hamish Watson, left the field with a serious knee injury which has ruled him out of the rest of the tournament!
Knee injuries are extremely common in rugby and in some circumstances, career ending.
The high intensity nature of this very physical, contact sport leaves the knee vulnerable to injury. Ligaments, mainly MCL (medial collateral ligament) and ACL (anterior cruciate ligament) and menisci (cartilage) can be injured during contact - tackles, rucks and mauls or when players change direction when running at speed.
Injury to the MCL can occur when there is impact to the knee, from the outside leading to a forced valgus stress (knee being pushed to the inside) on the medial aspect of the knee.
MCL injuries can be graded from Grade 1 where the ligament is 'sprained' / over stretched through Grade 2 - partial tear to Grade 3 - total rupture. MCL injury can also occur when a player is running at speed and pushes off one leg to run in the opposite direction, e.g. pushing off the right leg to run to the left. In this situation the knee can 'fall' into valgus leading to stress on the MCL. A contributory factor to this non-contact injury can be lack of control around the hip - particularly in the gluteus medius muscle (on the outside of the buttock). This muscle helps to keep the knee in neutral alignment by keeping the hip from 'falling' into rotation. If the muscle is 'weak' or fatigued then the hip will rotate contributing to the valgus stress at the knee, putting the MCL at risk.
In rugby, the ACL is most commonly injured in a contact situation resulting in a forced rotation and or hyperextension force to the knee. It is suggested that the ACL plays a significant role in the proprioceptive feedback (position sense) from the knee - players with this injury often describe the knee as 'just not right', 'feeling unstable', 'not sure what the knee is doing/where the knee is'.
It is extremely important following ACL injury / post-surgical repair that proprioceptive retraining is included as part of the rehabilitation programme right from the early stages of recovery. This is vital to ensure full function and successful return to rugby.
The menisci in the knee can be injured when a rotation force is applied to the knee when it is in a weight bearing, semi-flexed position with the foot fixed.The knee may become 'locked' i.e. inability to fully extend the knee or the injured player may feel a 'catching' sensation in the knee and painful feeling of instability.
With all knee injuries early assessment and diagnosis is vital to ensure correct treatment plan, rehabilitation and in the majority of situations, return to rugby.
Enjoy the rest of the RWC, may good luck be with your team to play well and avoid injury and may the best team win!!
Bronwyn Walton, Clinical Specialist Physiotherapist