Rugby Injures: The Hamstring strain and the Medial Collateral Ligament sprain

Rugby injuries are vast in occurrence, diverse in diagnosis and common in both training and match scenarios. The role of an osteopath is not just bad backs, but we commonly treat athletes from the recreational to the elite, including dancers, weightlifters, rugby players and swimmers.

Through 2011-2015 the most common injury seen during rugby training was a hamstring strain (figure 1) followed by a calf strain (www.englandrugby.com)

With exception of a concussion, the hamstring strain is also the most commonly seen injury in a match based scenario. The second most commonly seen injury in a match scenario is a sprain to the Medial Collateral Ligament (figure 2) in the knee.

 


The Hamstring strain

Picture1Function
The hamstring muscles are used to flex (bend) the knee, and extend the leg at the hip.

Where does it occur?
The muscles can be strained or torn at the attachments or within the muscle belly itself.

How does it occur?
Most hamstring injuries occur when the muscle is at the greatest point of stretch, such as at the end point of a kick, or the just before the foot hits the ground whilst sprinting.

What you will feel?
Symptoms of a hamstring strain include pain in the back of the thigh or buttocks, bruising, intense pain with actively bending the knee, or straightening of the leg. The pain may come on suddenly, or over a longer period of time.

Why does it occur?
Hamstring strains often occur due to a lack of flexibility or strength within the muscle. The likelihood of straining the hamstring increases without a sufficient warm up regime, or as the muscles get more fatigued (at the end of a training session/match).

Rehabilitation Exercises

Stage 1Stage 2Stage 3Stage 4
Gentle passive Range of motion (1)Straight leg stretch (2)Dynamic Hamstring stretch (4)Non resisted and Resisted Hamstring (8a/b)
Gentle active range of motion (1)Bent leg stretch (3)Active Straight leg raise (5)Bridge (9)
Upside down cycling (6)Lunge (10(b)
Dynamic Walk (7)Good Mornings (11)

 


Medial Collateral Ligament Sprain

Picture2Function
The Medial Collateral Ligament stabilises the inside of the knee

Where does it occur?
The ligament can either be stretched (grade 1), experience a slight tear (grade 2) or a complete tear (grade 3). The injury may also coincide with injury to the meniscus (cartilage within the knee), and the anterior collateral ligament of the knee.

How does it occur?
In rugby, the ligament is often sprained or torn during a direct force to the outside of the knee forcing it to stretch the inside of the joint (such as being tackled sideways). It is also often during a pivoting motion (such as avoiding a tackler), or sudden deceleration after sprinting.

What you will feel?
The pain and swelling will likely be located on the inside of your knee. It will be felt with bending and twisting motions, and you may feel unstable in the knee.

Rehabilitation Exercises

Stage 1Stage 2Stage 3Stage 4
Gentle passive (1a) and active (1b) range of motionMini squat (15a)Full squat (15b)Sport specific training
Quadricep setting (12)Mini Lunge (10a)Full lunge (10b)Running
Bilateral calf raises (13a)Bridge (9a)single leg bridges (9b)Weight reisted training
Non resisted abduction/ extension (14a)Resisted abduction/ extension (14b)CyclingGradual increase to match scenario
Wobble board (16a)Wobble board exercises (16b)