Fall out from the Lions Tour

When the original Lions tour party was announced I was quite pleased how few Irish players had been called up. This was purely selfish as I recalled those who had been to SA in 2009 and of whom we had seen very little since then - think Luke Fitzgerald for example.

As this year's tour progressed I did wonder at the number of injuries especially the number of damaged hamstrings. Seemed a bit odd that so many players were suffering the same injury. having been injured early in the tour we were told that Tommy Bowe was receiving extra Vitamin D to speed his recovery from his broken hand. At least that is what was reported at the time:
http://www.bbc.co.uk/sport/0/rugby-union/23088752

Now we are told that Bowe has NOT recovered and could be out for 12 weeks with ligament damage

http://www.rte.ie/sport/rugby/provincial/2013/0814/468126-injured-bowe-could-face-12-weeks-on-sidelines/?utm_source=NewsWhip

http://www.bbc.co.uk/sport/0/rugby-union/23693258

Was Bowe brought back to play for the Lions whilst not fully fit?

In the aftermath of Rory Lamont's comments about players being pressured to play through injuries the SRU Chief Exec said that "We look after our players extremely well and ensure these people are fit, looked after properly and only reintroduced to the field when they're fit enough to do so."

Looking at the Bowe situation should we take the words of the suits with a very large dose of salt (I am quoting the SRU CE, but not targetting him, just using him as an exemplar)? Should pressure be put on coaches, directors of rugby and everyone else who SHOULD be concerned with player welfare to treat it a bit more seriously?

Players will probably always play if they can crawl onto the pitch. When the coaches perhaps don't care about long term issues (no Irish coaches on tour) who's to stop them? Is Dr Robson proving to be full of Poopie with his "I won't let them play if not fit"?

Adam Jones (Tighthead for Wales), a couple of seasons ago stated that no player is fully fit. The best they can hope for is 90% at any given time.

The issue regarding detecting injuries to players that responsibility has to lie with the player himself. For all the medical advances we have made it would still be impossible to detect symptoms without help from the players themselves. But as pointed out above, its difficult to stop players telling coaches they are ok to play.

I don't think management can be blamed for being short sighted. They are likely to listen to key players and put their trust in them.

From a Welsh perspective, with the amount of welsh players in the Lions, I think we could struggle on the regional front a bit this year. The WRU have been notoriously good at resting key players and this season I would be very surprised to see some of the superstars in the early half of the season very often. I hope they do have the sense to look after the players first because a player out for a season through injury wont help the national cause or regional rugby.

On a side note I wonder if Wales will be installed as favourites for this years 6 Nations. I only wonder because last year the bookies and pundits had us down to finish 3/4th. Surely after 2 seasons of topping the 6 Nations and the recent Lions success they will put Wales as favourites this year?

Bookies odds lengthen or shorten depending on how many bets are placed. That's why England are invariably installed as favourites, more punters. If you want to be favourites splash the cash!

Pundits are another matter entirely and should generally be ignored otherwise you end up with someone like Barnes. *shudders*.

Players will always be keen to play. It's what they do.

However, if you are willing to put a player back on the pitch 3 weeks after a fracture that has been internally fixated you need to be darn sure that you are complying with your oath to "first, do no harm".

This is not a case of asking a player if they feel okay, this is a case of seeking a particular treatment with the sole aim of getting the player back by a certain deadline. I doubt there was a doctor in the land who didn't balk at the thought of Bowe playing again so soon after that injury.

Was this a short cut worth taking? Was accuracy sacrificed for speed?

It really is time that we started to ask whether these young men are being encouraged or persuaded to take risks that are just not worth taking. From clearly concussed players being allowed back onto the field because they were able to fulfill some criteria to players being rushed back from other injuries. Yes, the players will always want to get back on the field asap but we need someone to ensure that they are protected from over zealousness, even if that is self inflicted.

EE wrote:Bookies odds lengthen or shorten depending on how many bets are placed. That's why England are invariably installed as favourites

http://www.oddschecker.com/rugby-union/six-nations/winner  

Ireland 7 / 1? I'll be having some of that.

I agree with the OP. So many players have never been the same after an exhausting Lions Tour.

2009 set Kearney back a year or two. Fitz also. What happened to Bowe in this one, is a prime example. I was hoping for even less Irish players to be picked this time out.

The HSBC over-sponsored gig has money at the very top of its priorities. Not players welfare.

I wonder if Tommy Bowe would have played the lions game again if he knew the damage it would have caused and the length of time he would be out for ? I have a suspicion he would have...not many players get a chance to win a lions series and I guess that's why he said it felt fine even though it likely hurt like hell.......similar to Richie mccaw struggling through the RWC with a broken foot, some occasions demand you to play through the pain.

sirtidychris wrote:I wonder if Tommy Bowe would have played the lions game again if he knew the damage it would have caused and the length of time he would be out for ? I have a suspicion he would have...not many players get a chance to win a lions series and I guess that's why he said it felt fine even though it likely hurt like hell.......similar to Richie mccaw struggling through the RWC with a broken foot, some occasions demand you to play through the pain.

He might have but he shouldn't have been allowed. If it was amateur I'd be more for the guys playing making the decision. But when so many are making so much money out of it the players safety has be taken out of their hands (which is what the doc claimed to be doing)

Most people will just put it down as yet another Cockerill whine, but he has been talking about the injuries suffered by Ben Youngs and Manu Tuilagi while with the Lions. These injuries will delay their availability this season as the Leicester medical staff will not release them to play until they are fit enough. However they played for the Lions while carrying these injuries (similar to Bowe).

Dr James Robson insists that he will only let players on the field if they are fit enough, yet 6 weeks later these players are deemed not fit enough when the very same injuries are assessed. I guess there are different standards in play?

It is also interesting that Youngs was selected for the second test, while carrying an injury so as to protect Mike Phillips who also had a niggling injury.

I never thought I would find myself agreeing with Cockerill! Oh, the embarrassment:roll: 

Certainly there is enough doubt about the judgement of the Lions medical staff by now, that I would be shocked to see any of the same people on the next Lions tour.  The Bowe situation was an obvious farce.  And I choose the word 'farce' with utmost care.  We were joking that giving him extra glasses of milk to drink (ie. Vitamin D therapy / witch doctors can do better than that) should have been the best advert for milk since the invention of the cow.  But, sadly, not.  

It's a great thing to be loved by the players.  All players would do anything to play for their country and even more for the Lions.  It is up to the medical staff to take a tough line, not give treatment intended to enable players to play now and potentially damn the future.  

When there are many of the same injuries, such as the hamstrings, it points clearly to a problem in the set-up.

I think we all know the problem.  The less said the better at the moment, but how to enact change?  It is cultural, an old-boys club, and a resistance to change.

The problem with the modern game is such that injuries occur,but pressure is on for results.
Taking aside the fact that Modern players are bigger,and heavier than in the past in most
positions more injuries are likely.The modern player is a gym monkey,and his strength etc.
and muscle is not like amateur days when .Many players were working outdoors, the injuries
seem to be a lot of ligament damage.Also a lot of injuries appear during prematch warmups
injuries as a whole.Are often minor compared to the old days if you could stand or walk
you completed the game.The work load doesn't encourage recovery either with players
playing/training something like 48weeks a year.
It is interesting that in muddy conditions the 1956 Bok side in NZ suffered badly with
hamstring injuries.

Alan,
You clearly identified the challenges in the Rugby of today for keeping our players on the pitch.  I agree with most of what you wrote.  However, you wrote abut the differences between yesterday and today.  Not about what we need to do to fix.

As a medical professional, I personally don't think we are getting it right.  It must be up to the docs, physios, et al, to draw a harder line with player care.  I believe 100% that proper longer term recoveries and better preventative methods will reduce the number of injuries and eventually result in our players on the pitch more rather than less.  

You get where I am coming from, mate?

You wouldn't be suggesting that we tend to rush our players back into the froy before they have fully recovered from an injury, would you Grey?

Absolutely, MrsP!

Compared to the 'good old days' our Rugby players today are:
better athletes, bigger, stronger, faster, fitter, healthier, better trained, and have access to much better medical care.
But,
They are injured at a much higher rate.

Why?
Many reasons, the ungodly long season is prime amongst them.
But I firmly believe the rush to return our players to playing sooner than is appropriate creates an increased frequency of injury.  Casting the logic of this statement to the side for a moment, there is ample data from other sports showing longer rehab/better care correlates directly to more time playing, not less, over a career.  In other words, not letting a player return to duty until properly healed reduces probability of re-injure and translates to more matches played over the long term rather than less.

It's a "Jam today" phenomenon!

A lack of taking the long view. Why should I try to make sure this player can play for 3 more seasons when they might be with another club by then?

You would hope the International management at the very least would recognise that they have a vested interest in player longevity and maybe the IRFU are showing that with their Player Management System.

Short-termism is a huge problem throughout the game from Mini Coaches who just stick the big lads on the pitch to Schools Coaches who see the School's Cup as the end point if they even look that far ahead.

Maybe we need a bit more "player power"?

The obvious answer is bigger squads,and less matches,or targetting matches.My point
was things today like blood injuries would have been ignored in the past because there
were no substitutes.Correction at Provincial level injuries substitutes were allowed in some
matches by agreement.But a doctor had to certify they were unfit things taken for granted
today did`nt happen then.Examples besides blood injuries,Concussion wasn't understood
as well.Energy Drinks/waterbreaks unheard of.One talks of levels of fitness but it seems at
top level a player is not expected to play more than an hour at the most.

They may play fewer minutes per game than in the pre-substitute era but there is no doubt the pace and intensity of the game has increased exponentially.

I don't think anyone would really doubt that players are fitter now, would they?

Also the energy in the collisions is much greater. Bigger, faster players. So the risk of injury (including concussion) is higher.

Mrs P certainly the levels of fitness/sports medicine is higher but less risk of injury?
in the 1950/60`s it was no holds barred.You really have no idea have you? punched
,gouged,testicles,tweaked in scrums and lineouts,aimed boots to heads and bodies
on the floor or in the rucks.Bigger and heavier?average height for a Prop between
5foot 8,to 6 foot 2,same average for backrow.Locks 6foot 4 upwards.Weight varied
16 stone up average for tight 5,Don Clarke FB 6 foot 2 was near 18 stone in 1963
at his best about 16 and half 1960.It was all relative to the age played and is
incremental.The Scrum was set by rows,and Technique and scrummaging/hooking
mattered then[a lost art today].Collapsing a Scrum was beyond the pale any thing else
went ,chewing ears,twisting and lowereing,moling and popping up a player,angle packing
splitting prop from hooker,the full wheel,the dribbling rush,rush stopping forgotten skills
Less injuries no different yes,and mostly a case of struggling to a job next day.

Are you saying that there were more injuries back then?

There may indeed have been more biting etc but those types of things didn't end careers. The problem now is the sheer energy discipated in a tackle. The players are all much bigger and they are all moving much much faster than I believe they were in the 60s and 70s.

Jackie Kyle said that the biggest guy on their Grand Slam winning team would be dwarfed by most players nowadays, even 9s!

I don't see how anyone can really doubt the increased toll on players nowadays and that is before we consider the number of matches they play.

emack2 wrote:Mrs P certainly the levels of fitness/sports medicine is higher but less risk of injury?
in the 1950/60`s it was no holds barred.You really have no idea have you? punched
,gouged,testicles,tweaked in scrums and lineouts,aimed boots to heads and bodies
on the floor or in the rucks.Bigger and heavier?average height for a Prop between
5foot 8,to 6 foot 2,same average for backrow.Locks 6foot 4 upwards.Weight varied
16 stone up average for tight 5,Don Clarke FB 6 foot 2 was near 18 stone in 1963
at his best about 16 and half 1960.It was all relative to the age played and is
incremental.The Scrum was set by rows,and Technique and scrummaging/hooking
mattered then[a lost art today].Collapsing a Scrum was beyond the pale any thing else
went ,chewing ears,twisting and lowereing,moling and popping up a player,angle packing
splitting prop from hooker,the full wheel,the dribbling rush,rush stopping forgotten skills
Less injuries no different yes,and mostly a case of struggling to a job next day.

Alan,
I am sure MrsP knows exactly what she is talking about.

Through my orthopeadic practise, I have been directly involved with top level athletes for 20 years.  I have trained and treated many Rugby players from earlier times as well, and still do.  All former players I have treated agree the game and the players from before and now are 100% different. It doesn't take much logic to see that being tackled by a 15 or 16 stone prop who smoked a pack or two a day and minimal core strength is different than being tackled by 18 stone props who are mostly muscle.  We now have terrifically fit centres who are 15 stone or more, and look like they are made from steel.  Almost unheard of before.  The game played 20 or more years ago was a very slow affair compared to today's game.  Which it had to be because players were not nearly as fit as today's blokes.  I do agree, sometimes it can hard to recognise in old replays because all players are slower, making comparison difficult.

I am sorry to say, but virtually all the 'greats' from earlier times couldn't compete with most 'A' side (or lower) club players today.  They would be out-muscled, out-run, and absolutely out-hit in contact.  Yes, they had great skill, but after 10 or 20 minutes would be finished.  Would probably even be dangerous for them to be on the same pitch at the same time as today's players. Clearly in the old days, most players had to work for a living wage, limiting time for training.  They also were in the cave-man days regarding training techniques.  Today's athletes train..  That is their job.  

The other point you make is about dirty play from the amateur era.  That is very true.  The game is much cleaner today, and is better for kids to see than the punching, gouging, and so on.  

I know some people view it as heretical, but the game is so much better today than in the past:
We have real athletes, not part-timers
The game is much faster
The players are fit, compared to the tubs of goo we used to have
The game is cleaner, though we still have to eradicate the dirty mentality from some remaining players/coaches
We are a real professional sport now

I should add that I'm not trying to suggest that the players of yesteryear were not hard men. Far from it!

It's just that while we have made cars heavier and faster we have also made strides in breaking efficiency and other safety features. We have not made the same adaptations to humans so those bigger faster men cause more damage to each other when they collide.

There is absolutely no question that more damage occurs when bigger, faster, harder objects collide.
And consequently the old-days meathead approach to return to play must be changed.

Did you just call Alan a "meathead"????

 

  (I'm probably able to out run you at the moment!)

You funny.

Right now you could out run me with one leg! Or less.

 

At least the opiates are wearing off!

You can tell I have an excellent bed-side manner, can't you? Mocking the afflicted!

Yeah, I could see you with a patient. You - most - pleasant - doc.
"come on, get up, you sorry _ _ _ _"

Only joking. No pain killers since last night, Only me and nature's own pain. Which is remarkably mild already. Can't take NSAIDS, so I am waiting until after lunch for a little of nature's own pain killer. Kind of amber in color. Rhymes with......'bliskey'

So long as it has that all important "e" before the "y"!

Wouldn't want you poisoning yerself on that other stuff!

I was absolutely thinking of you when I typed!

I knew making that typo would be fatal.  I don't want you reaching through the internet and beating me up...........

Ah sure I'd go easy on you since you're crook!

 

I just moved my bowels.  
I thought you would want to know.  

Just saw you PM.  Things are moving in the right direction.

If those 2 sets of statements are related then I am very unhappy indeed to hear it!

The alternative would not be good!

With respect both of you are right and wrong,I will elucidate further during the Non-Professional era.Injuries were not less just different,fitness levels were for there work
not for rugby.Greats of the past couldn't live withplayers today? errant rubbish given
same facilities as today.They would not be lesser players they would adapt to different
positions and just as fit as today.Danny Hearn is/was in a wheel chair after a Tackle
by Ian Macrae,Nicky Allen died after complications from injury on the pitch[may even
have died on it].Don Clarke had all four ligaments removed from his knees,he pulled
a Hamstring in first few minutes.Of the Wales match,not only stayed on took the goalkicks
too.Was out for several matches post that,and effected his Goal kicking until the Barbarians
match.Recovered to some extent in1964 but further injuries forced his retirement.Colin
Meads had his arm deliberately broken by an aimed kick on the 1970 Bok tour.Played
Lions 1971 wiith virtually one arm,many injuries sustained in the Scrums today.Would`nt
have happened Deliberate Scrum collapses were beyond the pale then,tip tackles very rare.
Players today couldn't sustain the pressures if it was a 15 man game instead of a squad.
As to impact injuries those are/were down to Scrum/Lineout changes and the game becoming
one just a job and two League style hybrid game.

Alan,
I apologise for any disagreement, and I will explain my points in a little more detail.  

I am absolutely not wrong about injury rates from the amateur era compared to today.  My conclusion is fact based/data driven, and based upon my experience as a player and as a medical professional whose time and career spanned bits of both time periods.  

Before I start, I want to say I find our discussion stimulating as you are helping me focus on points I haven't given a lot of thought to in recent years.  So, please let me go through some of your points:

There were always horrible injuries, but the overall rates were indeed lower.  And probably less severe - this is subjective, but I will explain why I think it is so.  However, I believe some of the injury problems we did have at the time was due to the condition of the pitches was generally worse than today, one divot could cause a catastrophic knee injury.

As to injuries in old days which were considered devastating in the old days, we need to be aware of the overwhelming advances in medical treatment since the end of the amateur era:  
The most obvious example is arthroscopy.  Previously a simple cartilage tear required a long open incision and the removal of the cartilage.  Usually the athlete required months of recovery and rarely had the same function as pre-injury.  Now arthroscopy enables the saving of the cartilage (broadly speaking) and on average a a 3 - 5 week recovery with full function.  Now we also have the mcrofracture process which goes against everything we were once taught and enables the growth of  cartilage-like fibres in the knee.  This has saved careers where the alternative was usually a career-ender.  My final example is knee ligament surgery.  None of the current procedures were available previously and we had less than a 5% chance of continuing athletic activity, let alone returning to top level sport.  Taking a piece of tendon and longitudinally splicing to bone in lieu of ligaments is highly advanced, yet is taken for granted today.  Not remotely imaginable previously.

My point is although players clearly had injuries in the amateur era, please keep in mind the severity cannot be compared to today because of the relatively limited ability to diagnose and correct.  Simple injuries were frequently major.

The players of the past could clearly not keep up with players today.  This is virtually irrefutable.  However, you injected the new theoretical condition about if they had access to today's training, care, nutrition, and so on.  This is a very different discussion.  The answer to this question is unknowable, but in theory I would probably agree.  Innate talent is unquestionably unique to each person, with a huge genetic and psychological component.  But as they were and as they played, compared to today, there is virtually no chance.  

Your last point about many players not sustaining the pressure of an 80 minute match any more, is partially correct, in my opinion.  But again, this goes back to conditioning.  Remember this is a much faster and more physical game today than ever before.  So players require much more conditioning to survive a full match compared to the amateur era.  And, most players can still do so.  But this would be expected with full time athletes instead of part time.  But, sadly, there are indeed coaches and trainers who only require about 60 minutes, most commonly from their forwards.  This is a disturbing change in Rugby, one of the few I do not like.  It is one of those self-perpetuating problems.  Once a coach brings in a fresh player, many coaches do so.  Some do it to get a presumed edge, others just to get players some match experience.  But it is too frequent for my taste.  

Sir, I am not denigrating Rugby played before professionalism.  I became a lifelong fan, was motivated to play, and decided to pursue a medical career to help athletes by watching amateur era Rugby.  But I am saying it is very clear we now have better athletes, faster and stronger players, who endure physical stresses far more severe than players from the previous era.  This doesn't mean I like everything about how Rugby is played now, but the differences are real and they are stark, none-the-less.

MrsP wrote:If those 2 sets of statements are related then I am very unhappy indeed to hear it!

The alternative would not be good!

I am happy now.  You should be happy, too.  For me and my digestion.

I don't know why that says "unhappy" as I meant "happy"!

No idea how that happened!

There must be someone changing my posts after I type them!!!!

...or maybe I made a mistake!!!! At least the presbyopic amongst us won't get to read this bit! Neck surgery makes you far sighted doesn't it?

emack2 wrote:The problem with the modern game is such that injuries occur,but pressure is on for results.
Taking aside the fact that Modern players are bigger,and heavier than in the past in most
positions more injuries are likely.The modern player is a gym monkey,and his strength etc.
and muscle is not like amateur days when .Many players were working outdoors, the injuries
seem to be a lot of ligament damage.Also a lot of injuries appear during prematch warmups
injuries as a whole.Are often minor compared to the old days if you could stand or walk
you completed the game.The work load doesn't encourage recovery either with players
playing/training something like 48weeks a year.
It is interesting that in muddy conditions the 1956 Bok side in NZ suffered badly with
hamstring injuries.

This is an interesting point(not ignoring the posts which followed). Having spoke with some the strength and conditioning coaches the belief seems to be that young players suffer badly from muscle imbalances due in part to a sedentary lifestyle and although they can shift heavy weights, their core strength is poor and are susceptible in particular to hamstring injuries and need lots of corrective work...also that players from farming backgrounds tend to do better because they have more functional, all round, conditioning.

I'm interested here in the ligament vs muscle comments. Is it a case today that although players are bigger and better athletes, that the increase in muscular strength and power is disproportionate to the connective tissue strength, which is a factor in their being so many ligament injuries?

Just some thoughts ....

It is definately important to balance training so that the entire muscle-tendon unit is developed in the right way.

Functional movement is also vital to maintain as an injury prevention strategy. It is amazing to see how quickly youngsters lose their ability to perform basic movements safely as they grow. How much of that is because they don't do the right stuff to maintain it and how much is because the stuff they are doing causes them to lose it I'm not completely sure. I will say that my experience of athletes would suggest that those who train heavily for rugby at a relatively young age tend to have much lower FM scores. And that those with low FM scores are much more likely to get injured.

I am not sure how the rugby academies are addressing this although I know at least some are aware of it. The real work needs to be done at a very early stage to prevent our kids losing their natural ability to move well.

MrsP wrote:
I am not sure how the rugby academies are addressing this although I know at least some are aware of it. The real work needs to be done at a very early stage to prevent our kids losing their natural ability to move well.

I was told that this is one of the primary aims of Brian McLaughlin's school program, to catch the problems early rather than spending a couple of years corrective work when the players join the academies. Maybe you know more about this?

Well.

Hmmmm....

How can I put this.

I had heard this too but I'm not sure if it is being followed through. My experience would suggest not.

Sounds like on its own training in the gym primarily improves your ability to train in the gym. The second effect is it helps to build muscle mass.

It certainly has a place but it needs to be guided and focused rather than just testosterone fueled "who can bench or squat the most".

It also raises questions about rehabilitation. I should think the right kind of gym training can be very useful in building up specific strength around injuries - but is there a danger of the feeling of the build up in strength hiding an underlying weakness that might have been more helped by different kinds of training?

Does spending too much time in the gym in general during rehabilitation actually have a negative effect on 'toughness' as opposed to strength - and does this lead to players returning from long term injury getting injured again all too quickly?

MrsP wrote:Well.

Hmmmm....

How can I put this.

I had heard this too but I'm not sure if it is being followed through. My experience would suggest not.

Damn, that's a shame...seemed like a good idea. Get the kids out cleaning chimneys and lifting bails of hay then. That will sort things.

lostinwales wrote:Sounds like on its own training in the gym primarily improves your ability to train in the gym. The second effect is it helps to build muscle mass.

Yeah my understanding of the issue is that young players are primarily focused on using gym training for aesthetics and performance - i.e. working in the agonistic muscle groups that they use in the sport like squats, bench press etc.

This is fine for performance but the problem is the antagonistic muscles aren't trained to the same level causing an imbalance. This combined with growth spurts and a lack of general core strength and flexibility means young players are very susceptible to injuries.

The optimal training for injury prevention, I've been told, is to work the antagonist muscle groups 3 times as much as the agonist -  so for example the hamstring needs worked to quads at a 3:1 ratio. The quads then needs stretched more. People tend to see it the other way round and focus on the main muscles they use, rather than the opposing muscle group which gets weaker.

There's a bit more to it but I think this is a big issue across many sports..

Nah! (To the chimney and hay plan!)

I suspect it's a combination of what we should stop them doing and what we should not stop them doing.

We need to find a way of stopping them unlearning good movement patterns.

I suspect a broader base of sporting ventures kept on through the teenage years would help. I think there is a terrible tendency to "cream off" the good rugby players at a very early stage and have them concentrate almost solely on rugby. They then miss out on all the other stuff and become far too tight.

In athletics the plan is to keep coaching as multidisciplinary as possible for as long as possible. They might not realise it but most sprinters use a throwing action etc so it makes sense to keep training as broad as possible.

Yeah good shout Mrsp... I'll be getting Katelyn to sweep the chimney just in case though, in between athletics training,Judo and pilates of course.

The climbing will do wonders for maintaining her flexibility!

Sure she must be nearly as good as you by now!

Well she does have a height advantage....