Injury Prevention in Rugby
Rugby has significant injury risk due to its collision nature. Proactive injury prevention is essential for career longevity and sustained performance.
Key Statistics (PRISP 2022-23)
| Category | Finding |
|---|---|
| Most common match injury | Concussion (7 consecutive seasons) |
| Most common training injury | Hamstring strain (6 consecutive seasons) |
| Contact injury percentage | 70% of injuries follow contact |
| Post-concussion risk | 60% greater risk of subsequent time-loss injury |
The Hamstring Protocol
Why This Matters
Hamstring strains have been the most common training injury in professional rugby for 6 consecutive seasons. This is preventable.
Risk Factors:
- •Running mechanism (68-85% of injuries)
- •Fatigue (highest risk in final 20 minutes)
- •Backs at higher risk than forwards
- •Prior hamstring injury
Nordic Hamstring Exercise
The most effective hamstring injury prevention intervention available.
Evidence: 51% reduction in hamstring injuries (PMC Umbrella Review 2024)
Volume Targets:
| Phase | Frequency | Volume | Weekly Target |
|---|---|---|---|
| Off-season | 2x/week | 4x6-8 per session | 48+ reps |
| Pre-season | 2x/week | 3x6-8 per session | 40+ reps |
| In-season | 2x/week | 3x5-6 per session | 30-36 reps minimum |
Progression:
| Week | Sets x Reps | Assistance |
|---|---|---|
| 1-2 | 2x5 | Partner-assisted descent |
| 3-4 | 3x6 | Slower eccentric (4 sec) |
| 5-6 | 3x8 | Unassisted |
| Maintenance | 3-4x6 | Unassisted |
Key Principles:
- •Progress by reducing assistance, not adding load
- •In-season maintenance is NON-NEGOTIABLE
- •Backs at highest risk - prioritize compliance
- •Partner or band assistance acceptable
L-Protocol for Rehabilitation
If injury occurs, the Lengthening (L) protocol provides structured return:
Phase 1 (Days 1-5): Isometric loading
- •Prone holds at 90°, 60°, 30° knee flexion
- •3-5 x 30 sec holds, 2x daily
Phase 2 (Days 5-10): Isotonic loading
- •Prone knee curls, standing single-leg curls
- •3 x 12-15, daily
Phase 3 (Days 10-21): Eccentric loading
- •Nordic curls (assisted), light RDL
- •3 x 8-10, every other day
Phase 4 (Days 21+): High-speed eccentric
- •Sprinting progressions
- •Sport-specific movements
Shoulder Health Protocol
The Problem
Shoulder injuries affect 6.5% of rugby players and are often career-affecting due to:
- •Tackling demands
- •Being tackled
- •Scrummaging forces
- •Mauling involvement
The Solution: Push-Pull Balance
Required Ratio: 2:1 pull-to-push (3:1 if history of shoulder issues)
Implementation:
- •2 pulling exercises for every push
- •Face pulls in every upper body session
- •Row variations regularly
Example Session:
- •Bench Press (push)
- •Barbell Row (pull 1)
- •Face Pull (pull 2)
- •Dumbbell Row (pull 3)
Rotator Cuff Work:
- •External rotation (band): 3x15
- •Y-T-W raises: 2x10 each
- •Frequency: Every upper body session
Concussion Awareness
The Severity
Concussion has been the most common match injury for 7 consecutive seasons. This demands attention.
Key Points
- 1.70% of injuries occur following contact - Technique is primary prevention
- 2.60% greater subsequent injury risk - Conservative return essential
- 3.No same-day return - Any symptoms require full protocol
- 4.Graduated return - Medical clearance required
Tackle Technique
S&C strengthens the body, but technique determines injury risk:
- •Head placement (behind or to the side, never in front)
- •Body position (low, driving)
- •Shoulder contact (not head)
- •Eye level (look at target)
Neck Strengthening
Context: Evidence for neck strengthening preventing concussion specifically is LOW quality (JOSPT 2023). However:
- •Helps athletes brace for expected contact
- •Supports proper tackle technique
- •Benefits scrummaging (forwards)
Protocol:
- •Frequency: 2-3x/week
- •Exercises: Flexion, extension, lateral flexion, isometrics
- •Volume: 2-3x12-15 each direction
- •Especially important for tight forwards
Key Message: Neck strength is part of comprehensive injury prevention, not primary concussion prevention.
Knee Injury Prevention
Risk Factors
- •Direct contact in tackles
- •Foot planted during impact
- •Non-contact cutting/deceleration
- •Landing from lineout
Prevention Strategies
- •Single-leg strength exercises
- •Landing mechanics training
- •Hip strengthening (glute med focus)
- •Neuromuscular control
Ankle Protection
Rugby-Specific Mechanisms
- •Foot trapped in ruck/tackle
- •Landing on other player's foot
- •Forced inversion during contact
Prevention
- •Proprioception training
- •Ankle strengthening
- •Taping/bracing for history
- •Pitch awareness
In-Season Non-Negotiables
When time is limited during season, these CANNOT be skipped:
| Exercise | Frequency | Volume | Purpose |
|---|---|---|---|
| Nordic Hamstrings | 2x/week | 30-36 reps/week min | Hamstring prevention |
| Face Pulls | Every upper session | 3x15-20 | Shoulder balance |
| Neck Work | 2x/week | Brief sessions | Contact preparation |
Position-Specific Considerations
Tight Forwards
- •Highest contact frequency
- •Scrummaging forces on neck and shoulders
- •Prioritize: Neck strength, shoulder balance
Loose Forwards
- •Highest work rate
- •Tackle frequency very high
- •Prioritize: Shoulder health, hamstring protection
Backs
- •Highest hamstring injury risk
- •More maximal velocity sprinting
- •Prioritize: Nordic curls (critical), speed maintenance
Return-to-Play Principles
General
- •Functional testing before clearance
- •Limb symmetry >90% on strength testing
- •Psychological readiness matters
- •Don't rush - reinjury risk elevated
Post-Concussion
- •60% greater risk of subsequent injury
- •Conservative approach even after clearance
- •Consider reduced contact in first 2 weeks
- •Monitor for fatigue, reduced reaction time
Summary
The Big Three for Rugby:
- 1.Nordic hamstring curls (51% injury reduction)
- 2.2:1 pull-to-push ratio (shoulder health)
- 3.Proper tackle technique (contact injury prevention)
Key Principle: You can't play if you're injured. Injury prevention IS performance enhancement.
References
- •PRISP 2022-23 Annual Report
- •PMC 2024 Nordic Hamstring Exercise Umbrella Review
- •PMC 2025 Rugby Position Injury Meta-Analysis
- •World Rugby Player Welfare Guidelines
- •JOSPT 2023 Neck Strength Systematic Review