Lower Limb Injuries in Rugby League
Rugby league is a high speed and quick change of direction game with high impact collisions. There is constant change in acceleration and deceleration, direction, pace with quick stops and starts.
Due to the amount of body contact as well as high speeds of impact in tackles, injuries to the lower limbs account for over 50% of all injuries. The most common specific injuries are ankle lateral ligament tears, knee medial collateral and anterior cruciate ligament tears occurring from contact forces or rotational forces during a quick change of direction as well as groin musculotendinous tears, hamstring and calf muscle tears, and quadriceps muscle contusions.
The types of injuries sustained can be broken down further into two categories: traumatic injuries and overuse injuries.
These injuries occur due to high contact forces from collision or from rotational forces due to quick change of direction.
Some of the traumatic injuries we see include:
- Ankle Sprains – sprains are injuries to ligaments. The quick direction changes and side on tackles result in ankle sprains most commonly to the lateral ligaments as a result of the forced plantarflexion/inversion movement.
- Fractures – fractures are common in contact sports. bones are vulnerable to large impact forces during play and fracture when the force exceeds what they can normally tolerate.
- Tears in muscles, tendons and ligaments – ankle lateral ligament tears and knee medial collateral and anterior cruciate ligament tears and meniscus tears are common. Impact to the lower limbs can cause muscles, tendons and ligaments to move in a way they weren’t designed for and can’t withstand, leading to a partial tear or at the worst case, a complete rupture.
- Turf toe – when a toe is jerked up and hyperextends, the ligaments surrounding the toe joint (metatarsophalangeal joint) can become damaged and sprained.
- Plantar plate injuries – most common causes of second toe joint pain. The plantar plate is a ligamentous structure that runs along all the toes at the ball of your foot at the joints and connects them together. It is designed to protect the metatarsal heads from pressure and hyperextension. Damage to this structure may contribute to turf toe.
- Toenail damage – repetitive trauma from standing on the toe, from the toe nail rubbing against the upper of shoe, impact from kicking the ball can result in subungal hematomas (bruising of the nail), lose of the toe nail and secondary complications like fungal nail infections and thickening of the toe nails.
Overuse injuries are caused by repetitive stress over time that lead to the damage of a muscle or tissue. Biomechanical issues are often associated that produce stress and overload on a structure past a point that it can normally handle. Due to the game having a high demand on running, overuse injuries are commonly seen. These conditions can adversely impact on performance and possibly lead to more complicated conditions if not properly addressed by a podiatrist. These injuries can include:
- Achilles Tendonitis– inflammation and pain of the Achilles tendon that can be felt in the back of the ankle.
- Bursitis-occurs when a bursal sac is inflamed. A bursa is a fluid filled sac that helps to lubricate and reduce friction between two surfaces in the body, usually muscles , ligaments and tendons as they glide over bony prominences.
- Knee pain – Sudden change of direction, twisting or a direct blow to the knee can result in a multitude of knee injuries such as anterior, lateral and medial cruciate ligament, torn cartilage, iliotibial band syndrome and fracture of the patella.
- Medial Tibial Stress Syndrome (shin splints)-a condition which relates to pain or a dull ache felt anywhere from the front of the lower leg(tibia) to the ankle. Commonly caused from running on hard surfaces and over pronation.
- Peroneal Tendonitis – inflammation of the peroneal tendons on the outside of the ankle from activities such as walking or running on uneven ground or sports that involve change of direction.
- Plantar Fasciitis – Plantar fasciitis is the most common cause of heel pain. The plantar fascia is the flat band of tissue (ligament) that connects the heel bone to the toes. It helps support the arch of the foot. If you constantly strain your plantar fascia it can cause tiny tears in the ligament resulting in inflammation leading to pain and irritation.
- Posterior Tibial Tendon Dysfunction (PTTD) – Posterior tibial dysfunction is a painful, progressive flatfoot deformity in adults. The posterior tibial tendon is one of the most important tendons in the lower leg as it helps hold up your arch and provides support. The condition results in overstretching or rupturing of the posterior tibial tendon, leading to tendon inflammation, weakness, foot deformity and arthritis.
- Sesamoiditis – Sesamoids are small bones located under the big toe. Inflammation surrounding the sesamoids causes pain underneath the big toe joint, often associated with increased pressure over the joint from poor biomechanics such as overpronation, sudden changes in training, trauma to the foot and ill-fitting footwear.
We have highlighted only a few traumatic and overuse injuries involved in the sport. Traumatic injuries are difficult to control but we can minimise the risk of overuse injury by doing the following:
- Good warm up, stretch and cool down routine to prepare muscles, joints and ligaments prior. A standard warm up should be 15-30 minutes.
- Orthotic therapy to correct underlying biomechanical issues.
- Develop a fitness program to develop endurance, strength, balance, coordination and flexibility.
- Adequate and supportive footwear.
- Start training and conditioning the body before competition – most injuries occur at the beginning of the season so give yourself time to gradually increase training duration and intensity.
If injuries prevail, at Mint Foot Care we diagnosis these injuries by taking a comprehensive history, performing a biomechanical assessment and video gait analysis to prescribe a treatment and rehabilitation plan that will return the player to competition as soon as possible.