Coaching Toolbox 
Injury Management
Injury Management
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Injury ManagementPDF | Print | Email
GET YOURSELF IN WORKING ORDER
Injury management involves identifying, treating and recovering from an injury. Players who return to play before they have fully recovered end up missing about three times as much play as they would have if they had completely healed before resuming play.
PHASES OF INJURY MANAGEMENT:
1. Acute
2. Rehabilitation
3. Return to play
SIDELINE CONCUSSION CHECK
Ask your coach or RDO for this great little resource that fits into your wallet.
Who takes responsibility in your team if there’s a serious injury?
Each team needs to appoint a person, present at the match, who is responsible for the immediate management of injured players. Preferably the same person should complete and return any serious injury report forms to their Provincial Union.
PHASE 1 - ACUTE
There are a few basic things that you can make sure happen immediately after an injury has occurred - this is called the immediate phase. Coaches and players should be 100% familiar with these procedures.
SUSPECTED SPINAL INJURY
In the event of a suspected spinal or other serious injury:
GET HELP FIRST, and GET IT FAST
1) Call 111 for an Ambulance
Don’t move the player until qualified medical personnel arrive! A player may have suffered a severe neck injury, and yet still be able to move. If the spine is unstable, and they are moved, they run the risk of permanent paralysis. Referees and coaches should err on the side of caution and seek medical assistance in the event of any potentially serious injury.
CONCUSSION
Concussion can occur when a player receives an impact to the head or body that causes the brain to shake inside the skull. If a player is knocked out or loses consciousness they have obviously sustained a concussion, but it is important to remember that a person can be concussed without losing consciousness.The Sideline Concussion Checklist is an essential tool to use to determine signs and symptoms of concussion.
If a player appears stunned, dazed or confused after an impact ask some of the following questions to check if the player is aware of their surroundings and that their memory is working correctly.
• What ground are we at?
• Which team are we playing today?
• Who are you marking?
• Which half is it?
• What is the score of the game?
Watch for unsteadiness when they stand up or poor balance and co-ordination as these are also signs of concussion. Players may also complain of other symptoms such as blurred or double vision, ringing in their ears, sensitivity to light and noise. They may experience nausea or vomiting, a headache or feel extremely tired or become irritable. If any of these symptoms are present a player should not return to play.
Players who are concussed are often unaware of their symptoms and may want to continue playing.- they usually do! It is imperative that the Coach / Referee take responsibility for the player’s wellbeing, assess the player and make an informed choice about whether the player should return to play or not – if any doubt the player must be removed from play.
Even if there are no immediate symptoms of concussion these can show up later, so it is important to keep a close eye on the player. Ensure the player is regularly checked and not left alone during the fi rst four hours after injury. As the coach YOU should make certain that your player has a ‘buddy’ who will make sure he is not left alone for the fi rst four hours” and get him home safely for his parents or guardian to monitor. Give the concussion advice slip (from the concussion checklist) to the player and their guardian so everyone knows what to watch for over the fi rst 24 - 48 hours.
Concussed Players must get urgent medical treatment if they show signs of:
• worsening headache,
• increased drowsiness or can’t be woken up,
• vomiting
• increased confusion or agitation
• weakness in any limbs
• slurred speech
• loss of consciousness or seizure
RugbySmart 2010 Concussion Video.
RETURN TO PLAY GUIDELINES
|
Level |
Activity Undertaken |
Time Post Concussion Guidelines (approximate) |
|
1 |
No activity, complete rest. Once symptom free and cognitive recovery is demonstrated, proceed to level 2 |
2 – 3 days |
|
2 |
Light aerobic exercise such as walking or stationary cycling. |
4 – 10 days |
|
3 |
Sport-specific training (e.g. running activity, ball-handling activity). |
11 – 15 days |
|
4 |
Non-contact training activities. |
16 – 20 days |
|
5 |
Full-contact training after medical clearance. |
21 days |
|
6 |
Game play. |
21 + days |
FOR ALL OTHER INJURIES
If the injury disrupts play, get the player assessed on the field so you can decide whether to keep the player on or take them off.
ASSESSING THE INJURY
For effective assessment of an injury, remember T.O.T.A.P.S.
TALK
Ask the player what happened
Where does it hurt?
What kind of pain is it?
OBSERVE
Look at the affected area for redness or swelling
Is the injured side different from the other side?
TOUCH
Touch will indicate warmth for inflammation – touch also assesses pain.
ACTIVE MOVEMENT
Ask the injured player to move the injured part without any help.
PASSIVE MOVEMENT
If the player can move the injured part, carefully try to move it yourself through its full range of motion.
SKILL TEST
Did the active and passive movement produce pain? If no, can the player stand and demonstrate some of the skills from the game? If an injury is identified, remove the player from the activity immediately.
TREATING THE INJURY R.I.C.E.D.
A soft tissue injury such as a sprain, strain, or bruise should immediately be treated with the R.I.C.E.D. procedure:
RugbySmart 2010 injury management Video.
REST
Rest reduces further damage.
Avoid as much movement of the injured part as possible to limit further injury. Don’t put any weight on the injured part.
ICE
Ice cools the tissue and reduces pain, swelling and bleeding.
Place ice wrapped in a damp towel onto the injured area.
Apply ice for 20 minutes every two hours for the first 48 hours.
COMPRESSION
Firm bandaging helps to reduce bleeding and swelling. Ensure that bandaging is not so tight that it cuts off circulation or causes tingling or pain past the bandage. Bandage the injury between ice treatments.
ELEVATION
Elevate the injured area to stop bleeding and swelling.
Raise the injured area on a pillow for comfort and support.
DIAGNOSIS
Consult a medical professional such as a doctor or physiotherapist especially if you are worried about the injury, or if the pain or swelling gets worse. If the pain or swelling has not gone down significantly within 48 hours, also seek treatment.
For a list of ACC endorsed physios click here . Injury related visits to ACC endorsed physios are usually free.
AVOID H.A.R.M. - FUL FACTORS
Once the injury has been diagnosed and treated, avoid the H.A.R.M.-ful factors for 72 hours:
HEAT
Heat increases the bleeding in the injured tissues. Avoid hot baths and showers, saunas, hot water bottles, heat packs and liniments.
ALCOHOL
Avoid alcohol as it increases the bleeding and swelling around soft tissue injuries and delays healing. It can also mask the injury’s pain and possible severity, which may result in the player not seeking treatment as early as they should. If a player has a suspected head injury alcohol MUST be avoided.
RUNNING
Running, or exercise of the injured part, will cause further damage. Do not resume exercise within 72 hours of the injury unless a medical professional clears the player.
MASSAGE
Massage causes an increase in bleeding and swelling and will prolong the rehabilitation process when done within 72 hours of the injury.
PHASE 2 - REHABILITATION
Rehabilitation focuses on restoring the player’s full functions and rugby-specific abilities to prevent re-injury and encourage their best possible performance. In this phase the player should be building up muscle strength around the injured area, working towards getting the full movement back in the joint, getting their balance back and keeping fit through activities like swimming and cycling. Once they are ready they need to gradually build in light rugby-specific skills and drills, extending themselves at training only as much as the injury allows.
The player needs support to:
• Restore strength
• Restore range of motion
• Restore co-ordination and control
• Restore balance
• Maintain fitness
• Build confidence
• Restore their rugby-specific ability
PHASE 3 - DEMONSTRATION OF PRE-INJURY
- PERFORMANCE LEVEL FOLLOWED BY RETURN TO PLAY
This is when the coach, doctor or physiotherapist puts a player through a set of tests to see if they are ready to get back out on the field.
These tests should be a combination of those you used for the fitness tests at the start of the season and rugby skills and moves that the player will have to make during a game – like side stepping and tackling.
You can use the Player Profiling information you recorded earlier in the year to see whether a player is ready to return to play based on a comparison of performance.
Remember – if your players continue playing with an injury they increase the chance of a further, more severe injury.
• Restore rugby-specific skills and techniques e.g. jumping, throwing, kicking
• When the rugby-specific skills are done at the same level as they were before the injury, the player can return to the activity
• Don’t play hurt!
THE COACH'S FIRST AID KIT
• Surgical gloves
• Small towel
• Compression bandages
• Adhesive tape
• Band-aids, plasters
• Antiseptic solutions, eg Savlon.
• Eye wash
• Scissors (not with sharp points)
• A sling bandage
• Sterile gauze dressing
• Ice should be available as well