Schools' Rugby: As the schools' rugby season builds to its annual climax, Alison Healy investigates concerns young players are being pushed too far physically
The Irish schools' rugby system has evolved into one of the most competitive in the world but does that mean young players are facing a greater risk of injury?
Players are bigger, stronger and faster than ever and while the rate of injuries has not increased, injuries are likely to be more serious than before, according to medical professionals.
The Irish Rugby Football Union (IRFU) says the schools' game has never been safer because of safety precautions and strict guidelines on the attendance of doctors and medically trained persons at matches.
However, some medical professionals have expressed concern about the game.
Prof Moira O'Brien, TCD professor of anatomy, who is an expert on sports injuries, says over-training is a common problem at that age, with students playing for schools and clubs as well as other sports.
"They could be training every day and playing matches at the weekends but they need their rest days. Very often they are not getting the chance to recover from injuries," she says.
If the correct rules and procedures are followed, rugby is as safe as any sport, Prof O'Brien says, but she often sees the results of mistakes made in training, refereeing, diet or weights. "The problem with weights is the lack of supervision. You have enthusiastic amateurs telling kids to do things they shouldn't do."
The need for this supervision is also stressed by Mr Ailbe McCormack, chartered physiotherapist to the Irish senior team.
"Power is beginning to come in at a younger age," he says. "But if you are doing a lot of weights on an immature skeleton, it could have a deeply detrimental effect. It's important that it is properly monitored and the IRFU takes this very seriously."
He has seen a change in the type of rugby injuries in recent years. "We see a lot more shoulder injuries now where we had a lot of knee and cruciate injuries in the past. The game has become much faster. Previously, most tackles were below the waist but now they are above the waist so the players have a better chance of getting the ball."
The increasing use of headgear has reduced the incidence of concussion, Mr McCormack says, while rule changes on line-outs mean less punching and dirty play.However, the use of shoulder pads may increase injuries in younger players by encouraging them to make tackles that they would not normally make, he says.
Dr Jim McShane, one of two medical officers with the Leinster team, has also noted the changing style of play. Over the past two World Cups, players have been making greater use of the tackle to get more room on the pitch, he says. "They are taking guys out on the tackle more so that they are out of the game for 30 seconds or so and this gives them more space."
On the other hand, changes at schools' level have made scrums safer, he says. With teenagers developing at different rates, players may be mismatched in size and power so changes to scrums have reduced the danger. "That mismatching is one of the problems with schools' rugby but it levels out by the time they reach 21 or so."
"Growing pains" account for many youth injuries, according to Limerick-based GP, Dr Michael Griffin. He has worked with Young Munster for 22 years and is a former medical officer with the senior Irish team.
"With schools' rugby down here, it's been my experience that physiotherapists would be the first port of call and I tend to see injuries that could be a little bit more serious."
The most common youth injuries are as a result of bone growing quicker than muscle and this muscle being tight and short, he says.These muscles may be overused because of intensive training and demands from other sports.
Dr Griffin is a strong believer in the value of psychoneurometric testing which tests players' cognitive response and eye-to-hand co-ordination. Each player does a test before the season starts and if they are involved in a concussion-type incident, the test is repeated to see if the results are similar.
Ms Marese Cooney, lecturer in physiotherapy at Trinity College, Dublin, says there is a clear need for more research into the area of rugby injuries. Five years ago, she researched the level of knowledge that school rugby coaches had to prevent serious neck injury. The study found 50 per cent of serious spinal injuries occurred on the pitch as a result of post-injury management.
It highlighted the eagerness of coaches for more training and education. Ms Cooney says there have been many developments in the game since then but that has not been accompanied by research.
She calls for the publication of data on numbers of injuries and near-misses, so trends can be evaluated. "For example, does the wearing of shoulder pads increase or decrease injuries?" she says. There is also a need for a study on women's rugby to see if it highlights gender-specific injuries.
Prof O'Brien would like to see pre-season evaluations being carried out on every player so minor problems are identified and properly treated before they escalate.
She also believes that training programmes should be individualised. "No two players are the same. Some are fitter, some are more flexible. It's absolute rubbish to think that one programme suits everyone."
Prof O'Brien says children's enjoyment of the sport must always be paramount. "An awful lot of pressure is being put on kids to perform and it's not only coming from the schools. It's coming from the kids themselves and the parents in some cases.
"We often talk about the 'ugly parents' syndrome', where parents are pushing kids to do things because they want to live their lives through them. I'm not saying that's common, but it certainly does happen."
More safety leads to fewer serious injuries
The spinal injuries unit of the National Rehabilitation Hospital in Dún Laoghaire, Co Dublin, has seen a fall in admissions of people with serious rugby injuries in the past 15 years.
"I'm happy to say the number of serious rugby injuries is much lower now," says Dr Angela McNamara, consultant in rehabilitation medicine.
"We had one significant injury in the past year from rugby. The situation was very serious 10 or 15 years ago but they introduced strict rules which seem to have made a difference."
Rugby injuries account for about one-quarter of sports injuries at the hospital.
In December, a British study by Brunel University found the injury rate for professional rugby league was much higher than reported in high-risk occupations such as mining and quarrying. But it's a different story here, according to the Irish Rugby Football Union (IRFU). Some 258 second-level schools are now involved in rugby.
"Relative to the vast numbers participating, serious injuries are few and under constant focus," a spokesman said. "Injury trends are closely monitored and, where felt appropriate, preventative measures are introduced to the laws of the game."
Muscle tears, hamstrings, knees, ankles and shoulders are the most common injuries suffered by younger players, according to sports injury doctors and physiotherapists.
Dislocated kneecaps, sprains, strains and lacerations are also reported, with broken bones featuring occasionally. The introduction of headgear has reduced the number of concussions.
