The passionate sound of national anthems, the noise of the bustling and expectant fans as the long anticipated wait of four years has come to an end – it’s time for the eighth Rugby World Cup to start.
The Rugby World Cup is a rugby union tournament contested every four years between the top international teams. The tournament was first held in 1987, when the tournament was co-hosted by New Zealand and Australia. The most recent tournament was held in 2011 in New Zealand, whose national team won the tournament by defeating France in the final.
The winners are awarded the William Webb Ellis Cup, named after William Webb Ellis, the Rugby School pupil who — according to a popular myth — invented rugby by picking up the ball during a football game. Three teams have won the trophy twice, Australia, New Zealand, and South Africa; while England have won the tournament once.
So over the last 28 years the game has grown and professionalism fully embraced. But it is not just the players that have developed along the journey but the medical support these players need to deal with the rigors of regular and intense play.
Ahead of the Rugby World Cup 2015 ISEH consultant Dr Ade Adejuwon and club Doctor for Saracens Rugby Club answers your questions and shares his specialist expertise on rugby injuries in our recent web chat.
Q: In light of Leigh Halfpenny's recent injury please can you explain what an ACL injury is and how long it takes to recover from this type of injury?
AA: Firstly I must send my commiserations to Leigh Halfpenny and the Welsh National team. He will be missed from the World Cup.
ACL stands for the anterior cruciate ligament. This is a ligament inside the knee that stabilises it during twisting actions. Typically it is injured when the player is changing direction so it is seen a lot in sports like rugby, football and skiing. Recovery is variable but typically can take anything from 6-12 months depending on the type of injury and the support the individual gets in their recovery.
Q: As the size of rugby players seemingly get larger and larger will the rules of the game have to be adapted to reduce injuries?
AA: Since the game became professional and players have been able to make a living from rugby the sizes have gotten bigger but this will plateau. What we are seeing is that the bigger the players the less dynamic they can be which changes the way the game is played. Some teams are beginning to reduce bulk to compensate for this.
Injury surveillance systems that are presently in place helps to identify the injury profiles which will influence the rules of the sport going forward and if size is a contributor it should highlight.
Q: Is the England squad in good enough shape to win the World Cup?
AA: I believe so. They have had an amazing preparatory period and had time to bond as a team. From what I have heard (and seen) the boys are in excellent physical form.
Q: Are there any statistics on which country’s national team get least injuries? And if so, can we learn anything form them?
AA: I am sure there are but probably not in the public forum. The best time such information is collected is during international tournaments like the World Cup or Olympics under the umbrella of World Rugby.
Q: Is the medical approach towards concussion applied across all ages/ standard the same?
AA: In short no. There are now internationally agreed management protocols depending on age; you can find this here
The message is if in doubt sit them out, have a low threshold particularly in adolescents and ensure they undergo a return to play process. In the elite setting there is an enhanced care pathway that is very tightly controlled that allows the player to return to play in a shorter period when they have recovered from the concussion.
Q: Are the levels of injuries increasing year on year or is it the severity of the injury increasing or both?
AA: It may seem like the injuries might be increasing but this is probably because there is more publicity around them. The RFU carries out injury surveillance across all international and premiership fixtures and we now know that the injury rates have plateaued over the last couple of years.
Q: How often do players play when they are injured?
AA: I am sure any professional player would answer that they are always carrying an injury of sort be it a bruise or a sprain. The physical nature of the sport means that this is unavoidable. It is the role of the medical team (plus parents/coach) to determine how severe an injury is, how likely they are to cause themselves further harm in playing and fundamentally protect them from themselves.
Q: As Saracens club Doctor do you have a close working relationship with respective National Team Doctors before and during competitions?
Q: As a Premiership club Doctor do you work closely with other club Doctors to improve ways of treating players and sharing knowledge?
AA: I will try and answer both at the same time. Premiership rugby club doctors do share knowledge and experience sometime informally but at times as part of a formal medical managers group. One can get isolated working in team sports and it is important that we all collaborate in the best interest of our charges. Obviously trade secrets on what makes Alex Goode such an evasive runner are kept closed of course.
Regarding interaction: the medical teams are always in liaison always with the player's interest in mind and this is before during and after tournaments. This is a key mantra in medical management be it in sports or in a hospital: good comms.
Q: Are you covering any of the games at the World Cup?
AA: I am privileged to say that I am. I have a number of responsibilities across the tournament which is an exciting opportunity for both me and for everyone involved in organising RWC2015. Let's all get out there and show the world what great fans we are.
Q: What's the most enjoyable aspect of being a Premiership club Doctor?
AA: This is a great question yet difficult to answer as there are so many great aspects. I have to say the camaraderie and the banter.
Q: How long does it take to train/study to enable you to become a Premiership club Doctor?
AA: Firstly you need to complete your training as a doctor and then go through foundation years as a junior doctor before undergoing specialist training in sports and exercise medicine. Different people take different paths but to become a consultant in SEM from graduation took me 10 years.
Q: When a player of a visiting nation gets injured how does the interaction between their medical team and the medical teams based in the UK work?
AA: Firstly a credit must go to the RWC2015 organising committee but in name Dr Simon Kemp and Dr Andy Smith who have organised all the medical provisions. On match day there is a pitch side team that will work with the nation's medics to provide emergent care. If the injury is not so urgent there are area medical officers around the country that will work with the nation's to organise the best care for their players.
Q: Do you work across a number of sports or are rugby injuries your specialty
AA: I love all sports. I happen to enjoy rugby the most because I used to play for my university first team a LONG time ago. I have worked in cycling, I am the CMO for a multisport event in London that includes 7s, netball and crossfit and started to look at injury pattern in polo. So basically any sport that people get or can get hit.
Q: Who's your favourite Premiership Doctor?
I can't surely answer that... they're all very friendly and we get on well, not sure about the Leicester Tiger's chap...! (Dr Kal Parmar also at the ISEH)
Who's going to win the world cup?
It would be easy to say New Zealand as they are currently ranked World number 1. But if you consider that anything goes in a tournament plus home advantage I have to say England. #Carrythemhome!
Thank you to everyone who submitted a question and for your interest. Enjoy the World Cup!
A number of questions from the web chat related to injury prevalence and severity in rugby. The simplest way to address this is to direct you to the latest edition of the injury surveillance report for the RFU and Premiership rugby, where the key points are summarised at the beginning.