How It Happens

Dr. Lewis Maharam, writing in Runner’s World, says that side stitches are likely to be caused by the pumping action of the legs putting pressure on the diaphragm from below, while rapid breathing expands the lungs and puts pressure on the diaphragm from above. This “dual pinching” effect shuts off the flow of blood and oxygen, and causes pain, cramps or both.

Other researchers believe that side stitches are caused by stretching the ligaments that extend from the diaphragm to the liver. When a runner or walker pounds the surface while breathing in and out, he or she stretches these ligaments, and that causes the pain.

A third theory is that eating a lot of food or fatty food, in particular, before exercise may cause stress on the diaphragm.

The truth is that no one knows for sure what causes the pain, but it’s real and there are some things you may be able to do about it. 

Symptoms

• A temporary stabbing pain on the lower right side of your abdomen.
• The pain subsides almost immediately after exercise stops.

Initial Treatment

There is no treatment. Simply stop doing whatever causes the pain or stop and try some of the in-race suggestions below, then resume the activity after 1-2 minutes. 

How to Avoid Side Stitches

There are many suggestions for avoiding side stitches, but what works for one person may or may not help another. Experiment with the ideas below, use the ones that work, and disregard the rest.

• Eat moderately-sized, low-fat meals 2-3 hours before practice or competition.
• Stick to familiar foods that are easily digested.  A small snack about an hour before a workout or run is OK, but this snack should be comprised mostly of carbohydrate and fluid, not fat. Examples include 1/2 deli sandwich and a sports drink, 2-4 fig bars and a sports drink, or a granola bar and a sports drink. If all else fails,try different sources of pre-workout foods (energy gels, sports drinks, bread, pasta, oatmeal, fruits) till you find something you can tolerate without getting a pain in the side.
• Stop running or walking and bend forward, while tightening the abdominal muscles.
• Exhale through pursed lips (to focus on breathing pattern).
• Stretch (right arm extended upward, lean to the left, hold for 20-30 seconds, repeat with the left arm stretched upward).
• Breathe deeply (to stretch the diaphragm).
• Change breathing patterns while running (inhale one extra beat than when exhaling (inhale 1-2-3; exhale 1-2).
• Slow your pace of running or walking.
• Hydrate during your workouts with 7-10 ounces of water or a sports drink (Gatorade) every 10-15 minutes. These amounts and types of beverages will promote better fluid absorption compared to consumption of larger amounts of  beverages such as fruit juices.

Ever felt stiff after a hard session, but only two days after the workout!? You may have never heard of the medical term, but you’re likely very familiar with delayed onset muscle soreness (DOMS), a condition involving muscle overuse that usually results from a single intensive exercise bout.

The discomfort begins at a muscle-tendon junction and spreads throughout the affected muscle. Soreness after almost any vigorous session of exercise is normal. DOMS is less common and probably indicates that you have stressed the muscle tissues beyond their normal capacity. DOMS hurts for a couple of days, but it’s not a serious condition and the symptoms will go away with rest.

How It Happens

Even though DOMS is relatively common, very little is known about the mechanism of the injury. The damage caused by muscle-lengthening—the kind that happens in downhill running, when your arm descends during a bicep curl, or during the lowering phase of a push-up, for example—is thought to last one to three days, followed by a period of regeneration of muscle tissue.

The pain is a result of small tears in the muscle tissue and the inflammation that goes with torn muscle fibers. The more (or longer) you overuse the muscle or muscle group, the greater the tissue damage. There does not appear to be any connection between the development of soreness and the loss of muscle strength. The two problems seem to occur at different times.

DOMS pain is likely to be the worst during the first two days after exercising beyond normal capacity.

3-7 is the number of days it can take DOMS symptoms to subside.

Symptoms

• Symptoms begin 24-48 hours after an intensive bout of exercise.
• Minor muscle soreness.
• More severe muscle soreness in out-of-shape exercisers.

Initial Treatment

DOMS is a self-limiting condition that requires no clinical treatment. The person who experiences the condition should follow these treatment guidelines:

• Rest for three or more days (until the soreness subsides).
• Take aspirin, ibuprofen, acetaminophen, or naproxen for pain/inflammation.
• Apply ice to the sore area for 15-20 minutes at a time, 3-4 times a day.
• Heat after the first 48-72 hours may diminish the pain, but there is no evidence that it speeds the healing process.
• Gentle stretching appears to help some people, but there is no compelling evidence to support this practice.

How to Avoid This Condition

• Follow the 10 percent rule: do not increase exercise intensity, frequency, or duration more than 10 percent a week.
• Cool down after vigorous exercise by jogging, walking, or slow-lap swimming.
• Immersion in cold water, ice baths.
• Use Hot/Cold Contrasts. 

If you have been following the press recently – especially the UK press you would have noticed that there has been a fair amount of concern about the large number of injuries amongst the England rugby players.

The concern is that the game is demanding more and more from a player and therefore if you are not physically prepared for the position that you play in or the level that you play your rugby at you could be at risk of sustaining an injury.

Due to the current format of professional senior rugby around the world the above statement must be a cause for concern for players and clubs alike. As a professional club you pay star players a large amount of money to represent your club. You are hoping for a number of returns from those players - 1.They will assist the team in achieving the goals for that year and hopefully keep the trophy cabinet full. 2. These top players will help and guide the young up and coming future stars of the club, and 3. These players are used to promote the club brand and keep top sponsors happy to be involved.

If these players are now at an increased risk for injury then they become a risk for the club as well – that risk is usually a financial risk.

I cannot foresee that they are going to change the way this game is played because of the number of injuries sustained. They will adapt rules to make the game safer in areas that appear to be dangerous or causing a large number of injuries – but the general format of the game will remain the same which means that players will want be in the best physical shape they can be.

What I think could be a solution to the problem is to recommend that rugby union follows the Australian rugby league format. By this I mean the following: The season is roughly a 35 week season and all the rugby is played during this time. The remaining 17 weeks are used to give the players an opportunity to get away from the game mentally by going on holiday. There is enough time left for a proper off season of gym training so that players work on the strength requirements for the position they play and the demands of the game. It also allows a team to prepare as a group for the new season – and not the situation we see around the world in rugby union at the moment which that is a staggered approach to preparing players for the new season depending on whether that player toured with the national team or not.

Injuries unfortunately are part of rugby; in fact they are part of sport. Yes we have to monitor the incidence, rate and serious nature of these injuries and intervene were we have too but until we have a recognized period were players can rest, recuperate and then prepare themselves for the new season I believe we are going to expose players to an increased level of injury risk.

Firstly, congratulations must go out the Bulls who on Saturday showed why they are regarded as the best rugby club in the world today.

In order to get yourself into a position to be as successful as the Bulls have been this year you have to put into place long term plans and then stick to those plans in order to reap the rewards.

This is something that the Bulls have done. Their success has been built up over a number of years – there were no short cuts. Everybody in the team and management have played their part, even those players and management who are not part of the 2009 group – just think of what Heyneke Meyer did for the team while he was in charge.

This brings me to the point I am trying to make. In order to get somewhere in the rugby world you need to plan and you need to put the hard yards. I was very concerned this past weekend having read a newspaper article in the Sunday times referring to the blatant abuse of performance enhancing substances and steroids by our schoolboys. At the present moment this is an area whereby players are not been policed by the South African Institute for Drugs in Sport (SAIDS) due to the current legal system regarding the testing of minors. I can however say that this matter is been investigated by SAIDS and hopefully in the not to distant future we will have a system whereby schoolboys can legally be tested for these substances.

As Dr. Jon Patricios put it in the article yesterday it has taken someone like Bryan Habana eight years to be the player he is today. There were no short cuts in Bryan’s approach, it took hard work, eating correctly and looking after his body (i.e. he not only monitored the bumps and bruises but he controlled what went into his system so that at all times he assisted his body to recover from hard training sessions and to grow).

It is important to consider the harm that is been done by the use of these substances. There is a very serious health risk to your body and yourself when you are using steroids. But an even bigger risk is that you may have no idea where those substances have come from so they could be potentially life threatening.

I am not trying to be over dramatic here I am merely stating that it is not worth it – the risk is too great. Over and above the health risk it is important to consider that when they start testing at school boy level for the presence of performance enhancing substances in your system, what initially seemed like a good idea to jumps start your career could have the opposite effect and actually and retard your progress towards been a professional rugby by you ending up with a two year ban from all forms of the game.

Remember it takes time to develop the strength and power and skills needed to perform at the highest level, so keep in mind the story of the current Bulls squad and you will realise that planning, hard work, determination and perseverance is not just some motivational cliché but actually the ingredients to sustainable success.

Overview

The pectoralis (pec) muscles are large, highly visible muscles located on each side of the chest. Their primary job is to help the shoulders and arms move and lift. When you perform a push-up or chest fly, you are activating the pecs. Because they are among the strongest muscles in the body, they are less likely to be strained (pulled), but it can happen.

• Grade 1 strains involve a few torn muscle or tendon fibers. Loss of strength is minimal, and recovery quite manageable.
• Grade 2 strains involve more torn fibers, some loss of strength, and a longer rehab period.
• Grade 3 pectoralis strains are rare, painful, debilitating, and can have long-term effects on strength, power, range of motion, and sports performance. In most cases, the muscle will never regain it original strength.

How It Happens

A strained pec can occur in two ways: a traumatic event or long-term overuse. An athlete can be injured when taking a hard blow to the upper body that the pecs cannot withstand.

A chronic strain is less dramatic—overusing the pecs to the point where they begin to tear, either in the muscle tissue or in the tendons that connect the pecs to the ribs and breast bone (sternum). The The Journal of the Academy of Orthopaedic Surgeons is more specific: “Pectoralis major muscle tears are relatively rare injuries that occur while lifting weights, particularly when doing a bench press.”

Who’s At Risk

Weightlifters are in the highest risk group, but the injury has been reported in rugby players, wrestlers, rodeo athletes, boxers, skiers, sailboarders, football players, hockey players and pole vaulters.

Symptoms

• Severe pain in the chest area
• Swelling, bruising (may extend into the shoulder and upper arm in severe cases)
• Loss of strength, particularly when lifting
• Difficulty in moving the arm across the chest

Initial Treatment

• Apply ice packs for 15-20 minutes, 3-4 times a day for the first 48-72 hours
• Avoid or limit any activity that causes chest wall pain
• Get immediate medical attention if the strain is severe. Surgery is usually required for a complete pec rupture
• Aspirin, acetaminophen, ibuprofen, and naproxen may relieve pain. Aspirin, ibuprofen, and naproxen may relieve pain and reduce inflammation.

Comeback Strategy

As in recovering from any other muscle strain, think about returning to training and competition when pain has subsided, strength has been regained, and range of motion is back to normal, regardless of how much time has elapsed.

• Grade 1 recovery takes a matter of days. You can return to training when the symptoms have disappeared.
• Grade 2 recovery is a matter of weeks—approximately 2-6.
• Grade 3 complete tears usually require surgery; full recovery takes months.
• Cross-train in activities that do not stress the pectoralis muscles (walking, jogging, riding a stationary bicycle, lower body water exercises).
• Go through each movement required in your sport without pain before resuming training or competition.

Prehab

Incorporate these exercises into your comeback routine:

1. Active Isolated Pec Stretch

• Stand with one leg behind the other, keeping good posture
• Lift your arms up, elbows straight out in front of you with palms up
• Contract your back muscles to bring your arms out to the side, keeping your palms facing up
• You will feel a gentle stretch in your chest
• Don’t stretch to the point of pain
• Repeat 10 times

2. Quadruped Stance

• Start on your hands and knees
• Comfortably shift your weight back and forth over your hands
• Once you feel comfortable there, you can extend into a push-up position
• Simply hold yourself in this plank position, gradually increasing your time
• Do not hold until the point of pain

3. Resisted Internal Rotation

• Starting with your arm at your side, hold a Thera-band or elastic tube that is tied off to the side on a stable surface
• Using your right arm, the band should be on your right side
• Gently rotate your hand in toward your belly button and then release
• Repeat 10-15 times
• Use a band that provides a gentle amount of resistance, but no pain.

How to Avoid This Injury

• Allow more time for warm-up in cold weather.
• Get help from a certified strength and conditioning coach to ensure proper lifting technique.
• Do not increase exercises intensity, duration, or frequency more than 10 percent a week.

Movement Prep

Incorporate these exercises into your warm-up routine:

1. Hand Walks

• Start standing up straight
• Put your palms on the floor, keeping your legs as straight as you can
• Walk your hands forward until you are in a plank position
• Once you are there, leave your hands where they are and walk your feet towards your hands
• Repeat 10 times

2. Active Isolated Pec Stretch

• Stand with one leg behind the other, keeping good posture
• Lift your arms up, elbows straight out in front of you with palms up
• Contract your back muscles to bring your arms out to the side, keeping your palms facing up
• You will feel a gentle stretch in your chest
• Don’t stretch to the point of pain
• Repeat 10 times

3. Resisted Internal Rotation

• Starting with your arm at your side, hold a Thera-band or elastic tube that is tied off to the side on a stable surface
• Using your right arm, the band should be on your right side
• Gently rotate your hand in toward your belly button and then release
• Repeat 10-15 times
• Use a band that provides a gentle amount of resistance, but no pain.

Ankle Sprain

Overview

The ankle is the one of the most frequently injured parts of the body among rugby players. The severity of the injury ranges from one that allows the person to return to normal activity in a few days to an injury that keeps a person out of action for weeks at a time.

How It Happens

A sprained ankle is a stretch, tear, or rupture of at least one of the ligaments that hold the bones of the ankle joint together. The tears may be microscopic in size or so large that they represent a complete disruption of the fibers. One of the ligaments that wraps around the outside of the ankle is the weakest of the ankle ligaments and is the one most frequently injured. It is possible that all three ligaments supporting the ankle, from front to back, may be sprained. The vulnerability of the ankle as a structure causes the foot to move like a badly mounted wheel.

The most common cause of a lateral (outside) sprained ankle is when an athlete rolls over on the outside of the ankle, forcing it to move beyond its normal range of motion. Common scenarios include trying to change directions when the pivot foot is in a fixed position, landing on an uneven surface, and being out of control when landing after a jump. All three situations often occur in basketball.

“Interestingly enough,” says Steve Smith, a physical therapist at Athletes’ Performance in Florida, “some research has shown a correlation between weak gluteals (buttocks) and the incidence of ankle sprains, possibly due to a lack of stability and control.”

Ankle Sprain Versus High Ankle Sprain

The dreaded high ankle sprain differs from a standard ankle sprain according to the ligaments that are involved. In a standard ankle sprain, the ligaments that connect the bones in the lower leg to the foot and ankle bones are injured. But in a high ankle sprain, the ligaments that connect the two lower leg bones together are injured, explains.

Naturally, the location is higher up the leg. High ankle sprains are usually associated with a higher degree of injury, and require a longer time to recover and return to sport.  That’s because the forces on these ligaments are greater and they need to be healed before athletes can tolerate running, jumping, and cutting—another reason for the longer time to return to sport. Standard ankle sprains allow return to sport in days to weeks, while high ankle sprains can be weeks to months.

Symptoms

The amount of pain depends on how much the ligament has been stretched or torn. Physicians categorize ankle sprains according to the severity or degree of tissue damage.

• Grade 1: Mild pain, tenderness, localized swelling, but no instability; the person can walk, but is limited when trying to jog or jump; the ligament is stretched but not torn, and there is some damage to the ligament fibers
• Grade 2: A tearing or popping sound of the ligament as the ankle rolls to the side; significant bleeding and bruising (sometimes developing 3-4 days after the injury); moderate tenderness and swelling; decreased range of motion; the ligament is partially torn and the ankle is abnormally loose; difficulty in walking
• Grade 3: Extreme pain, swelling and tenderness; major instability, difficulty in walking, feeling of the ankle giving out; the ligament is completely torn

Initial Treatment

• Rest 24-48 hours to prevent further damage
• Apply ice packs for 15-20 minutes, 3-4 times a day for the first 24-72 hours, but don’t apply ice directly to the skin
• Use an elastic bandage or wrap to limit swelling, from the base of the toes to the top of the calf muscle, for the first 24-36 hours
• Protect the ankle with an air brace or other ankle support device
• Elevate the leg/ankle higher than the trunk to limit swelling 2-3 hours during the day; use pillows at the foot of the mattress or elevate the end of the bed with securely placed books or blocks of wood
• Aspirin, ibuprofen, and naproxen may relieve pain and reduce inflammation

Comeback Strategy

Recovery time depends on the grade of the injury and ranges from a few days to six weeks or longer. Continue your rehabilitation program until all symptoms have subsided, you have full strength in the injured ankle (when compared to the uninjured ankle), and you have full range of motion with pain. Go through each movement used in your sport (without pain) before you return to action.

How to Avoid It

• Wear high top shoes that protect the ankle during sports activities.
• Wear shoes that provide lateral (side-to-side) support.
• Wear a brace or tape your ankle for added protection and support.
• Do not increase training intensity, duration, or frequency more than 10 percent a week.

References

1. M. Ramin Modabber, MD, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California
2. Steve Smith, PT, DPT, SCS, CSCS, Manager, Performance Physical Therapy Services, Athletes’ Performance in Florida
3. Penn State Sports Medicine Newsletter
4. American Academy of Orthopaedic Surgeons
5. University of Michigan Health System

Knee pain is one the most common reasons that rugby players seek out physician assistance. Structural abnormalities can make the problem worse.

How It Happens

The knee is an intricate joint consisting of multiple structures that have to distribute forces from the ground up through the body, as well as from the upper body down through the leg. As a result, there are many different reasons and causes of knee pain, and the pain can be in several different places throughout the knee.

Most knee pain results not because the knee itself, but from some other part of the body. For instance, a tight iliotibial band, hip flexors, or quadriceps muscles, dominant hamstrings or quads, or weak hip rotators can all contribute to excessive stress and strain being transfered to your knees. Also, if your core is unstable, your body will try to gain that stability somewhere else—often times at the knees.

Where Does It Hurt?

Front of the knee

Above the knee - pain from quadriceps muscle strain and quad tendon inflammation, often from activities where the knees come past the toes, as with poor squatting technique.

Below the kneecap - the source of pain is the patellar tendon, which connects the knee cap to the top of the lower leg.

Under the knee cap - pain from excessive compression of the knee cap and from arthritic changes underneath the knee cap.

Back of the knee

Pain can be to the inside, middle, or outside, often due to hamstring or calf muscle tendon involvement or poor joint mobility, especially when bending the knee.

Inside of the knee

Pain can be due to tendinitis from the groin muscles and where the tendon inserts. It also can be due to ligament strain of the medial collateral ligament (MCL) or irritation to the medial (inside) meniscus.

Outside of the knee

Pain can be due to tendinitis, often from a tight iliotibial (IT) band. It also can be due to ligament strain of the LCL or irritation of the lateral (outside) meniscus.

Symptoms

· Intense pain, inflammation, or bruising at the site of the injury

· Pain when walking or getting up and down, and with stairs

· Reduced and/or painful range of motion

· Feeling of locking, catching, giving out or buckling with weight-bearing

Initial Treatment

· Apply ice applications for 15-20 minutes, 3-4 times a day.

· Aspirin, acetaminophen, ibuprofen and naproxen may relieve pain and reduce inflammation.

· Compress the knee joint with an elastic wrap if inflammation and swelling are present.

· Use a pillow to elevate the knee while at rest and during the night.

· Rest until symptoms diminish, which could take several days or several weeks.

· See a doctor if the pain is severe or if the pain persists for two weeks.

Comeback Strategy

Gradually increase the intensity, duration, and frequency of training. Coming back too early might force you to compensate for the injury by changing the way you move or the technique necessary to perform well in your sport. So go through all the movements required in your sport without pain before returning to action. And apply ice packs for 15-20 minutes after an exercise session.

How to Avoid This Injury

Do not increase the intensity, frequency, or duration of your exercise routine more than 10 percent each week. Wear pads or other protective devices (braces, wraps) to cushion blows.

Written by Dr. Dion O’Cuinneagain

During a rugby tackle or fall, you usually extend your arm to reduce the force of the impact when you hit the ground. If you try to break your fall on the palm of your hand, your thumb may be injured. The main ligament (ulnar collateral), which supports pinch and grasp activities, may be torn (sprained). The ligament helps your hand to function properly, acting like a hinge to keep your thumb joint (metacarpophalangeal) stable.

Diagnosis
When you have a sprained thumb, you lose some or all of your ability to grasp items between your thumb and index finger. It may or may not hurt right away. Other signs include bruising, tenderness, and swelling.

You usually will be able to finish the game. To make sure your injury won’t cause long-term weakness, pain, and instability, see your doctor for evaluation and treatment.

Your thumb ligament may have a partial or complete tear. Your doctor will probably move your thumb joint to test its stability and take x-rays to make sure you do not also have a broken bone. You may also get a stress x-ray showing what the joint looks like when your ligament is being used. If it hurts to do this, a shot of local anaesthetic may help. Your doctor will probably also x-ray your uninjured thumb for comparison.

Treatment Options
If you have a partial tear, your doctor will probably immobilize your thumb joint with a splint or other bandage until it heals. You will wear the splint for about three weeks, then start taking it off to do flexion and extension exercises with your thumb. Put the splint back on for protection when you are not doing the exercises. Keep doing this for another two or three weeks until the swelling and tenderness are gone. You may also put ice on your thumb twice a day for two to three days after the injury.

If your thumb ligament is completely torn, you may need surgery. Fragments of bone that sometimes get pulled away when your ligament tears may be removed or put back in their correct positions. After surgery you will probably need to wear a short-arm cast or a splint to protect your thumb ligament for six to eight weeks while it heals.

How can I prevent a thumb sprain?
The best way to prevent reoccurrences of a thumb sprain is to only return to practice and competition when all symptoms of the injury are gone and strength of the affected thumb has returned to normal. Furthermore, the rehabilitation exercises should be continued to ensure protective strength, range of motion, and stability of the injured joint.

Improving sports performance
The key to improving sports performance after recovering from a thumb sprain is a proper a rehabilitation program and adhering to some of those same principles after the injury is gone.

The single most important aspect of improving performance is by utilizing the stretching exercises mentioned above before and after you step onto the field, you should be able to pass the ball comfortable before starting training again.

Benefits derived from stretching include:

 increased physical efficiency and performance
 decreased risk of injury
 increased blood supply and nutrients to joint structures
 increased coordination
 improved muscular balance and postural awareness
 decreased risk of lower-back pain
 reduced stress
 enhanced enjoyment

Thumb sprain rehabilitation
As a rugby player, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important.

The most common rehabilitation for a sprained thumb often includes the following:

 Rest

Do not perform activities that cause pain during the acute phase.

 Ice

Apply ice or a cold pack to the thumb for 15 to 20 minutes, 4 times a day for few days.

 Medication

Take ibuprofen to help reduce inflammation and pain.

 Compression

Wrap your thumb in an elastic compression bandage (Ace bandage) to limit swelling and support your thumb joint.

 Stretching

When the acute pain is gone, start gentle stretching of the thumb as recommended by your doctor. Stay within pain limits. Hold each stretch for about 10 seconds and repeat 6 times.

Rehabilitation exercises

The primary focus of rehabilitation for a thumb sprain is to prevent aggravation of the existing injury. This means refraining from the activity that caused the injury and from similarly hazardous activities, as well as using appropriate support in the form of a splint or cast when being physically active.

Regaining and increasing the original range of motion of the injured thumb joint facilitates recovery and reduces the possibility of re-injury. Exercises to increase the range of motion of the base of the thumb follow. Many sports and activities expose the thumbs to injury. Once injured, re-injury is more likely.

These exercises are thus recommended for both hands as a preventive measure:

 Thumb extension

While seated, place the elbow of the injured-side arm on the same-side thigh with the elbow at a right angle and fingers extended. Grasp the injured thumb with the forefinger of the opposite hand. Gently draw back on the injured thumb, stopping at the point of pain. Hold the injured thumb in this position for 10 seconds, then release and rest for 10 seconds. Do this sequence five times, three times per day. You should be able to draw the injured thumb back a bit further with each day. If not, see your doctor for advice.

 Thumb flexion

While seated, place the elbow of the injured-side arm on the same-side thigh with the elbow at a right angle and fingers extended. Move the injured thumb inward so that the end of the thumb is brought as closely as first pain permits to the base of the small finger of the same hand. Hold this position for 10 seconds, then relax the injured thumb for five seconds. Perform this sequence 10 times, three times a day. From day to day it should be possible to press the injured thumb closer to the base of the same-side small finger. If not, see your doctor for advice.

 Hand grasp

While seated, place the elbow of the injured-side arm on the same-side thigh with elbow at a right angle. Using a grasping ball (available at most pharmacies), grasp the ball in the palm of the hand with the thumb and fingers and squeeze as firmly as pain allows. Hold this position for 10 seconds, then relax the injured hand for five seconds. Perform this sequence 10 times at least three times daily. From day to day greater grasping force without significant pain should be possible. If not, see your doctor for advice.

Alternative exercises

During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury.

They include:

 swimming
 jogging
 stationary bicycle

How long will the effects of my injury last?

A thumb sprain from overuse usually lasts 2 to 4 weeks, provided that you refrain from the activity that caused the injury and followed the rehabilitation program. These symptoms gradually lessen over time, so they may prohibit normal training for only 7 to 10 days.

When the thumb has been sprained in an accident, the duration of effects vary with the degree of the sprain. With first- and second-degree sprains, symptoms may persist on some level for 3 to 6 weeks. Third-degree sprains of the thumb may require surgical treatment, and full recovery can take months.

When can I return to my sport or activity?

It’s not advisable to return to your sport until all signs of swelling and pain have subsided. This includes painless full range-of-motion. If the injury is from overuse, you may return to activity if you simply modify the way you use your thumb. This can be achieved by positioning it differently than you did before.

If the thumb has suffered a first- or second-degree sprain, you may return to activity within two weeks if you wear a protective splint or cast. Full return without such protection generally takes four to six weeks. When there has been a third-degree sprain, full return to training and competition may take several weeks and may require a protective cast.

Remember: The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your thumb sprain recovers, not by how many days or weeks it has been since your injury occurred.
A good rule is to allow pain to dictate when you’re ready to return to activity. You should return in moderation, and back off if you feel any pain.

With the school and club rugby programs (Well done Hamiltons on Winning the club champs) having been completed for this year it provides the perfect opportunity for those of you that have battled with injury or niggles to have the problem/s sorted out.

It is important that you address these problems as they will not resolve on their own. The symptoms of pain and stiffness may disappear but the underlying dysfunction will still be present and will reappear as soon as you start training/playing next season.

Injury rehabilitation is based on several different things. The key is to return the body back to normal function. Depending on the type of injury, there can be lots of different areas of dysfunction. The most common of these are mobility restrictions, strength deficits, balance deficits and incorrect recruitment of muscles in order to perform a particular function.

The body is made up of hundreds of joints. Each joint has normal range of motions, as well as muscles that move the joint. If there are restrictions in the mobility of the joint, or in the efficiency of the muscles to move and control that joint then a dysfunction can occur.

What is also important to realise is that you may be suffering from a problem that is secondary to the underlying cause. I refer to the classic example of players who suffer from recurring hamstring injuries and keep having the hamstring seen too. The problem could be a result of an underlying back problem which refers pain to the hamstring or interferes with the neural activation of those muscles, or they have developed a dysfunctional movement pattern and the Gluteal muscles may not working efficiently this will result in the hamstring been overloaded and result in potential injury.

It is important to acknowledge that there are situations that require a simple approach to management of the injury. This may involve a period of cross training so as to stay active and not overload the injured structured allowing it time to recover. Once the recovery has started a graduated approach of improving the strength of the muscles surrounding the joint, maintaining normal joint range of motion and retraining the proprioception of the joint is all that is required to restore normal function. I must stress though that if you have recurring problems, joints that repetitively subluxate or dislocate joints that swell following activity or un-explained pain then it is advisable to see a medical professional with an interest in sports injuries.

Please keep in mind that with the advent of the internet there is a lot of advice and information available today at the click of a button. I encourage the use of the internet to research possible answers for your problems but I must stress again that it is important to get the input and guidance from a proper trained medical professional before trying to manage problems that have been worrying you for some time and tend not to have a straight forward explanation. By doing this you could possibly be doing more harm than good.

Enjoy the off season and start planning for next season by having a look at the training programs provided for you on Rugby IQ.

Clint.