Back injuries in Rugby
Back injuries are common in Rugby, most often occurring while tackling. A sudden impact of two facet joints in the lower spine can be caused by tackling at an awkward angle, or being forced back by the opposing player causing an over-extension of the lower back. The facet joints are located on either side of the vertebrae. Each enclosed by a capsule, they provide stability for the spine. If the soft tissue on the facet joint surfaces is compressed, if can cause micro-tears on the tissue. Inflammation then occurs, which can irritate the nerve that runs directly next to the facet joint. This is why back injuries often have associated nerve irritation or ‘pinching’ and take a while to settle.
So how do you manage a facet joint problem?
Accurate diagnosis
It’s a given that accurate diagnosis from a professional physiotherapist or medic is essential to managing an injury in the best way possible. There are many different injuries that can occur in the back and, unfortunately, there is no ‘one treatment fits all’ solution. Furthermore, identification of any underlying or predisposing factors such as poor muscle tone due to a previous unresolved injury will help to ensure this problem is less likely to occur again.
Relative rest
10-14 days of relative rest (non-aggravating activity only) allows new tissue to be laid down at the injury site, this lets inflammation do its job in repairing damaged tissue. This process cannot be sped up, not even by the country’s best physio! Rest is free and not to be undervalued.
Physiotherapy
Manual therapy to help reduce adhesion and scar tissue (which might lead to loss of mobility), optimise circulation and ensure optimal joint congruency.
Exercise Prescription
The appropriate loading is needed to gradually strengthen that new tissue. Very gentle stretching should start about 5 days post injury to help align the new tissue- think about it, if you pull too hard on new weak tissue, it might just re-tear. Although there is the temptation to stretch an injury as soon as you do it, more often than not this is not the best thing to do. Pilates exercises can be useful to help regain strength and control into the deep postural muscles that surround the facet joints in the early stages of rehabilitation.
Medication
Non-steroidal Anti-Inflammatories (NSAIDs) are often prescribed to reduce pain, however the inflammatory process is necessary to kick start healing. It might be better to take pain killers like paracetamol for the first 2-3 days and then use NSAIDs if the pain persists. The body sometimes overreacts with the inflammatory process, causing too much scar tissue to be laid down, which might cause aggravation from adhesions, limit healthy blood flow to recovering tissue and aggravate the nerves (think about how swollen a sprained ankle gets!). It’s this excessive inflammation that causes problems as the adhesions can bind to healthy tissue. In this case the NSAIDs are useful to limit excessive inflammation.
If you think you may have this injury, contact a physiotherapist to help guide you on the optimum management to get you back to sport as quickly and safely as possible.