Rugby lower leg injuries

About 5% of rugby injuries are to the calf muscles. Backs are particularly vulnerable to leg injuries.

Injuries to the lower leg include shin and muscle bruises and contusions, calf strains and ruptures, and leg fractures. You also encounter medial tibial stress syndrome and exertional compartment syndrome - problems commonly referred to as shin splints.

Stress fractures of the tibia and the fibula are some of the incidents of injury that also occur.

Muscles of the lower leg
The most important muscles of the lower leg are the calf muscles and muscles on the outside front of your shin:

  • The calf muscle consists of the gastrocnemius muscle (a well-developed gastrocnemius will look like two aubergines under your skin) and the lower soleus muscle.
  • The “shin” (anterior compartment) muscles are used to lift your foot while walking.

The gastrocnemius muscle starts above the knee and inserts via the Achilles tendon into the heel. The soleus originates below the knee and also inserts via the Achilles tendon. Although either of these two muscles can be strained or torn, the most common injury is to the muscle-tendon junction of the gastrocnemius, roughly half way between the knee and the heel.

An acute strain is caused by trauma or an injury such as a blow to the muscle or overstressing the calf muscle. Chronic strains are usually the result of overuse - prolonged, repetitive movement of the muscles. Contributing factors include an inadequate warm up, lack of flexibility, fatigue and insufficient strength.

Symptoms include pain midway up the calf muscle (involving the gastrocnemius) or pain lower down in the leg and when the muscle contracts with the knee bent (in the case of a soleus injury).

Shin splints is the colloquial name given to pain that is experienced in the lower shinbone (tibia), more commonly in the front of the leg than at the back or the sides. The name arose from joggers and runners who commonly describe the pain as though the shinbone were “splintering” during exercise.

The leg muscles attached to the tibia (shinbone) become inflamed and injured at the attachment. Shin splints are therefore not a condition of the bone.

A stress fracture needs to be ruled out by repeating an X-ray two weeks later, or by doing a bone scan. A stress fracture is a far more serious injury and means that part of the bone has developed micro-tears or a hairline crack, and will require a six to eight week period of healing.

Shin splints are not confined to runners alone - anyone performing pounding-type exercises with the legs, like aerobics, tennis or even ballet dancers (and of course rugby players) can experience this affliction.

There are many different causative factors that can lead to injuries like shin splints. These include:

  • Overtraining
  • Running on hard surfaces
  • Biomechanical factors, such as excessive pronation (inward rolling of the foot) or supination (outward rolling)
  • Stiff, tight or weak calf or lower leg muscles
  • Hard or worn out shoes. These shoes no longer provide adequate shock absorptive capacities, and thus increased stress is applied to the shinbone
  • Improper stretching or a lack of correct stretching exercises (one should stretch for at least 20 min prior to a rugby practice or game)
  • Training too hard, too fast, too soon 
  • Dietary factors, e.g. too little calcium intake can lead to a weakened bone structure

Symptoms include:

  • Pain on the inside of the shinbone when running or exercising
  • Lumps and bumps over the bone may indicate swelling and inflammation
  • Excruciating pain when tapping or pressing directly onto the shinbone with your thumb (could also be a stress fracture)
  • Some swelling on the inside edge, lower third of the shinbone
  • Pain with resistance tests for the muscles attached to the bone and when standing on your toes
  • Muscle spasm on inside shin muscles

If pain starts during running after a particular time or distance, the problem may be a compartment syndrome injury, which can be a more severe problem.

Osgood Schlatter’s diseases mainly affects boys aged 10 to 16 years old and is caused by repetitive stress or tension on a part of the growth area of the upper tibia. Symptoms include swelling or a visible lump just below the knee cap and pain below the knee which worsens with activity.  

(Health24, September 2011)

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