The summer weather and longer evenings gets everybody feeling more energised and motivated to spend time outdoors. A great way to get out in the sun is by joining a local team or group of co-workers in the popular sport of tag rugby. Tag rugby is a social game that is played by all levels of skill, age, fitness and teams are usually of mixed gender.

Tag rugby is a non-contact sport where the player wears shorts with a Velcro strip and two “tags” attached. The opposition pulls the tag of the defendant who is in procession of the ball, as opposed to tackling which is seen in other forms of rugby.

However, like all sports; tag rugby is not without the complication and risk of injury.

Tag rugby’s ethos encourages absolutely everyone to participate, regardless of pre-existing fitness levels, skill or training. This automatically predisposes those less fit to picking up an injury, so it’s advisable that if you plan to play tag that you work on your fitness and strength. An assessment with your Physiotherapist will assess your biomechanical needs, any areas of weakness and your running style. The Physiotherapist will also be able to recommend a strength and conditioning exercise program to help you prepare, keep you strong through the season and, hopefully, keep you injury free!

Hands And Fingers

Hand and finger injuries have become a common occurrence on the tag field. During the grab for the tag, it is very easy for the player to catch a finger in the other person’s belt, leading to a sprain or ligament injury or dislocation or fracture.

In multiple studies, it has been found that the middle finger has a higher prevalence of injury, which is often caused by a hyperextension. Another recent study found that the middle finger is the most likely area on the hand to become fractured in tag rugby. This type of fracture usually requires surgery for fixation. Following surgery, your Consultant will recommend Physiotherapy to promote your return to normal activity.

Some Common Conditions

“Mallet Finger”

A form of injury that happens when the finger is forced into flexion during active extension of the distal interphalangeal joints (last joint of the finger). This can develop when the tip of the finger is hit from a rugby ball or from impact or collision. It is important to seek medical attention from your doctor or your physiotherapist who can assess the injury, as the untreated mallet finger can result in a swan neck deformity.
Conservative management can be applied by splinting the finger in an extension position, advice on PRICE principles and exercises to return function to the finger. However, open surgical repair is often required where K wires are inserted and the finger is immobilised for up to 6 weeks. Restoring the normal alignment and integrity of the joint is important to improve the range of movement of the finger, reduce pain and improve control of the finger which can be enabled with the aid of Physiotherapy.

“Jersey Finger”

Seen where the tendon of the muscle in the finger, called digitorm profundus, is ruptured. 75% of this injury will happen to the ring finger. The injury process is mainly from a forced extension movement when the finger is actively flexed such as grabbing a tag, short or as the name suggests a jersey. To repair this injury surgery is required, followed by Specialist Hand Physiotherapy which can be ongoing for 3 to 6 months.

Collateral ligament injuries of the finger joints

An injury associated with contact sports, however this injury is often seen as a result of tag rugby. Again, this injury will need assessment for diagnosis. The incomplete rupture of the collateral ligament can be managed with taping of the finger to the next finger to maintain a neutral position and promote healing.
Where there is complete tear of the ligament, taping can still be an option however it is more likely surgery will be required where sutures are placed and the finger is immobilised for two weeks. Hand Physiotherapy is usually followed post-surgery.

Ulnar collateral ligament injury of the thumb

This injury frequently presents following a fall on an outstretched hand, which can happen in tag rugby or any other sport. This injury results in joint instability, abduction deformity, chronic pain, reduced grip strength and, if left untreated, an increased risk of developing arthritis due to the instability.
The partial tear of the ulnar collateral ligament can be managed through immobilisation of the thumb to allow for healing however surgery may also be indicated. Surgery is required for the complete ligament injury and to return stability to the joints of the thumb followed by Hand Physiotherpy.

Other injuries such as fractures and dislocations may also require surgical interventions in the management.

It is best to have early diagnosis in hand/finger injuries to improve prognosis and for optimum recovery, as delayed diagnosis has been found to result in complications, slower recovery and increased days off work or off play. If you injure your hand or fingers during a game of tag rugby it is advisable to go to a medical practitioner or a Physiotherapist who can assess the injury. Your Doctor or Physiotherapist may feel the need to have your injury further investigated by either X-Ray, MRI or CT scan to determine the extent of the injury.

Physiotherapy can enable recovery of finger injuries through advice on self-management in the acute phase, taping, strength and conditioning exercises, joint mobilisation and improving range of motion. Suspected fractures should be reviewed in A+E as soon as possible.

Soft Tissue Injuries

Another common complaint from tag rugby players who limp into clinics are from soft tissue injuries. The hamstring muscle is usually the culprit, in the majority of cases.

Even when tag is played amongst friends, there can be a degree of competitiveness where the player makes intermittent fast sprints with plenty of change in direction in order to dodge their opposition. This type of running puts increased effort on the hamstring muscle. Suddenly, the player may feel a pain in the back of the leg, resembling the feeling of been kicked. Their running comes to a halt and they realise they have not been kicked, as they had outrun their competition. Unfortunately they have pain from a muscle strain/tear to the hamstrings.

It has been found in all sports that 29% of injuries occur in the hamstring muscle group, with the majority of hamstring injuries resulting from high speed running. Injury to the hamstring muscle can result in, on average, to 8 to 25 days lost of play - depending on the extent of the injury. It’s important to note that hamstrings are particularly vulnerable to re-injury following a tear on return to sport. With this in mind, it is crucial to visit a Physiotherapist who can safely guide your rehabilitation and return to sport.

Sprinting with sudden acceleration and sudden deceleration with a change of direction requires the hamstring to contract eccentrically in order to slow down the movement, and it is at this stage that tears can occur in the muscle tendon junction (i.e. the middle of the muscle). Another form of injury to the hamstring can occur from slow speed stretching where there is both hip flexion and knee extension. This is often seen in kicking, twisting and cutting movements, such as a sudden change of direction.

Less common is an avulsion injury of the hamstring, which is where the muscle tendon tears from the bone insertion. In some cases the tendon can pull away part of the bone. This type of hamstring injury is mainly seen at the proximal insertion (upper hamstring area, below the base of the pelvis). In this case you will need to have further investigation to assess the extent of the injury, such as an MRI.

Middle muscle tears can be treated conservatively under the guidance of your Physiotherapist, while proximal injury or avulsion injury will often require a surgical repair.

A recent study which investigated a Rugby tournament found that majority of injuries were lower limb with 33% of the injury been tendon or muscle injury. 41 % of these tendon/muscle injuries were related to high speed running.

Why Is The Hamstring So Commonly Injured During Tag Rugby?

A number of factors are related to the cause of hamstring strains. Environmental factors can have a contributing role to the cause of injury. Tag rugby is a summer sport, so the warmer weather brings drier and harder ground. Running on harder ground increases the reaction forces, which means the hamstring must absorb more.

Muscle weakness, imbalance in strength to the quadriceps, poor flexibility and muscle fatigue also increase your risk of injury to the hamstring muscle group.

Sore Muscles

A number of players will likely also experience transient soft tissue injury or muscle soreness, fatigue and tightness, which usually resolves with the end of the game or with the application of RICE principles over the next 24 – 48 hours. However, if you are experiencing pain that lasts 2+ days or is worsening it is advisable to see a Physiotherapist who can assess your injury.

Due to the high speed and twisting movements involved in tag rugby, soft tissue injuries in the lower limb can also present as ankle sprains, knee ligament injuries, calf strains and groin injuries, to name a few.

Like all sports, there is a risk of trauma from bumping into a player or from sudden falls which can result in traumatic injury. Falling on a twisted ankle or knee can result in serious ligament injury or a fracture.

It is also important to be aware of head trauma and the risk of concussion injury. If you have a head injury it is advisable to stop playing and seek a medical attention.