Team Doctor Br J Sports Med: first published as 10.1136/bjsm.23.4.211 on 1 December 1989. Downloaded from Donald A. D. Macleod, MB, ChB, FRCS Ed.

Honorary surgeon to Scottish Rugby Union, Member of Medical Advisory Sub-Committee of The International Rugby Football Board

Mr Macleod has been a team doctor injury rate, based on the number of lac- working with the Scottish Rugby erations stitches, or Union and their international teams needing games for 20 years. He accompanied the Scot- missed each season, occurred among tish Rugby Union touring party to international rugby players. The pat- New Zealand in 1981 and returned to tern of injuries affecting inter- New Zealand as the team doctor with nationalists was no different from the British Lions in 1983. other rugby players, but the severity and frequency of injury, and the inci- The team doctor must supplement his dence of over-use injuries was far knowledge of exercise physiology and higher. sports medicine with a passionate com- The commonest injuries involved mitment to his own particular sport. the knee, shoulder and ankle joints, He must know the game, the players, musculotendinous tears, cuts and con- the officials, the laws and the specialist cussion. It is essential that the team media. He must work as an integral doctor has appropriate expertise and member of the players' party and be equipment to deal with these. It is not recognized and respected as the often possible to give an accurate players' doctor, while at the same time, assessment on one examination and a working closely with the coaches. This second may have to be arranged 48 to can be a difficult balance to achieve and 72 hours later. This mav involve liaison it is essential that the team doctor main- with the player's own doctor or char- tains the integrity of the doctor-patient tered physiotherapist if the player can- relationship. This frequently involves not readily be seen by the team doctor, protecting the players from some of the . <1 ,. a common problem with international many complex pressures which are Donald Macleod - one of the players' squads. brought to bear on them and also being party The team doctor can make his life a prepared to offer the player a lot of time lot easier by working with a group of for discussion and consultation. be looking for a doctor, chartered people who will share his duties and Top class rugby plavers are rarely physiotherapist or magician with the provide complementary support, for free from injury because of the inevita- elixir of sporting life. example, a chartered physiotherapist, ble high speed collisions that occur As a high speed collision sport, masseur and a first aid attendant. The http://bjsm.bmj.com/ during the game and the increasing de- rugby is associated with both contact well informed player, coach, referee mands of their training programmes. and over-use injuries. The five home and club official are also essential mem- The team doctor must work with the nations (Scotland, England, Ireland, bers of an extended medical team. The players and coaches, trying to help Wales and France) funded a two year team doctor will therefore be commit- them achieve and maintain maximum study into the epidemiology of rugby ted to teaching them. fitness in spite of these inevitable injuries. This was carried out in Wales The therapeutic use of medicines bumps and bruises, associated with between 1982 and 1984 (Figure 1). This and drugs can be a nightmare for the muscle pulls and joint strains. This fre- study demonstrated that the team doctor, especially if on October 1, 2021 by guest. Protected copyright. quently involves regular modification highest travelling 897 away from home with a young, inex- of training schedules. Building up the perienced team. He must be up to date trust and respect of the players and with the lists of banned and approved coaches takes time. If the rest of the I medications and have players' party is out there training or good knowledge 01 of proprietary preparations available competing in the rain, why shouldn't over the counter which contain the team be might a doctor present too? I banned substance. It is nearly always Sports participants nowadays are possible to avoid prescribing drugs widely read and up-to-date with most X I 13 by CL giving the player time to talk out his aspects of sports medicine and so the problems while giving common sense team doctor cannot afford to get behind medical advice. Drugs or injections can with his reading. Players soon spot frequently be a double-edged sword. weakness and any respect that the doc- I 63 56 60 Any prescription to one in tor C player the might have earned will rapidly dis- team invariably lead to a 'me too' appear. The 'shop around syndrome' effect going through the party, particu- then develops among the players, larly if the first player does well. Are coaches and selectors, all of whom will you prescribing to achieve a placebo Address for correspondence: Mr Donald effect? Are you treating yourself? Are A.D. MacLeod, Bangour General Hospital, Figure 1. Relative frequency of injuries you genuinely providing the plaver, Broxburn, West Lothian EH52 6LR, UK. adjusted to number of games who is now your patient, with the best ) 1989 Butterworth & Co (Publishers) Ltd (Epidemiology of Rugby Injuries: Five course of action for the problem in 0306-3674/89/040211-02 $03.00 Nations Fellowship-Dr P. Williams) hand? Are you doing any harm? Are

Br. J. Sp. Med., Vol. 23, No. 4 211 you treating the plaver with an 'experi- value in significant injuries, where an physiotherapist and club coach. Occa- mental preparation'? appropriate splint frequently speeds sionally, it is necessary to advise Br J Sports Med: first published as 10.1136/bjsm.23.4.211 on 1 December 1989. Downloaded from Among the useful drugs are short up recovery. It is important to remind players to retire from playing rugby be- acting hypnotics, particularly when the players that the first priority in manag- cause of recurring injuries. This is not team is awav from home, staving in a ing a soft tissue injury is not the use of an easy task, and requires a careful as- strange environment. A supply of ant- drugs but the need to rest the injured sessment and joint consultation with acids is essential. Liquid antacid is par- part for 36 hours using ice packs and the player and his own doctor. ticularly helpful to calm 'butterflies in compression bandaging. The doctor's The team doctor has a first class op- the stomach', frequently associated immediate care of soft tissue injury portunity to initiate research on the with heartburn. Antacid tablets are of should not be geared to allowing the basis of his detailed knowledge of the value when the players' party has been player to go to a dance or social func- team and the fitness training program- a little self-indulgent with regard to its tion, but should be to minimize the mes as well as the effects of the game. food intake around the time of a major time lost from training and playing These projects may look into injury match when they may have been temp- rugby! patterns, the prevention of injury, or ted by exotic items on a menu if they Travelling away from home, espe- the first aid facilities required in rugby are staying away from home in a first cially overseas, requires careful plan- club houses. Collecting data for its own class hotel. Colds and upper respirat- ning to cope with the many additional sake is of no value unless some positive ory tract infections can be a problem in problems that may arise such as jet leg, action is taken to prevent injuries and that many of the standard 'cures' that acclimatisation, infections, insurance, improve their treatment. players can buy from a chemist contain stress and the availability of medical I have tried to outline some of the banned products. Soluble asprin and and physiotherapy support. duties I have aimed to undertake with steam inhalation, with or without the The team doctor's duties do not end the Scottish international rugby teams. addition of Friar's balsam or menthol with the game, the training session or It is a great privilege to work with top crystals, can be very effective in help- the international tour. Communication class amateur sportsmen, helping ing people get over a cold. with the player's own general prac- them and their coaches achieve win- The immediate use of a non-steroidal titioner is essential to maintain good ning performances at rugby football anti-inflammatory drug, after the initial standards of clinical practice. This also from a relatively small rugby playing examination and assessment of a soft acts as an active form of peer review. nation. This would not have been pos- tissue injury, for 36 to 48 hours appears Advice to a player about fitness pro- sible without the support of a commit- to speed up recovery. Non-steroidal grammes or rehabilitation may have ted and extended medical team, to anti-inflammatory drugs are of no to be co-ordinated with his local whom I offer mv sincere thanks. http://bjsm.bmj.com/ on October 1, 2021 by guest. Protected copyright.

212 Br. J. Sp. Med., Vol. 23, No. 4