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Newsletter 4 draft

olume 2 Issue 1
November 2012 V
There are no regulations in Rugby Union that refer to the use of non-
steroidal anti-inflammatory drugs (NSAIDs), however, there is anecdotal
evidence that many players take NSAIDs before and after playing and
training. NSAIDs are permitted in sport from an anti-doping perspective but
in view of the many recognised adverse effects related to NSAID use in
athletes, there are some areas of concern. These areas are discussed in the
the first edition of the 2012-2013 season IRFU Medical Newsletter by IRFU
Medical Director, Dr. Conor McCarthy. We also give you an update on some
of the latest medical research in Rugby Union.

NSAIDs are medications used to treat painful conditions, like arthritis. There are many
different types of NSAIDs, but most require a prescription for use. Some NSAIDs can be
bought over the counter (OTC) (e.g. ibuprofen (Nurofen)). They work by reducing the level
of substances (prostagalandins) at the site of inflammation and thereby reduce pain,
stiffness and swelling.

The clinical indications for use of NSAIDs varies according to the type of drug but different
reasons include the treatment of soft tissue injuries, peri-articular and articular disorders,
musculoskeletal disorders, and the treatment of pain from arthritis. The newer agents
(e.g. Arcoxia and Celebrex) are only licensed for the treatment of osteoarthritis,
rheumatoid arthritis and gout.

Individuals who participate in sport frequently use NSAIDs to treat painful conditions, like
sports injuries. In the 2006 FIFA Soccer World Cup more than half of all players took an
NSAID at least once during the tournament and more than 10% took an NSAID prior to
every game1. There is much controversy regarding the role of NSAIDs in the treatment of
sports injuries but the majority of scientific evidence does not prove that NSAIDs prevent
sports injuries or help to speed up recovery following a injury. However, the symptoms of
pain and swelling can be significantly reduced by the early use of these drugs following

There are a number of potential side effects from the use of NSAIDs. The main concern
relates to causing stomach symptoms – these symptoms can include stomach ulcers and
bleeding, nausea, vomiting, diarrhoea, heart burn, stomach pain or cramps. It is
recommended that NSAIDs are taken after food to lessen these potential side effects. It is
also possible than NSAIDs may cause significant stomach related side effects, like an
ulcer, without any warning symptoms. Hence, it is recommended that these drugs are only
used for a short duration and at the lowest possible dose.

Other than these effects, the following may occur with the use of NSAIDs:
Exacerbation of asthma
Allergies – skin rash, tongue and/or lip swelling
Kidney effects – fluid retention, increased blood pressure and kidney
Liver effects – liver inflammation
Heart effects – there are reports of higher incidence of heart attack
and strokes in people who take NSAIDs regularly

Bleeding – bleeding and easy bruising can occur
Delay in bone healing after fractures
In order to monitor for potential side effects frequent users of NSAIDs should have their
blood pressure checked from time to time and blood tests may also be necessary to
monitor for side effects.

NSAIDs should be taken for the shortest possible time at the lowest possible dose
Over the counter (OTC) NSAIDs, like ibuprofen, may be sufficient for pain control
and have a lower incidence of adverse effects

Long term use of NSAIDs should be avoided for the treatment or prevention of
sports injuries

Extra caution is advised in players with any pre-existing problems (e.g. stomach
ulcers, colitis, asthma, kidney and liver disorders) or in any player who has had
previous intolerance to NSAIDs

Interactions can occur with other drugs - so check with your doctor before taking
an NSAID with other drugs. If an adverse event occurs this should be reported to
the prescribing doctor

References for Healthcare Professionals
Tscholl P, Junge A, Dvorak J. The use of medication and nutritional supplements during the FIFA World Cups 2002
and 2006. Br. J. Sports Med 2008;42;725-730.

In this year’s newsletter we will keep you up to date on some of the latest research in
Rugby Union. Please see below for some of the latest studies.

Positional demands of international rugby union: Evaluation of player actions and
movements. Quarrie et al, Journal of Science and Medicine in Sport, September 2012

This study from New Zealand coded player movements in 90 international matches for the
All Blacks between 2004 and 2010. Forwards
sustained the highest contact loads per match and
the mean distance covered by players ranged from
5400 to 6300m per match with the backs generally
running further. There were marked differences in the
specific match demands for positional groups
indicating that this should be considered when
managing player workloads. This is one of the largest
ever studies conducted on player movement
demands in Rugby Union. This study also has
implications for players attaining a level of fitness and
running load prior to returning to play in that players
should experience similar loads to that in games as
part of their rehabilitation from injury.

Effect of compression garments on short-term
recovery of repeated sprint and 3-km running
performance in rugby union players. Hamlin et al,
Journal of Strength and Conditioning Research, November 2012

This study measured 22 players performance two test sessions one week apart that
included a 40m repeated sprint test (10 sprints at 30 second intervals) followed by a 3-km
run 10 minutes later. Players wore compressive garments for 24 hours prior to one test
sessions and for the next test session wore similar looking non-compressive garments.
They were not aware which garment was the compressive pair. Compared to the non-
compressive garments, when players wore the compressive garments they improved their
average sprint times by 1.2% and fatigue was diminished by 15.8% over the repeated
tests. They also decreased the time to complete the 3-km test by 2%. Delayed onset
muscle soreness (DOMS) was also less when players wore the compression garments.
The authors concluded that wearing compressive garments during recovery is likely to be
worthwhile and unlikely to be harmful for well trained Rugby Union players. Compression
garments are not a stand alone recovery tool and simple strategies such as appropriate
sleep and nutrition, as well as ice baths, massage, stretching and active recovery may also
assist this process.

Dr. Garrett Coughlan
Dr. Conor McCarthy
IRFU Medical Department
With thanks to Dr. Michael Webb and Dr. Eanna Falvey


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