Artificial Surfaces and new injury challenge.
This blog serves to provide the reader with greater understanding and information on how friction burns occur on an artificial playing surface and how that this new surface is proving challenging to the medical teams that manage the player’s week on week.
In all there are 4 major Clubs within South Wales that have reverted from the traditional grass root based pitch to the 3/4Generation pitches. Although the advantages (all season pitch, multiple use, faster free flowing game) outweigh the disadvantages (friction burns, new injuries, harder surface) the friction burns can cause some severe risks. It’s the purpose of this blog to discuss what the injuries are, how they occur and how to best manage and prevent them.
Artificial playing surface
The introduction of the new surface into rugby has seen a change in the injuries sustained by players. The common injuries such as ankle sprains, hamstring strains and concussion still remain evident in the game but theres a new kid in town (Abrasions injuries) and its proving difficult to manage.
Now following on from the media hype Wales online, BBC Wales this isn’t a blog that serves to slander artificial pitches. Yet, what its meant to do is understand the injuries specifically abrasions that may be sustained whilst using an artificial surface. As a medical person I want to know the best way to treat these injuries and allow the players to continue playing without putting themselves at further risk??
Firstly, we need to understand these new injuries (abrasions) and how they occur. As a physiotherapist I except the broken bones and ligament sprains and muscle tears in rugby and undertake rehab sessions with players on a weekly basis to facilitate a safe return to play but the abrasions sustained from such artificial surfaces are time demanding on the medical team and expensive to manage.
What are Abrasions?
Are more commonly seen in cyclists and track and field athletes and are usually caused by a fall on a hard surface. Abrasions are also known as ‘Road Rash, excoriation or “brush burn”. As the athlete falls then the impact with the ground and coinciding with the frictions causes layers of skin to be removed (Fig 1.)
An abrasion means the superficial surface of the skin (epidermis) has been broken or damaged. Its commonly seen around the extremities where bony and less fleshy parts of the body such as (knees, Ankles, Elbows and hips)
Whilst cyclists, track and field athletes and more recently rugby players have the potential to cause painful abrasions due to the high speed of the sport and impact when falling. Abrasions do not extend into the dermis and do not cause a great deal of bleeding. However, whilst there is little blood loss from an abrasion they can often be painful due to nerve endings being exposed.
Layers of the skin
Fig 1: Layers of the skin
The epidermis provides protection, and a deep inner layer (Dermis), which provides the firmness and flexibility of the skin. These Abrasive type injuries would typically be classified as a first degree burn (Classification of Burns-Fig 2). Nonetheless, the risk from infections of these injuries if not managed correctly can be high.
Fig 2: Classification of Burns
Risk from Abrasions?
The abrasion can contain elements of dirt and in this case rubber crumb from the artificial surface. This may lead to an infection or other complications if not cleaned and attended to. Most abrasions can be treated at home, and a trip to the emergency room is typically not necessary.
- Wounds may interfere with function of the injured body part (knee when bending to walk up the stairs).
- Wounds may become infected, usually with bacteria if not irrigated properly.
- If wounds don’t heal properly they may leave scars.
Acute management and Treatment for Abrasions
- Clean the wound with a non-fiber shedding material or sterile gauze, and use an antiseptic such as Chlorhexidine is a disinfectant and antiseptic that is used for skin disinfection before surgery and It may also used for cleaning wounds.
- If there is embedded dirt, chlorhexidine may be used as it contains an antiseptic and a surfactant to help remove debris. Rinse the wound after five minutes with sterile saline or flowing tap water. Ideally, you want to irrigate the area with a nontoxic surfactant such as Chlorhexidine or Shur-Clens with a bit of pressure (use a syringe if possible).
- Don’t scrub at embedded dirt, as this can traumatize the site even more.
- Cover the cleaned wound with an appropriate non-stick sterile dressing. Use a semi permeable dressing such as Tegaderm, Bioclusive or second skin. Cover the wound and attach the dressing to the clean dry unaffected skin. Whilst brand names have been mentioned here we are aware there may be other products available.
- Another product that is said to be useful to help heal minor skin abrasions is Antiseptic Healing Ointment made by Brave Soldier. This unique blend of natural botanicals (Tea Tree Oil, Aloe, Jojoba Oil, Vitamin E/Comfrey) helps wounds heal quickly and reduces the likelihood of scarring. It includes 4% Lidocaine which reduces the pain and abrasions can certainly is painful. This ointment is becoming a favorite healing ointment of triathletes and cyclists and works well on road rash, minor cuts, burns, blisters, and even saddle sores.
- Change the dressing according to the manufacturer’s instructions (some may be left in place for several days to a week). A moist clean environment promotes healing, improves tissue formation and protects the area from infection. If you reapply antiseptic, wash it off after five minutes and then redress the wound.
- If signs of infection are evident then a course of antibiotics may be used as an additional treatment.
After the injury is sustained the damaged layers of the skin will first heel from deep to the superficial layers of the skin and from the outer edges to centre. As healing begins, the area of the abrasion may look pink and raw, but in time, the wound will form new skin that is pink and smooth.
Factors such as patient’s age, health, extent of injury, possibility of infection, and availability of first aid supplies help to determine the amount of time necessary for an abrasion to heal. Other factors that affect the rate of abrasion healing include:
- Diet – the immune system and skin need healthy and proper nutrition
- External temperature and weather conditions
- Drug use
- Pre-existing medical conditions, such as vascular disease or diabetes.
Most abrasions and minor scratches heal in a few days. The formation of a scab is your body’s natural way for protecting the wound from dirt and germs, and a sign that new skin is growing beneath. Try not to pick at or scratch scabs, as the new skin underneath may not yet be fully developed.
Prevention of abrasions
Prevention of abrasions is possible by using Vaseline prior to sessions/Game or protective pads, should the rules of the game allow it or covering any exposed skin with a layer of clothing. You can’t always predict when you will suffer an abrasion, but within rugby and the use of artificial surfaces it is certainly now becoming more common place.
Awareness of your Pitch/ground and other grounds artificial may aid you and the players to minimize the risk of moderate to severe abrasions. Due to the contact nature of the sport and the ever increasing exposure to artificial surfaces they are always going to be a factor in the game and during training. However, other precautionary steps include
- Wearing long skins, legs and arms, or other layers of clothing as additional layers of protection for the skin
- Wearing protective pads for knees, wrists, elbows, and hands during training.
- Using lubricants such as Vaseline on exposed extremities with less flesh.
- Keeping a well-stocked first-aid kit available can help provide immediate treatment for abrasions
- Antibiotic ointment as mentioned above
- Wound care management kit (irrigation kit with suitable dressings)
Points to consider
- Keep a close watch on the injury
- watch for signs of infection or complications.
- If the abrasion does not seem to be healing, seek medical attention. You may also need an updated tetanus shot, particularly if you have not had a booster shot in the last five years.
With the increasing number of artificial pitches now in rugby, abrasion injuries are becoming more common place and need to be managed acutely and effectively to ensure the risk factors of infection and scarring are kept low. This blog serves as a guideline only in the management of acute abrasion injuries and should not supplement medical advice.