Preparing a team for the Rugby World Cup 2019: a medical perspective

By Dr Geoff Davies @GeoffSportsdoc and Mr Prav Mathema @PravMathema

A considerable amount of planning, teamwork and communication is required to enable a team to function to its full potential. Trying to support a team to peak at the Rugby World Cup (which comes around every 4 years) could be considered a sport in itself. Our work, as part of the Medical Team for Welsh Rugby Union is roughly divided into pre-tournament preparation, travel and the competition itself.

WRU Medical Team members (L to R) John Miles, Geoff Davies & Prav Mathema celebrate winning the 2019 Grand Slam on the Principality stadium pitch in Cardiff, March 2019.

Pre-tournament preparation

Planning starts with an extensive reconnaissance process. 24-months prior to the tournament, we assess the stadia training facilities/gyms/hotels in the potential regions where the team will compete. Emergency action plans are then put in place to cover the possible medical issues that players may encounter at each training and playing venue. In addition to this, we ensure appropriate medical insurance and planning for the repatriation of severely injured players and suitable protocols for replacing injured players during the tournament. We take note of destination-specific immunisations that are required, and check if there are any local diseases we should be aware of.

With military precision, we plan the logistics of transporting a huge amount of medical kits, supplies and medications. In Japan some medications require a special declaration and appropriate supporting licenses and private prescriptions.

Prior to the announcement of the extended RWC squad in May, significant medical and physical performance data is shared between the National Squad and respective Club teams. This includes regular medical updates on injured players as well as regular load monitoring through live GPS data of the extended squad. The WRU are somewhat unique in having a centralised GPS monitoring strategy shared between the National team and the Regional club teams.

When players arrive into the pre-RWC camp, a thorough medical screening programme is undertaken by all squad members, which includes a general medical assessment, cardiac screening, blood screening & concussion screening (including baseline SCAT 5, Gait analysis, VOMS and an extended computerised cognitive assessment). Much of this assessment data supports a number of our research projects ongoing in the field of injury surveillance and head injury management.

Our RWC training camps involved a period of altitude acclimatisation in Switzerland with a “live high, train low” strategy, as well as a heat and humidity stress camp in Turkey where a period of physical overload is undertaken to mimic the environment in Japan. On return to the WRU National Centre of Excellence in South Wales, these physical gains are maintained by recreating these training environments in the WRU’s heat and altitude acclimation chambers.

Travel: what does the medical team consider?

With all the hard conditioning and rugby over this 3-4 month period (including 4 “friendly” warm-up matches), the last controllable to consider is the travel involved. Travel needs to be planned to ensure players arrive in the best possible physical and mental state. Jet lag protocols, adequate hydration, compression modalities, hand hygiene and post flight recovery sessions all need to be considered and factored into the timetable by the medical team.

The challenge of recovery is always to get our players ready for intense physical performance as soon as possible. We are always trying to find the optimal balance between preservation and performance so that our athletes are able to deliver on the highest stage.

The Competition

The itinerary in Japan involves a lot of travel between the 4 group match destinations as well as the potential knockout stages for the most successful teams. Liaising with the local RWC Area Medical Officers at each location is essential to ensure we are able to provide the best medical care, particularly in cases of emergency. Imaging is likely to be needed during the tournament so the local medical teams will provide us with their knowledge to facilitate this process. We also send images back to the UK for reporting needs and this ensures that we continue to work with our team Radiologists.

With good preparation, careful planning and optimal management we would like to think we are as well prepared as any other nation. The medical planning which goes into putting a team into a RWC is hugely demanding and challenging, but ultimately very rewarding!

Diolch yn fawr!

Dr Geoff Davies and Mr Prav Mathema

Medical Team, Welsh Rugby Union

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Dr Geoff Davies @GeoffSportsdoc is a Consultant Sports Physician and has been WRU National Team Doctor for the past 7 years. His SEM practice is based in Cardiff. He is also an FSEM council member.
Mr Prav Mathema @PravMathema is the WRU National Medical Manager and Senior Physiotherapist to the National Squad. He was appointed as one of the Physiotherapists for the British and Irish Lions on the last three occasions in 2009, 2013 and 2019. He is also a member of World Rugby’s global concussion working group.

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