Dr James McGarvey splits his time between working with us at Axis and as the Team Doctor for The All Blacks, in this article he shares the process they go through for preseason, which can be applied to anyone overseeing the health and well being of rugby players (or any sports players for that matter).

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The rugby preseason is a busy time for medical and physio staff but will vary depending on the level of competition and the time available. From club level through to the pros, it's important that quality time is spent preparing for the season ahead. Doing the work now will give you a great head start as you head into the season.

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As a general rule the more work you can do in this time, the less you will have to deal with in season and the more smoothly things should run.

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The first job should be to review the lessons of any previous seasons. What went well? What didn’t? Have you recorded injury data to look at trends or areas of concern? You will only move forward if you learn from your mistakes and to do this you will need some records. Make sure you write down any thoughts on improvements or lessons learnt through the season: you can come back to this in the next preseason to help guide change for the better.

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The preseason is also the time to implement any protocols or processes you want in place. Once the season hits it is really too late to make many changes. Lines of communication, the coaches preferred method of medical reporting, systems around returning injured players to play: all of these benefit from preseason work and fine-tuning. The larger the management group, the more you will need to work on ensuring these systems are well oiled.

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Once the players are available they obviously need a full medical assessment. You need to know your player's medical history, medications, allergies and prior injuries. At Super Rugby level we do a mandatory cardiac risk assessment with an examination, family history and ECG read by a sports cardiologist. All of this allows you to ensure that your players (and management) have their long-term conditions (medical or physical) managed appropriately. The injury history identifies players at risk of further injury and guides prehabilitation prescription. All of this should be nailed in the preseason so that once competition begins you can concentrate on the acute issues.

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The next job is baseline testing. Knowing what your players are like at the outset makes any subsequent assessment far more accurate. This is especially true of concussion: without a baseline, any post-injury testing is very hard to interpret. The depth of testing will depend on time available, Super Rugby use cogsport and an embellished SCAT5 assessment, with baselines both at rest and after exertion. We also stratify concussion risk based on history.

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Baselines can also be established for key examination features: knee and ankle ligament laxity, shoulder laxity, calf/hamstring strength, hip range of movement, sit and reach testing, adductor squeeze quantification and more. Some of these baseline figures allow more accurate testing after injury (was the players MCL always this loose?) while others while others estat-riskat risk groups  (calf or hamstring asymmetry or weakness) which can guide injury prevention strategies and prescription of individualized rehab/prehab. Other baseline measures allow accurate monitoring over the season to assess for over-training and athletes at risk of injury: we use adductor squeeze testing quantified with a pressure manometer, as well as sit and reach, and knee to wall.

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You should also take advantage of the preseason to educate. Brief presentations around concussion and its management, appropriate use of medications or WADA and its rules can make your job easier later in the season. General health messages such as hygiene and sexual health can be delivered here also. Outline your expectations around injury reporting, punctuality and players responsibilities in the medical area. We also get players up to speed on our international travel protocols and what is expected.

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You will need to work closely in the preseason with your strength and conditioning staff and coach (or coaches, we have four!). They will be hammering the players into the shape required to compete at competition intensity. The preseason therefore holds risk of overuse injury and illness as the player’s bodies and immune systems are put under a blowtorch. Our S&C staff are excellent at measuring and prescribing load, but this needs to be a collaborative effort to ensure gains are made but wellness is also preserved. It is a fine balance to achieve. Look at the schedule and discuss any concerns or suggestions for change. Check your monitoring and wellness and be prepared to change your plans and adapt based on the results. Expect illness in periods of rapid load increase and emphasise basic hygiene practices in this time.

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Finally, the preseason is a vital time to form tight bonds before competition begins. This is true of the medical team, the management team, and the full squad. Ensure there is downtime and social occasions to get to know each other as people: this will make interactions through the season far easier and less stressful. If possible involve partners and kids: they are making big sacrifices too and should be included in the team whanau.

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Basically, the preseason is a time to look ahead, to gather information, and to prepare as well as possible for the coming competition. It can be challenging to keep everyone energized and engaged without the reward of gameday but every hour of work you put in here should be amply rewarded.

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