Ulster Rugby Lad: As someone who struggled for many years with a chronic back injury, I know better than most people the value of a good physio!
Rugby is a high impact, brutal sport and injuries are somewhat inevitable. The unsung heroes of the sport are the physios and team doctors who help get players back on the pitch doing what they love.
Huge thanks to Declan Judge of Pendulum Physiotherapy for contributing a guest article to Ulster Rugby Lad. It’s a great insight to the important and often overlooked work of a physio. Also, if you’re squeamish I warn you there’s a bit about a fairly horrendous injury so reader discretion is advised!
Declan:
Many thanks to Peter from Ulster Rugby LAD for the invitation to write a blog. As an Ulster fan I have massively enjoyed the content from Peter, especially the UlsterRugbyLAD Podcast. If you’ll stick with me for a few paragraphs I’m going to share what it’s like to be a Rugby Physio on the Ulster clubs scene, and how it has changed the entire trajectory of my life’s path.
Let me first introduce myself, my name is Declan Judge and I am a clinical specialist physiotherapist. I own 2 clinics and my special interest area is sports medicine.
About 15 years ago I was invited to speak with Portadown Rugby Club. At the time I was in the latter stages of my Physio degree in Jordanstown and my good friend & classmate Richie Johnston was playing in the back row for the Ports. I had been already building experience working with several GAA and football clubs, but this was a great opportunity to get started working in rugby.
The director of rugby was a big chap named Ernie Liggett and a new head coach had just been appointed – former All Black, Hika Reid. I had absolutely no idea who these guys were – I had grown up playing GAA and other sports but had never even been to a rugby match.
In retrospect I’d had no real exposure, rugby was not permitted at my school in that era, for me it is one of the great shames of this country how we segregated kids to certain sports at school (that segregation still continues in some parts but not as much anymore thankfully).
It feels so ridiculous now to admit that the first trip to Chambers Park to meet the staff and squad made me nervous. It wasn’t the fact that I was the skinniest guy in a room of 50 people that had me sheepish, but the worry about would be made here of a lad born and raised on the Garvaghy Road. I had grown up through horrendous times in Portadown, I had witnessed things that young people should not have to see, but my nervousness that day could not have been more misplaced. I was welcomed so warmly and earnestly that I am proud to say that nearly every person in that room that day remains a close personal friend. PRFC is now my club, my family’s club, a sort of family in itself.
I started working with the squad as they battled hard in the AIL. Hika was putting some new things in place and there was a huge team spirit, but the squad wasn’t strong enough and we got relegated.
That first season gave me more experience with sports injuries than 5 years of NHS 9-5 work. It was gold for any aspiring physio. The second season we added to the squad and I got to meet guys like the larger-than-life Mark Chunka Neilly, and a NZ import to play 10 – Ruki Tipuna. Ruki was a different class and would later go on to play 7s for NZ and have spells playing 9 at Bristol, Scarlets, and the Hurricanes. Portadown were able to get promoted from Q1 at the first time of asking and we had a great time doing it – work hard, play hard (looking back we definitely partied far too hard).
The next few years brought plenty of ups and downs, but my level of experience was skyrocketing. I was seeing fractures, sprains, muscle tears, dislocations etc. every Saturday. The IRFU and Ulster Rugby were beginning to dramatically change the way that medical & player welfare issues were dealt with, more education/awareness/training/engagement. Everything was being done better & better and the Irish rugby community was clearly working hard to look after players at every level.
I was continuing my education through different jobs, post-grad qualifications, and rugby specific medical courses. I kept working with Portadown the whole time. About 10 years ago a young number 9 came through the team named Marc Beggs. Young Beggsy put in some cracking performances in a blue shirt while studying to become a physio himself. It was a pleasure to help him with teaching and experience for rugby physio so early in his career. Marc even got the privilege of real-life sports injury experience including being put in a neck brace by me one cold January night in Dromore, he learned not to tackle a No8 with his face again.
When he asked for my advice about the best way to eventually become a physio in professional sport I told him to abandon all selfish ideas of having a personal life, a stable career path, or a predictable location to settle. He immediately set these wheels in motion and currently resides as lead rehab physio at Bath Rugby after excellent spells as physio with Welsh Rugby Union and Munster.
The thought of working with a professional club appeals to most young physios but I am certainly glad I never chose that path. In recent years I have managed to somehow wrestle my life into something very fulfilling. My work has allowed me to build a team of professionals and we work with a terrific array of people including professional athletes. I have recruited excellent younger physios to our team and guiding them into the rugby work is one of the fastest ways to turn them into better physios. You cannot last long in a rugby changing room if you are not good at the job.
In just a couple of hours the physio must tape 6 shoulders, 14 wrists/thumbs, 4 elbows, 5 ankles, 3 knees, pad some blisters, rub 12 legs, rub 5 backs, maybe crack a couple of them. Then get changed, get the kits ready, get involved in the warmup, sort some random injury that has just happened, then cover the game. Most people think the physio is dealing with injuries during games but we are not really. The primary role is to respond to emergencies, everything else is a bonus. The physio will deal with the worst injury events in the sport in a calm and proficient way.
I have taken care of some horror situations and that’s when the training from years of sports trauma courses kicks in. I recall one day we played Bangor and one of their players took the ball into contact. Two Portadown players dipped low into the tackle and both ended up making a hit on his standing leg, which let out a huge echoing crack as it hyperextended with a buckle backwards.
At the exact moment his knee was snapping, two of his teammates were mauling up behind him to try and push forwards. All within about 1 second his ACL, PCL, Lateral & medial ligaments were all snapped and the crowd of 5 or 6 players was collapsing to the ground. As he went down his foot folded up into his groin (everyone could see this happening and your eyeballs know when they see a body part move in a direction it should not go).
As the players from both teams got to their feet from on top of him the elastic tone in his muscles pulled his lower leg down away from his thigh and groin and it flopped into a weird position where the knee was entirely dislocated with the lower leg now overlapped behind the femur. Two lads watching this instantly vomited at the sight. For whatever reason I was the only physio or medic there that day and instantly told one of the coaches to phone 999.
I tried to calm the guy a little as I took control of his leg, but he was going white and looked like he was experiencing a form of shock. I cut his sock and boot off and his foot had no pulse and had already started going pale white and cold, I also noticed in this moment that I was kneeling in a puddle of vomit. Normally I never move a severe trauma like this, just pack it up stable and get them to the Emergency Dept, but this guy was in a really bad situation and the word on the phone was that help was 15 or 20 minutes away. I made the decision to try and move the leg to restore blood flow, it took a few of us to hold and pull to get it done but thankfully as soon as it was out straight the foot started to come back. I got a fracture splint in place and we put him on a stretcher and got him off the field. The paramedics arrived soon afterwards and took him away.
I worried about that incident for ages. I had made a difficult decision in a time-pressure situation, but I was fully aware that any time we move such a mangled limb on the pitch we could be doing more damage. It was a relief but also a delight when the player came to see me the following season. He was wearing a leg brace to stand and walk but he looked well. He shook my hand and then gave me a sort of hug with the other arm. We had a chat about how he’d been getting on and he thanked me for that day, saying that he’d since seen 4 specialist consultants who all agreed I’d saved his leg that day. It felt good to get that feedback, the guy was so thankful and sincere, even a bit emotional. Physios do amazing work, but we rarely save lives (instead maybe make lives worth living?). I was proud to have at least saved a leg.
Being a physio in amateur rugby is a unique challenge. There is not a lot of money around, clubs do their best. You’re working on your own most of the time, yes the coaches are there but you’re herding 30 guys with no other medical assistance, the buck stops with you. Cold changing rooms, setting up physio room in the showers, explaining to brandy drinkers why the fly half hasn’t healed from his hamstring tear in 6 days. You have to be everything at once: psychology skills for the headcases, nursing skills for the softies, coaching skills for the lazies, business skills for the management staff updates.
Portadown have always been excellent to work with, they’ve done whatever they can to make sure that equipment & protocols are up to date to protect the players. We have a great Doctor & clubman in Ian Kennedy who I chat with every week. As I said before the culture of player welfare in Irish rugby keeps improving but that’s a process, and processes are rarely perfect. Thinking now of how myself and everyone else dealt with head injuries years ago is sort of embarrassing, we were in the dark ages! Concussion now is rightfully a primetime issue
Despite some negative press in recent months I honestly feel that Rugby can be proud of how it has led the way in changing the understanding and culture around concussion. IRFU & Ulster have been shining lights in preparing and disseminating information and training to make sure everyone is safer, and they haven’t stopped, the process is ongoing.
We continue to work with PRFC because amateur rugby is genuinely the pinnacle of sports physio. Despite my adoration for professional players at the peak of their game, they are just not as good as my lads. My guys get up at 5am to squeeze in a gym session, and then go to work. They rush home to see their families for an hour and maybe skip dinner because its training night.
Out into the cold and wet night to hit bags and slog fitness, all leading towards Saturday. When I walk around the changing rooms after games I get a gauge of how many injuries are new and how bad. Guys are sipping cold beers while putting ice packs on their newly swollen limbs. The seriousness of the pregame prep is gone and if we’ve won then the tunes are on and the craic is 90. The drinking scene is not like it used to be, most players are much more sensible these days, but the vibe in the club after a game (win or lose) is the best feeling.
Amateur players slaughter themselves physically and mentally every week for years and years. No money, no glamour, very little glory. Just because they love the game. I played my first game of rugby at the age of 25. I learned the rules by being a physio every Saturday. I played for PRFC 5th XV and for the first time learned what it was like to come back to the changing room as a beaten-up player. I used to play just when our 1s had no game but and in the last couple of years I’ve played across our 2s, 3s & 4s at weekends instead of doing physio (thank you to my staff Dee & Scott who have stepped into the pitch side roles). I truly love it and thanks to guys like Geoff Caldwell & Keith Boyce there is even an over 35s touring team which will allow me to keep playing until my hips give out.
Even though our senior team has struggled to recapture some of its old successes recently there is still plenty to celebrate at our club. The inclusiveness and togetherness that brought me in and made me one of the gang is still going strong. The club have a massive focus on youth and in recent years have added a women’s team, The BlueBelles.
My son James got started at the minis this year (between lockdowns) and Santa was good enough to gift him his first PRFC playing jersey. I’ve been thinking a lot this week about Willie Gribben who sadly passed a year ago. Willie and his wife Edna generously gifted things to my kids any time I did anything for them. Willie is of course a legend and we all miss him terribly. He seemed to form such a strong bond to people and I felt that connection as he helped me and guided me with things around the club for years.
The eulogies at Willie’s funeral talked about how he was setting up cross community youth rugby in the 70s when nobody in the area would have dreamt of it, this resonated with me. He embodies everything about why sports clubs are a hub of the community, and how RUGBY IS FOR EVERYONE. Portadown Panthers is a great example of Willie’s work continuing on the path of inclusiveness and youth investment. The mixed abilities team gives young and old an opportunity to play and coach, with Rory Best as their patron and people like Ian & Karen Flack being involved, the project is in very good hands. Ian, by the way, is 55 and still playing social rugby while his sons Drew and Brett play for the seniors. I had the great pleasure of playing with Flackie last year on tour in France and I had the great displeasure of rooming with him.
I will be 36 soon but I’ll keep paying my players membership. Ian Flack gives me hope that maybe one day I’ll get to play on the same pitch as my sons. All rugby clubs need our membership right now, there’s no business coming through our clubs due to C19 closures and we will need them to regain our sanity when normality returns. Being around rugby clubs as a physio, player, or spectator is one of the things I’ve missed most during lockdowns.
Of course, I look forward to getting back to Ravenhill too, but there’s something that just gets me about grassroots. I was clearing the garage today and opened a kitbag that I forgot to empty after my last game back in September. The smelly boots just brought me back to the changing rooms in my mind, I cannot wait for everything to be back and I am eagerly awaiting my own Covid-19 vaccine. I would encourage any young physio to get working in amateur rugby, there are few roles that offer so much learning and exposure, it will make you a better physio. For me it also brought travel, friendships, community, opportunity, business relationships, and so much more. Many people will know these values from your own local rugby club. Our local clubs are the lifeblood of Ulster & Irish Rugby. I hope we can all spend more time together at our clubs soon and connect even more with our neighboring rugby clubs, our schools, our other sports clubs.
Here’s to a better year ahead
Declan Judge – Pendulum Physio