A recent study conducted by the British Journal of Sports Medicine revealed that despite improvements in training techniques and preventative measures over the last two decades, knee injury rates in professional rugby union have remained at a consistent level.
Knee injuries remain the most common, potentially career-ending injury in rugby. The stop-start nature of the game puts a huge amount of pressure on the knees, and while it might seem like a quick solution to keep playing through any discomfort, this isn’t advisable. Pushing on through the pain can lead to more severe injuries, prolonged recovery time and even long-term complications.
Physiotherapy is the first line of treatment for almost all knee conditions, other than full tears of ligaments, muscles and tendons and specific types of meniscus tears that have poor recovery rate due to lack of circulation to the structure in certain areas. Treatment with one of Benenden Hospital’s highly experienced Physiotherapists consists of regaining function (range of movement, strength, stability) and then preventative management to reduce the risk of re-injury - developing strength and stability with sport-specific movements.
Understanding the different causes of knee pain, and how to treat them, is crucial for ensuring the longevity of a rugby player’s career. We explore some of these causes and treatments below.
Ligament injuries
The knee is held together by four major ligaments: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). The anterior cruciate ligament (ACL) and medial collateral ligament (MCL) are particularly vulnerable in contact sports like rugby, and a strain or tear can be debilitating. A sudden tackle, awkward landing, or twisting motion can lead to ligament injury, which often requires rest and may require surgery, depending on the severity.
The ACL is one of the most commonly damaged knee ligaments and is usually injured through sudden stops or changes in direction. In rugby and many other sports, torn ACLs are responsible for some of the longest layoff times, with six months to a year to recover from surgery.
An MRI scan will usually be required to diagnose an ACL tear and assess the damage to ligaments before surgery to reconstruct them. ACL reconstruction is performed using a minimally invasive technique called arthroscopic surgery.
MCL, PCL and LCL tears may heal with non-surgical treatment such as physiotherapy, but severe tears may require ligament reconstruction surgery.
Cartilage injuries
Meniscus tears are a very common injury in rugby. The meniscus is a C-shaped piece of cartilage that acts as a shock absorber between the thigh bone (femur) and the shin bone (tibia). Rugby players are prone to meniscus tears due to the frequency of sudden twisting motions. A meniscus tear may be felt as a popping sensation and can cause pain, swelling, difficulty moving the knee or locking of the knee. You may also experience a sense of your knee giving way when you try to stand.
Your GP may refer you to a consultant orthopaedic surgeon for further tests, such as x-rays or an MRI scan, to identify the specific problem.
Small tears will often heal on their own, and your GP may recommend the ‘RICE’ principles: rest, ice, compression, and elevation - but more severe cases may require surgery, known as an arthroscopic repair.
Following arthroscopic repair of a torn meniscus, a physiotherapist will discuss your rehabilitation and give you a programme of exercise to help restore full range of movement to your knee.
Tendon injuries
Patellar tendonitis (‘jumper’s knee’)
Repeated stress on the patellar tendon, which connects the kneecap (patella) to the shinbone (tibia), can lead to inflammation and pain - a condition known as patellar tendonitis or ‘jumper’s knee’. Rugby players are often susceptible to this injury due to frequent sprinting and pivoting, which both put considerable strain on the tendon.
If identified in its early stages, patellar tendonitis can subside with rest. Playing through the pain can lead to complete tears in the tendon, which require surgery.
Patellofemoral pain syndrome ('runner's knee’)
Patellofemoral pain syndrome occurs when the kneecap does not track properly over the femur (thighbone), leading to pain behind the kneecap. This condition can result from misalignment, overuse, or poor technique during movement. Rugby players who perform repetitive squatting or lunging movements are especially at risk.
The RICE principles, along with reducing your activity level, are usually effective methods of relieving the pain and the condition rarely requires surgery.
Osteoarthritis
A 2020 Durham University study found that osteoarthritis – a condition causing joints to become painful and stiff – was twice as common amongst elite rugby players compared to non-contact athletes.
While osteoarthritis is typically associated with aging, repeated stress and injury to the knee joint can lead to the breakdown of cartilage over time, causing chronic pain and inflammation. This condition can develop after years of playing rugby and may become progressively worse if untreated.
Mild symptoms can be alleviated with regular exercise, whilst more severe symptoms may need managing with medication and a structured exercise plan with a physiotherapist.
Benenden Hospital also offers Arthrosamid® - an innovative, minimally invasive injectable hydrogel implant to treat knee pain associated with knee osteoarthritis.
Don't play through the pain
Rugby is a sport that demands a lot from players physically, but remember: your knee’s health is vital to your game - don’t risk it by battling through pain.
Sports injuries can be hugely frustrating, but if they’re left untreated, they could severely limit a player’s career and their ability to return to the sport at the same level. A compromised knee will not only hinder performance but also increase the likelihood of making poor decisions or mistakes on the field.
At Benenden Hospital, we offer a wide range of self-pay treatment options for knee pain to help you get back on the pitch.
Get fast access to a face-to-face private GP or Physiotherapy appointment via our online booking system. Find out more about our self-pay tests and scans by completing our online enquiry form or by contacting our Private Patient team via Livechat or on 01580 363158.
Published on 23 April 2025