Dr Geoff Davies – Behind the Scenes with the WRU and British & Irish Lions Team Doctor – Injury Rehab Network

The February Injury Rehab Network event with BASRaT featured a presentation from Dr Geoff Davies. The online event took place on the evening of Monday 10th February with 140 sports rehabilitation practitioners in attendance.

Dr Davies discussed the medical aspects of international rugby union. The recording is available to watch here

Dr Geoff Davies – Consultant Sports Physician, Team Doctor WRU and British & Irish Lions (2021)

Geoff is a Consultant Sports Physician with 25 years of experience in professional rugby union. He was formerly Team Doctor for Cardiff Blues & Wales U18 prior to his appointment with the WRU National Squad in 2012. Until recently he had a thriving private practice in Cardiff which he has recently curtailed to wholly concentrate on his rugby commitments.

Previous roles included SEM Physician at Tidworth & St Athan RRU’s and SEM Physician at BUPA MSK in Bristol.

He had previously spent 16 years as a GP partner in Barry before pursuing a full-time career in Sports Medicine in 2006.

He gained entry to the SEM Specialist Register in 2011. He is a Fellow of the Faculty of Sports & Exercise Medicine and a Member of the Royal College of General Practitioners. He has a master’s degree in Sports Medicine from the University of Bath and a Postgraduate Certificate in diagnostic Musculoskeletal Ultrasound.

He was an Honorary Senior Lecturer at Cardiff Metropolitan University and is an examiner for the Bath University MSc course in Sports Medicine. He is also an examiner for the Faculty of Sports & Exercise Medicine UK.

Behind the scenes with the WRU and British & Irish Lions Team Doctor

Dr Davies discussed his roles and what they entail, with an emphasis on the medical aspects of international rugby union, including test matches and touring.

Dr Geoff Davies

Geoff is a Consultant Sport and Exercise Medicine (SEM) Physician and has been a Team Doctor with the Wales Rugby Union (WRU) men’s senior team since 2012. Geoff was also the Team Doctor for the British & Irish Lions in 2021.

Dr Davies summarised his CV, stating that he qualified from the Welsh National School of Medicine in 1986, followed by GP Training in South Gwent from 1987 – 1990. Geoff was then GP Partner in Barry from 1990 – 2006.

Dr Davies has been a Consultant Sports Physician since 2011, worked with Cardiff Blues from 2003-2011 and was the WRU U18 Team Doctor from 2004-2011.

Rugby Medical Doctor

Geoff described the medical team for the men’s senior team at the WRU, which includes 3 Physios, 2 Therapists, and Geoff (Team Doctor). The Lions medical team structure is similar but includes 2 Team Doctors.

Geoff also discussed the wider management teams, which are made up of around 35-40 professionals with various roles and responsibilities.

Dr Davies’s position with the WRU is essentially a half-time role focused around the Six Nation and summer and autumn touring with the team. In addition, the Rugby World Cup takes place every four years, with the 2027 tournament due to take place in Australia.

Pre-Matchday

Geoff considered the preparation required by the WRU medical team prior to matches. Staff need training and experience in pitch-side emergency care and completion of the Pre-Hospital Immediate Care in Sport (PHICIS) training course. The team practices extrication regularly so they are well prepared to respond to incidents/ injuries.

Sample forms are completed and in place, and medications are ordered as required. The medical team also ensure imaging slots x 2 are reserved for the Monday morning.

Geoff ensures players are compliant with the Instrumented Mouth Guard (IMG) system and that all players are on the SCRM Concussion App.

Matchday

Dr Davies described the logistics of the medical team on matchday. Geoff will meet with the Match Day Doctor (MDD) and liaise with the Match Day Medical Team. Sample forms are provided to the MDD.

In preparation for the recognition and management of concussion, Head Injury Assessment (HIA) protocols are in place, with all IMGs and associated monitoring systems/ tools ready. The IMGs need to be charged and working on the tablet used by the medical team, and the SCRM concussion app needs to be available and working, too.

Stadium Matchday Medical Staff

Dr Davies provided details of the stadium matchday medical staff, which includes Match Day Doctor (MDD), Immediate Care Lead x 2, Hawkeye Doctor, Max Fax (maxillofacial) Consultant +/- Dentist, Orthopaedic Surgeon, Ophthalmologist, Anaesthetist and Radiologist.

Common Match Day Issues

Geoff considered some of the common injuries/ issues that may require treatment and management on match day, such as head injuries and concussions, requiring collaboration between all medical teams, coaches, and players.

Traumatic bony injuries such as fractures are common, and ligament injuries are a regular occurrence, too. The medical is prepared for dislocations and lacerations, with treatment often provided on the pitch side or in the stadium medical room.

Geoff described how muscle tears and soft tissue injuries are also common.

Concussion is…

Dr Davies described how concussion is a traumatic brain injury and the most common match-day injury in professional rugby. Dr Davies advises that concussion is to be taken very seriously in all levels of rugby, with the amateur game following the “Recognise and Remove” protocol.

Geoff discussed how there is the potential for concussion to cause CTE (Chronic Traumatic Encephalopathy) / early onset dementia.

Recognition and Management of Concussions on Match Day

Geoff described the different systems and personnel involved with the recognition and management of concussions. The Hawk Eye video system is monitored by a doctor who reviews live footage to identify potential head injuries and signs of concussion. Data from IMGs, which signal any potential concussion events, supports this.

The SCRM Head Injury Assessment app, which I used to assess concussion, includes Maddocks Questions, memory questions, and balance tests, with players assessed against symptoms.

Dr Davies presented video footage of concussion injuries and described how the medical team, coaches, and players managed them, including strategies for removing an athlete from play.

Injury Management

Dr Davies discussed the management of other injuries. Nasal injuries require the nose to be straightened, and this is often completed with successful long-term outcomes.

Suturing is completed where possible in the stadium medical room, with players often being able to return to play immediately. Dr Davies showed images of various facial wounds that required suturing and described how some wounds are best treated by a specialist who can ensure the best outcome.

Aspiration/ drainage is used to drain fluid from ears and prevent the formation of cauliflower ear. Geoff described the importance of ultrasound scanning for the assessment of injuries. Dislocations are often managed pitch-side but occasionally require further management and treatment.

Dr Davies showed a video of an ACL rupture and described the mechanism of injury.

Rugby Touring

Geoff described his international rugby touring history, including Rugby World Cups and tours in Asia, Australasia, South Africa, Europe, and North and South America.

A lot of planning and preparation goes into a tour. Dr Davies discussed pre-tour preparations, which include a recce trip, medical screening of players and staff, immunisations, medicines and customs requirements, insurance, repatriation planning, medical kit/ supplies, and pre-booking imaging slots.

Geoff considered the requirements of the medical team when touring and playing, including Emergency Action Planning, liaison with local medical teams and medical facilities, payment for medical care, language issues and sourcing of any items required locally, such as oxygen.

Dr Davies discussed the medical equipment required for a rugby tour which includes:

• Defibrillator
• Scoop Stretcher
• Vacuum Splints and Mattresses
• Oxygen
• Entonox / Penthrox
• Fully Stocked Emergency Bag
• Drugs including cardiac
• Diagnostic Ultrasound Machine
• Shock Wave Machine
• Gameready / Recovery Equipment

Post-tour, Dr Davies and the medical team will support ongoing injury management, imaging modalities and may seek specialist opinions. Geoff will also feedback to players parent clubs regarding any injuries as soon as possible.

Dr Davies also shared information about warm weather and high-altitude training camps.

Journey to Japan via Heathrow RWC 2019

Geoff told the story of the journey on the team bus to Heathrow when travelling for the Rugby World Cup in Japan in 2019. Geoff had noticed that Adam Beard wasn’t himself, and his condition had worsened during the journey to Heathrow. Dr Davies decided to examine Adam on the team bus before heading into the airport and decided that Adam should not fly due to abdominal pain.

Adam returned to Wales and was diagnosed with Appendicitis, which required emergency surgery and may have been required mid-flight, prompting an emergency landing had he gotten on the plane.

Adam made a quick recovery and joined the team for the latter stages of the tournament.

Take Home Messages

Geoff summarised by saying it is such a privilege to have a job like his. Dr Davies’s advice for practitioners keen to have a career in elite sport/ rugby is:

• Get yourself known for your particular sport
• Be prepared to volunteer
• Ensure appropriate training for roles
• Undertake post-graduate qualifications only if they add value
• Prepare to graft
• Follow your dreams – they can come true!

Follow Dr Geoff Davies

@GeoffSportsdoc

Q&A

Geoff kindly answered questions put forward by practitioners who attended the session. Please see the recording of the presentation for the insights from Dr Davies on the questions.

Presentation Recording

The recording of Geoff’s presentation is available to watch here

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