Professor John Ryan — Abdominal Injuries in Sport — Injury Rehab Network

The second Injury Rehab Network with BASRaT of 2026 featured a presentation from Professor John Ryan, Consultant in Emergency Medicine, University College Dublin, Clinical Professor, Leinster Rugby Team Doctor. The online event took place on the evening of Monday, 26th January, with 300 practitioners in attendance. Attended by sports rehabilitators and health professionals from around the globe—including viewers from Chicago and Sri Lanka—the session provided a masterclass on the diagnosis and management of abdominal injuries in sport.

Dr Robinson shared insights into abdominal injuries in sport. The recording is available to watch here.

Professor John Ryan – Consultant in Emergency Medicine, University College Dublin, Clinical Professor, Leinster Rugby Team Doctor

Professor John Ryan is a Consultant in Emergency Medicine in South East Dublin, based at St Vincent’s University Hospital. John has a particular interest in Sports & Exercise Medicine and is a Founding Fellow of the Faculty of Sports and Exercise Medicine.

His career spans over four decades, including roles with the British and Irish Lions and Irish national teams. Uniquely positioned at the intersection of acute trauma care and professional sport, Prof. Ryan brings the rigorous decision-making of the emergency room to the pitch-side management of elite athletes.

John has been Team Doctor to Leinster Rugby since 2007 and is Team Doctor for the Irish under-18 schools’ rugby team. He is the Match Day doctor and Immediate Care doctor for Ireland Rugby, URC and EPCR. John also maintains involvement with grassroots rugby and contributes as Team Doctor for St Michael’s College school’s cup teams.

Professor Ryan is Vice-Dean for Advanced Speciality Training in Emergency Medicine in Ireland. He is an Emergency Medicine trainer and an examiner for the Royal College of Emergency Medicine.

John holds a public-only Concussion Clinic for patients who have sustained a Sports and Exercise-related concussion injury.

Abdominal Injuries in Sport

Abdominal Injuries: “Paid to be Paranoid”

Prof. Ryan’s presentation emphasised that while abdominal injuries may not be the most common sports injury, their consequences can be catastrophic if missed. He adopted the mantra that medical professionals are “paid to be paranoid” regarding these potentially fatal injuries.

John described how he is in a unique position at the epicentre of rugby in Dublin, with mirrors between his work in both emergency medicine and elite/ professional sport. These factors are highlighted best through the importance of areas such as availability, professionalism, and enthusiasm of staff.

The presentation covered:

• Anatomy & Vulnerability: A review of solid organs (liver, spleen, kidneys) and hollow organs (bowel, bladder), noting that, unlike the chest, the abdomen lacks significant bony protection.
• Mechanisms of Injury: Applying Newton’s Second Law (Force = Mass X Acceleration), Prof. Ryan explained how high-impact collisions in sports like rugby, or deceleration injuries in cycling and motorsport, transmit massive forces to internal organs.
• The “Handlebar” Injury: A specific warning was issued regarding handlebar injuries in cyclists, which can cause devastating damage to the pancreas or duodenum (retroperitoneal organs) that presents with delayed symptoms.

Red Flags & Diagnostics

A key section of the talk focused on identifying “Red Flags” in athletes after trauma. Prof. Ryan highlighted that an inappropriate tachycardia (a fast heart rate that doesn’t settle after rest), hypotension, and increasing pain are critical warning signs of internal bleeding.

He detailed the diagnostic pathway, emphasising:

• Vital Signs: Monitoring pulse, blood pressure, and respiratory rate.
• Blood Tests: Using lactate as a marker for shock and amylase to screen for pancreatic injury—a test often forgotten but vitally important.
• Imaging: The value of Point-of-Care Ultrasound (POCUS) for detecting free fluid (FAST scan) and the necessity of CT scans for definitive diagnosis.

Case Studies

Prof. Ryan brought the theory to life with seven fascinating case studies, including:

• Splenic Trauma: A 19-year-old rugby player who fainted after a game. Despite being initially dismissed, he was found to have a splenic hematoma and a litre of free fluid in his abdomen.
• Renal Injury: An international player who noticed haematuria (blood in urine) during halftime. A CT scan revealed a ruptured kidney, which was managed conservatively.
• Bowel Perforation: A jockey with a history of Crohn’s disease who suffered a perforated bowel after being kicked by a horse, requiring emergency surgery.

Summary

Professor Ryan concluded his presentation with a summary of the key points covered:

• Abdominal injuries are uncommon
• A lot can go wrong
• Things that go wrong can go badly wrong
• Low index of suspicion
• Review by competent medics is critical
• Access to appropriate diagnostics is crucial

Q&A

John kindly answered audience questions following his presentation.

Q1 – What about pelvic floor injuries in female athletes? Answer – This is a massively important and under-recognised area. Prof. Ryan noted that women wanting to return to collision sports after childbirth often face issues like stress incontinence or hernias due to pelvic floor trauma. He highlighted that the Irish Rugby Football Union is currently fostering research in this specific area.

Q2 – How can sports rehabilitators help prevent these injuries? Answer – Prevention lies in close collaboration with coaches. This includes teaching proper tackle technique in rugby to protect the tackler and the ball carrier, teaching athletes how to fall safely (e.g., in equestrian sports), and ensuring equipment safety, such as good grips (with the end intact) on bicycle handlebars.

Q3 – What are your thoughts on sports hernias? Answer – Prof. Ryan emphasised that you cannot play collision sports with a true hernia. The bowel is too vulnerable to rupture. He advised that these must be surgically repaired, ideally close to home, to ensure proper follow-up and access to records should complications arise later.

Further information and follow Professor John Ryan

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St Vincent’s University College Dublin

Presentation Recording

The recording of Professor Ryan’s presentation is available to watch here

2026 Injury Rehab Network events

The next Injury Rehab Network event is on February 26th, featuring Mike Davison, who will be discussing Organisation Design Principles for Performance and Medical Departments.

Find out about and register your interest for all the Injury Rehab Network events with BASRaT planned for 2026

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