Mechanisms of cervical spine injury in rugby union: is it premature to abandon hyperflexion as the main mechanism underpinning injury?

An investigation into axial impacts of the cervical spine using digital image correlation

“…Additionally, the dislocations combined with facet fractures observed in the present study have also been reported in vivo [2,10,11].…”

“…These studies have demonstrated the complex nature of spinal injuries and the variation of injury mechanism(s) under seemingly similar conditions. Assessments of the injury mechanisms due to axial loading encountered in rugby scrummaging have been reported as being due to hyperflexion and buckling [2,10,11]. However, care must be taken in classifying cervical spine injury mechanisms, as injury may have occurred because of more than one mechanism and before any outwardly observable change in head position [3,12].…”

Injury and biomechanical perspectives on the rugby scrum: a review of the literature

“…Their interpretation was that the weight of evidence suggests the primary mechanism for the commonly observed bilateral facet joint dislocation (normally C5–C7) injury to be buckling. In opposition, Dennison et al ,90 stated that it is too early to conclude that buckling is the predominant mechanisms of injury within the rugby union context. This opposition was partly based on the limitations associated with the ex vivo cadaveric testing on which some of Kuster's evidence was based and the fact that the same injuries produced via buckling mechanisms in cadavers have not been recreated in vivo, possibly due to an active involvement of the musculature in protecting from injury.…”

A modified prebind engagement process reduces biomechanical loading on front row players during scrummaging: a cross-sectional study of 11 elite teams

“…In general, the determinants of cervical injury mechanics include force characteristics (magnitude, vector direction and rate level),31 head constraints and trunk/neck orientation before impact 32. High magnitude and eccentricity (off-centre application) of the compressive axial load causes bending moments in the cervical column segments leading to buckling mechanisms and consequent ligament disruptions and facet dislocations 31 33 34. The described situation, with regard to constrained head movement and non-axial external loads, is exactly the one experienced by rugby forwards when scrummaging.…”