Serious neck injuries in U19 rugby union players: an audit of admissions to spinal injury units in Great Britain and Ireland

Abstract

U19 rugby players continue to sustain serious neck injuries necessitating admission to spinal injury units with a low but persistent frequency. The recent rate of admission in Scotland is disproportionately high when the respective estimated playing populations are considered. While more injuries were sustained in the tackle, spinal cord injury was significantly more common in neck injury sustained in the scrum (p<0.001). No register of catastrophic neck injuries exists despite repeated calls over the past three decades, and a study such as this has not been reported before. Data collection of this serious category of injury is incomplete and very variable across the home unions, as a consequence a large proportion of the serious neck injuries that have occurred in U19 players over the past 14 years have not been analysed. Rigorous data collection and analysis have to be established so that problem areas of the game such as scrum engagement and the tackle can be made safer.

An evidence-driven approach to scrum law modifications in amateur rugby played in South Africa

“…This finding is comparable to similar studies documenting serious spinal injuries 10 12. That said, the scrum had a greater proportion of permanent injury outcomes than the tackle.…”

“…That said, the scrum had a greater proportion of permanent injury outcomes than the tackle. Collectively, these findings echo reports by MacLean and Hutchison10 that noted that even though the scrum has proportionally less frequent serious neck injuries than the tackle, the neck injuries sustained in the scrum are more severe and are associated with an increased risk of permanent spinal cord injury.…”

“…This education is also important for improved player performance, and for the continued growth, development and promotion of rugby in South Africa. Given the initial systematic increase and relatively high proportion of scrum ASCI in South Africa,1 and the increased level of severity (permanent outcomes) of scrum-related ASCI as opposed to other facets of the game such as the tackle situation,10 11 it became apparent that BokSmart's current interventions, albeit supported by research evidence,12 13 would not necessarily be able to have an immediate impact in reducing the number of these catastrophic scrum-related injuries. The reason for this was that it would take a reasonable amount of time to filter the necessary and appropriate education and knowledge to all stakeholders of the game in South Africa, that is, to the approximately 47 000 coaches and referees, and then for them to implement and transfer this knowledge to the players that they have control over.…”

“…Using a similar education model to that developed by RugbySmart New Zealand,12 13 BokSmart realistically only expected to have a noticeable impact on catastrophic injuries following a 5–10-year period of implementation, once the necessary safety protocols, policies and interventions had received sufficient attention within the national rugby landscape and amateur structures. Considering this, and additional evidence available from studies in France,11 Britain and Ireland10 on cervical spine injuries during the scrum, BokSmart had to implement alternative measures which could potentially have an immediate impact on making the scrum safer 14. Amateur rugby was targeted as most of the players in South Africa are amateur, and the increases in, and numbers of, scrum-related injuries were observed at this level.…”

Are we currently underestimating the risk of scrum-related neck injuries in rugby union front-row players?

“…However, considering the relatively small number of players at risk of scrum-related injuries,7 14 and without acknowledging the reduction in relative exposure, we are in danger of masking the real risk of injury to the front row and, more specifically, the hooker playing position in the scrum. This ‘masking’ effect is evident when data from previous publications7 9 are recalculated with only those players who are at risk of injury in the scrum (front row) being considered in the exposure calculation (figures 1 and 2).…”