Br J Sp Med 1992; 26(4) Br J Sports Med: first published as 10.1136/bjsm.26.4.253 on 1 December 1992. Downloaded from Injuries of the spine sustained during rugby J. R. Silver MB BS FRCP(Ed)(Lond) National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Bucks, UK A comparison was made between the number of rugby Table 1. Number and type of player injured and the level of injury injuries seen between 1956 and 1982 (67) and the number between 1956 and 1982 and between 1982 and 1987 of rugby injuries seen between 1982 and 1987 (20). The standards, the positions, the mechanics of injury and the 1956-1982 1982-1987 fitness of the players were analysed. It was concluded that the law changes had resulted in a dramatic fall in the Players injured Players injured number of players injured, that it was the less fit and less 63 Rugby Union 19 Rugby Union skilled players that were getting injured, and that the laws 2 Rugby League were adequate but were not being enforced. 2 US Football Keywords: Rugby injuries, comparisons and mechanisms 67 Total 19 Total of injury (One patient injured twice) Level ofinjury Level ofinjury Although numerically few, serious injuries of the 59 Cervical 18 Cervical 1 Thoracic spine that give rise to paralysis have attracted (fell down drunk) considerable attention over the past few years1 2. I 1 Malingerer 1 Malingerer have been studying the cause, incidence, and 7 Unknown possible means of preventing serious injuries of the spine in rugby players since 19723. I obtained details Schoolboys Schoolboys of 63 players over the period to 1982. 20 3 These results were presented to the Administrators of the Rugby Union at a joint meeting of doctors, rugby players and administrators in 1983 and as a Standards result a working party was set up to which I was the 1956-1982 http://bjsm.bmj.com/ chief witness. Recommendations were made, initially on an experimental basis, for schoolboys in the UK Of the 67 games in which injuries were sustained, These were supported by other unions and particu- three were of first-class standard, 34 were club larly by the New Zealand Rugby Football Union and games, 12 were school team games, four were other subsequently adopted by the International Board, in school games, and three were practice games; in 11 an attempt to make the game safer. cases the standard of the game was not known or not The work was brought up to date by studying a relevant. further 19 players between 1983 and 19874, the on September 25, 2021 by guest. Protected copyright. majority treated by myself at the National Spinal 1982-1987 Injuries Centre. The purpose of this article is to study whether the law changes introduced in 1983, which Only two patients were members of a first-class club constituted a controlled experiment in which the and both were playing for their third teams. The rest players were the subjects, have produced any were second- and third-team players from second- reduction in the number, type or mechanisms of dass dubs. Two were injured in training sessions and injury. two of the three schoolboys were injured in games played against adults. Players In concdusion a striking difference between the two periods is evident. From 1956 to 1982 many players From Table 1 it may be concluded that the distribution were from first-class and school games, whereas in is the same. There was a marked drop in the number the later period the game was of a lower standard of schoolboy injuries. implying less skill. Players injured in scrums Address for correspondence: Dr J. R Silver, National Spinal Injuries Centre, Stoke Mandeville Hospital, Mandeville Road, Between 1956 and 1982 15 players were injured in Aylesbury, Bucks HP21 8AL, UK scrums, 14 while playing rugby union and one while ©)1992 Butterworth-Hememann Ltd playing rugby league. Only one player was a second 0306-3674/92/040253-06 row forward, which indicates the dangers of playing Br J Sp Med 1992; 26(4) 253 Spinal injuries sustained during rugby: J. R. Silver Br J Sports Med: first published as 10.1136/bjsm.26.4.253 on 1 December 1992. Downloaded from Figure 1. The front rows have been disrupted. Should the second rows continue to push then the front row players are at risk of having their heads driven into the ground. Reproduced with the permission of Colorsport Sports Photographic Agency and Library, London, UK http://bjsm.bmj.com/ on September 25, 2021 by guest. Protected copyright. Figure 2. An extremely dangerous situation. jeavons is being tackled by three people simultaneously and is unable to move away from the tackle. Reproduced with the permission of Colorsport Sports Photographic Agency and Library, London, UK 254 Br J Sp Med 1992; 26(4) Spinal injuries sustained during rugby: J. R. Silver in the front row. Three players were injured at the In conclusion, it would appear that the method of Br J Sports Med: first published as 10.1136/bjsm.26.4.253 on 1 December 1992. Downloaded from formation of the scrum as a result of extension or injury is unchanged and players are still breaking forced flexion of the neck, eight were injured when their necks and are still at risk in the front row. the front row collapsed and the second row continued to push and this fulfils the mechanisms required by Bauze and Ardran5 when the head is locked on the ground less force is required to dislocate the neck than if the neck was free. Of the Players injured in tackle remaining players, two (one of whom was a malingerer) were injured when the scrum collapsed Between 1956 and 1982 14 players were injured when and in the remaining case the mechanism of injury they were tackled while carrying the ball - four of was not known. Collapse of the scrum may be due to these tackles were illegal. An example of an illegal a discrepancy of strength and skill or may be tackle was when a player was strangled by an deliberate (Figure 1). opponent who broke his neck in a 'friendly' match. Between 1982 and 1987 seven players sustained Four players were injured as a result of a multiple injuries in scrums. All were front row forwards. One tackle (Figure 2). It was not dear in some cases was injured when the players charged at each other whether the neck was broken in the tackle or in the in contravention of the laws. Two players were ensuing pile up. Four players were injured when inexpert and had not played in their positions before, their heads struck the ground violently. One player or were overmatched. The other cases all followed a speared himself. collapse of the scrum after which the second rows Between 1982 and 1987 five players - three continued to push. One hooker's shoulder struck the forwards and two backs - were injured while ground. His spine was hyperextended - there was a tackling. One schoolboy suffered an illegal high tearing noise and he experienced a transient para- tackle, two other players struck their heads while plegia. No convincing fracture was ever demon- tackling their opponents (Figure 3). strated. He subsequently also turned out to be a It may be concluded that the mechanism of injury malingerer. appears unchanged. http://bjsm.bmj.com/ on September 25, 2021 by guest. Protected copyright. .. .. Amiga:!"...... .... Alm * tat ... - u }~~~~~~~~A . v::.., Figure 3. The dangerous tackle. The tackler's head and shoulders are in front of Laidlaw. The tackler's head may be injured as Laidlaw's thigh comes through, sweeping the head up. Reproduced with the permission of Colorsport Sports Photographic Agency and Library, London, UK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~........... t Br J Sp Med 1992; 26(4) 255 Spinal injuries sustained during rugby: J. R. Silver Players injured in ruck and maul years, who had retired from rugby some two seasons Br J Sports Med: first published as 10.1136/bjsm.26.4.253 on 1 December 1992. Downloaded from before was at a match to run the line but came on for Between 1956 and 1982 20 players were injured in a half a game when a player on his own side went off ruck and maul. Of these, 15 were forced to the injured. One other player had been out of the game ground and either their own side continued to push and had come to referee but was persuaded to play. on their buttocks so that their heads were driven into This leads to the conclusion that despite the the ground or players piled on top of them in an introduction of leagues, competitive rugby and the attempt to kill the ball. One player described how he emphasis on being fit to play, rugby players are still felt a click as his head struck the ground, followed by occasionally turning up to play in an unfit state. The severe pain and paralysis as supporting forwards importance of being trained for a particular position, pushed on his buttocks, raising his hips. Two players especially the front row, is not appreciated in the injured themselves by trying to force their way lower echelons of rugby. through other players and striking their heads. One player was kicked and another deliberately strangled. More forwards than other players are injured in rucks and mauls because they actively seek out the ball Discussion there. The numbers of injuries incurred in rucks have increased strikingly between 1973 and 1982, none The one player with a thoracic injury received his having occurred before 1970.