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Rugby and the spine

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Rugby is a full-contact sport which has one of the highest injury rates when compared to other team sports. Although injuries are expected from any high-speed and high-impact situation, steps have been taken to minimise the high injury rates within rugby. Here Neil Hopkins (registered biokineticist) writes about the preventative rehabilitation for rugby injuries to the lower back and core. Read more on SA Rugby.

Law changes, cutting down on foul play, improving protective equipment, as well as increasing the emphasis on proper conditioning are to name but a few of the steps taken with the goal of reducing the risk of injury.

Trends in the nature of injury in rugby have changed since 1995 as a result of numerous modifications to the laws combined with the advent of professionalism. However, these changes have been associated with some negative consequences, such as an increase in injury risk for both professional and amateur games.

As a result, a vast amount of research has been conducted on the nature and cause of injuries in rugby, and their prevention. A significant amount of this research is concerned with the risk of spinal injury associated with playing rugby.

Most common injuries

Injury to the spine in rugby occurs mainly to the cervical spine (neck); however there is also a risk of injury to the lower back and its supporting structures.

There are numerous mechanical forces involved in producing spinal injuries and the most common injuries to the lower back and core occur as a result of one, or a number, of these forces acting on the lumbar spine or the surrounding tissue.

These forces can be broken down into: flexion forces (forward bending), extension forces (backward bending), rotation forces (twisting), shear forces (one vertebra sliding in relation to another), and compression forces (vertical pressure).

It is often the extremes of range or force that result in injury; however even a relatively small force can result in an injury if the spine is not adequately supported. The most effective way to categorise sport related injuries to the lower back is to break them down into the structures affected.

These include: fractures to the spinal column, injury to the interverterbral disk, ligament strain, joint inflammation, and muscular spasm. Other less common injuries also occur, which is why an accurate diagnosis is essential before treatment.

Tackles responsible for most injuries

The research on the incidence of injury shows that the majority of injuries in rugby occur when tackling or being tackled. Tackles have been found to be the rugby event responsible for the greatest number of injuries as they are by far the most common contact event in the game.

As a result they account for the greatest cause of all injuries, followed by the ruck/maul. Blind tackles occur when the player is tackled from behind or from a position outside of their range of vision (in the player’s peripheral vision).

There is a higher risk of injury with this kind of tackle as the player is often caught unaware, and often unprepared for the impact.

The tackle with the greatest risk of spinal injury is the spear tackle, and has subsequently been banned from rugby as it constitutes foul play. Further studies have also shown that although tackles cause the greatest number of injuries it is collisions which are more likely to result in injury.

Scrums pose danger to the spine

Even though there are fewer collisions during a game, they are more likely to result in an injury than a tackle.

The forces involved in scrumming and the positioning of the players has always been a concern when it comes to spinal injuries. However, thanks to a greater awareness of the dangers involved in scrumming, the risk of spinal injury in the scrum has decreased.

Due to improvements in refereeing and laws governing the scrum, the number of injuries as a result of scrumming has decreased in comparison with the number of injuries sustained during the ruck and maul phases.

Nonetheless scrums are inherently dangerous because the players are placed into positions which have the potential to compromise the safety of the spine.

As a result, scrums carry a much greater risk of injury than tackles. The majority of research up until now has focused on the incidence of traumatic injuries to the spine, especially the cervical spine, but there is also a risk of overuse injuries as well.

The forces involved in scrumming place an increased amount of strain on the lower back, especially on the discs between the lumbar vertebrae.

The most dangerous position?

There is no consensus on the most dangerous position in rugby, because certain positions carry different risks for different injuries. It is however safe to assume that the positions that carry the greatest risk of injury are the ones involving the most contact and the greatest number of tackles, such as the loose forwards and certain players in the backline.

However, some players have a greater risk of injury for other situations which are unique to their position; for example, props and hookers carry a greater risk for lumbar spine injuries due to their location and positioning in the scrum.

More injuries occur in higher teams (1st team) and older age groups and fewer injuries occur in lower teams (5th team) and junior levels of rugby. It has also been found that rugby matches carry a far greater risk of injury than practices, especially matches played at the start of the season.

Research has indicated that most injuries occur at the start of the season or during the first few weeks following a break in midseason.

A generally accepted principle in the discipline of sports medicine is that the greatest predictor of a future injury is a previous injury. This is an important finding because the return to sport phase following an injury will carry a similar level of risk compared to the early phases of the rugby season.

Most injuries result in time off, with injuries caused by tackles resulting in the greatest amount of time off. It is imperative that injured rugby players be fully recovered and conditioned before returning to game situations, in order to avoid further injury, further time off, and possibly a reduction in the length of their rugby career. 

Read here for more information on how to protect the spine during training.

Source: Neil Hopkins is a registered biokineticist working at Murphy and Hopkins Biokineticists in a private hospital in Cape Town. Written for SA Rugby.

(Health24, August 2011)

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