Sports Medicine: Just the Facts

• In the United States 47.5% of all rugby cervical spine
  injuries occurred in hookers versus 18.6% outside of
  the United States (USA Rugby website; Wetzler et al,
  1998).
  •Total 57.6% of U.S. catastrophic rugby injuries occur in
  the scrum in contrast to 41.5% outside of the United
  States (Dietzen and Topping, 1999; Wetzler et al, 1998).


• It is theorized that the discrepancy may be due to the
  fact that most rugby players in the United States learn to
  play the sport at college age or older. This is in contrast
  to other countries where rugby skills and techniques are
  learned at a much younger age (Wetzler et al, 1998).


• In the United States, there is not a good database for
  rugby injuries other than catastrophic.

INJURIES BY POSITION

• The front row is most susceptible to injury during a
  scrum.
  
  
  1. When the ball is put into play during a scrum, the
     necks of the front row are already in a position of
     slight flexion.
  
  
  2. The two opposing scrums are applying an axial force
     on the cervical spines that is equivalent to 0.5–1.5
     tons (Dietzen and Topping, 1999; Milburn, 1993).
  
  
  3. Collapse is often related to the following (Milburn,
     1993):
     a. Inappropriately vertical force vectors during
     engagement
     b.Poor field conditions with poor traction
     c. Inexperience
     d. Fatigue
     e. Playing with injury
     f. Opposing scrum mismatch in terms of size,
     ability, strength, and experience
  
  
  
  


• The second row is susceptible to the following
  injuries:
  
  
  1. Neck injury—for the same reasons as the front row
     but to a lesser extent.
  
  
  2. Auricular hematomas, ear avulsions, and head lac-
     erations, as their heads are positioned between the
     thighs of the front row players.
     a. Often wear scrumcaps or an electrical tape head-
     band to secure their ears to the side of their head.
  
  
  3. Susceptible to injuries when they are being lifted
     during line outs.
  
  
  
  


• Flanker/Wing forward
  
  
  1. Susceptible to injuries in the tackling situation
  
  
  2. High incidence of acromioclavicular joint injuries
  
  
  
  


• Eightman
  
  
  1. Susceptible to similar head and facial injuries as
     the locks because of his or her head position
     between the locks.
  
  
  
  

•Scrumhalf

1. Susceptible to contact injuries while attempting to
   secure the ball.
   •Pack


2. At risk for contact knee injuries (Dietzen and
   Topping, 1999).

• Backs

1. At risk for contact and noncontact knee injuries
   (Dietzen and Topping, 1999).


2. Susceptible to injury of the head, neck, and
   shoulders during tackling (Dietzen and Topping,
   1999).

• In rucks, the players on the ground are at risk for abra-
  sions, lacerations, contusions, and orofacial trauma
  from the cleats of other players.


• In mauls and rucks, players are susceptible to hand and
  finger injuries from binding to each others’ jerseys.


• During tackling, players are at risk for the same
  injuries as other collision sports.

PREVENTION

• Locks often wear scrumcaps or electrical tape head-
  bands to secure their ears to the side of their head to
  prevent ear injuries.


• Some players wear shoulder pads to attempt to pre-
  vent acromioclavicular(AC) joint injuries.


• There are currently no studies to date that show the
  above measures have prevented injury.


• On the rugby boots, no toe cleats (like baseball cleats)
  are allowed.
  
  
  1. Tackled players are frequently on the ground
     underneath players from both teams who are
     attempting to secure the ball with their feet.
  
  
  
  


• The referee conducts a safety inspection of the pitch
  and all players prior to the match.
  
  
  1. The referee may prohibit a player from participat-
     ing if unsafe footwear, uniform, illegal equipment,
     or long fingernails are found.
  
  
  2. Medical personnel are encouraged to join the ref-
     eree for the inspection.
  
  
  
  


• Since tight fiveplayers have the highest incidence of
  cervical spine injury in the United States, they should
  have extensive practice and instruction prior to com-
  petition.


• Depowering the scrum or having uncontested scrums
  in less experienced play may decrease the risk of cer-
  vical spine injury.


• Since fatigue is thought to be a risk factor for injury
  (Milburn, 1993), all players should maintain a high
  level of fitness.


• USA Rugby encourages all coaches to complete a
  series of coaching clinics. These clinics will arm

518 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS