Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Alternative to banning scrummaging?
- Lawrence R Kidd (1 June 2007)
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It's now time to address safety in the tackle
- Alastair P Greystoke (3 June 2007)
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The Need for Worldwide Consistency in Interpretation of Scrummaging Laws
- Adam C Cox (6 June 2007)
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Living with the injury.
- Robin Christie (8 June 2007)
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Rugby related spinal injuries
- Anne Savage (8 June 2007)
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Urgent need for serious injury registry in rugby union
- Joseph S. Butler, Martin J. Shelly, Joseph M. Queally, Keith Synnott, John M. O'Byrne (12 June 2007)
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Lawrence R Kidd, Medical Student UHW, Cardiff
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Maybe this education-based approach, whilst costing both time and money will prove to those sceptics (James B Bourke Rugby union should ban contested scrums BMJ, May 2006; 332: 1281) that wish to see scrummaging banned in Rugby Union, that injury can be avoided. With interventions such as these that have proven effective over a prolongued time period and over a wide area in existence, surely this is a better alternative than to remove an essential part of this game. Competing interests: None declared |
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Alastair P Greystoke, Research Fellow, Medical Oncology Paterson Insititute of Cancer Research M20 4BX
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As an amateur rugby referee who spent the 2005 season refereeing in New Zealand and took part in the RugbySmart campaign I was interested to read Quarrie et al’s analysis of its impact on spinal injuries (1). As they point out most of the reduction in injuries was accounted for by a reduction in scrum related injuries. Whether a similar campaign would be equally effective in Britain is unclear, given the recent 2006 changes in the scrum engagement procedure, however, as pointed out in the accompanying editorial it can certainly do no harm (2). The paper highlighted another area of concern; 7 out of 8 spinal injuries occurred at the tackle. Over the last 10 years there has been an increase in the high impact, chest high “ball and all” tackle. This area of the game is now associated with the most injuries (3) and this type of tackle puts the tackling player at risk of a head-on-torso collision and spinal injury. Instead of further debates over banning the scrum we should concentrate on improving the safety at the tackle area by legislation and educational initiatives similar to those described by Quarrie et al. 1. Quarrie KL, Gianotti SM, Hopkins WG, Hume PA. Effect of nationwide injury prevention programme on serious spinal injuries in New Zealand rugby union: ecological study. BMJ 2007; Jun 2;334(7604):1150. 2. Noakes TD, Draper CE. Preventing spinal cord injuries in rugby union. BMJ 2007; Jun 2;334(7604):1122-3. 3. Fuller CW, Brooks JH, Cancea RJ, Hall J, Kemp SP. Contact events in rugby union and their propensity to cause injury. Br J Sports Med 2007; May 18;. Competing interests: A Greystoke is a rugby referee who took part in the RugbySmart campaign |
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Adam C Cox, FP1 doctor Cardiff and Vale NHS Trust
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As a former Wales Under-19 international rugby player with the aspiration of a career in orthopaedic surgery I read this article (1) with great interest. Having played rugby semi-professionally for four years I am not the only person to have become increasingly frustrated with the current European scrummaging laws. These now season-old rules of engagement - “crouch-touch-hold-engage” - have proven to confuse more than educate players as supported by All-Black hooker Anton Oliver who “bemoaned” the state of the scrum when New Zealand hosted France a week ago(2). Serious neck injuries sustained when scrummaging although rare have recently been brought to public attention by the British media (3, 4). Even rugby purists must agree that although scrummaging is an integral part of rugby football union, player safety is of paramount importance and this area is perhaps an advantage that rugby league has over its union counterparts. It is perhaps food for thought that the Federation Francaise de Rugby (French Rugby Union) has made scrums uncontested below amateur level. Ultimately at each scrum the burden of player safety lies with the referee but with the current inconsistence and uncertainty in interpretation of these laws this may be jeopardised. With this promising (and hopefully increasing) body of evidence the International Rugby Board (IRB) should sit up and take heed to implement worldwide Rugbysmart-type protocol for the protection of players, coaches and referees alike. 1. Quarrie KL, Gianotti SM, Hopkins WG, Hume PA. Effect of nationwide injury prevention programme on serious spinal injuries in New Zealand rugby union: ecological study. BMJ 2007; Jun 2;334(7604):1150 2. Barclay C. Scrums wear down Oliver’s patience. NZPA, 5th June 2007, http://www.stuff.co.nz/stuff/manawatustandard/4083559a1823.html 3. Vowles v Evans: [2002] EWHC 2612 (QB) 4. Rees P. Hampson injury prompts move towards uncontested scrums. The Guardian, 30th August 2006 Competing interests: None declared |
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Robin Christie, G.P Portmill Surgery,Hitchin,Herts
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My wife and I are full time G.P's. Fifteen months ago, our 12 year old son was playing for his prep school first fifteen and was kicked on the back of his head in a ruck.The referee and spectators did not witness the event. Shortly afterwards, he left the field and developed double and blurred vision.Thankfully, all investigations were normal and our consultant colleagues locally and at Moorfields have been encouraging but his visual disability persists. It is exam week at his new school. Revision is difficult as he cannot see to read. The school ( Perse,Cambridge) have been very supportive and have had "readers" to help him.He is a bright boy and retains information well but it has been a struggle. He was a very keen sportsman and loved rugby but is no longer able to be involved in contact sports as a further injury could be catastrophic. This event has completely changed our lives. Our intelligent and talented son has been reduced by what happened although we are continually impressed by his optimism and tenacity. Any initiative that helps to prevent Rugby injuries must be encouraged and especially young players as well as referees must be continually educated and updated on the safety aspects of the game. In my view, there should not be contested scrums under the age of 15, there should be touch judges at all competitive school matches and teams should be matched for weight, size and experience in younger team matches. This injury happened in a moment but has had long term consequences.Rugby is a dangerous game,especially for young players. Much more should be done to protect them from injury. Competing interests: None declared |
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Anne Savage, retired NW3 5RA
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Some years ago I worked as a volunteer for a Trust set up to help those rendered tetraplegic from sports injuries. In the course of this job I visited sufferers in their homes and 10 of the 11 Spinal Injuries Centres in the UK. Rugby then came second to diving into shallow water as a cause of these devastating injuries and it was the amateurs who were mostly affected. Often this resulted from a reluctance to cancel or postpone a match if the referee was away or ill or the player not fully fit. It ought to be an absolute rule that safety comes before everything else, even the long standing arrangements for a return match. The transformation of a keen young athlete to a totally dependent invalid is a major tragedy. So, also, is the case of the holiday maker who, primed with wine, goes for a midnight swim. Why don't we adopt the American slogan 'Feet first, first time'? Competing interests: None declared |
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Joseph S. Butler, Orthopaedic Research Fellow National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland, Martin J. Shelly, Joseph M. Queally, Keith Synnott, John M. O'Byrne
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We read with great interest the recent article dealing with the impact of a national injury prevention programme on the frequency of spinal cord injuries in rugby union [1]. The impressive effects brought about by the introduction of RugbySmart in New Zealand certainly should lead the way for further education-based initiatives worldwide. In Ireland, rugby union is one of the leading sports with approximately 90,000 players currently registered with the Irish Rugby Football Union (IRFU). As the tertiary referral centre for all spinal cord injuries within the Republic of Ireland, we receive several rugby related spinal injuries annually [2]. Although the overall incidence of serious injury in rugby is low, the potentially catastrophic consequences brought about such injuries warrants serious concern. The on-going surveillance of trends and mechanisms of injury in sports, such as rugby, is necessary in order to enforce appropriate law changes and minimize the incidence of devastating injuries. A registry of serious injury is central to the administration of any sport where there is an established risk of serious injury for the participants. In a number of the main rugby playing nations, including Ireland, this has yet to be instituted. This is clearly the first step if the issue of serious sports- related injuries is to be adequately addressed. Although injuries are inevitable in contact sports, all those involved have a duty of care to minimize them. The persistent focused education of those at greatest risk in sport is crucial to addressing the incidence of serious injury. However, without the mandatory introduction of a serious injury registry for contact sports, such as rugby, further progress in injury prevention will be delayed. 1.Quarrie KL, Gianotti SM, Hopkins WG, Hume PA. Effect of nationwide injury prevention programme on serious spinal injuries in New Zealand rugby union: ecological study. BMJ 2007;334:1150-3. 2.Shelly MJ, Butler JS, Timlin M, Walsh MG, Poynton AR, O’Byrne JM. Spinal injuries in irish rugby. J Bone Joint Surg Br 2006;88B:771-5. Competing interests: None declared |
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