Reviews Personal views

Rugby union should ban contested scrums

BMJ 2006; 332 doi: (Published 25 May 2006) Cite this as: BMJ 2006;332:1281
  1. James B Bourke, consultant general surgeon (jandabourke20vc{at}
  1. University Hospital, Queen's Medical Centre, Nottingham

    For 30 years I have been an honorary medical officer to Nottingham Rugby Football Club. In this time I have attended about 25 games a season and on many occasions have been the “duty doctor,” either officially or unofficially. In that time four players have been removed from the field of play at Nottingham with serious neck injuries. Three of the injuries were associated with scrums, and one occurred in a tackle. All four players had initial sensory and motor impairment. Two recovered within minutes or hours; one recovered in days; and one became paraplegic. Three needed an operation for fracture. Another three Nottingham players injured their necks in scrums while playing away from home and needed to be removed from the pitch. One player needed an operation and is paraplegic. Therefore I have experience of seven serious spinal cord injuries, five of which have required an operation. Two of the players are wheelchair dependent. Six of the seven injuries were related to the scrum, and in all cases the scrums were of the contested type—in which each set of forwards tries to shove the opponents off the ball—and that is more dangerous than the uncontested scrum, in which the players are not allowed to push their opponents away from the spot where the scrum occurs.

    The continuing risk of injury cannot be accepted

    A recent Australian study looked at acute spinal cord injuries among players of rugby union, rugby league, Australian rules football, and soccer from 1997 to 2002 (Medical Journal of Australia 2005;182: 561-4). These data were compared with those from a 1986-1996 survey. Fifty two players (45 men and seven schoolboys) suffered acute spinal cord injuries over the study period. The average annual incidence of such injuries per 100 000 players was 3.2 for rugby union, 1.5 for rugby league, 0.5 for Australian rules, and 0.2 for soccer. Although the incidence had changed little since the earlier survey, there was a trend towards less severe injuries in rugby union and league but not in Australian rules. No scrum injuries have occurred in rugby league in Australia since 1996, when contested scrums stopped being allowed. Seven injuries occurred in rugby union scrums, six at the moment of engagement with the opposing team. Overall 39% of injured players became permanently dependent on a wheelchair. The Australian authors also noted that the cost of care of a quadriplegic young man over his lifetime is enormous. For a 19 year old with C5 quadriplegia resulting from a road traffic crash in 2002 the payout would be between $A7m (£3m; €4.2m; $5.4m) and $A9m. They say that under the existing insurance cover for rugby union players, however, the maximum award for quadriplegia is $A300 000. The study concludes that the laws of scrum engagement in rugby union and the amount of insurance cover for injured players are grossly inadequate.

    In Britain acute spinal cord injuries in rugby union continue to occur, typically associated with scrums at the moment of engagement. Wheelchair dependency among those injured is common, and insurance is inadequate. The rugby football union is known to be concerned about the high level of injury, severity, and insurance.

    Rugby union became professional in 1995; players are paid to play and train. Professional rugby union is now often described as an industry. It may be subject to the Health and Safety at Work Act (1974), which requires working practices that are safe and do not put workers at risk. In the under 19 game contested scrums are not allowed.

    The authors of the 2005 Australian paper noted: “In our opinion there has been a gradual return to a forceful scrum engagement. While this may allow a tactical advantage for a team, it increases the risk of engagement injury. In our present study six of the seven scrum injuries occurred at engagement. We recall the 1988 warning of Burry and Calcinai [BMJ 1988;296: 149-50] of the need to make rugby safer—that “failing to alter the procedures of a game despite the knowledge that existing practices were hazardous and a safe alternative existed could well be held by a court to constitute culpable negligence.”

    In Britain such a case went to court in 2002: that of Richard Vowles of the Llanharan second XV against the Welsh Rugby Union. Vowles had suffered a severe injury in a game in January 1998 that left him paralysed when the players in the scrum failed to engage properly. The court ordered the union to compensate Vowles.

    The incidents involving the two young Nottingham players who are now wheelchair dependent have caused me to change my opinion on contested scrums. The consequences of injury are so great that the continuing risk of injury cannot be accepted.

    Players now deserve uncontested scrums in rugby union. In rugby league in Australia no acute spinal cord injuries have occurred since the scrum stopped being contested. Rugby union should follow this example. Rugby union outlawed the “flying wedge” and the “cavalry charge” as they are potentially dangerous. It should now also outlaw the contested scrum.

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