Spinal cord injuries were first identified as an important sporting problem in the early and mid-1970s in rugby union,1 2 American (gridiron) football,3 and ice hockey.4 Subsequent studies have identified the most common mechanisms that cause these injuries.5 6 In some sports, like such as American football, single mechanisms that cause spinal injury, such as the spear tackle, have been identified,7 which has allowed effective preventive measures to be swiftly implemented (the spear tackle has now been banned in gridiron football).8 But in other sports progress in preventing spinal injury has been slow and difficult to measure.

In this week's BMJ, a before and after study by Quarrie and colleagues assesses the effect of RugbySmart, a nationwide educational injury prevention programme, on the frequency of spinal cord injuries in New Zealand rugby union.9 It found that the introduction of the programme …