Intended for healthcare professionals

Rapid response to:


The unknown risks of youth rugby

BMJ 2015; 350 doi: (Published 08 January 2015) Cite this as: BMJ 2015;350:h26

Rapid Response:

We welcome the BMJ’s recognition of the issues of injury risk in schoolboy rugby players as an area very much in need of further study[1, 2]. However, it is unfortunate the editorials do not discuss the current efforts in this area.

In response to Mr Carter comments ‘it is vital that schools, clubs, medical facilities, and, most importantly, regulatory bodies cooperate now to quantify the risks of junior rugby’[2], we wish to highlight there is an active programme of research into this very issue in different parts of the UK, which is in the peer reviewed literature[3-9] and the national press.

In Scotland, a collaboration of medical professionals and research academics was formed 4 years ago to address schoolboy rugby injuries. This independent group has worked with the rugby authorities, clubs and schools in order to effect change. As such we have been able to influence schoolboy rugby playing policy in Scotland through the provision of evidence based recommendations.

We have already pursued a path that is suggested in the current editorial: We initially focussed on collating the serious injury risk[3] then addressed the troublesome issue of differing physical statures of youth players[4] and progressed to looking at particular areas of high risk, such as the transition to senior rugby and the scrum [6]. As a direct result, the playing age for schoolboy rugby competitions in Scotland has been changed, and specific policy adopted to prevent ‘under aged and undersized’ boys playing in a potentially dangerous environment with older boys. An evidence based system of maturity testing[4] has been in place in Scotland for the last 3 years.

We do not wish to sound complacent; much more work needs done, as has been identified in the editorials. We wholeheartedly agree with the need for robust epidemiological data collection and have repeatedly called for this[4, 10] but we disagree with the statement that there is a lack of will or ambition to set up a national data set of injuries. We are currently working with the rugby authorities, schools and clubs to achieve comprehensive reporting of injuries. However, the work we have done has been unfunded relying on support from the University of Edinburgh. If schoolboy rugby injuries were a higher priority for funding bodies, and resources were available, considerable progress could be made; we would like to highlight this as the major barrier rather than denial, concealment or conspiracy.

Yours sincerely

David Hamilton [1], Jamie Maclean [2] & Hamish Simpson [1]

[1] University of Edinburgh
[2 ]Perth Royal Infirmary

1. Godlee F, The NHS is not (yet) in crisis, but what about school rugby? BMJ 2015;350:h78
2. Carter M. The unknown risks of youth rugby: And the urgent need to quantify them. BMJ 2015;350:h26
3. MacLean JGB, Hutchison JD. Serious neck injuries in U19 rugby union players: an audit of admissions to spinal injury units in Great Britain and Ireland. Br J Sports Med 2012;46:591–4.
4. Nutton RW, Hamilton DF, Hutchison JD, Mitchell MJ, Simpson AHRW, Maclean JGB. Variation in physical development in schoolboy rugby players: can maturity testing reduce mismatch? BMJ Open. 2012;2:e001149
5. Hamilton DF, Gatherer D, Jenkins PJ, Maclean JGB, Hutchison JD, Nutton RW, Simpson AHRW. Age-related differences in the neck strength of adolescent rugby players: A cross-sectional cohort study of Scottish schoolchildren. Bone Joint Res 2012;1:152–7.
6. Hamilton DF, Gatherer D, Robson J, Rennie N, Graham N, Maclean JGB, Simpson AHRW. Comparative cervical profiles of adult and under-18 front row rugby players: implications for playing policy. BMJ open 2014;4:e004975.
7. Palmer-Green DS, Stokes KA, Fuller CW, England M, Kemp SP, Trewartha G. Match injuries in English youth academy and schools rugby union: an epidemiological study. Am J Sports Med. 2013;41:749-55
8. Palmer-Green DS, Stokes KA, Fuller CW, England M, Kemp SP, Trewartha G.Training Activities and Injuries in English Youth Academy and Schools Rugby Union. Am J Sports Med. 2014 [epub] Dec 15
9. Nicol A, Pollock A, Kirkwood G, Parekh N, Robson J Rugby union injuries in Scottish schools. J Public Health (Oxf). 2011;33:256-61
10. Hamilton DF. Addressing cervical injuries in schoolboy rugby players. International Rugby Board Medical Conference. 2013. Dublin

Competing interests: We have no financial competing interests

10 January 2015
David F Hamilton
Research Fellow
Jamie Maclean, Hamish Simpson
University of Edinburgh
49 Little France Crescent, Edinburgh, EH164SB