Intended for healthcare professionals

Rapid response to:

Reviews Personal views

Rugby union should ban contested scrums

BMJ 2006; 332 doi: (Published 25 May 2006) Cite this as: BMJ 2006;332:1281

Rapid Response:

Spinal Cord Injuries and the Scrum in Rugby Union

The recent review by Bourke suggesting the banning of contested
scrums contains a number of points which need addressed 1.

The quoted study by Carmody is one of the largest series addressing
the issue of spinal cord injuries in rugby 2. However, Bourke has chosen
to ignore certain integral facts of the paper. Firstly, the scrum only
accounted for 31.8% of spinal cord injuries in rugby union players. The
tackle was actually the most dangerous area, and this fact has been shown
to be consistent in another recent series 3. Secondly, the number of
injuries due to scrum collapse was actually significantly reduced compared
to previous years, highlighting an improvement in overall scrum safety.

The quoted case of Richard Vowles was indeed a scum related injury
but was in fact due to the presence of a non-specialised player in the
front row of a contested scrum. This has been banned under the laws of
rugby union for a number of years and the case against the Welsh Rugby
Union was for allowing poor refereeing, rather than against the scrum

However, this case did highlight the need to continue to reduce the
incidence of spinal cord injuries within rugby. Ways to do this must
include not just the enforcement of the rules of the game, but also
increasing the awareness of players, coaches and referees to the dangers,
careful player selection, and an emphasis on player fitness 4.

As JW Kyle, a former international player and surgeon once said: “Let
us have no conspiracy of silence with regard to these serious injuries.
Our duty is to study the mechanisms of injury in all phases of the game.
Then, and then only will we be able to take preventative action.”5

Bourke’s paper highlights the weakness and inherent bias that
unfortunately affects personal reviews such as this. As Kyle suggests,
only evidence based studies should be used as a basis for suggesting any
changes to the game. This is particularly the case where the change
proposed is as fundamental as banning scrums completely.

1. Bourke JB. Rugby union should ban contested scrums. BMJ 2006;
332: 1281.

2. Carmody DJ, Taylor TKF, Parker DA, Coolican MRJ and Cumming RG.
Spinal cord injuries in Australian footballers 1997-2002. Med J Aust
2005; 182: 561-4.

3. Quarrie KL, Cantu RC, and Chalmers DJ. Rugby union injuries to the
cervical spine and spinal cord. Sports Med 2002; 32: 633-53.

4. Haylen PT. Spinal injuries in rugby union, 1970-2003: lessons and
responsibilities. Med J Aust 2004; 181: 48-50.

5. Kyle JW. Cervical spine injuries. Collected papers and
discussions of the International Congress on injuries in Rugby Football
and Other Team Sports. 1975 Apr 15-18: Dublin, Ireland. Dublin: Irish
Football Union, 1975: 116-9.

Competing interests:
None declared

Competing interests: No competing interests

07 June 2006
Gordon J. McArthur
Registrar in Plastic and Reconstructive Surgery
St. George's Hospital, London, SW17 0QT