Preventing head and neck injuries in rugby
Ruggers are a hardy bunch. We accept that we play a tough sport, and that injuries are part and parcel of the game we love. Hopefully, most of those injuries will be nothing worse than bruises and muscle strains.
However, some injuries are more serious. The most worrying injuries are those that affect the head & neck.
While it’s all-but impossible to completely eliminate the risk of injury in rugby, it’s always a good idea to try stack the odds in your favor.
This is especially true for injuries of the head and neck because they have the potential to be the most severe.
Risk of injury
Your head and neck are very susceptible to injury. Impacts to the head can literally scramble your brain. Your skull is immensely strong, but your brain is not. It can bounce around inside your skull and that can cause a variety of brain injuries, the most common being concussion. Concussion occurs when the brain is shaken violently. This causes chemical changes within the brain and could cause damage to cells and blood vessels.
Your neck comprises of seven vertebrae and is the most mobile part of your spine. It also has to support the weight of your head. This mobility, combined with being relatively lightly muscled, means the neck is easily injured. There are many situations where the neck can be forced into unnatural positions such as collapsed scrums and big tackles. Tackles can also cause whiplash-type injuries. Neck injuries can affect the muscles, ligaments, intervertebral discs, and even the spinal cord.
While head and neck injuries can be very serious, occurrence is relatively low. This is somewhat surprising considering the nature of rugby but is testament to proper coaching, good refereeing, rule changes, and the skill of the players.
Head and neck injuries tend to happen most in one of three playing situations:
Head and neck injuries are more likely when teams or players are very mismatched, either in size, skill, or playing experience.
Because rugby is played in so many different countries and at so many levels, it’s very hard to determine exact head and neck injury rates. However, one study that tracked the incidence of injury in Australian professional rugby league players over a 12-year period revealed 25.7 head and neck injuries per 1000 playing hours, and of those injuries, 12.7 resulted in concussions.
Regarding neck injuries only, another study conducted with Australian amateur rugby players in 2010 reported 2.9 neck injuries per 1,000 playing hours. Of those injuries, 69.3% were described as minor, 17% were mild, 6.8% were moderate, and 6.8% were deemed to be severe.
Unfortunately, a small but significant number of head and neck injuries can be very serious and even life-threatening.
Preventing head injuries
Tackles are the most common cause of head injury in rugby. Statistically, the tackler is more likely to suffer a head injury than the ball carrier. Because of this, it is vital that all players learn to tackle correctly from the outset, leading with the shoulder and wrapping the arms rather than leading with the head.
Check out this article for a review of good tacking technique and exercises to improve your tackling.
Some head injuries are unavoidable and are the result of accidental contact e.g. a clash of heads when contesting a high kick. Protective headgear may help reduce the incidence of head injury and concussion in rugby but relatively few players choose to wear it. Some studies even suggest that protective headgear could increase the incidence of head injury because it provides only minimal protection but increases player recklessness (1).
Rule changes outlawing high tackles and reducing the incidence of reckless and accidental head contact have also helped lower the risk of head injury. Referees also have a responsibility to assess head injuries, carrying out a head injury assessment (HIA) if they suspect there has been a head impact. This will help prevent players with serious head injuries playing on when they actually need rest or medical attention. Check out this article for an in-depth discussion about concussions in rugby.
Preventing neck injuries
One of the most effective ways to reduce the likelihood of suffering a neck injury in rugby is to strengthen the neck muscles. Stronger neck muscles can help absorb impact and also resist hyperflexion and hyperextension. Front row forwards have been doing neck training for years, but it’s a good idea for all players to include neck training in their workouts.
Some traditional neck exercises are quite high risk, especially those using neck harnesses and the wrestler’s bridge. The aim of neck training should be to reduce the chances of an injury and not cause one!
Isometric or static exercises are amongst the safest neck exercises because they allow you target the relevant muscles without overstressing the vertebrae, intervertebral discs, or ligaments of the neck.
Exercises for Injury Prevention
The following exercises are good choices for ruggers:
1. Isometric lateral flexion
Place your hand against the side of your head. Push your head against your hand without allowing your neck to move. Hold for 15-30 seconds and then swap sides.
2. Isometric flexion
Place both hands against your forehead. Push your head forward against your hands without allowing your neck to move. Hold for 15-30 seconds.
3. Isometric extension
Place both hands against the back of your head. Push your head back against your hands without allowing your neck to move. Hold for 15-30 seconds.
4. Lateral neck flexion with stability ball
Place a stability ball against a wall and lean the side of your head against it. Press your head against the ball. Hold for 15-30 seconds and then swap sides.
5. Neck extension with stability ball
Sit on a stability ball. Walk your feet forward and lean back. Keep moving your feet forward until the ball is behind your upper back and neck. Press the back of your head into the ball. The further forward you move your feet, the more demanding this exercise will become. Hold for 15-30 seconds
6. Neck flexion with stability ball
Place a stability ball against a wall and lean your forehead against it. Walk your feet back as far as required to load the muscles at the front of your neck. The further back you position your feet, the harder this exercise will be. Hold a weight in your hands to make this exercise more demanding. Hold for 15-30 seconds.
Head and neck injuries are relatively rare in rugby but, because of their potential severity, anything you can do to reduce your chances is time well spent. Include neck exercises in your workouts and protect your head at all times. Learn and be aware of the symptoms of concussion, and always report head impacts to a match official.
Does rugby headgear prevent concussion? Attitudes of Canadian players and coaches https://bjsm.bmj.com/content/36/1/19