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Mechanisms of cervical spine injury in rugby union: is it premature to abandon hyperflexion as the main mechanism underpinning injury?
  1. Christopher R Dennison1,2,
  2. Erin M Macri3,4,
  3. Peter A Cripton1,2,3
  1. 1Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics, University of British Columbia, Vancouver, Canada
  2. 2International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
  3. 3Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
  4. 4Department of Experimental Medicine, University of British Columbia, Vancouver, Canada
  1. Correspondence to Dr Peter Cripton, Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada; cripton{at}

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Cervical spine injuries in rugby union have received growing worldwide attention owing to their often catastrophic nature.1,,3 Kuster et al4 considered recent changes in the epidemiology as well as the ex vivo biomechanics literature on cervical spine injury during head-first impacts. Kuster postulated that the majority of catastrophic cervical spine injuries before year 2000 occurred through a hyperflexion mechanism in the scrum and since the year 2000, these injuries have occurred during tackles via an axial compression mechanism and related ‘buckling’ of the cervical spine.

Regulators and other stakeholders in the game continually seek to improve understanding of the scope, true incidence and mechanism of these catastrophic injuries. Ideally, a full comprehension of cervical injury mechanisms occurring during rugby would lead to changes in the game, through rule changes or changes in enforcement and/or player coaching or education, which in turn would reduce the incidence of these injuries.2 Achieving such a full comprehension, however, has been elusive.1,,3 ,5,,9 For example, recent changes to the rules have led to reduced time spent in scrum and have altered scrum engagement, which subsequently have been associated with a reduction in incidence of scrum-related cervical spine injury (an injury primarily involving forward positions and accounting for 37%–51% of cervical spine injuries).5 ,7 ,8 ,10 ,11 These changes have therefore affected the distribution of players who get injured, with increased percentage of these injuries now being sustained by back positions than prior to these rule changes, and up to 57% of cervical injuries are now occurring …

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