A scheme educating coaches and referees in the dangers of the rugby scrum could be a key reason for a reduction in the number of spinal injuries suffered by rugby players, says a researcher writing in this week's BMJ.
Spinal cord injuries, although rare, are a major cause of permanently disabling injuries and death in rugby.
In 2001 a wide-ranging injury prevention programme was introduced by the New Zealand Rugby Union in partnership with the Accident Compensation Corporation. Known as RugbySmart it focuses on educating participants about physical conditioning, injury management and safe techniques in the contact elements of rugby.
Referees and coaches, who have a key role in educating teams how to play more safely, must complete the course annually. Coaches who do not complete RugbySmart have their team withdrawn from the competition; referees are not assigned matches. Mr Quarrie says as a result the reach and influence has been extensive.
The New Zealand study assessed the number and cause of spinal injuries resulting in permanent disability preceding the introduction of RugbySmart and compared them with data gathered since 2001.
There were 77 injuries recorded between 1976 and 2005. Based on the figures from 1976 to 2000 the researchers calculated there should have been 18.9 spinal injuries between 2001 and 2005. In reality there were eight.
It was also found that before 2001 the scrum was the most dangerous part of the game accounting for 48% of spinal injuries. Yet between 2001 and 2005 it was the cause of 12.5% of injuries. There was one spinal injury from the scrum in this period, the predicted number was nine.
There was little change in the number of spinal injuries in the other contact areas of rugby - the tackle, ruck and maul. There were seven instead of the predicted nine spinal injuries in these elements of play between 2001 and 2005. Yet where tackles had accounted for 36% of spinal injuries between 1976 and 2000, between 2001 and 2005 that percentage rose to 87.5.
The education scheme has not been successful in reducing the number of spinal injuries unrelated to the scrum says Mr Quarrie. This could be because compared to the relatively controlled environment of the scrum, the direction and size of forces applied to player's bodies in the tackle, ruck and maul are much less predictable.
Furthermore, as the initiative was introduced country-wide there was no control group which means it is difficult to assess the impact of other factors on the reduction in spinal injuries. There is no way for example to take into account evidence from international matches which indicates a long-term decrease in the number of scrums per match.
He concludes that while it is unclear whether the programme has had an effect on injuries suffered during other phases of play: "Educational initiatives seem to represent a viable option for decreasing the rate of serious spinal injuries in rugby union scrums".