Jamie Maclean: Issue of schoolboy rugby injuries needs measured approach

A RECENT publication in the Journal of Public Health has reported the incidence of injuries in a small number of schoolboy rugby players.

Unsubstantiated conclusions have been drawn from this study and banning the scrum is one of the recommendations from one of the authors. Such knee-jerk reactions are counterproductive, as are some of the vitriolic criticisms of the study as a whole.

The main benefit of the study was to establish a method of data collection which can be used on a larger scale to investigate the issue of injury in schoolboy rugby. Of greater concern than the findings in the study is the fact that only a small proportion of the schools invited to participate did so. There is reluctance in some circles in the rugby community to recognise that there are questions that need to be answered if the game is to be preserved.

Since the advent of professionalism in rugby the level of physicality has increased. There is evidence to suggest that injuries have increased in the professional game, but there is no data that can be compared in amateur and schools rugby.

Nobody can ignore the report from the National Spinal Injuries Unit in Glasgow, which has observed an unexplained increase in admissions of schoolboy rugby players over the last three years, in excess of the number predicted for the population it serves. When compared with figures from New Zealand and South Africa, where there is good data on catastrophic injuries, the conclusion is that we do need to look closely at the game in Scotland.

Shortly after release of the spinal injury figures the governing body for orthopaedics in Scotland (SCOT) sanctioned a small group of senior orthopaedic surgeons to address some of the issues. The four members of the group have all played rugby, have sons playing and have a large combined experience of treating injuries associated with the game.

The main focus has been on senior school rugby (age 13 to 18), as it is in this group that the most significant injuries occur. One aspect that is being pursued is the question of mismatch between players. While it would seem intuitive that matching players for weight and height should reduce the injury risk, this is not supported in the literature.

Physical maturity has been shown to correlate with injury risk in contact sports in America and it was on the basis of published work there that maturity testing was introduced by the SRU last season, in combination with various other measures under the "Are you ready to play rugby" initiative. This programme and variations of it have been brought in by other rugby nations under the aegis of the IRB with the intent of making the game safer.

Age banding is relevant mainly in relation to the maturity of the player. It is no coincidence that a lot of the injuries occur around the adolescent growth spurt and the timing of this varies greatly between individuals.

Our group is involved in research which assesses various parameters in schoolboy rugby players. It is hoped this will help inform the authorities in administering the game.

In contrast to some of the claims in the press, much is being done in Scotland to look at this problem. It cannot be overstated however that quality data on injuries, with analysis, is critical to making the game as safe as possible and it is in this area that resource needs to be directed. Full cooperation from the rugby community is essential if our aims of making the game safer without wholesale change are to be achieved.

l Jamie Maclean FRCS is a consultant orthopaedic surgeon at Perth Royal Infirmary and chairman, SCOT Rugby Injury Group.