title: Impact of the national prevention policy and scrum law changes on the incidence of rugby-related catastrophic cervical spine injuries in French Rugby Union.
abstract: OBJECTIVE
  Catastrophic cervical spine injuries are rare in rugby union but require close monitoring. The aim of this study was to analyse the incidence of severe cervical spine injuries and determine the impact of a national prevention programme and new scrum rules implemented by the French Rugby Union.
  
  
  METHODS
  A prospective study was performed between 2006 and 2013 including all players affiliated to the French Rugby Union. All cervical spine injuries resulting in death, tetraplegia or a permanent neurological deficit were included. Prevention programmes were implemented from 2007 to 2013 and a change in scrum rules in 2010. To measure the impact of rule changes, results between 2006-2010 and 2010-2013 were compared using a Poisson regression.
  
  
  RESULTS
  Altogether, 31 injuries were observed and the mean annual incidence was 1.6 per 100 000 players. There were significantly more injuries in senior players compared to junior players (3.5 vs 0.6 per 100 000 players; CI 95% (2.1 to 4.9) vs (0.1 to 1.0)). Incidence decreased from 1.8 in 2006 to 1.0 per 100 000 players in 2013 (p<0.0001). After 2010, there were significantly fewer injuries during scrums (p=0.02). In contrast, there were significantly more injuries in backs during 2010-2013 compared to 2006-2010 (p=0.003).
  
  
  CONCLUSIONS
  The incidence of catastrophic cervical spine injuries has declined in French Rugby Union. The implementation of specific prevention programmes and scrum law changes has notably resulted in a decrease in scrum injuries in forwards. This prospective study should be continued to monitor the future progression of injuries and adapt prevention programmes accordingly.
authors.affiliation: Institut Régional de Médecine du Sport CHU Caen, Caen, France.|Fédération Française de Rugby, Marcoussis, France.
authors.forename: E
authors.initials: E
authors.lastname: Reboursiere
authors.affiliation: Fédération Française de Rugby, Marcoussis, France.|Clinique du Sport Paris V, Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Bohu
authors.affiliation: Fédération Française de Rugby, Marcoussis, France.
authors.forename: D
authors.initials: D
authors.lastname: Retière
authors.affiliation: Institut Régional de Médecine du Sport CHU Caen, Caen, France.
authors.forename: B
authors.initials: B
authors.lastname: Sesboüé
authors.affiliation: Institut Régional de Médecine du Sport CHU Caen, Caen, France.|Clinique Médipôle Garonne, Toulouse, France.
authors.forename: V
authors.initials: V
authors.lastname: Pineau
authors.affiliation: Centre de Gestion Administratif Colonna, Paris, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Colonna
authors.affiliation: Fédération Française de Rugby, Marcoussis, France.|Centre Orthopédique Santy, Lyon, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Hager
authors.affiliation: Fédération Française de Rugby, Marcoussis, France.
authors.forename: J C
authors.initials: JC
authors.lastname: Peyrin
authors.affiliation: Fédération Française de Rugby, Marcoussis, France.
authors.forename: J
authors.initials: J
authors.lastname: Piscione
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000517:prevention & control*; D002574:Cervical Vertebrae / Q000293:injuries; D005538:Football / Q000293:injuries* / Q000592:standards*; D005602:France; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D013124:Spinal Injuries / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
keywords: Cervical spine; Injury prevention; Rugby