Can a Specific Neck Strengthening Program Decrease Cervical Spine Injuries in a Men's Professional Rugby Union Team? A Retrospective Analysis

Abstract

Cervical spine injuries in Rugby Union are a concerning issue at all levels of the game. The primary aim of this retrospective analysis conducted in a professional Rugby Union squad was to determine whether a 26-week isometric neck strengthening intervention program (13-week strengthening phase and 13-week maintenance phase) was effective in reducing the number and severity of cervical spine injuries. The secondary aim was to determine whether at week five, where the program had been the similar for all players, there was increased isometric neck strength. All 27 players who were common to both the 2007-2008 and 2008-2009 seasons were included in this analysis and data was extracted from a Sports Medicine/Sports Science database which included the squad's injury records. Primary outcome variables included; the number of cervical spine injuries and the severity of these injuries as determined by the total number of days lost from training and competition. Secondary outcome variables included isometric neck strength in flexion, extension and left and right lateral flexion. Using non-parametric statistical methods, no significant differences were evident for the total number of cervical spine injuries (n = 8 in 2007-2008, n = 6 in 2008-2009) or time loss due to these injuries (100 days in 2007-2008, 40 days in 2008-2009). However, a significant (p = 0.03) reduction in the number of match injuries was evident from 2007-2008 (n = 11) to 2008-09 (n = 2). Non-significant increases in isometric neck strength were found in all directions examined. A significant reduction in the number of match injuries was evident in this study. However, no other significant changes to primary outcome variables were achieved. Further, no significant increases in isometric neck strength were found in this well-trained group of professional athletes. Key PointsWhile many authors have proposed that neck strengthening could be an effective strategy in preventing cervical spine injuries in Rugby Union, there is currently little information in the literature pertaining to how such a study might be conducted.A significant decrease in the number of injuries recorded in matches can be achieved using a specific neck strengthening program at the elite level.In an elite rugby union team as investigated in this study a significant increase in neck strength is difficult to achieve in a short period of time such as five weeks.

Keywords: Rugby Union; cervical spine; injury; isometric; neck strength.

Figure 1.

Exercises used in the neck strengthening intervention program. a) Isometric cable hold- neck flexion b) Isometric cable hold - neck extension c) Isometric cable hold – lateral neck flexion d) Isometric cable hold – 45 degree neck flexion left and right e) Isometric cable hold – Bent over neck extension f) Isometric cable hold – Bent over lateral neck flexion.

Figure 2.

Exercises used for front rowers only in the neck strengthening intervention program. a) Tight head prop isometric cable hold – bent over right lateral neck flexion with shoulder/pectoral fly b) Loose head prop isometric cable hold – bent over lateral neck flexion with shoulder latissimus dorsi pull-down c) Scrum truck simulation with external force applied to lateral neck flexors and extensors.

Figure 3.

Experimental set up for testing of neck strength in a) flexion b) extension and c) right lateral flexion