BokSmart: medical management of suspected serious acute spinal cord injuries in rugby players

Abstract

Injury to the spinal cord with paralysis during rugby is rare but remains an emotionally charged issue, especially at schoolboy level. The game has evolved over the years with rule changes to reduce injury risk. Scrums were originally perceived as the high-risk phase of play and rule changes in the early 1990s have reduced the number of scrums per game by as much as 40%. Over time the ferocity of play has also increased with bigger, fitter
players and possibly more at stake with professionalism. Catastrophic
injury rates are low but still occur. Although risk and injury cannot be totally avoided in a contact sport, it does appear that there are deficits in the management of this risk and subsequent injury.
SA Rugby has introduced an educational programme (BokSmart) to increase the level of understanding by players and support staff. This article was prepared for the BokSmart programme in an effort to highlight the deficits and provide a basic understanding of spinal injury.
Terminology, diagnosis and appropriate investigations are dealt with. The early emergency management is discussed as would occur at the first medical point of contact. This allows standardisation of injury assessment so communication between personnel is clear.
An algorithm has been suggested to provide an appropriate management strategy should an injury occur.