Justifying BokSmart for rugby injury prevention


The June 2012, Volume 46 (8) issue of the British Journal of Sports Medicine is led by the South African Sports Medicine Association and so it is fitting that it has a major focus on injury prevention in rugby union.  In describing the issue, Patricios’ editorial item specifically mentions describes BokSmart which is South African Rugby’s injury prevention program. Injury prevention experts will recognize the strategies that underpin BokSmart ‘s major components:

– Training and education of coaches and referees in safety and injury prevention

– Development of medical protocols for the management of injuries that do occur

– Ongoing injury surveillance and research driven by this

– Rule modifications to reduce injury risk

– Promoting safety more broadly.


One of the major issues faced in rugby union is the risk of cervical spine injury, which can be catastrophic.  For this reason, much of the surveillance and associated research in this sport has focused on this particular type of injury. The most recent research has been compiled in this issue. MacLean and Hutchinson report an audit of admission to spinal injury units in young rugby union players in Great Britain and Ireland.  They concluded that certain game aspects relating to the tackle and scrum engagement need to be made safer to reduce these injuries.


Of course, knowing exactly what to do to make these game features safer requires good understanding of the underlying mechanisms of the injuries.  Two reviews by Dennison et al and Kuster et al provide different perspectives on the fundamental mechanism of cervical spine injury but both agree that the severity of the problem requires action on the part of the rugby delivery system.


Notwithstanding the absence of a clear underlying mechanism of injury, Dennison et al also stress that there are still some actions that people involved in rugby union – the administrators, coaches and players- can be doing now to reduce the risk of injury.  This is where programs such as BokSmart come in, through their broad approach outlined above.  The Australian Rugby Union has also instituted a Mayday procedure in which players who believe they are in a potentially dangerous on-field situation in a scrum can call out an alert so that the risk can be averted.  Using the RE-AIM Framework, Poulos and Donaldson demonstrate that whilst coaches’ awareness of the Mayday procedure is high, they still face significant challenges when trying to implement it in their usual coaching practice.


Like many other areas where identified injury risks require preventive solutions, rugby union is somewhat limited by the lack of a strong evidence-base for what should work and why.  Nonetheless, it is clear that peak bodies (in this case the national rugby union bodies) still need to respond to safety challenges and needs and develop multifaceted programs.


But ensuring success of these programs is not as straightforward as just having a procedure or education program in place. There also needs to be significant investment by, and commitment from, the same peak bodies to support the other factors that can impact of the reach, adoption, implementation and maintenance of these programs.


As injury prevention researchers, we should be providing significant support to these peak bodies, through actively engaging in partnerships with them to enhance the evidence to underpin their safety programs and to document the broader actions needed to sustain these programs so that they prevent injuries well into the future. Let’s do what we can to support BokSmart and other similar rugby injury prevention programs in other countries.



Caroline Finch is an injury prevention researcher from the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Monash Injury Research Centre, Monash University, Australia.  She specializes in both injury surveillance and implementation and dissemination science applications for sports injury prevention.  She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and a member of the Editorial Board of Injury Prevention; both journals are published by the BMJ Group.  Caroline can be followed on Twitter @CarolineFinch

(Visited 103 times, 1 visits today)