[Sheree Bekker] After reading ‘In a blink of an eye your life can change’: experiences of players sustaining a rugby-related acute spinal cord injury, I simply had to invite the first author, Marelise Badenhorst to write about her paper for this blog. 

Marelise Badenhorst is a Physiotherapist and PhD student as part of the Vrije University-NRF South Africa Desmond Tutu Doctoral Programme. She is based at the Division of Exercise Science and Sports Medicine at the University of Cape Town. Her research investigates the consequences of catastrophic injuries in South African Rugby Union players.

[Marelise Badenhorst] The aim of this study ¹ was to explore the injury experience and its related context, from the perspective of the catastrophically injured player. Semi-structured interviews were conducted with forty-eight players that had sustained a Rugby-related acute spinal cord injury (ASCI). Participants described the context around the injury incident and mechanism of injury, the factors they perceived to contribute to their injury, as well as the physical and emotional experience of ASCI.

Though rare, Rugby injuries are sometimes catastrophic in nature. The word is appropriate, as spinal cord injuries are indeed catastrophic, with life-altering consequences. Previous studies have investigated injury mechanisms, the effectiveness of prevention programmes and immediate medical management of these injuries. In contrast, we took an insider’s view into what players experience during their injury and factors that they considered to contribute. The study emphasises that the context around the injury, both in the scrum and tackle, could be extremely valuable to help minimise the risk. For example, in scrum-related injuries, participants described not being ready, or not properly aligned before impact. Factors such as these are important to consider within the complexity of the injury mechanism. These findings reiterate the importance of education and execution of proper technique and also emphasises the importance of the referee’s responsibility in ensuring safety in the player environment.

Participants also described factors they considered to contribute to their injury. These included descriptions of foul play, which included illegal tackles (both by themselves and others) and description of unsanctioned aggression with the intention to harm. Participants also reported playing in unaccustomed positions, especially in the scrum. Another factor that became apparent was the risk of injury for the ‘weekend warrior’, who play irregularly, without sufficient training, conditioning or coaching. Participants were often either not supposed to play, had stopped playing or had not played for a while, but were asked to play a match at the last minute. For some participants, the pressure to perform meant winning against all odds, which they felt led to increased risk-taking behaviour. Coaches, like parents, have substantial influence over the behaviour of players and they should be aware of that they have a responsibility for their welfare. Therefore, they are key role-players in all the factors mentioned above and have the power to play a role in the prevention of these catastrophic injuries.

The findings also provided unique insights to some of the first signs and symptoms of ASCI. This is relevant information for coaches, teammates and referees, who are often the first ones to reach the injured player, especially in the community. All participants described the sudden inability to move. Additionally, sensations such as intense burning, pins and needles and impairment of the senses are described. Several participants reported proprioceptive disturbances; players asked teammates to move their limbs or put them down, as it felt as if they are floating in the air or bent in awkward positions. While some players describe excruciating pain, others reported no pain indicating that the absence of pain is not necessarily the absence of injury. Importantly, players with ASCI were also generally alert and breathing normally, which might mislead first responders about the seriousness of the injury.

Major efforts have gone into the prevention of injuries in Rugby. Programs such BokSmart ² and RugbySmart ³ are key examples of dedicated national interventions. But preventing sports injuries is a complex matter ⁴ and it is important to acknowledge that the context in which these injuries occurs, matters ⁵. Of course, it is not one or two single causes that increases injury susceptibility, but rather combinations of factors that put the person in a vulnerable situation. Nonetheless, these experiences may be used to inform and educate players, coaches, referees and contribute to shaping context-driven interventions. For these players, theirs lived indeed changed within the blink of an eye. Their experiences should remind us that even one such injury, is one too many ⁶.

1. Badenhorst et al. ‘In a blink of an eye your life can change’: experiences of players sustaining a Rugby-related Acute Spinal Cord Injury’ (2018) (https://injuryprevention.bmj.com/content/early/2018/07/05/injuryprev-2018-042871)
2. BokSmart (http://boksmart.sarugby.co.za/)
3. RugbySmart (https://www.rugbysmart.co.nz/)
4. Bekker & Clark (2016) (https://bjsm.bmj.com/content/50/24/1489)
5. Bolling et al (2018) (https://link.springer.com/article/10.1007/s40279-018-0953-x)
6. BokSmart Vision Zero (http://boksmart.sarugby.co.za/content/visionzero