England may have been knocked out of the Rugby World Cup but, with the tournament building to a climax on English soil, the profile of the game has never been higher. Greater awareness is needed, however, of the ramifications of high-impact sports on children. 

High-impact sports and the medical repercussions for children

There is a huge drive to promote sports including football, cricket, rugby union, rugby league and tennis in schools, with a promise from the Health Secretary, Jeremy Hunt, that over 6,000 partnerships between schools and local sports clubs will be established by 2017.

While this is obviously a positive step for encouraging children to take up sport, there are real concerns that rugby carries such risks of injury that some circumspection should be exercised as it is promoted to young players.

The capacity for serious injury in rugby is significant. Rules have been introduced to lessen the frequency of collapsed scrums, an area that has traditionally been the source of a large proportion of injuries, including paralysis. The 'spear tackle', in which a player is lifted from the floor and dropped on his head or neck, is illegal, but even legal tackles, like the 'dump tackle' favoured by rugby league players, carry an element of risk if the tackler lacks control or technique.

More than just a kids' menu

In a high-tempo contact sport, the difference between the junior and professional game must be more marked than elsewhere. Research suggests that certain injuries, such as second concussion syndrome, have a greater impact on adolescents than adults; on a more practical level, young players simply lack the training and conditioning to withstand the same punishment as professionals.

Research from Australia has found that at least a third of professional rugby players have experienced spinal injuries equivalent to those sustained in a car accident or a fall from height. Vertebral fractures and severe neck injuries can occur at all levels of the game and, while the rules are continually evolving to promote safety, there are still controversies over management of on-field concussion.

All of these dangers are relevant to the sport at junior level; referees bear huge responsibility for ensuring that play remains safe and legal.

Junior players will not have access to the multi-million pound club infrastructure of doctors, physiotherapists and other healthcare professionals, potentially leaving them more vulnerable to undetected injury. In 2006, Research conducted by the British Journal of Sports Medicine found that children aged between 10 and 18 suffer cervical spine injury (CSI) more frequently from sports than from motor accidents. A delayed diagnosis of CSI can have dire consequences – if left untreated, a CSI can lead to paralysis and, in extreme cases, death. Players need to be monitored for red flag symptoms and deterioration, something that can be difficult to achieve for members of a Sunday league club.

What can be done?

There are calls for greater separation of the professional rules and the rules for rugby played in schools, allowing schools and their insurers to know, with greater certainty, the extent of their obligations to safeguard young players. The UK is a signatory to the United Nations Convention on the Rights of the Child, meaning that the government has a duty to inform children and protect them from risks of injury, and the medical profession has voiced its concerns; a poll of doctors in the British Medical Journal reported that 72% of doctors believed that the game should be made safer, with the editor-in-chief saying that 'the current state of monitoring and prevention of rugby injury in schools... needs urgent remedy before more children and their families suffer the consequences of collective neglect.'

While there has been a steady rise in the prominence of rugby since the professionalisation of the sport in 1995, there is still a dearth of data for incidences of injuries, including spinal damage and concussion, in the amateur game.

Greater participation in a compelling and dynamic sport is good news, but more needs to be done to ensure safety.