Physiotherapy Exercises For Neck Pain

Injuries are common in rugby, with roughly 1 injury per 1.9 games in the 19/20 season in the UK. Around 25% of injuries were sustained to the neck and face – this includes simple facial cuts through to spinal injuries. In Australia, approximately 3 injuries occur per 1000 hours playing with approximately 3-9% of all injuries occurring in the neck. 46% of players reported a neck injury at least once in their career. Injuries during games are significantly higher than training. The front 3 and back rows represent the highest injury rate with longer periods out of the game. Prehab, good coaching and rule changes to maintain player safety can help limit injuries. The issue with any level of spinal injury is that the results can be catastrophic, but that doesn’t mean they will be. Spinal cord injuries are fairly rare within rugby, never less, we should be mindful to do all we can to continue preventing them.

The neck, or cervical spine, is made up of 7 vertebrae in the superior aspect of the vertebral column. Its role is to provide an adequate range of motion of the head and to protect the spinal cord. The cervical spine is supported by ligaments that run throughout the vertebral column and ligaments specific to the neck. Further support is provided by the surrounding musculature. The neck attaches to the skull using a peg in-holes-like system, supported by strong ligaments and musculature. To note, the average head weighs about 5kg, therefore we need a good support system to allow the head and neck to move through all its available ranges. Neurologically, the spinal cord controls everything below each level; therefore an injury high in the spinal cord can cause symptoms throughout the arms, trunk and legs. Outside of the spinal cord, the nerves of the neck control the shoulders and arms.

Neck injuries can occur during any phase of the game such as neck hyperextension when a scrum collapses. Other common injury scenarios include forced flexion during a high impact tackle (similar to a whiplash-type injury) and high tackles. The front five in particular require good neck strength due to the nature of their role; scrummaging, rucking, mauling and are generally the heavier players therefore high impact tackles etc. If you know anyone who has been in a scrum, they will tell you the pressure felt throughout the body is huge. Scrums present with a high level of injury risk due to the force involved. Individually forces can be up to 200kg with a combined load of up to 800kg as a full pack. Hence it is essential for players to have a strong neck as well all the other muscle groups. The laws of the game have changed a lot over the past few years, particularly in regards to scrummage and high tackles. Limiting the impact at the scrum to reduce the forces put on players and red card offences for high tackles to encourage better technique and body control are two changes that have occurred to improve player welfare.

Concussion

The evidence now states that stronger neck muscles lead to reduced concussion risk. In fact, the RFU’s ACTIVATE injury prevention programme has been shown to reduce concussions by up to 59% when completed three times a week.

Neck training is a common part of rugby training, particularly for the front 5 forwards. Outside of professional sport (particularly rugby, boxing, formula one), there is, what I believe, a somewhat stigma around strengthening the neck. Anecdotally, patients seem to be fearful to strengthen their necks or just don’t think of it as an area of the body to strengthen. I also think there is a lack of understanding around this area, which I fully understand. When was the last time you went to the gym and did neck day? When it comes to strength training, there really isn’t much difficulty between strengthening a knee or a neck. The simple aim is to build bigger and stronger musculature. Combined with proprioception training, this improves both sports performance and reduces injury risk. Like the knee, we train the muscle to let us run fast, lift heavier, turn faster whilst reducing the risk of injury. The neck is no different and this is particularly prevalent for rugby. A stronger neck will allow the player to push harder in the scrum, absorb impact better in a tackle and maintain a sustainable drive in a maul.