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gains (13). Hence with children it’s important that correct technique of joint movement is taught with resistance exer- cises carried out using a theraband, until the post-adolescent period where the body adapts.

Changing the laws of the game particularly in rugby union has helped de-power the impact of certain phases of play in chil- dren’s rubgy. At schoolboy level the scrum has become de-powered due to feedback to administrators following statistical collec- tion of data regarding the potential injury risks to the cervical spine.

4. Improve proprioception of the cervical spine Proprioceptive training is an important part of rehabilitation post-injury and it address- es three levels of motor control: a) spinal reflexes b) cognitive programming c) brainstem activity

The orientation of the head in space with respect to the trunk is governed by visual, vestibular and cervical proprioceptive infor- mation (14). Which of these is dominant has not yet been established, however experimentally it is felt that cervical spine proprioceptive information predominates (15). Kinesthetic performance was believed to be linked to muscular and articular receptors in the cervical spine. Unfortunately the kinesthetic studies on the cervical spine in sportsman are not well known. Studies on healthy subjects with neck pathology have shown that cervical pain alters the ability of the neck to repo- sition itself in both the horizontal and frontal planes. Thus a player who has an acute ‘stinger‘ is at risk of further injury due to the influence of the pain response.

In collision sports often the player will compete with some degree of neck pain or muscle pathology. This might occur in the match and is quite common in front row forwards in rugby. These players usually show signs of early cervical spine degener- ation which would affect the normal articu- lar response (4). Potentially this could be a mechanism for further injury to the cervical spine but in rugby union there is no evi- dence to support this.

However it was found that in American Football at intercollegiate level, of the players that received neck injuries, 50% of

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Figure 7: Demonstration of the use of the tackle shield for checking technique of the arm position in the tackle in Rugby Union

Figure 8: Demonstration of the use of the tackle shield for checking technique of the head, neck and arm position in the tackle situation in Rugby Union

together to address abnormalities in tech- nique with the individual player. Learning a good technique is vital at an early age not only to prevent injury, but also to enhance skill acquisition. The use of video techniques provides an ideal learning tool for the player.

Figure 6: Proprioceptive neuromuscular facilitation technique of ‘stabilisations’ of the glenohumeral joint with the ball providing proprioceptive input to the cervical spine.

those players had experienced significant neck pain before the injury occurred (16).

In the ‘stinger’ where the brachial plexus has been stretched, or the cervical joints have been compressed in the ‘pincer’ movement, proprioceptive exercises should be incorporated into the rehabili- tation programme. These exercises enhance the neuromuscular control required for precision movements and contribute to the muscle reflex required for joint stability. Traction to the plexus in the ‘stinger’ may alter the normal neu- rological feedback mechanism which con- trols muscle stability about a joint thus causing potential for further injury.

Proprioceptive exercises may include use of the small ball against a wall (Fig.6) or by proprioceptive neuromuscular facilitation (PNF) stabilisations to the cervical spine. In the ‘stinger’ as the biomechanical chain is linked, both the thoracic spine and weightbearing through the arm must be incorporated in proprioceptive retraining.

5. Correct abnormal biomechanics Physiotherapists and coaches must work

In rugby one of the most vulnerable situ- ations causing the ‘stinger‘ is the tackle. Players must be taught to tackle correct- ly. In the rugby scrum situation ‘illegal‘ scrummaging methods in the ‘hit’ must be eradicated. In understanding the biome- chanics of a sport, referees, coaches and administrators have a major role to play in the prevention of injury.

6. Teach functional specific exercises relative to the individual’s sport Following a ‘stinger‘ injury the player must be rehabilitated and have undergone rehabilitation exercises in the injury caus- ing situation.

The early stage of the rehabilitation pro- gramme should concentrate on specific goals: - increase range of movement of the cer- vical spine - increase isometric and isotonic strength of the cervical spine muscles and the bio- mechanical chain - increase neural tissue mobility - increase proprioception of the cervical, thoracic spines and the upper limb.

Following this, specific functional exercis- es are given to return the player to sport. In rugby union the use of tackle bags and shields is very useful to allow the cervical spine and shoulder joint to take con- trolled contact to functionally stress the