Abstract
There is an ongoing concern about the risk of injury to the spine in professional rugby players. The objective of this study was to investigate the prevalence of vertebral fracture using vertebral fracture assessment (VFA) dual energy X-ray absorptiometry (DXA) imaging in professional male rugby players. Ninety five professional rugby league (n = 52) and union (n = 43) players (n = 95; age 25.9 (SD 4.3) years; BMI: 29.5 (SD 2.9) kg.m2) participated in the research. Each participant received one VFA, and one total body and lumbar spine DXA scan (GE Lunar iDXA). One hundred and twenty vertebral fractures were identified in over half of the sample by VFA. Seventy four were graded mild (grade 1), 40 moderate (grade 2) and 6 severe (grade 3). Multiple vertebral fractures (≥2) were found in 37 players (39%). There were no differences in prevalence between codes, or between forwards and backs (both 1.2 v 1.4; p>0.05). The most common sites of fracture were T8 (n = 23), T9 (n = 18) and T10 (n = 21). The mean (SD) lumbar spine bone mineral density Z-score was 2.7 (1.3) indicating high player bone mass in comparison with age- and sex-matched norms. We observed a high number of vertebral fractures using DXA VFA in professional rugby players of both codes. The incidence, aetiology and consequences of vertebral fractures in professional rugby players are unclear, and warrant timely, prospective investigation.
Highlights
Rugby union and rugby league are intensely physical contact sports that place players at risk for frequent traumatic injury
There were no differences in age, BMI, body fat or bone mineral density (BMD) between rugby union and rugby league players (p.0.05)
Examples of vertebral fracture assessment (VFA) images and morphometry from our sample are presented in Figures 1 to 3
Summary
Rugby union and rugby league are intensely physical contact sports that place players at risk for frequent traumatic injury. Vertebral fractures (VFs) are under recognised and under-reported [26], with only around 1 in 4 receiving clinical attention [6] This lack of recognition is due both to the absence of notable symptoms, given that VFs commonly occur without pain of a sufficient magnitude to arouse concern, and there is often difficulty in determining the cause of symptoms [26]. This may be the case for rugby players who, with a higher than average pain threshold and being accustomed to injury, may be less likely to report minor pain or symptoms. Vertebral fracture may be a catalyst for degenerative disease, discopathy, kyphosis, back pain and neuroplaxia [27,37]
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