Part of Rugby injuries: where they come from and which ones matter
Rugby neck injury: the scrum, the tackle and what to do on the pitch
Warning signs, and when to get help
What to do if you suspect a neck injury on a pitch
Nothing, with your hands. That is the whole instruction, and it is harder to follow than it sounds, because a crowd of teammates standing over an injured player all want to do something useful. World Rugby's own first aid course material addresses that directly: it says that players and officials are often seen hurrying to turn an injured player onto their side, that this is unnecessary, and that it can make a spinal injury worse, and it asks whoever is taking charge to prevent it until an assessment has been made.
So the sequence is call, protect, wait. Call emergency services. Keep the player's head and neck as still as they are, which usually means kneeling at their head and asking them not to move rather than holding anything. Stop other people from lifting, rolling or dragging them. World Rugby's concussion guidance of August 2024 says that where a neck injury is suspected, the player should only be removed by emergency healthcare professionals with appropriate spinal care training.
The reasoning is the part that stays with you, because it survives the panic. Nobody at the scene can tell whether the spinal cord is permanently damaged or just temporarily squashed by an injury to the bones around it, which is exactly why the head and neck are moved as little as possible. The course's own summary of the whole module comes down to acting on doubt rather than waiting for certainty: if you are not sure, treat it as a neck injury.
Two players on that list will never say a word about their neck, and they are the two a club is most likely to get wrong. World Rugby's first aid course says to treat as a serious neck injury anyone who is unconscious, anyone with an injury above the collarbone, anyone with pain in the neck, anyone who has lost movement in the arms or legs or is having difficulty breathing, and anyone you are unsure about. A player who has been knocked out cannot report neck pain or weakness, which is why the course says he must be regarded as having a spinal injury until proved otherwise. The instinct to roll an unconscious player into the recovery position is the exact instinct this instruction exists to stop, unless the airway or the breathing is the problem.
One thing comes before all of that, and it is the only thing that does. Breathing takes priority: if the player is not breathing, cannot keep their airway clear, for example because there is blood or vomit in their mouth, or you cannot be sure whether the airway is open and they are breathing, that is dealt with first, and the person on the other end of the emergency call will tell you how. The uncertain case belongs here on purpose. The same material that asks for the neck to be held still says that a player with an open airway who is breathing need not be moved at all, and that a player you cannot confidently say is breathing has to be moved so that you can find out.
What raises the suspicion in the first place
World Rugby's immediate care module names the situations that should make anyone at the ground think about the neck, and they are specific to this sport in a way that a general first aid list is not. A head impact in the front row as the scrum engages. A scrum that collapses. The front row popping up out of the scrum. A head impact in a tackle. A neck injury from squeeze ball. A spear tackle. A fall from height, which includes being tackled in the air or dropped from a lineout lift. And any head injury where the player's level of consciousness is altered.
Alongside those it names what to look and ask for: pain down the middle of the neck or back, a spinal column that looks out of shape, loss of movement in the limbs, numbness, tingling, limbs that feel heavy, shock caused by the injured spinal cord, which the same course describes as skin that stays warm and pink rather than pale and clammy, with a slow pulse rather than a fast one, breathing that is difficult, breathing that moves only the belly rather than the chest, breathing that stops altogether, and, in a male player, a persistent erection. That last one is on the list because it is a recognized sign of a spinal cord injury and a bystander who does not know that will dismiss it.
Two of those items need translating for a club bystander. Pain down the middle of the back of the neck is not the same as the muscular ache across the top of the shoulders that everybody has after a scrummaging session. And a player describing heaviness, pins and needles or burning in both arms is describing something different from one dead arm, which is covered further down this page.
The general question of when any neck pain needs checking, away from a pitch, is answered on when neck pain is serious, and the rules hospitals use to decide on imaging after an accident are set out on whiplash. This page does not repeat them.
Is the scrum or the tackle more dangerous?
The tackle produces more neck injuries and the scrum produces worse ones. In an audit of 36 under 19 players admitted to spinal injury units in Great Britain and Ireland, with a mean age of 16.2, the tackle was behind 17 injuries, 47 percent, and the scrum behind 13, 36 percent. But some degree of spinal cord injury had occurred in 92 percent of the scrum injuries against 53 percent of the tackle injuries (MacLean and Hutchison, 2012). What those admissions amounted to is worth stating once rather than left as a proportion: 16 of the 36 had complete neurological loss, 9 had an incomplete neurological injury, and 11 had injured the bony column without damaging the cord. The authors state that the home unions carry out no prospective collation and that data collection is inconsistent, which is a limit the figures carry with them.
A systematic review of 14 studies of catastrophic injury across contact sports is where the rate usually quoted for rugby union comes from, 4.1 per 100,000 player hours, and that figure deserves reading before it is repeated: it rests on a single cervical dislocation recorded in 24,372 hours of elite play, the review counts it only on the assumption that the injury was catastrophic, and its confidence interval runs from 0.4 to 19.1. The review says in the same paragraph that if that one dislocation left no permanent damage, the rate would be 0.0, with an interval running up to 10.1. A figure that moves between zero and 4.1 depending on the outcome of a single case is evidence that these injuries are rare and badly counted, not a measured rate. In the four of those studies that followed mixed elite and recreational rugby players, the scrum accounted for 30 to 51 percent of these injuries and the tackle 29 to 39 percent, and the same four put the league figures beside them, where the scrum accounts for 0 to 4 percent and the tackle 78 to 100 percent (Hutton and colleagues, 2016). Different laws, different scrum, different numbers.
The mechanism itself is still argued about, and the balance has shifted across four decades. A narrative review from 2002 reported hyperflexion producing a fracture dislocation at the fourth and fifth or fifth and sixth cervical vertebrae as the most commonly reported mechanism, with hookers and props at disproportionate risk, the scrum dominant through the 1980s and the tackle rising through the 1990s (Quarrie, Cantu and Chalmers, 2002). In New South Wales, the incidence of tetraplegia in rugby union fell from 9.8 to 6.1 per 100,000 player years between 1986 and 2003, but the trend was not statistically significant, and nor was the parallel trend in league (Berry and colleagues, 2006). Reporting a decline as a fact would overstate what those authors found. Those are player years and the 4.1 in the paragraph above is player hours, so the two numbers are not two measurements of the same thing and cannot be set against each other.
For a front row forward it adds up to something small but usable. The positions that take the load have been named consistently for 20 years, the engagement and the collapse are the moments the governing body asks people to watch, and a neck that hurts in the middle at the back after either of them is a reason to come out, not a reason to pack down again.
What does an ordinary club neck injury look like?
Mostly stiff and sore, and costing a fortnight of rugby at most. In 262 Australian men's amateur club players followed through 31,143.8 hours of rugby, 90 neck injuries were recorded, 8 of them recurrent, at 2.9 per 1000 player hours with a confidence interval of 2.3 to 3.6. Of those injuries 69.3 percent were minor, 17 percent mild, 6.8 percent moderate and 6.8 percent severe, neck compression was the commonest mechanism, and cervical facet injury the commonest type (Swain, Pollard and Bonello, 2010). That study graded severity by weeks lost from play, with minor meaning under a week and mild meaning one to two weeks, so roughly 86 in every 100 cost two weeks of rugby or less. Weeks lost from play is not the same as the day your neck stopped aching.
Those proportions are the reason this page is written the way it is. Seven injuries in ten cost less than a week of rugby, which is exactly why the serious ones get missed: the base rate teaches everybody at the club that a sore neck after rugby is nothing. The warning signs are what separate the two, not how the player is walking off the field.
For the ordinary end of it, once a clinician has seen the neck and is happy, the program on neck pain is the general one, and a neck that has locked to one side overnight is more likely wry neck in adults. Pain with pins and needles running into one arm, lasting rather than passing, belongs with cervical radiculopathy.
What is a stinger, and why is it not a shoulder injury?
A stinger, which plenty of players call a burner, is the dead arm after a hit to the shoulder or the side of the neck: burning, numbness, tingling or weakness down one arm. World Rugby's immediate care module is precise about the timing, and the two halves are not the same: the burning and the numbness usually settle within seconds, while weakness can last longer. The symptoms come from the bundle of nerves that leaves the neck on its way to the arm (the brachial plexus), usually the fifth and sixth nerve roots or the upper trunks, which is why it belongs on a neck page even though the player points at a shoulder. That is also why shaking the arm out and running back on is not a decision anybody has made on evidence.
Our searching for this page found no readable rugby specific research giving figures or recovery times for stingers, so there are none here, and no program either. That absence is a finding about the research and not a statement that the injury is trivial. What there is instead is the governing body's own course material, and it is stricter than most clubs are.
World Rugby's immediate care module keeps a short list of what it calls on-field red flags for a stinger: symptoms in both arms, pain in the middle of the neck, neck movement that hurts, neck movement that is blocked, sensory symptoms that do not settle, and weakness that does not settle. Any one of those takes the player out of stinger territory. Then it adds the part that catches people out. A first stinger, and a repeat stinger that does not look like that player's usual one, should raise a high suspicion of a cervical spine injury, and the module says such a player is treated as a possible spinal injury and managed as one. So a first dead arm is not a dead arm until somebody qualified has said so: that player comes off, is not walked about or driven home, and gets help at the ground.
The page's answer rests on the warning signs it shares with the rest of this site, and they are not negotiable. What decides the speed is whether the symptoms have gone. World Rugby's own course has a section for the player who sustains a serious neck injury and then gets up and walks about, or comes to the touchline afterwards complaining of neck pain or electric shocks in the arms or legs. Its instruction is that major and minor injuries cannot be told apart in that setting, so he is treated as a serious injury with pressure on the spinal cord: moved very cautiously and as little as possible, sat down carefully with the head and neck supported, and more experienced medical help called. Letting a player with symptoms wander round the pitch, or drive himself home, is the part of this that gets missed.
The same day route is what is left when the arm has cleared completely, this has happened to that player before in the same way, and none of the red flags above is there. Symptoms in both arms at once, or anything in the legs, moves up to the same day at least and to emergency services if it comes with the signs in the list below. An arm that is still weak, still numb or still not working properly keeps the player off the field until somebody has examined the neck, however good the player says it feels. A shoulder that came out of its socket rather than went numb is a different injury and is covered on rugby shoulder dislocation.
Does neck strength training help?
It builds neck strength. That is the claim the evidence supports, and it is a smaller claim than the one usually made for it. A pilot randomized trial put 28 male under 18 regional age grade players, 15 in the intervention group and 13 in the control, through trainer led self resisted neck contractions of 15 seconds, three times a week for eight weeks, and total neck strength improved significantly, with an effect size of 1.2 (Attwood and colleagues, 2022). Each contraction was a maximal push against the player's own head, forward, backward and to each side, supervised at a regional training center through preseason in a squad already in full training. The trial measured strength, not injury, it was done in one age group, and a 28 player pilot is a starting point, not a result to build a policy on.
The wider field was reviewed in 2025 alongside a Delphi consensus exercise with 18 international experts, and the review's own summary of its 21 included papers is that the existing interventions are heterogeneous, which is to say that nobody is yet doing the same thing twice (Fownes-Walpole and colleagues, 2025). That summary and the size of the review are what its abstract states, and they are all this page takes from it: none of its 57 consensus statements is quoted here, because we have not read them.
So: worth doing while you prepare for contact, once somebody qualified has set it up for you, with a measured effect on strength, no demonstrated effect on injury, and no bearing at all on what to do when a neck is hurt. The seconds, the frequency and the weeks in that trial describe what was tested in one squad of under 18s with a trainer standing over them. They are not a program for a reader of this page, and not one for a coach to run off this page either, which is why this page sets out no neck exercise and no range of movement routine of its own: a neck that has been hurt in contact is examined before it is loaded, not loaded to see what happens. Those numbers also do not travel down the age groups or across to a women's side.
The players in that trial were regional age grade under 18 boys already in full training, with a trainer in the room, and that is the only group the trial can speak for, so a club that wants neck work for its juniors or for its women's team has a physiotherapist or a qualified strength coach set it up and look at each player first. A maximal push against your own head is not a thing to try unsupervised the first time, at any age.
Two readers should take nothing at all from those numbers. One is anyone with pins and needles, numbness or weakness running into an arm, which is a reason to be examined rather than to start a strength program. The other is anyone who has had an operation on the neck, because whether you ever push maximally against your own head again is a question for the surgeon who operated, and that trial was done in uninjured teenagers.
If your neck has started to feel as though it cannot hold your head up, that is in the warning list below and it means leaving the loaded neck work out until somebody has examined you. That line is filed under "Book an appointment" because for most people it is a within a few days job, but read its own words: if nobody has looked at your neck since the injury, it is the same day.
When to see a physio, and going back into the front row
A neck that has been checked and is settling is ordinary physiotherapy work, and two weeks of the same stiffness is the usual trigger for an appointment. Bring the detail that matters in this sport: your position, what happened in the contact, whether anything went into the arms at the time, and whether this has happened before. Recurrent neck injuries were 8 of the 90 in the club study above, so a second one gets taken more seriously than the first.
Going back into contact is where a sport page should stop talking. Who clears a player, and when, is decided by the clinician who assessed the injury, and after any head injury there are also rules set by your union, which are the subject of rugby return to play. This page carries no return timeline, no staged program and nothing about recovering from cervical spine surgery: if you have had an operation on your neck, your surgeon's plan is the only plan, and nothing here is a substitute for it. Whether a player goes back into contact at all after neck surgery is part of that plan and not a general rule anybody can look up, so it is the surgeon who operated who answers it, at your follow-up rather than off a web page.
The rest of the sport's injuries, and how the tackle comes to dominate them, are set out at rugby injuries. The warning signs below come first, at the speed each line sets, and the first line in the list is the one to read before you ever stand on a touchline.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: a player who has gone down in contact has pain down the middle of the neck or back, numbness, tingling, burning or weakness in the arms or legs, limbs that feel heavy, a neck or back that looks out of shape, or trouble breathing. Treat it as a neck injury in the same way if the player has been knocked out, or has any injury above the collarbone, because somebody who is not fully awake cannot tell you their neck hurts. Do not move the player, and do not let anybody roll them onto their side. Call emergency services, keep the head and neck as still as possible, and wait for emergency healthcare professionals with spinal care training to move them, which is what World Rugby's own immediate care and first aid course material instructs. If you are not sure whether the neck is injured, treat it as though it is. If the player is not breathing, cannot keep their airway clear, for example because there is blood or vomit in their mouth, or you cannot be sure whether the airway is open and they are breathing, that comes first, and the emergency call handler will tell you what to do.
- Emergency: severe neck pain after a knock to the head, whatever the fall or the knock was like. Keep still and call emergency services, and do not let anyone move you until someone trained has checked your neck. If the neck pain only starts later and nobody has checked your neck since, go to an emergency department straight away, and do not drive yourself.
- Emergency: in the first days after the injury, numbness, tingling, pins and needles or weakness in your arms or legs, or a sudden electric shock feeling in your neck and back that runs into your arms or legs. If it starts straight after the injury, keep still and call emergency services. If it starts later, call emergency services or go to an emergency department straight away, and do not drive yourself.
- Emergency: new problems walking, for example your legs feel stiff, heavy or weak or you have become unsteady on your feet, new trouble controlling your bladder or bowels, or hands that suddenly become clumsy, for example you can no longer do up buttons. Call emergency services straight away. These can be signs of pressure on the spinal cord in the neck.
- Emergency: after a knock to the head, being very drowsy or finding it hard to keep your eyes open, confusion, a fit (seizure), new weakness or numbness anywhere in your body, new trouble understanding, speaking, walking or keeping your balance, new problems seeing or hearing, clear fluid coming from your ears or nose, bleeding from your ears or bruising behind them, a black eye when your eye was not hit, a dent in your head or a wound with something stuck in it, or a change in behavior. Call emergency services straight away. These can be signs of an injury to the brain.
- Emergency: after a knock to the head, you were knocked out, even for a moment, you cannot remember what happened just before or after, you have had a headache ever since, or you are being sick (vomiting). The same applies, even if you feel fine, if you take medicine that thins your blood, other than aspirin on its own, have a bleeding or clotting condition, have had brain surgery in the past, or had been drinking alcohol or taking drugs when it happened. Go to an emergency department straight away, and do not drive yourself.
- Emergency: after a knock to the head, swelling, a deep cut or severe pain at the exact spot that was hit. Call emergency services or go to an emergency department straight away, and do not drive yourself. These can be signs of a broken skull.
- Emergency: any sign of a stroke, even if it goes away. That means a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, sudden dizziness with unsteadiness or falling over, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack). Call emergency services straight away. With neck pain, these can rarely come from a tear in an artery in the neck.
- Emergency: a new headache, or new pain on one side of your face, jaw or neck, with a drooping eyelid or a smaller pupil on the same side, or with a new pulsing or whooshing sound in one ear that keeps time with your heartbeat. Call emergency services or go to an emergency department straight away, and do not drive yourself. This can be a tear in an artery in the neck (cervical artery dissection), which can lead to a stroke.
- Emergency: a sudden, severe headache or neck pain that feels new and unlike anything you have had before. Call emergency services straight away.
- Emergency: new neck or back pain after a fall, a knock or a jolt, even a minor one such as a trip or a sudden stop in a car, if you have a condition that stiffens the spine, such as ankylosing spondylitis. Call emergency services or go to an emergency department straight away, do not drive yourself, and tell the staff about your spine condition, so they keep your neck and back in their usual position. A stiff spine can break after a small injury, and the break is easy to miss at first. If the pain started straight after the injury, or you also have numbness, tingling or weakness in your arms or legs, keep still and call emergency services.
- Emergency: your arm, hand or fingers turn cold, pale, blue or gray compared with the other side. Call emergency services or go to an emergency department straight away, and do not drive yourself. The blood supply to the arm may be blocked.
- Emergency: a stiff neck with a fever, a severe headache that is getting worse, pain when you look at bright lights, confusion, or a rash that does not fade when you press a glass on it. Call emergency services. These can be signs of meningitis.
- Emergency: after a ball, a boot, a hand or elbow, a collision or a fall to the face, any change to your sight, severe pain in the eye, a headache or finding light hard to bear, feeling sick or being sick, an eye you cannot move or keep open, or blood or pus coming from the eye. The same applies if something has pierced the eye or hit it at high speed, or if a strong chemical has gone into it. Go to an emergency department or call emergency services straight away, and do not drive yourself.
Get help today
- Same day: you have had a knock to the head and you take aspirin on its own, without any of the emergency signs above. Get medical advice the same day. Aspirin on its own is the only blood thinning medicine left out of the emergency line above, and the NHS still asks anybody taking a medicine that thins the blood to get urgent advice after a head injury.
- Same day: pins and needles in an arm together with neck or arm pain, or an arm that feels heavy or weak, and nobody has checked it yet. Get medical advice the same day. If it came on in contact and the symptoms are still there, or this is the first time it has happened, follow the first line in this list instead and get help at the ground, because World Rugby's own course material treats that player as a possible neck injury.
- Same day: an arm or hand that is getting weaker. Get medical advice the same day.
- Same day: pain or tingling in both arms at the same time, rather than in one. Get medical advice the same day. This can also be a sign of pressure on the spinal cord in the neck.
- Same day: hands that have slowly become clumsy, for example trouble doing up buttons or dropping things, or numbness in both hands. Get medical advice the same day. These can be signs of pressure on the spinal cord in the neck (cervical myelopathy). If the clumsiness or numbness gets worse quickly, call emergency services straight away.
- Same day: an electric shock feeling runs down your back or into your arms or legs as your head bends forward, without any of the emergency signs above. Stop and get medical advice the same day.
- Same day: you feel dizzy after a knock to the head, without any of the emergency signs above. Get medical advice the same day.
- Same day: neck pain with a fever or chills, or you feel generally unwell. Get medical advice the same day, and go to an emergency department if you feel very unwell.
- Same day: new neck pain and you have had cancer, now or in the past, or you have lost weight without trying. Get medical advice the same day and mention it. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a few days: your neck feels as though it cannot hold your head up, you keep having to support your head with your hands, or it feels as if it might give way, without any of the emergency signs above. Leave out the strength work and any exercise that asks your neck to hold or lift the weight of your head, and get your neck examined before you load it again: see a doctor or physio within a few days, and the same day if nobody has checked your neck since the injury.
- Within a few days: pain that is there all the time and does not ease with rest or changing position, or pain at night that keeps getting worse. See your doctor within a few days.
Common questions
What do you do if someone hurts their neck on the pitch?
Stop the game, do not move them, and call emergency services. World Rugby's own first aid course material says plainly that players and officials often hurry to turn an injured player onto their side, that this is unnecessary, and that it can make a spinal injury worse, and it asks whoever is in charge to take control and stop it happening until the player has been assessed. Its list of who gets treated as a serious neck injury is wider than most people expect: anyone unconscious, anyone with an injury above the collarbone, anyone with neck pain, anyone who has lost movement in the arms or legs or is struggling to breathe, and anyone you are unsure about. A knocked out player is on that list precisely because he cannot tell you his neck hurts. Its reasoning is worth knowing, because it is what makes the instruction stick: nobody at the scene can tell whether the spinal cord is permanently damaged or temporarily squashed by an injury to the bones, so the head and neck are moved as little as possible. World Rugby's concussion guidance adds that where a neck injury is suspected, the player should only be removed by emergency healthcare professionals with appropriate spinal care training. The one thing that comes before keeping the neck still is breathing: if the player is not breathing, cannot keep their airway clear, for example because there is blood or vomit in their mouth, or you cannot be sure whether the airway is open and they are breathing, that is dealt with first, and the emergency call handler will talk you through it. World Rugby puts the uncertain case on that side of the line as well, because a player who is breathing need not be moved, while a player you cannot confidently say is breathing has to be.
My neck hurts after a scrum. Is that serious?
Usually not, and the warning signs decide it, not the pain level. In 262 Australian men's amateur club players followed through 31,143.8 hours of rugby, 90 neck injuries were recorded, 8 of them recurrent, at 2.9 per 1000 player hours with a confidence interval of 2.3 to 3.6. Of those, 69.3 percent were minor, 17 percent mild, 6.8 percent moderate and 6.8 percent severe, neck compression was the commonest mechanism and cervical facet injury the commonest type (Swain, Pollard and Bonello, 2010). So the ordinary outcome of a sore neck after a scrum is a stiff neck that settles. What changes that is any of the warning signs on this page, above all severe neck pain, pain down the middle of the back of the neck, or anything going on in the arms or legs, and those are seen on the day rather than slept on.
Is the scrum or the tackle more dangerous for the neck?
The tackle produces more neck injuries and the scrum produces a higher proportion of severe ones, and that split is as close as the literature gets to an answer. An audit of 36 under 19 players admitted to spinal injury units in Great Britain and Ireland, mean age 16.2, found the tackle behind 17 of them, 47 percent, against the scrum behind 13, 36 percent, but some degree of spinal cord injury occurred in 92 percent of the scrum injuries against 53 percent of the tackle injuries (MacLean and Hutchison, 2012). A systematic review of 14 studies of catastrophic injury across contact sports is quoted for a rugby union rate of 4.1 per 100,000 player hours, although that comes from one cervical dislocation in 24,372 hours of elite play and carries a confidence interval of 0.4 to 19.1, so it says the injury is rare rather than how rare. In the four of those studies that followed mixed elite and recreational rugby players the scrum accounted for 30 to 51 percent of these injuries and the tackle 29 to 39 percent (Hutton and colleagues, 2016). The authors of the audit note that the home unions carry out no prospective collation and that data collection is inconsistent, which is a real limit on any count of this kind.
What is a stinger?
It is what players call the dead arm that follows a hit to the shoulder or the side of the neck: burning, numbness, pins and needles or weakness running down one arm. The burning and numbness usually settle within seconds, while weakness can last longer. The symptoms come from the bundle of nerves that leaves the neck and supplies the arm (the brachial plexus), which is why it is a neck problem wearing a shoulder costume, and why a player who shakes the arm out and carries on has not actually been assessed. Our searching found no readable rugby specific research giving figures or recovery times, so this page offers none, and no program. World Rugby's immediate care module does cover it, and what it says is stricter than most clubs are: symptoms in both arms, pain in the middle of the neck, neck movement that hurts or is blocked, or sensory symptoms or weakness that do not settle are its on-field red flags, and a first stinger, or a repeat one that does not look like that player's usual one, is treated as a possible spinal injury. A player who is up and walking but still has neck pain, or pins and needles or burning in an arm, is the situation World Rugby's own course calls impossible to read at the scene: it tells whoever is there to treat him as a serious neck injury, move him as little as possible, sit him down carefully with his head and neck supported, and get help. The same day rule is what is left when the symptoms have cleared completely, the player has had exactly this before, and none of those red flags is there. Symptoms in both arms at once, or anything in the legs, can mean emergency services.
Does neck strength training prevent neck injuries in rugby?
Nobody has shown that it does, and it has been shown to build strength. In a pilot randomized trial, 28 male under 18 regional age grade players, 15 in the intervention group and 13 in the control, did trainer led maximal self resisted neck contractions of 15 seconds three times a week for eight weeks, and total neck strength improved significantly, with an effect size of 1.2 and a mean difference of 155.9 plus or minus 101.9 newtons (Attwood and colleagues, 2022). That trial measured strength, not injuries, and 28 players is a pilot. A systematic review and Delphi consensus study of neck training aimed at reducing head acceleration events reports that the existing interventions are heterogeneous, which is a fair summary of the state of the field (Fownes-Walpole and colleagues, 2025). So neck training is a reasonable part of preparing for contact, it is not protective equipment, and nothing about it changes the pitchside instructions on this page. The seconds, the frequency and the weeks above describe what one supervised squad of under 18 boys was given in preseason, not a program to copy, and least of all on a neck that has just been hurt or on a younger or a women's side the trial never looked at.
References
- World Rugby Passport. World Rugby First Aid in Rugby, Chapter 5: Neck and spinal injuries in Rugby Union. https://passport.world.rugby/player-welfare-medical/world-rugby-first-aid-in-rugby/chapter-5-neck-and-spinal-injuries-in-rugby-union/
- World Rugby Passport. World Rugby First Aid in Rugby, Chapter 7: Circulation and shock, Neurogenic shock. https://passport.world.rugby/player-welfare-medical/world-rugby-first-aid-in-rugby/chapter-7-circulation-and-shock/neurogenic-shock/
- World Rugby Passport. Immediate Care in Rugby, Spinal Injuries: recognition, assessment and management. https://passport.world.rugby/player-welfare-medical/immediate-care-in-rugby/spinal-injuries/recognition/
- World Rugby Passport. Immediate Care in Rugby, Spinal Injuries: assessment and management. https://passport.world.rugby/player-welfare-medical/immediate-care-in-rugby/spinal-injuries/assessment-and-management/
- World Rugby Passport. Immediate Care in Rugby, Spinal Injuries: stingers. https://passport.world.rugby/player-welfare-medical/immediate-care-in-rugby/spinal-injuries/stingers/
- World Rugby. Concussion Guidance, August 2024. https://resources.worldrugby-rims.pulselive.com/worldrugby/document/2024/08/26/ab286493-d1b4-4213-b476-ee6309a3f9c9/Concussion-Guidance-August-2024.pdf
- Swain MS, Pollard HP, Bonello R. Incidence, severity, aetiology and type of neck injury in men's amateur rugby union: a prospective cohort study. Chiropractic and Osteopathy. 2010;18(1):18. https://doi.org/10.1186/1746-1340-18-18
- MacLean JG, Hutchison JD. Serious neck injuries in U19 rugby union players: an audit of admissions to spinal injury units in Great Britain and Ireland. British Journal of Sports Medicine. 2012;46(8):591-594. https://doi.org/10.1136/bjsports-2011-090183
- Hutton MJ, McGuire RA, Dunn R, Williams R, Robertson P, Twaddle B, Kiely P, Clarke A, Mazda K, Davies P, Pagarigan KT, Dettori JR. Catastrophic Cervical Spine Injuries in Contact Sports. Global Spine Journal. 2016;6(7):721-734. https://doi.org/10.1055/s-0036-1586744
- Quarrie KL, Cantu RC, Chalmers DJ. Rugby union injuries to the cervical spine and spinal cord. Sports Medicine. 2002;32(10):633-653. https://doi.org/10.2165/00007256-200232100-00003
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Written and checked by the PocketPhysio editorial team. Last updated 2026-11-06.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.