A recent study in the Journal of Neurosurgery, which found that former professional rugby players have greater cervical spine degeneration than the regular populous, raises the question, what is the true physical toll of playing rugby?

Rugby is a full contact sport in which the goal, similar to American football, is to carry the ball over the goal line or kick it over a goal post.  Unlike football, they wear little or no protective gear therefore technique and strength and conditioning are especially important to prevent injuries.

In different styles of rugby, certain types of injuries may be more prevalent. Traditional rugby is played with 15 players on each side. Rugby Sevens which is now an Olympic sport and will be played at the 2016 and 2020 Olympic Games, is played on a full-sized rugby pitch with only seven players on each side. At the 2015 Rugby World Cup next month they will play 15 v. 15. In Rugby League as opposed to Union, teams play with 13 players and the scrum is of less importance.

Dr. Thomas Trojian, a sports medicine specialist and team physician at Drexel University who assisted with the U.S. Rugby match against the London Harlequins this past weekend, explained that there are a lot less traumatic injuries then there used to be because of changes to the rules to better protect the players.

In the scrum is where there is the most potential for head and neck injuries because the players on one team bind together and push against the other side. When the proper technique isn't used, head and neck injuries can happen.

"Players need to know where to put their head and not to duck," he said.

"There are definite skill sets to prevent injury. In the younger leagues, referees can pull a player if they are not using proper technique," Dr. Trojian said.

The most common rugby injuries today are bruises, contusions, concussions and knee and shoulder injuries like other collision sports.

Dr. Demtrios Menegos, a Main Line Healthcare physician who specializes in orthopaedics and sports medicine broke it down even further: "Due to the nature of continuous play with limited substitutions, the majority of injuries in rugby are acute strains and sprains. These account for approximately 70% of all rugby injuries," he explained.

"Specifically, 40% of rugby injuries are muscular strains or contusions. These are mainly comprised of acute hamstring strains, quadriceps contusions and calf strains. These three injuries specifically account for three of the five most common rugby injuries."

"In addition, 30% of rugby injuries involve sprains, the most common of which are ankle sprains and Medial Collateral Ligament Sprains. Fractures account for approximately 9 to 10% of rugby injuries, with clavicle fractures being common among those. Concussions account for less than 5% of all rugby injuries. Spinal Cord injuries are very rare," he added.

"Most of the studies done in regards to rugby related injuries are based on full sided matches consisting of 15 players per team. When looking at Sevens rugby, what one will see is that many of the players suffer from overuse injuries and acute strains/sprains. This is due to the nature of Sevens, where players participate in 3 to 4 games per day, playing intense, but wide open seven minute halves over the course of 2 to 3 days."

"Most cervical spine injuries occur as a result of scrums collapsing during 15 a side rugby, in which eight players from each team interlock pushing neck to neck. Therefore placing the most experienced players in the front row of the scrum, decreases the incidence of injury."

Dr. Menegos explained, "New rules introduced during the professional era, have certainly made the scrum safer. The scrums in Sevens consist of only three players from each team and are therefore much safer."

Dr. Ted Loos of Great Life Chiropractic is a former rugby player and knows the physical toll of the game firsthand. "I haven't played for 15 years and I still have pain," he said. "The scrum can really put the neck in a bad situation."

In reference to the recent study done on retired rugby players he said, "International rugby is trying to make play safer. They have modified play to be more sensitive to the neck. It will be interesting to see the results of a similar study in another 10-15 years."

Dr. Loos in his practice treats some rugby players, mostly with lower extremity injuries. He doesn't see catastrophic injuries, but range of motion issues and chronic pain.

For him, the keys to prevention of injuries in rugby are fitness, flexibility and making the most of recovery between games by doing physical therapy, seeing a chiropractor or getting a massage. "Fitness is most important," he emphasized.

Dr. Menegos agreed. " The most important factor in terms of preventing injuries in rugby, is a comprehensive strength and conditioning program. Most rugby injuries tend to occur early in the season and in the second half of matches. This shows preseason training and conditioning is of the utmost importance in terms of preparing the players for matches, as most rugby injuries occur during match play, as opposed to training."

"Fatigue as the match wears on likely contributes to poor technique, which increases the risk of injury. Adequate preseason conditioning is therefore paramount in preparing for a very long rugby season."

Dr. Menegos believes that with the greater emphasis that is placed on improving conditioning programs, training, nutrition and providing players access to cutting edge sports medicine, players will come out of their professional rugby careers healthier than in the past.

"Rugby will create wear and tear by nature of the sports, but comprehensive sports medicine care will leave our players healthier moving forward," he added.

Read more Sports Doc for Sports Medicine and Fitness.