Cervical spine injuries prevention in elite male rugby players: an electromyographic study on neck muscles activity

Background: Rugby is a high-contact sport with a significant injury risk, particularly cervical spine trauma. The repeated mechanical overload can contribute to long-term cervical dysfunctions. Surface electromyography (sEMG) and inertial sensors (IMU) offer valuable insights into neuromuscular function. Methods: This observational cross-sectional study followed STROBE guidelines. We included male professional rugby players with at least two years of experience. An anamnestic assessment was performed to collect data on previous injuries; sEMG was applied to the sternocleidomastoid and cervical paraspinal muscles, and the IMU on the head. Athletes performed lateral bending, flexion-extension, and rotational head movements to analyze head kinetics, energy content, muscle symmetry, and activation timing. Results: Thirty-six players participated, including 25 forwards (14 1st-line, 11 2nd/3rd-line) and 11 backs. Most athletes trained their necks 0 to 2 times per week, with 30.6% performing 2 sessions weekly. The 41.7% of players reported 1 concussion. Lateral bending and rotation exhibited low symmetry mostly on sternocleidomastoids. First line players showed reduced range of motion (ROM) in right head rotation (ROT-R ROM, r=-0.377, P=0.023) and flexion (FL ROM, r=-0.330, P=0.049). Backs players demonstrated significantly higher ROM across all movements, particularly in bilateral head rotations (ROT-R ROM, r=0.353, P=0.034; ROT-L ROM, r = 0.402, P<0.15). Conclusions: This study highlights the importance of monitoring cervical muscle symmetry and mobility as potential risk factors for cervical pain. The findings suggest that personalized rehabilitation programs focusing on strengthening, mobility, and proprioception training could help mitigate cervical spine pain.