# Cervical Spine Degeneration in Rugby Players: Position-Specific Differences in Radiographic and Clinical Outcomes Among 64 Brazilian Athletes

## TL;DR

Rugby forwards show more cervical spine degeneration and pain than backs, suggesting position-specific risks for spinal issues.

## Contribution

Identifies position-specific differences in cervical spine degeneration and pain among rugby players using radiographic and clinical data.

## Key findings

- 20.3% of rugby players showed cervical spine degeneration.
- Forwards reported significantly higher pain than backs (p = 0.007).
- Cervical lordosis deviations correlated with higher pain scores (p = 0.024).

## Abstract

Background: Rugby exposes athletes to high mechanical loads, especially during scrums and tackles, potentially predisposing players to early cervical spine degeneration. This study evaluated the prevalence of degenerative changes in the cervical spine and sagittal alignment alterations in Brazilian rugby athletes, with secondary analyses comparing forwards and backs and examining associations between alignment parameters and pain and disability. Methods: Sixty-four professional rugby athletes underwent cervical spine radiography, and the images were analyzed for degenerative findings and sagittal parameters (cervical lordosis, T1 slope, cervical sagittal vertical axis, and T1–CL mismatch). Pain and disability were assessed using the Visual Analogue Scale (VAS) and Neck Disability Index (NDI). Comparative analyses included Student’s t-test and Fisher’s exact test, while additional exploratory analyses were performed using correlation and multiple linear regression models. Results: Cervical degeneration was present in 20.3% of players. Forwards reported significantly greater pain than backs (VAS: 1.64 ± 1.58 vs. 0.76 ± 0.93; p = 0.007). Deviations in cervical lordosis (>2 SD from normative values) were associated with higher VAS scores (p = 0.024). No significant associations were found between T1 slope or cervical sagittal vertical axis and pain or disability. Conclusions: Forwards demonstrated greater symptom burden and a higher prevalence of cervical degenerative changes, suggesting that positional demands may contribute to early cervical spine alterations. These findings highlight the need for targeted preventive strategies and support future longitudinal investigations to clarify the progression and clinical relevance of cervical misalignment in collision-sport athletes.