A serious or catastrophic concussion, head, neck or spine injury is a very real risk in a contact sport such as rugby union. However, very few of these injuries occur relative to the number of player exposure hours to the training and playing of rugby. An acute brain or spinal cord injury can lead to severe and/or permanent functional disability. This can range from death, to permanent damage such as quadriplegia, tetraplegia, paraplegia, or to what is commonly termed a “near miss” injury; this refers to an acute brain or spinal cord injury with complete recovery or partial recovery with some residual damage remaining after the injury. Due to the enormous following and immense amount of media exposure given to rugby union in South Africa, a huge amount of pressure has been placed on Rugby’s controlling body to make the game safer for all involved in the game and reduce the risk of these injuries occurring. Given the diversity of the South African population, the demographic vastness of the country, and the great economical disparity between communities, it is a challenge to implement a program of this nature.

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In school-boy rugby, an average of seve a year, and in Rugby Union as a whole, an average of 14 serious and/or catastrophic injuries a year have been reported to the Fund over this time period. The average catastrophic spinal injuries (those players with no or little chance of recovery) in school-boy rugby average two a year, club rugby, three a year, and combined five a year. This does not however account for those injured players missed or not picked up by the system.

The accuracy of these statistics has greatly improved over the last few years, and since 2006, is a close reflection of the occurrence of these injuries in SA. Compared to New Zealand, where they have been averaging around 1-2 per year since 2001, South Africa’s statistics are high. However, there are between 400 000 - 500 000 players playing rugby in South Africa vs. approximately 150 000 players in New Zealand, which represents around 2-3 times more players exposed to rugby and the risk of serious and/or catastrophic injury. Regardless of this fact, the statistics are still too high, and one of these injuries, is one too many. The common and ultimate goal of the BokSmart, Rugbysmart, Smartrugby, the IRB’s Rugby Ready and other similar program initiatives in the world are to eliminate these from the game.

The impetus for the development of a program like BokSmart increased in 2006 after various action groups approached the South African government to complain about the high incidence of serious head, neck and spine injuries that occurred on rugby fields across South Africa. Government then approached SA Rugby and requested that SA Rugby develop a safety program to address this very important and concerning issue.

As a result of this directive SA Rugby then held talks with all the relevant rugby stakeholders around the country. A stakeholder meeting was held in 2006 and a key decision was made to compile a strategic framework and funding plan for consideration, which was presented and refined at a second stakeholder meeting in May 2007. The agreed upon solution was to develop a rugby safety program along the lines of the one currently used in New Zealand (Rugbysmart). The New Zealand Rugby Union and their joint partner, the NZ national insurance fund or the Accident Compensation Corporation (ACC) have been exceptionally effective in reducing the number of serious and/or catastrophic head, neck or spine injuries by more than 80% since making their annual Rugbysmart course compulsory for all coaches and referees in 2001. The Rugbysmart initiative has widely been revered as the golden standard in sporting injury prevention programs around the world.

At a third stakeholder meeting in December 2007, funding was secured for the BokSmart project, a position of National manager was advertised and the successful candidate started in January 2008. BokSmart has since then come about as a result of an exciting partnership between the South African Rugby Union and the Chris Burger/Petro Jackson Players’ Fund. Both of these well respected rugby organisations in SA have made a keen investment of time and effort to make rugby safer for all participants. Absa, one of the biggest sponsors of South African rugby, also came on board and is the main sponsor of the BokSmart program.

The first job of the new management was to initially start researching the most appropriate strategy for implementing this type of program in SA. We approached similar initiatives around the world; more specifically the NZ ‘Rugbysmart’ and Australian ‘Smartrugby’ programs to learn from them and try to figure out what would be most effective within our culturally and demographically diverse country.

Both international unions were very accommodating and willing to share their experiences over the years with us and contribute to the ultimate benefit of rugby as a game and the safety of its players. We learnt a great deal from them and are extremely grateful for their assistance. A local provincial initiative called Sharksmart (an injury prevention program running in one specific area of South Africa) was also consulted and provided valuable insight into this type of program. We then tried to combine the most successful strategies of the different programs, and bring a very unique South African flavour to it.

The strategic framework for BokSmart rests on 5 main pillars:

• Coaches and referees
• Medical protocols
• Research
• Legislation
• Marketing and communication