The scrum under scrutiny: Better coaching, better refereeing and better insurance cover are just some of the issues to be addressed in the debate about this intrinsic part of the game, argues Jack Anderson

Peter Stringer's performance during Munster's European Cup victory in Cardiff on May 20th has been widely praised. The bravery of the diminutive scrumhalf, epitomised by his first-half try, earned him the man of the match award.

Stringer's opportunistic score was facilitated by a solid Munster scrum and, in particular, the power of tighthead John Hayes. However, if a leading consultant general surgeon at the University Hospital in Nottingham has his way, contested scrums of this nature will cease to be part of the game of rugby union.

In the most recent edition of the British Medical Journal, James Bourke has called for contested scrums to be banned because of the risk of paralysis. Bourke argues that the consequences of injury are so great that the continuing risk of injury cannot be accepted.

Bourke's views are personal. They are not the product of a controlled study but originate from his 30 years as the honorary medical officer to Nottingham Rugby Club. In that time, he has had experience of seven serious spinal cord injuries, with two of the players now wheelchair-dependent. Six of the seven injuries were related to contested scrums.

Clearly, rugby union is an invasive contact sport. Bourke cites an Australian study from 2005 that looked at acute spinal cord injuries among players of rugby union, rugby league, Australian Rules football and soccer. The average annual incidence of such injuries per 100,000 players was 3.2 for rugby union, 1.5 for rugby league, 0.5 for Australian Rules, and 0.2 for soccer.

These dry statistics were put in context during Ireland's Triple Crown victory at Twickenham on March 18th when the RFU's guest of honour was former England Under-21 player Matt Hampson. Hampson was rendered paralysed after a neck injury sustained during a collapsed scrum in a full-contact England Under-21 training session last year.

A crucial issue highlighted by Hampson's injury, and flagged by Bourke, is player insurance. It appears most rugby players in Britain are significantly under-insured. In an interview this year with the Times, Hampson noted that the RFU's policy, which provides £625,000 (€900,000)of cover for amateurs and a little over £1 million for professionals, must be contrasted with estimates of lifetime medical care and costs for a permanently disabled individual in his 20s as between £5 million and £8 million.

Hampson, an inspirational figure, is fortunate that his club, Leicester, have raised over a quarter of a million for his trust fund. Not all players can avail of the support of a powerful and popular club.

Although the support given in Ireland by the IRFU's Charitable Trust for seriously injured players is significant, participants should also heed the view of the chief executive of the Professional Rugby Players' Association in England, Damien Hopley: "The irony is that you get players who spend more on their car insurance than on their personal insurance in a gladiatorial contact sport."

To be fair, the rugby authorities have long been aware of the dangers associated with contested scrums. The rules of the game have been altered in numerous ways. Referees have an obligation to tell frontrows to crouch and hold before engaging. Only players suitably trained and experienced in playing the frontrow can replace injured props and hookers; otherwise scrums from thereon are uncontested.

At underage level, scrums cannot be wheeled more than 45 degrees, as opposed to 90 degrees at senior level, and the scrum is not allowed to be pushed more than 1.5 metres.

Equally, players, while anxious to assert their physical superiority wherever possible, are acutely aware of the dangers. For example, during the semi-final of the World Cup in 2003, Australian prop Ben Darwin lost the feeling from his neck down after being buried under a collapsed scrum.

Subsequently, he paid tribute to his All Blacks opponent, Kees Meeuws, for saving him from possible further injury. On contact in the scrum, Darwin had heard a crack and called out "neck, neck, neck". Meeuws immediately stopped pushing, thus preventing Darwin from crumpling to the ground.

The elephant in the room in the debate on contested scrums is the law. The comprehensive amendments to the regulation of the scrum were prompted in part by the International Rugby Board's (IRB) experience in the Australian High Court in 2000. In that case, two young men were seriously injured while playing in local leagues.

Both suffered broken necks and serious spinal injuries when their scrums failed to form properly. It appears that the opposing teams charged before the claimants' teams had positioned themselves, leaving their necks exposed.

Ultimately, the claimants sued the IRB on the grounds that the IRB had negligently failed to update its rules to reduce the risk of spinal injury. Although the IRB avoided liability - the Australian High Court held that a world governing body had no duty of care towards individual players - reaction to the ruling, in the form of amendments to the rules of rugby, was swift and comprehensive.

Rules, however, are only as effective as the manner in which they are implemented. The past decade has seen a number of referees facing liability for negligently failing to implement the laws of the game. In 1996, an English player, Ben Smolden, was successful in his claim against a referee after he broke his neck in a collapsed scrum. The injury occurred in an under-19s game, where there had been continuous collapsing of scrums and the referee had clearly failed to implement the "crouch and hold" procedures for the engagement of scrums.

In 2003, the English Court of Appeal upheld a ruling that former Welsh club player Richard Vowles had been a victim of the referee's negligence after a scrum collapsed and damaged his spine. In legal terms, Vowles argued successfully that the referee, by allowing the scrum to be weakened by an inexperienced player, was in breach of his duty to take reasonable care for the safety of the frontrow forwards.

It appears the referee, a solicitor, had not asked Vowles, who had lined out as a reserve frontrow substitute, whether he was trained to play at hooker. Approaching the end of the game, and with the pitch in an atrocious state, the scrum collapsed, crushing Vowles' spine.

Other contact sports have long faced the circumspection of the medical and legal professions. The British Medical Association has, for instance, been a leading lobbyist in the campaign to ban boxing, or at least to prohibit blows to the head. The boxing fraternity has rejected these arguments, noting that the statistical rates of injury are, relative to motor, mountaineering and equine sports, quite low and infrequent. Boxers note that to ban blows to the head would fundamentally alter the nature of their sport and that the medical profession is, on occasion, overly paternalistic in its attitude towards contact sport.

A similar debate must take place in rugby union as to the future of contested scrums, a set-piece that is still seen as an integral aspect of the game. In Ireland, that debate takes place in the context of an increasingly litigious society. Undoubtedly, a combination of better coaching and refereeing standards, as well as enhanced insurance and medical facilities, will minimise the threat of litigation, as will a general acknowledgement that participation in contact sports such as rugby is underpinned by a legally recognised assumption of risk.

Put simply, injuries will always occur in rugby union. Darwin's injury eventually forced him to retire prematurely. Matt Hampson's regrettable and catastrophic injury occurred in a controlled environment where the training session in question had been supervised by leading international referee, Tony Spreadbury.

Nevertheless, it is suggested that where every reasonable effort is being made by a sports body to avoid unnecessary risk and to fund compensation, then the law should avert its gaze and enjoy the game.

Or, as Darwin put it in his retirement statement: "Rugby is a great game . . . Accidents sometimes happen in life and in sport, so I don't regret playing the game at all. It has provided me with countless friends and contacts that I will have for life."

Jack Anderson lectures in law at Queen's University, Belfast