Head collisions in sport can result in catastrophic injuries to the cervical spine. Musculoskeletal modelling can help analyse the relationship between motion, external forces and internal loads that lead to injury. However, impact specific musculoskeletal models are lacking as current viscoelastic values used to describe cervical spine joint dynamics have been obtained from unrepresentative quasi-static or static experiments. The aim of this study was to develop and validate a cervical spine musculoskeletal model for use in axial impacts. Cervical spine specimens (C2-C6) were tested under measured sub-catastrophic loads and the resulting 3D motion of the vertebrae was measured. Specimen specific musculoskeletal models were then created and used to estimate the axial and shear viscoelastic (stiffness and damping) properties of the joints through an optimisation algorithm that minimised tracking errors between measured and simulated kinematics. A five-fold cross validation and a Monte Carlo sensitivity analysis were conducted to assess the performance of the newly estimated parameters. The impact-specific parameters were integrated in a population specific musculoskeletal model and used to assess cervical spine loads measured from Rugby union impacts compared to available models. Results of the optimisation showed a larger increase of axial joint stiffness compared to axial damping and shear viscoelastic parameters for all models. The sensitivity analysis revealed that lower values of axial stiffness and shear damping reduced the models performance considerably compared to other degrees of freedom. The impact-specific parameters integrated in the population specific model estimated more appropriate joint displacements for axial head impacts compared to available models and are therefore more suited for injury mechanism analysis.

Knowledge of neck muscle activation strategies prior to sporting impacts is crucial for investigating mechanisms of severe spinal injuries. However, measurement of muscle activations during impacts is experimentally challenging and computational estimations are not often guided by experimental measurements. We investigated neck muscle activations prior to impacts with the use of electromyography (EMG)-assisted neuromusculoskeletal models. Kinematics and EMG recordings from four major neck muscles of a rugby player were experimentally measured during rugby activities. A subject-specific musculoskeletal model was created with muscle parameters informed from MRI measurements. The model was used in the Calibrated EMG-Informed Neuromusculoskeletal Modelling toolbox and three neural solutions were compared: i) static optimisation (SO), ii) EMG-assisted (EMGa) and iii) MRI-informed EMG-assisted (EMGaMRI). EMGaMRI and EMGa significantly (p¡0.01) outperformed SO when tracking cervical spine net joint moments from inverse dynamics in flexion/extension (RMSE = 0.95, 1.14 and 2.32 Nm) but not in lateral bending (RMSE = 1.07, 2.07 and 0.84 Nm). EMG-assisted solutions generated physiological muscle activation patterns and maintained experimental co-contractions significantly (p¡0.01) outperforming SO, which was characterised by saturation and non-physiological "on-off" patterns. This study showed for the first time that physiological neck muscle activations and cervical spine net joint moments can be estimated without assumed a priori objective criteria prior to impacts. Future studies could use this technique to provide detailed initial loading conditions for theoretical simulations of neck injury during impacts.

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In Rugby a high proportion of catastrophic cervical spine injuries occur during tackling. In the injury prevention literature, there is still an open debate on the injury mechanisms related to such injuries, with hyperflexion and buckling being under scrutiny. The aims of this study were to determine the primary cervical spine injury mechanism during head-on rugby tackling, and evaluate the effect of tackling technique on cervical spine intervertebral loading. We conducted an in silico study to examine the dynamic response of the cervical spine under loading conditions representative of accidental head-on rugby tackles by using a subject-specific musculoskeletal model of a rugby player. The computer simulations were driven by experimental in vivo data of an academy rugby player tackling a punchbag, and in vitro data of head-first impacts using a dummy head. Results showed that: i) the earlier generation of high compression and anterior shear loads with low values of flexion moments provides evidence that hyperflexion is unlikely to be the primary injury mechanism in the sub-axial cervical spine (C3-C7) during central and posterior head impact locations; ii) a higher degree of neck flexion at impact poses the cervical spine in a more hazardous position. These findings provide objective evidence to inform injury prevention strategies or rugby law changes, with the final view of improving the safety of the game of rugby.