Broken bones, torn ligaments, cuts, bruises, and stiff backs in retirement are all part and parcel of rugby—one of the toughest and most physically demanding sports in the world.
However, no one signs up for permanent, progressive brain damage potentially caused by cumulative concussive or sub-concussive blows to the head sustained over a rugby career.
Rugby has been slowly waking up to its concussion problem over the last few years. Acknowledgment of the issue has accelerated due to a class-action lawsuit involving almost 300 former players against World Rugby, the Rugby Football Union (RFU), and the Welsh Rugby Union (WRU) for negligence and failure to put in place reasonable measures to protect their health and safety.
Long-term neurological complications from repeated impacts to the head in rugby are alleged to cause disorders in some former players, such as early onset dementia, epilepsy, motor neurone disease, and Parkinson’s disease.
High-profile cases like that of England’s 2003 Rugby World Cup winner Steve Thompson have sent shockwaves through the sport. When he revealed he had been diagnosed with early onset dementia, it opened the door for hundreds of other former players to share similar stories.
New research suggests a causal link between repeated blows to the head in rugby and various neurological conditions. A 2023 study led by the University of Glasgow found that rugby players who played for longer were at a higher risk of developing a degenerative brain disease. Out of 31 donated brains analyzed, 21 had evidence of a condition linked to repeated head injuries and concussions. Worryingly, 68% of the brains had traces of chronic traumatic encephalopathy (CTE), and with each extra year played, players had a 14% increase in the risk of developing CTE.
Similar potential risks exist in other sports, including American football, soccer, and boxing. However, given the frequency of high-impact collisions in rugby and the apparent increase in head injuries since Rugby Union turned professional, there may be greater cause for concern.
The lead study author, Professor Willie Stewart, argues that reducing head impacts in rugby games and training is necessary to mitigate the risks, but the sport is currently not doing enough to address the problem. “It’s the shaking and twisting and rotating of the head thousands of times over decades that’s likely to cause deep damage in the brain,” he explains.
While certain measures to improve player safety, such as lowering tackle height and educating coaches, players, and parents, will undoubtedly help, these steps may not go far enough in addressing the problem. ‘Smart’ mouthguards, which can measure head movements, are another innovative solution that can provide data to monitor the safety of players. A pitch-side concussion assessment for players with head injuries is used in the professional game, but obtaining the requisite expertise to conduct a thorough assessment on the sidelines may not be readily available at all levels of the game.
The NFL has already faced a similar battle with a class-action lawsuit in 2013. A $765 million settlement with thousands of former players was eventually reached after they sued, claiming they had been misled about the long-term risks of head injuries. This sparked changes in how players were managed in training, with strict limits imposed on the number of contact sessions players were allowed to have.
Rugby’s governing bodies have been slower to impose practical measures. However, in response to the ongoing litigation, they released a joint statement: “Player welfare is rugby’s top priority, and will continue to be our top priority. Rugby is committed to leading the welfare agenda in sport, driven by evolving science and research to protect and support players at all levels. This includes world-first initiatives, such as the use of smart mouthguard technology by all elite players to facilitate in-game monitoring and treatment of concussive and sub-concussive impacts. A lower tackle height is also being trialed in the community game to ensure that the benefits of our great sport can be enjoyed by all.”
If a strong link between neurological conditions and rugby can be shown, the defense will undoubtedly argue that no one could have known. However, with science now catching up with years of anecdotal evidence, the argument will be made that the governing bodies were aware of the risks for many years but negligently failed to act on them.
Solicitor Richard Boardman, who represents the players involved in the lawsuit, notes that the effects of head trauma extend beyond issues experienced later in life. “It’s very difficult for everybody, not just the players, but their partners, their children, their parents. The symptoms are relatively consistent across the cohort, depending on what damage there is,” Boardman explains. “Many of the players exhibit symptoms such as depression, introversion, suicidal tendencies, memory loss, sensitivity to light and noise, aggression, short temper, and inability to concentrate.”
Part of the problem arguably stems from a lack of information and clarity provided to players when they first start playing the game. Former England International Courtney Lawes has expressed sympathy for the rugby-playing cohort involved in the case, echoing their frustration at the lack of awareness of the potential risks. “I do feel for those guys, especially because you just didn’t know at the time what sort of repercussions there would be from playing rugby,” Lawes said. “It’s not like they signed up for it, because they had no idea. I suppose none of us do really, but if you’ve got some awareness you might think twice. There’s never going to be no concussions. We play a physical contact sport, a rough game. As long as people understand that there are risks in playing this game, they can make a decision whether they want to do it.”
The question is: Was there enough evidence, reporting, and recognition of the potential long-term risks of head injuries in rugby over the years for the governing bodies to have taken action to protect players? Head injuries are not a modern concern. In 1985, the Rugby Football Union’s official journal ‘Rugby World and Post’ noted: “In recent years there has been increasing concern amongst involved medical workers who see the long-term effects, that concussion is one of the most serious injuries that can be sustained by any participants in sport.”
The ongoing debate between the governing bodies and the group of former players highlights the importance of relying on medical advice and research from independent experts to ensure best practices. The influential Concussion in Sport Group (CISG) has been accused of ignoring peer-reviewed medical and academic literature in this area and downplaying the long-term effects of repetitive head injuries.
Several former players, particularly those playing in the early days of professional rugby union, have explained that they were encouraged to play through injury or return to playing quickly after suspected or diagnosed head injuries because that was the culture in the game at the time. Whether or not those at the top of the game buried their heads in the sand about the potential long-term dangers will now be a matter for the courts to decide. Like any litigation of this nature, especially involving swathes of medical evidence and hundreds of claimants, it is doubtful the case will be resolved any time soon.
The more pressing question for the governing bodies to address in the meantime will be: how, in a game in which players are lauded for making big hits and often praised for playing through injury, can the governing bodies secure a safer future for today’s generation of players?
WORDS: Peter Lockhart.
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