Rugby is more dangerous since going pro in 1995 and players are terrified of the effect huge tackles are having on the brain, study suggests, as scientists urge for immediate change in the rules
- Stars playing since 1995 were more likely to suffer lasting trauma to their heads
- A survey also found 62 per cent of those involved in the game fear huge tackles
- This rises further to 73 per cent for parents who don’t play but whose child does
- As many as 61 per cent said rugby was more dangerous at all levels since 1995
Rugby has turned more dangerous since the sport went pro and has left the majority of players terrified about the long-term effects on their brain, a study suggests.
Stars playing since 1995 – when being paid to play began – appear more likely to suffer lasting trauma to their heads than those who retired before this date.
A survey linked to the research found a staggering 62 per cent of those involved in the game fear huge tackles could be damaging their brains.
This rose even further to 73 per cent for parents who do not play but whose child is getting into the sport.
Meanwhile as much as 61 per cent of those asked said they felt rugby had become more dangerous at all levels since the game turned professional.
The concerning findings have reignited calls for an urgent review into the laws of rugby union to make it safer across all disciplines.
Former England captain Lewis Moody welcomed the study and said it was ‘essential’ those going into rugby understood the health ramifications first.
It comes amid a wider focus on the effect of devastating head injuries in sport, with a renewed focus on footballers heading the ball in recent months.
English football announced in July restrictions on heading among adults, which means professional players are limited to 10 ‘higher-force’ headers per training week.
Stars playing since 1995 – when being paid to play began – are more likely to suffer lasting trauma to their heads than those who retired before this date, scientists said. Pictured: Former English rugby union fullback Jonathan Webb taking part in the study
The Drake Foundation and London School of Hygiene & Tropical Medicine worked with 146 former elite rugby players who were mostly from before 1995 when the sport turned pro and either competed for England, Oxford University or Cambridge University. Pictured: Former English rugby union fullback Jonathan Webb taking part in the study
The BRAIN study found stars who had three concussions did not have a significant impact on cognitive function before turning 75 than those who had fewer than three. Pictured: Former English rugby union fullback Jonathan Webb taking part in the study
Former rugby players who have been diagnosed with dementia:
- Steve Thompson
- Dan Scarbrough
- Adam Hughes
- Neil Spence
- Alix Popham
- Michael Lipman
The Drake Foundation and London School of Hygiene & Tropical Medicine worked with 146 former elite rugby players who were mostly from before 1995 when the sport turned pro and either competed for England, Oxford University or Cambridge University.
The BRAIN study found stars who had three concussions did not have a significant impact on cognitive function before turning 75 than those who had fewer than three.
It did not see an overall group association between concussion history and worse cognitive function.
But tests found 29 per cent of over 75s who had suffered three or more rugby-related concussions during their career had significantly worse cognitive function.
The researchers found earlier this year over a fifth – 23 per cent – of post professional era athletes have abnormalities in brain structure and half had a change in brain volume.
They said it raises urgent questions about the direction of safety in rugby since 1995 and called for immediate changes to the laws of the game.
A number of recent ex-stars have suffered early brain problems, including Steve Thompson who has early onset dementia aged just 43.
There has also been a rise in former athletes suffering other brain defects such as probable CTE, which has also been linked to American Football players.
Meanwhile a survey of 508 people this month found 62 per cent of people involved in rugby union are concerned about its long-term effects on brain health.
But this skyrocketed to 73 per cent for adults who do not play the game but whose child does.
Nearly two-thirds – 61 per cent – said they thought rugby had become more dangerous at all levels since it turned professional.
And 66 per cent said they felt that a fundamental change in the laws are needed to make the sport safer.
Concussions in rugby:
As a contact sport, rugby involves frequent body impacts and a risk of accidental head impacts, and therefore a significant potential risk of concussion.
According to the data collected through the RFU’s Community Injury Surveillance & Prevention Programme (CRISP) in age grade rugby (age 15 – 18) the most recent rate shown equates to 1 concussion per team every 10 games and 1 concussion per team every 25 games in adult male rugby.
In professional rugby it is 1 every 2-3 team games.
The rise in the rates seen since 2012/13 are almost certainly due to the increased awareness and the much lower threshold for suspecting concussion, and reflect the success of the awareness and education programmes, and media coverage.
Source: England Rugby
The Drake Foundation, which published its results in The Journal of the Alzheimer’s Association today, is urging for a review into the rules of the game to protect participants.
Its study worked with 146 ex-elite rugby players in England aged 50 years and over – with most having played in the pre-professional era – to examine brain health trends.
Participants took extensive tests capturing physical and cognitive capabilities as well as questions about their playing and concussion history.
Researchers said decreases in cognitive function may have come at such an older age due to the players generally being highly educated with a higher than average cognitive function at the start of their careers.
But they said the results still call into question whether safety standards in the sport have worsened since the game turned professional.
The scientists said further research was needed to get data on long-term brain health in players from both the professional and amateur eras.
Former England international and Drake Foundation Ambassador Lewis Moody MBE, said: ‘This study funded by The Drake Foundation takes us another step further in our understanding of the links between rugby and later life brain health, and continues to widen the conversation in this area.
‘It’s essential that everyone participating at all levels of the game is included and educated on the topic of rugby player welfare.
‘The fact that two thirds of those involved in the amateur game are concerned about rugby’s effect on long-term brain health shows there is a big issue here that needs to be urgently addressed across both the grassroots and elite levels.
‘As well as widening the conversation, I would like to see enforceable guidelines across all levels of rugby to limit players’ exposure to head impacts in order to protect players and the game that we love.’
The BRAIN study did not see an overall group association between concussion history and worse cognitive function
A list of the research tools used by the study to check the former elite rugby players for the tests
The average height and weight of rugby players as the sport moved from the amateur to professional era
The volume of impact has also ballooned, with the number of tackles per game more than doubling in the last three decades
James Drake, founder of The Drake Foundation, said: ‘As a passionate sports fan who loves rugby, I’ve witnessed first-hand the way the game has evolved since turning professional.
‘In my view it’s a sport that has become ostensibly less safe for the players involved and my concerns are reflected by our research this month, which reveals 61 per cent of adults who either play the game or have children that do, are concerned about the sport’s long-term effect on brain health.
‘A further two thirds of adults believe the sport could be made safer if law changes were introduced to return it to the game as it was played in the amateur era.
‘The Drake Foundation is calling on rugby’s authorities to give this immediate consideration to protect the sport we love and the current and future generations who play it.’
Lauren Pulling, CEO of The Drake Foundation, said: ‘The BRAIN study, which we funded, yielded some interesting results and new insights into the long-term effects of rugby as it was played in the pre-professional era.
‘These findings are broadly reassuring for players from the amateur era. However, given the findings of the Drake Rugby Biomarker Study and recent cases of early-onset brain disease in ex-players from the professional era, the new study results do call into question how long-term health might differ in players from the modern era.
‘The evidence we have so far suggests that the sport may actually be travelling in the wrong direction in terms of player welfare and brain health.
‘In addition to further research, we therefore also urge the sport’s governing bodies to review the modern game’s laws and protocols and take urgent, preventative action to universally reduce players’ exposure to head impacts both in matches and training.’
Dr Susan Kohlhaas, Director of Research at Alzheimer’s Research UK, said: ‘Collisions in sport is an area of increasing scrutiny for public health, however relatively little is known about the long-term impact of concussions received in rugby union.
‘Findings from this study of ex-amateur elite level rugby union players adds to our understanding of the risks involved with professional sports.
‘While we know exercise is good for our brain health, certain sports involving high energy collisions have been linked to risk of long-term neurological problems.
‘There hasn’t been enough long-term research involving ex-rugby players for us to know what specific risks might be associated with a rugby career.
‘Further research in a larger number of volunteers is required to establish if any link between concussions sustained on the rugby field and memory problems in later life exists.
‘While the game of rugby has evolved over a number of years, so has the approach to managing concussions, and creating a safer game should continue to be an important for public health goal for all.’
Dr Neil Graham, Alzheimer’s Research UK Clinical Research Fellow based at the UK Dementia Research Institute’s Care Research and Technology Centre at Imperial College London, said:
‘This is an important paper which looks at the effects of concussion in former elite male rugby players now in their late 60s/70s.
‘The researchers found association of head injuries and later life cognitive problems in older players.
‘This raises the question of an interplay of head injury, ageing and long-term brain health, although the study did not address this specifically.
‘It remains important to clarify what type, or total amount of head injury poses the greatest risk of memory problems in later life, and whether these cognitive difficulties are static or progressive such as in dementia.
‘Recent advances in biomarkers, which enable ultrasensitive diagnosis of brain injury and characterisation of its consequences, are likely to accelerate the longitudinal studies which are key to answering these important public health questions.’
LOCKS: Left is former England captain Bill Beaumont (6ft 3in) in 1980, and right is current player Joe Launchbury (19st 12lbs and is 6ft 5in) playing last month
CENTRES: Left is England centre Clive Woodward (12st 8lb and 5ft 11in) in 1982 and right is Manu Tuilagi (17st 4lb and 6ft 1in) in a recent game
FLANKER: Left is England’s Nick Jeavons (16st 1lb and 6ft 3in) in action against Scotland in 1982, and right is current player Sam Underhill (16st 10lb and 6ft 1in) earlier this year
PROP: Left is Fran Cotton (16st 7lb and 6ft 2in) playing for the Lions in 1980 and right is England’s Kyle Sinclair (18st 13lb and 5ft 10in) in 2019
‘I can’t remember any of the games whatsoever’: Steve Thompson revealed the extent of the damage done to his brain
Steve Thompson, 42, who retired in 2011, revealed last year his memory of winning the World Cup had vanished.
He said: ‘I have no recollection of winning the World Cup in 2003 or of being in Australia for the tournament’
‘I can’t remember any of the games whatsoever or anything that happens in those games.
‘It’s like I’m watching the game with England playing and I can see me there, but I wasn’t there, because it’s not me.
‘You see us lifting the World Cup and I can see me there jumping around. But I can’t remember it.’
Over the last four decades the average rugby player has swelled from 14st and 5ft 11ins to 16st 3lbs and 6ft 1in.
Scotland’s Richie Gray is 6ft 8in while Bill Cavubati – who used to play for Fiji – was 26st.
Advances in sport science and investment in strength and conditioning saw players swap the pub for the gym and pile on muscle.
Asked what it would be like to be hit by one of the new-era players, Professor Bill Ribbans flatly replied: ‘It’s like being hit by a truck.’
That such alarming accounts from ex-players are only coming to the fore now – when the sport was founded in the early 19th Century – has been traced to the pro age.
Professionalism largely flushed the post-match drinking culture and put emphasis on nutrition and athleticism.
A 2012 analysis found players in the 1980s weighed an average 14st and stood at 5ft 11ins.
By contrast in 2020 the average English Premiership player weighed 16st 3lbs and was 6ft 1in.
The gulf in size between the generations is most striking in some positions in particular.
Once slight and nimble wingers were replaced by powerhouses built in the image of the late All Black icon Jonah Lomu – whose devastating combination of size, strength and speed set the bar for the next generation of players.
Stars of the amateur age included the likes of legendary Welsh winger JJ Williams, whose slight build of 12st and 5ft 9ins allowed him to carve through the opposition’s defences.
The difference is striking compared with George North, the current Welshman to wear the Number 11 jersey, who stands at 17st and is 6ft 4ins, allowing him to bulldoze through players.
Professor Ribbans said tackling one of the bigger stars could put as much as a fifth of a tonne of force on one shoulder.
The volume of impact has also ballooned, with the number of tackles per game more than doubling in the last three decades.
Demands for action reached a crescendo when Steve Thompson (pictured) went public with his early dementia diagnosis and said he had no memory of winning the 2003 World Cup due to brain damage
In 1987 there was an average 94 tackles per game compared to 257 in 2019, according to official World Rugby statistics.
Richard Boardman, the lawyer bringing Thompson’s case to World Rugby, echoed the concerns over rugby’s physicality.
He said: ‘Every guy involved in this action loves the game, and they love the physicality of it.
‘The caveat to that is, since 1995 when the game went professional, the size of the guys has increased, the power, the strength, the pace of the game and therefore the collisions have increased.
Strong link between heading and brain disease, dementia expert finds
Neuropathologist, Dr Willie Stewart, found former players are 3.5 times more likely to die of neurodegenerative diseases than the general public.
Dr Stewart is one of the leading experts on the link between football and dementia having studied the medical records of 7,676 men who played professionally between 1900 and 1976.
In addition, the scientist also conducted tests on the brain tissue of the celebrated West Bromwich Albion centre forward, Jeff Astle, in 2014, concluding the striker suffered chronic traumatic encephalopathy (CTE), a condition traditionally associated with boxers.
The University of Glasgow academic told the MPs earlier this year that while it will be difficult to demonstrate a direct causal link between heading a football and suffering dementia forty years later, he said, ‘on a balance of probabilities, I think we are there’.
MPs on the Digital, Culture Media and Sport select committee has been investigating the link between sport and brain disease.
It has heard from experts and campaigners, including Dawn Astle, the daughter of West Bromwich Albion forward, Jeff.
Jeff Astle died Astle aged 59 in 2002 from a degenerative brain disease due to heading the ball and Dawn has been an indefatigable campaigner.
His daughter told MPs she had taken up the campaign over football and dementia after her father had been badly let down.
‘Football doesn’t want to think that football can be a killer. But I know it can be, because it’s on my dad’s death certificate,’ she said.
‘I want to make sure players affected are looked after properly,’ she added. ‘And I want to make sure the game is safe for players now and in the future.
‘I certainly think potentially there are things within a game that could change. If you think of the 2019 World Cup final when the ‘bomb squad’ – six 18-stone South Africans – came off the bench in the second half, that just means that the days of the 15-stone Jeff Probyn have gone.’
Professor Ribbans added the laws have evolved in a way that encourages players to tackle higher, leading to more serious injuries.
He said ‘rugby always had the potential to be a dangerous game’ but hoped that recent players would not suffer the same damage of the likes of Thompson because of improved treatment.
But the surgeon, whose book Knife In The Fast Lane chronicles his career in sports medicine, said ‘a lot more needs to be done’.
He joined calls for clubs to reduce the amount of contact training during the week to allow players’ bodies to recover, and also suggested a review of the substitute rules to stop fresh players coming on and smashing tired opponents.
Mr Boardman warned of an ‘epidemic’ in brain disease among retired professionals without serious reform of the game.
He said: ‘We believe up to 50 per cent of former professional rugby players could end up with neurological complications in retirement.
‘That’s an epidemic, and whether you believe the governing bodies and World Rugby are liable or not, something has to be done to improve the game going forward.’
Thompson, 43, who retired in 2011, revealed that his memory of winning the World Cup had vanished.
He said: ‘I have no recollection of winning the World Cup in 2003 or of being in Australia for the tournament’
‘I can’t remember any of the games whatsoever or anything that happens in those games.
‘It’s like I’m watching the game with England playing and I can see me there, but I wasn’t there, because it’s not me.
‘You see us lifting the World Cup and I can see me there jumping around. But I can’t remember it.’
Football is also seeing a renewed focus on protecting players heads, with heading during training being curbed.
English football announced in the summer restrictions on heading among adults, with professional players limited to 10 ‘higher-force’ headers per training week.
The guidance follows research which has established ex-stars are more likely to die of neurodegenerative diseases than the general public.
Initial studies found most heading takes place in training and on many occasions the forces involved are low.
But where the ball is crossed for forwards or defenders to attack, or if an aerial pass is made over more than 35 metres, the forces are higher and these headers will now be limited.
Guidelines applied from the Premier League to grassroots from the start of the 2021-22 season.
BRAIN INJURIES IN SPORTS: FAST FACTS ABOUT CTE RISKS, TESTS, SYMPTOMS AND RESEARCH
As athletes of all sports speak out about their brain injury fears, we run through the need-to-know facts about risks, symptoms, tests and research.
1. Concussion is a red herring: Big hits are not the problem, ALL head hits cause damage
All sports insist they are doing more to prevent concussions in athletes to protect their brain health.
However, Boston University (the leading center on this topic) published a groundbreaking study in January to demolish the obsession with concussions.
Concussions, they found, are the red herring: it is not a ‘big hit’ that triggers the beginning of a neurodegenerative brain disease. Nor does a ‘big hit’ makes it more likely.
In fact, it is the experience of repeated subconcussive hits over time that increases the likelihood of brain disease.
In a nutshell: any tackle or header in a game – or even in practice – increases the risk of a player developing a brain disease.
2. What is the feared disease CTE?
Head hits can cause various brain injuries, including ALS (the disease Stephen Hawking had), Parkinson’s, and dementia.
But CTE is one that seems to be particularly associated with blows to the head (while the others occur commonly in non-athletes).
CTE (chronic traumatic encephalopathy) is a degenerative brain disease that is caused by repeated hits to the head.
It is very similar to Alzheimer’s in the way that it starts with inflammation and a build-up of tau proteins in the brain.
These clumps of tau protein built up in the frontal lobe, which controls emotional expression and judgment (similar to dementia).
This interrupts normal functioning and blood flow in the brain, disrupting and killing nerve cells.
Gradually, these proteins multiply and spread, slowly killing other cells in the brain. Over time, this process starts to trigger symptoms in the sufferer, including confusion, depression and dementia.
By the later stages (there are four stages of pathology), the tau deposits expand from the frontal lobe (at the top) to the temporal lobe (on the sides). This affects the amygdala and the hippocampus, which controls emotion and memory.
3. What are the symptoms?
Sufferers and their families have described them turning into ‘ghosts’.
CTE affects emotion, memory, spatial awareness, and anger control.
Symptoms include:
- Suicidal thoughts
- Uncontrollable rage
- Irritability
- Forgetting names, people, things (like dementia)
- Refusal to eat or talk
4. Can sufferers be diagnosed during life?
No. While a person may suffer from clear CTE symptoms, the only way to diagnose their CTE is in a post-mortem examination.
More than 3,000 former athletes and military veterans have pledged to donate their brains to the Concussion Legacy Foundation for CTE research.
Meanwhile, there are various studies on current and former players to identify biomarkers that could detect CTE.
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