Questions & Answers
Sign up for our mailing list below for latest info & updates.
About brain trauma in rugby union
Why is brain injury in rugby union so worrying?
Rugby has always been a tough, physical game. However, since the turn of the professional era in 1995, players have got bigger, stronger, faster as the amount of time in the gym and on the training ground has increased. The result is that the game has transformed into one based predominantly on collisions. To even a casual eye, the difference between, say, the British & Irish Lions tour to South Africa in 1997, and the 2009 Lions tour, are clear examples of just how brutal the game has become in such a short amount of time. To quote Dr James Robson, the Lions medic from that 2009 tour:
“I would have to say this has been the most physical tour, the most physical Test matches I have been involved in,†said Robson. “I think we are reaching a level where the players have got too big for their skill levels. “I think they have become a little too muscle-bound and too bulky. “I think you may see changes in the physical nature of the player that brings them back a little – I hope so – in order to speed up the game and introduce a higher level of skill.â€
This new version of rugby union, with a focus on collisions, 40-45 week seasons, shorter returns to play (following a concussion) and unregulated training has created an existential crisis in the game. We now have hundreds, maybe thousands, of retired players, particularly those from the early professional era, who have varying degrees of neurological impairment. This does not necessarily mean dementia / probable CTE, but epilepsy, motor neurone disease, Parkinson’s Disease, post concussion syndrome, persistent post concussion syndrome and others. The recent UK lawsuit is understood to include over 150 former players with neurological symptoms. A cursory glance online will conjure up hundreds of players speaking out about this issue over the last 20 years. There is evidence to suggest that women are more susceptible to brain trauma in contact sports than men.
Other sports are struggling with the issue of brain trauma too. We have all by now heard about the tragic cases in American football, where, in 2015, Dr Ann McKee found CTE in the brains of 99% of the American footballers she examined (in 110 of the 111 brains). Aaron Hernandez and OJ Simpson are strongly believed to have had / have CTE.
Yet rugby is arguably the most dangerous sport for concussion. Various credible studies suggest that, e.g. Complete Concussion Management.
Game Play
Men’s rugby match play (3.00/1,000 Athlete Exposure (AE))
Men’s American football (2.5/1,000 AE)
Women’s ice hockey (2.27/1,000 AE)
Men’s Ice hockey (1.63/1,000 AE)
Women’s soccer (1.48/1,000 AE)
Men’s football (or soccer) (1.07/1,000 AE)
During practice
Men’s rugby (0.37/1,000 AE)
Women’s ice hockey (0.31/1,000 AE)
Men’s American football (0.30/1,000 AE)
Women’s football (or soccer) (0.13/1,000 AE)
Men’s ice hockey (0.12/1,000 AE)
Men’s football (or soccer) (0.08/1,000 AE)
Concussions are not the sole cause of brain trauma either. A sub-concussion is a minor trauma to the brain and, in itself, nothing to worry about. However, if you are potentially suffering a sub-concussion every time you hit a ruck, tackle or carry, you are soon racking up high numbers. A generation ago, back row forwards had to make around 50 contacts a game. Nowadays, an international flanker is up to 70, and making 20 plus tackles a game.
“From 2013 to the current season there’s been a 44% increase in contacts. Our average number of contacts per game last season was 600–650 … but this season we’ve had over 800 six times and against Exeter we had 1,042 contacts, so you don’t have to be a rocket scientist to work out there will be more injuries.†Bath coach Toby Booth in The Rugby Paper, 14 January 2018.
As well as the contacts during a game, rugby has failed to regulate contact in training. Many current players say still they have up to four days of contact a week in training, which usually involve scrummage machines (for forwards), plus ruck and tackling drills. If a player is sustaining sub-concussions from these too then the amount of dings to the head increases considerably over a 40, 45 week season, over a 10, 15 year career.
Excessive contact sessions in training can lead to needless concussive and sub-concussive blows. What frustrates current and former players are those pointless training sessions in the middle and end of the season, when they are knocking lumps out of each other, simply because the coach does not know what else to do with them. If the NFL can limit contact in training since 2011 – why cannot rugby? How would this impact revenue?
Things have to change
About Progressive Rugby
We firmly support the core physicality that comes with an 80-minute game of rugby union. This extends, for example, to tackling in schoolboy rugby. That being said, we believe that urgent changes are needed to ensure the long-term survival of the game.
The answer is not yet another sports science study into training, injuries and workloads to leave this problem to future administrators of the game. A multi-year study into reducing substitutions will not help those currently playing. Instead, we demand the game adopt a new philosophy when it comes to player health and safety: when in doubt, err on the side of caution.
If the game really is doing everything it can to protect the players then why is contact in training unregulated? Why have a six day return to play? Why have such a lengthy season? Why no concussion database? Why allow an entire bench of forwards enter the game on the hour in every game?
Despite the current negativity surrounding the game, there is an opportunity for rugby to turn the page, to show that the game cares and that retired players will be looked after, and current and future generations will be adequately protected.
One could argue that the NFL as a sport has been able to change the narrative, from being found to have suppressed information relating to head injuries, to creating a concussion fund and making considerable changes to the game, such as the regulation of contact in training, concussion spotters and a concussion tent at every game.
If the hurdle to such changes is financial, then we have tried, instead of simply suggesting changes to World Rugby, to cost out those changes and find sponsors. Indeed, we are currently speaking to a number of sponsors about financing some of these changes.
If it helps save our heroes in retirement, then having sponsors fund a concussion database is surely something any company that cares for the game would like to be part of?
We are keen to speak to World Rugby about how we can work together to solve the current crisis.
We are all first and foremost fans of the games. For many of us, our legacies are tied up to the game, having been players, medics, coaches and referees. Put simply, we want to ensure that the game survives well into the future.
And yet, right now, we firmly believe that there is an existential threat to the game. Teachers, parents, sponsors and those playing are unsure whether the game as it currently is is worth it. No one plays rugby expecting to get dementia in their 40s.
Like any lobby group, we wish to push for solutions to make the game safer, and work with World Rugby and any other relevant organizations to achieve that. Despite the current crisis, there is a way to turn this around – just look at the NFL.
If you agree with our aims, what can you do to get involved?
The first step is to register your interest via this website. We plan to send out regular updates on what we are upto. If you love the game, but believe change is needed – join us, and be on the right side of history.
Why do we limit contact in training?
A quick calculation shows that your average NFL player will have far less contact a year than his rugby counterpart:
NFL
- Each regular season is 16 games (plus at least one play-off game for 14 of the 32 teams).
- Each team is granted a maximum of 16 padded training sessions a season.
- A typical NFL player will therefore have between 30-40 days of physical contact per season (including games and training).
Rugby Union
- The regular season for an international player is around 30 games per season (including domestic, European and international games).
- The amount of contact in training sessions per year is unregulated, so many teams have between two to four days of contact per week across a 40 to 48 week season.
- Your typical back row player will be tasked with making 50-70 contacts (tackles, carries and rucks) per game.
- A typical international rugby union player will likely have in excess of 100 days of contact per season (including games and training).
Many senior figures in rugby have spoken about the need to regulate training, yet nothing has been done. Why? We cannot understand what the issue is. It cannot be cost, as this should not impact revenue. Coaching? But the NFL has shown what innovative changes can be made to training – and some contact in training is still allowed. Why not frontload contact sessions at the start of the season, and then lighten the workload when players are exhausted in the latter part of the year. Quality of game impacted? Surely a more refreshed playing squad will produce better results on the pitch.
Do you want to remove contact from the game?
We are all lovers of the physicality of a game, and that goes for schoolboy rugby too. If you remove tackling in schoolboy rugby, the adult game will become extinct within a generation or two. There is always going to be a degree of risk involved from playing. However, all of us who played accept the broken bones, the torn ligaments and stiff backs. But around that physicality, the game can be much smarter around the issues of brain trauma and workload.
Why do you believe there is an existential threat to the game?
We believe there are hundreds, if not thousands, of former players (whether that’s professional, amateur, male or female) with neurological impairments who are struggling in retirement. Given the physicality of the modern professional game, as well as the tremendous workloads asked of the players, this issue is not going to go anywhere soon.
In the last few weeks alone, we have seen:
- Johnny Sexton, the Irish fly-half, return to play for Leinster against Ulster on 8 January, only six days after being substituted in the 24th minute in a game against Connacht, having failed a HIA.
- Various infringements at rucks by Tom Wood on Josh Van Der Flier on 19 December 2020, and Dan Du Preez on Gloucester’s Chris Harris on 3 January 2021, showed players not binding and recklessly targeting the head area at the breakdown, yet no on-pitch sanctions followed.
- Various high profile names still currently playing have confirmed that they still have three to four days of physical contact in training a week during the season (for both their clubs and international teams).
Alongside the above, questions have to be asked about the overuse of substitutes in each game, where oversized forwards, like turkeys fed for Christmas, waddle on to the pitch on the 50th or 60th minute ensuring that collisions remain ever consistent, or the ever increasing tackle rate of the game (see the increase in the number of contacts per game), this issue is as concerning as ever.
Help with brain trauma
Dementia is an overall term for diseases and conditions characterized by a decline in memory, language, problem-solving and other thinking skills that affect a person’s ability to perform everyday activities. Alzheimer’s is the most common cause of dementia.
Chronic traumatic encephalopathy (CTE) is a brain deterioration disease caused by repeated head blows – and is common when playing contact sports. CTE is also associated with the development of dementia. Potential signs of CTE are problems with thinking and memory, personality changes, and behaviour changes including aggression and depression.
Former rugby players have symptoms such as considerable memory loss, an inability to concentrate, depression, migraines, insomnia, personality changes, shortness of temper, aggression.
What should I do if I suspect I have signs of CTE?
You should consult your local doctor who can then refer you to a neurologist who can arrange a CT scan of the brain. There are also various foundations that help:
UK
Alzheimer’s UK – www.alzheimers.org.uk
Dementia UK – www.dementiauk.org
Head for Change – www.headforchange.org
Dementia NI – www.dementiani.org/
Ireland
The Alzheimer Society of Ireland – https://alzheimer.ie/
Understand Together – www.understandtogether.ie/
France
Alzheimer’s Association – www.alz.org/fr/dementia-alzheimers-france.asp
Australia
Dementia Australia – www.dementia.org.au/
Alzheimer’s Association – www.alz.org/au/dementia-alzheimers-australia.asp
New Zealand
Dementia New Zealand – https://dementia.nz/get-information
Dementia Auckland – https://dementiaauckland.org.nz
South Africa
Dementia South Africa – www.dementiasa.org/