A significant number of former elite rugby players have been identified as being “at risk” of cognitive issues in later life, according to World Rugby’s brain health service. This program, launched last year, offers free assessments to former players from select countries including Ireland, Australia, Wales, South Africa, and New Zealand. The service has so far assessed 131 players, with 65 completing the process. Of those who completed it, a quarter were referred for specialist treatment. Importantly, the service provides a risk assessment rather than a definitive diagnosis, aimed at helping players understand their potential for neurological issues.
The concern surrounding player health extends beyond this service, with Rylands Garth, a law firm representing a growing number of former players, reporting a surge in sign-ups. The firm now represents 725 former rugby union players and 280 former rugby league players, many of whom are suffering from neurological conditions such as Parkinson’s, motor neurone disease, chronic traumatic encephalopathy, and dementia. This highlights the increasing concern within the rugby community over the long-term health impacts of the sport, particularly from repeated concussions and head injuries.
Despite the program’s positive intentions, the uptake and retention rate has been lower than expected. The high number of players dropping out of the brain health service is a source of concern. According to the team running the service, many participants withdrew due to anxiety over the possible results of the tests. There is a strong emphasis on trying to ease this anxiety and improve the experience, with plans to promote face-to-face consultations as a means of supporting players through the process and encouraging them to stay engaged.
This initiative is part of broader efforts to address the risks players face, especially concerning concussions. The World Rugby annual injury review for the 2023-24 season revealed that the number of concussions in elite male rugby remained stable at around 13 per 1,000 playing hours, while the figure for elite women’s rugby had increased slightly to 11 per 1,000 playing hours. Each concussion typically sidelines a player for about three weeks.
Sub-concussive impacts, however, are emerging as an equally significant concern. In France’s Top 14, research shows that elite players experience up to 2,000 physical contacts per year, underscoring the need for monitoring and mitigating these sub-concussive impacts. In response, World Rugby is focusing on reducing “player load” to manage the cumulative impact of these contacts, with new guidelines being introduced in collaboration with the International Rugby Players union. These guidelines recommend that all players should have at least 12 weeks without physical contact each year, in addition to existing guidelines that encourage a five-week off-season and limit the number of matches to 30 per season or a one-week break for every six consecutive games.
While these measures are designed to protect player welfare, the balance between the demands of the sport and the commercial pressures of international rugby is a constant challenge. For international players, particularly those involved in cross-border competitions, the schedules can become grueling. For instance, Argentinian players competing in the English Premiership face the prospect of a year-round season, which can exacerbate the physical strain on their bodies.
There is a growing awareness of the need to protect the health of players, particularly those in international and high-pressure club settings. Coaches and players alike are acknowledging the importance of rest and recovery, but as the sport grows more commercialized, finding a sustainable balance between performance and player welfare remains a difficult task.
