On Why Rugby May Be A Health Risk

While it is old news that the men who play top level rugby union are a heavier (and taller) lot than they used to be, the details can still be illuminating. Here, for example, are the comparative heights and weights of the All Blacks who played in the first test against South Africa in 1960, and the All Blacks who lined up in the first test against South Africa earlier this year. The 1960 statistics have been taken from Noel Holmes’ book Trek Out Of Trouble.

As you can see… Not only are the forwards bigger today, but so are the backs. Compare 1960s wingers Ralph Cautlton (77kgs, 1.88m) and Russell Watt (80kg 1.84m)with today’s Caleb Clark (107kg 1.89m.) and Rieko Ioane (103kg, 1.89m). Even a modern speedster like Will Jordan (94 kg and 1.88m) is a far bigger player.

In 1960, Adrian Clark (75kg, 1.73m) was the All Blacks first five; this year Beauden Barrett (91kg, 1.87 m) played in the same position. (BTW, Richie Mo’unga (83kg,1.76m) is no pipsqueak, either. As you can see from the table, today’s hard running, hard tackling centres are also heavier and taller etc. Keep in mind these simple weight comparisons are even before the changes in muscle density and in body fat measurements between these eras are taken into account.

Clearly, 1960’s legendary full back Don Clarke (105kg, 1.94m) was a big guy, but he was selected mainly because he was a goal kicking machine at distance, and not because of his defensive abilities or speed around the park. An equally legendary figure like Colin Meads (101kg, 1.93m) would be dw arfed by today’s Sam Whitelock (120kg, 2.03m) Overall, the All Black team that ran onto the field for the first test against the Springboks in 1960 had an average weight of 89.4kg.This year, the team average was 106.6kg.

Trust me, I’m getting to a point with all this weight and height palaver. Yet before I get to it, you can find a useful link right here to the height and weight of the entire All Black squad for 2021/2022. At 24, Ethan De Groot (135kg) is a really big guy.

Points of contact

OK, so what is the point? IMO, where the weight/height differences are most telling (and alarming) is in relation to the parallel pressures for rule changes to speed up the pace of the game, to reduce the size of the reserves bench, and to crack down on “time wasting” in the setting of scrums and lineouts and in taking kicks at goal. Hurry up, Jonny Sexton.

In short: what the possible rule changes and some coaching attitudes are aiming to produce is an even faster contact sport between ever bigger and heavier players given fewer opportunities from natural stoppages to rest and recover. In today’s rugby Coliseum, the goal is for heavier, taller players making bigger hits, and more of them, at a cranked up pace. That’s happening before we get to the crowded schedules for international and domestic rugby competitions.

Contact Highs

This trend is occurring despite the scientific evidence that what is loosely called “concussion” is not merely a problem of "big hits" that can be safely addressed by requiring longer layoff times between matches. Instead, the medical evidence appears to indicate that the incidences of memory loss, reduced cognitive function and early onset dementia among retired players has been caused by the constant body contacts central to the modern game. Regardless, rugby’s governing bodies (and the fans) still appear willing to increase the incidence of those collisions.

The risk of harm is worse the younger the players are. This is recognised within the world rugby guidelines for concussion which state:

Concussions can happen at any age. However, children and adolescent athletes:

• are more susceptible to concussion
• take longer to recover
• are reported to have more significant memory and mental processing issues
• are more susceptible to rare and dangerous neurological complications, including death caused by a single or second impact

Such concerns are among the reasons why weight class restrictions are a feature of New Zealand secondary school rugby teams, which are divided into Under 55kg, Under 65kg, Under 75kg, Under 85kg and ‘Open Grade’ teams, rather than dividing by year. This may not offer enough of a protection however, for those still not yet fully formed adolescent bodies and brains.

The backlash

Belatedly, the health risks of playing professional sport are being recognised. Researchers at the University of South Wales for example, have measured the changes to cerebral blood flow and cognitive functions among players before and after a single season of rugby. Among the telling asides in the USW study is the incidence of contact events:

Professional rugby union players may be exposed to over 11,000 contact events per-season comprising tackles, collisions, mauls, rucks and scrums… Tackles are the most common contact-match event in rugby union and cause 52% of all injuries that have been associated with elevated concussion risk.

To repeat: along the spectrum of what we call “concussion” the now better recognised (and hopefully, better treated ) big hits to the head are just the tip of the iceberg:

It is not the concussions. They do play a part, as the outward manifestation of a distressed brain, but the damage to those brains is constant in a sport like rugby and correlates to the sheer number of blows each brain takes, directly or indirectly, over a prolonged period. “You cannot interpret it any other way,” says Professor Damian Bailey, lead author of the University of South Wales study. “You’ve got this noxious, cumulative, recurrent contact that doesn’t actually need to be anywhere near the head, so long as there’s some sort of torsional movement imparted to the brain. And it just builds up over time.” Bailey is the director of the neurovascular research laboratory at USW and works, among other projects, with the European Space Agency on blood flow to the brain of astronauts.

The problems appear to be getting worse. In part, this may be a reflection of the pace of the modern game. It may also be the result of concussion finally being detected earlier, and more often.

Concussion rates in elite English rugby have hit their highest levels since records began, according to the latest injury audit with the Rugby Football Union rolling out its “smart” mouth-guard programme in an effort to combat the rise. The audit of the 2020-21 season, published on Tuesday by the RFU in conjunction with Premiership Rugby and the Rugby Players’ Association, showed that for the 10th season running concussion was the most reported injury, accounting for 28% of injuries.

Elsewhere, class actions are being taken on behalf of players to force rugby authorities to take head injuries more seriously, and to pay sone compensation for the damage done. Former All Black prop Carl Hayman, 42, has been diagnosed with early onset dementia and has joined one of the class actions being mounted. Hayman has described his current condition here. Former Wales captain Ryan Jones is another casualty of the game, being diagnosed with early onset dementia at the age of 41.

Women’s rugby and brain injury

As we celebrate the Women’s Rugby World Cup, lets not forget that women players are not exempt from the risks inherent in the game :

An audit into the women’s game showed that concussion was the most commonly reported injury, making up 26% of all match injuries. Again, measured against 1,000 hours, the rate was 12.6, more than double the previous season – a rise put down in part to more consistent reporting and identification of concussion.

In fact, there is some evidence that women players in contact sports may be more susceptible than male players to brain injury:

Recent studies suggest that the incidence of and recovery from sport-related concussion varies between male and female athletes, with women having a higher risk of sustaining a concussion and taking a longer time to recover than men.

A more general discussion of gender differences in the risks involved in contact sport is available here. That article includes this observation:

Female athletes…generally have shorter and narrower necks, and lower head mass (their heads are smaller and less dense). These factors are associated with lower neck strength. Neck strength is a protective factor against concussion, so women may be more susceptible for this reason. Further, female brains metabolise glucose (sugar) and oxygen faster than male brains. If a head injury temporarily disrupts blood supply to the brain, it could have a greater effect on the faster nutrient-burning female brain.

Clearly, more research needs to be done in this area.

Gauging the trade-offs

Still... It has to be good news that for whatever reason, rugby administrators are finally starting to acknowledge the toll that a rugby playing career can have on the brains and bodies of the gladiators who play rugby for our entertainment. Surely, before any new rules meant to speed up the game get implemented, there has to be a mandatory analysis of the medical implications of any such rule changes for the wellbeing of the players.

Arguably for adults, the medical evidence could then make it a free choice. Players could choose to sacrifice a certain number of brain cells for the big bucks, even if only relatively few top players ever make it into the national squads where the really big bucks can be made. This pathway would have to be a truly informed choice. Currently however, a lot of players are still at school when they start to pursue rugby as a career, well before they know the health risks they are running.

That’s a problem. At the end of the day… And despite the money being made by the rugby franchises, very few safety nets currently exist to support the players who end up with a serious and premature medical condition, one that’s been largely brought on them by what they gave to the game, and what the game did to them.

Given the inherent risks mentioned above… You do have to wonder why so many parents still seem happy to let their kids onto the rugby field.

Footnote: While this column began with a comparative example of the size increase in All Black teams over the past 60 years, there are more recent comparisons. The same trend has been evident over the past 30 years as well. Here for example is a table comparing the England and All Black teams in 1991, and again in 2019:

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