International rugby is experiencing an unprecedented level of brutality, with players facing increasingly demanding schedules that experts warn are compromising their welfare. Sir Clive Woodward, former England coach, has spent six months investigating the sport's player safety issues, speaking with health experts, affected players, and current stars.
The sport's top talent is subjected to ever-greater physical demands. England, for instance, is scheduled to play on three consecutive weekends across different continents for the Nations Championship. This intense schedule, coupled with additional, seemingly less critical matches, has led to serious injuries, such as Alex Dombrandt's knee injury during a match against a French XV, which will sideline him for the upcoming season. Woodward argues that such games should be eliminated to protect players and their clubs.
Rugby is grappling with both a workload issue and a crisis surrounding head injuries. Data indicates that a player's exposure to 'head acceleration events' – the mechanism by which brain injuries and concussions occur – is significantly higher in matches than in training. The drive for revenue is cited as the primary reason for these demanding schedules, but Woodward stresses that player welfare must not be sacrificed. He warns that stars may either burn out or decide the risks are no longer worth it, pointing to England captain Maro Itoje and player Tommy Freeman exceeding the RFU's 30-game-a-season limit last season.
Former players are currently engaged in legal battles with governing bodies like World Rugby, the RFU, and WRU over neurodegenerative diseases, which they attribute to head injuries sustained during their careers. The lack of resolution impacts the sport's reputation and potentially grassroots participation.
Dr. Sabine Donnai, founder and CEO of health management company Viavi, emphasizes the need for a proactive approach to player health. "Nobody is helping the players to protect themselves, and I find that really tragic," she stated. "Rugby is brutal. The demands on the brain are a lot more than in the past... There is a need for young sportspeople to start taking these things seriously."
Donnai suggests that understanding an individual's vulnerability to brain injury is key, noting that while most players may not experience severe issues, a percentage are more susceptible due to their brain's constitution. She advocates for proactive assessments, stating, "It is never too late to start looking after your brain."
Gloucester Rugby has initiated a pioneering project utilizing a mobile MRI scanner and other advanced medical equipment to assess player brain health. This initiative, developed in partnership with Oxford University and the Podium Institute, aims to track changes in players' brains, particularly after head injuries. While the project has incurred significant costs, Gloucester's head of medical services, Rhys Hughes, views it as a worthwhile investment for safeguarding current and future players.
Technological advancements and procedural changes, such as improved head injury assessment protocols, extended stand-down periods post-concussion, and instrumented mouthguards, have contributed to increased safety. Experimentation with a lower tackle height, currently being trialed at the Under-20 Junior World Cup, is another potential measure that could significantly impact player safety if adopted at an international level.
Players themselves are showing a greater willingness to prioritize their health. Unlike in previous eras where playing through concussion was often seen as a sign of toughness, leading players are now reporting symptoms and withdrawing from matches. Gloucester captain Lewis Ludlow expressed confidence in the sport's safety, stating, "Let's not fear head injuries. Let's try to understand them better." He also highlighted the importance of players flagging concerns, such as when a teammate's mouthguard indicates a significant impact.
Woodward believes that World Rugby should take a more dominant role in establishing mandatory, standardized concussion guidelines across all nations. The organization has the financial capacity to provide grants to clubs and unions, enabling them to implement better protective measures for their players. While acknowledging the good work being done, Woodward points out that it lacks cohesive coordination. Hughes, however, defended the current approach, highlighting the value of diverse research projects and significant improvements in concussion management over the past five years, with support from PREM Rugby and the RFU.
Woodward plans to further explore player welfare issues at the grassroots level in a subsequent article.