Former international rugby union players are 15 times more likely to suffer the devastating impact of motor neurone disease, according to landmark new research which has sparked calls for drastic changes to the sport.
The study, which was conducted by the University of Glasgow, compared the health outcomes of more than 400 former Scottish internationals, largely from the amateur era, and also found that they were twice as likely to develop dementia and three times more likely to suffer Parkinson’s Disease than the wider population.
It was the findings in relation to motor neurone disease (MND), however, which were described by researchers as the “standout high risk”.
A series of rugby heroes, notably Scotland’s Doddie Weir, South Africa’s World Cup winner Joost van der Westhuizen and former Gloucester forward Ed Slater, have been diagnosed with motor neurone disease but this is the first peer-reviewed study which makes a direct link to the heightened risk of playing rugby.
It also reinforces the findings of similar studies in other sports where there are repeated head impacts, notably professional football and the NFL. Former players were found to be around four times more likely to suffer MND in these two sports.
The study, which has been published in the Journal of Neurology, Neurosurgery and Psychiatry, was led by Professor Willie Stewart, the neuropathologist who also proved football’s link to neurodegenerative disease.
Stewart stressed that the former players who had been studied had predominantly played in the era before professionalisation in 1995 and, with head impacts and injuries having further increased in the past 27 years, urged immediate measures to mitigate the risks.
“Contact training during the week, during the competition season, should be pretty much a thing of the past,” said Stewart. “At the same time look at the number of matches that are being played – is it credible that young men and young women are playing week-in, week-out for the majority of the year just for entertainment? Is there a way we can trim back?
“I am genuinely really concerned about what's happening in the modern game [and] whether in 20 years’ time, if we repeat the study, we may see something which is even more concerning.
“Those conversations have been going on a while and the pace of progress is pretty slow. I think this stimulus to them [is] to really pick up their heels and start making pretty dramatic changes as quickly as possible to try and reduce risk.
“Instead of talking about extending seasons, and introducing new competitions and global seasons, they should maybe talk about restricting it. Getting rid of as much training as possible. I know it is tough to think about less rugby than more but maybe less is more. You can’t continue to put young men and women through what they are being put through now we know that, from the amatuer era, there is this risk of degenerative brain disease.”
Stewart, who was an amateur rugby player, did also outline the benefits of sport and suggested that non-contact forms of the game may become increasingly commonplace.
Following a similar method as their football study, researchers examined the medical records of former international rugby players in Scotland and matched them with people of the same age, gender and socioeconomic background in the wider population.
They then compared their health outcomes over an average of 30 years, with people from the study all born between 1900 and 1990.
Although the former rugby players did on average live slightly longer (79 years compared to 76.5 years), the overall neurodegenerative disease risk increase was 267 per cent, a figure described by Stewart as “much higher than we would expect to see from the general population”.
He also stressed that the data was set in the context of their wider work in sport, which includes brain autopsies that have shown chronic traumatic encephalopathy (CTE), a type of dementia associated with head impacts, in 80 per cent of the former rugby players they have examined.
“The story we are getting from all of our evidence is that exposure to head impacts is a risk and it is a risk we need to do something about,” he added.
The precise cause of the heightened risk could not be definitively identified and, in acknowledging the particular rarity of MND and the limited size of the sample, researchers are now calling for urgent similar studies across the world.
MND does not currently have a cure and affects around one in 400 people over the course of their lives, with around two in 10,000 people diagnosed each year.
Dr Eanna Falvery, who is World Rugby’s chief medical officer, said that they welcomed the call for more research and stressed that they had established an independent concussion working group to consider the latest evidence.
“This enables us to have a constant and open conversation about what changes to the game may be appropriate,” said Falvery, who added that the governing body had invested more than €10 million in welfare studies. “We will continue to build on this work in our quest to make our game as safe as it can possibly be for players at all levels within the rugby family.”
Scottish Rugby’s chief medical officer Dr James Robson said that the study would inform continued “proactive” improvement in player welfare. “Rugby continues to have many health and social benefits. Important research like this can help us continue to improve safety and mitigate risks associated with contact sport,” he said.
Head for Change, the brain injury charity whose founders include Alix Popham, the former Wales international who is part of a legal action against World Rugby, said that the connection between repetitive head impacts and neurodegenerative disease was “increasingly irrefutable”.
The charity also called for “a precautionary approach to reduce and manage this risk exposure from head impacts,” adding: “Now is the time for action. Stop talking about protecting the players. Instead prevent them from becoming victims of the future.”
Doddie Weir: 'Playing rugby did not cause my disease'
Scotland’s legendary former lock forward, Doddie Weir, has stressed that he has no worries about his children playing rugby union and does not believe that the sport caused his motor neurone disease.
MND is a relatively rare disease, with various genetic, lifestyle and environmental risk factors and Weir, who as diagnosed with the disease in 2017, has no regrets about a career that included 61 Scotland caps and a British and Irish Lions rugby tour.
“I personally wouldn’t change anything about the game and I enjoyed the game,” the 52-year-old said. “I also feel that playing rugby was not the cause for my disease. I’m delighted for my sons to play the game and have no concerns for them getting MND.
“I was very surprised with their findings. It would be very interesting to see how they came to that conclusion. I find it hard to believe. It would be good to see the bio markers and evidence before I comment more.”
Weir did echo the call for urgent new research into the causes of the disease as well as potential treatments and cures. His charity, My Name’5 Doddie Foundation, is funding a study investigating the potential link between strenuous activity and the development of MND. As well as head impacts, previous studies have suggested a possible link to agricultural chemicals.
Weir remains convinced that a cure can be found. “MND is not incurable, it is only underfunded,” he said. “The more money we can generate, the more answers to unknown questions we can gather.”
Although his movement and speech is now significantly impacted, Weir said that he was “very well” and recovering from a “fabulous” weekend away. “Twelve of us went to the Isle of Coll to see Rob Wainwright for lunch, and visit a distillery when we where there,” he said. “I’m still managing to annoy the wife and kids. I’m still enjoying the odd Guinness and red wine.”
Jessica Lee, who is the director of research at My Name’5 Doddie Foundation, described the Glasgow research as “concerning” but said that the findings should be viewed with caution and did not prove a causal link.
“The sample size included in the study is relatively small, especially when studying an uncommon condition like MND,” she said. “These findings therefore warrant further investigation in larger scale studies.”
Prof David Sharp, a neurologist at Imperial College London’s UK Dementia Research Institute, said that the Glasgow research “aligns with previous work showing increased risk in other sports” and called for initiatives to monitor the brain health of active and former sportspeople who have been exposed to repetitive head injuries.
As well as the MND findings, the former Scottish international rugby players were found to be twice as likely to develop dementia and three times more likely to suffer Parkinson’s Disease.
His colleague, Dr Neil Graham, said that dementia research required significantly more investment, including from sports governing bodies. The Glasgow study was a continuation of its work in former footballers and was part funded by the Football Association and the Professional Footballers’ Association.