The Drake Foundation urges immediate changes in rugby to further prioritise player welfare


  • The Drake Rugby Biomarker Study shows that 23% of elite adult rugby players had abnormalities in brain structure, and half showed an unexpected change in brain volume
  • The Drake Foundation has invested more than £2.2m into researching the short- and long-term impact of sport on brain health in rugby and football
  • Former England international Lewis Moody backs The Drake Foundation research
  • For the full research article, click here

LONDON, July 22, 2021 – The Drake Foundation is calling for immediate changes in rugby protocols to ensure the long-term welfare of elite players, following the release of their latest research today.

The Drake Rugby Biomarker Study was funded and instigated by The Drake Foundation and published in the journal Brain Communications. It has found that around a quarter of elite adult rugby players had changes in their brain structure, specifically in the neuronal wiring (white matter) and blood vessels of the brain, and 50% showed an unexpected reduction in brain volume.

Foundation founder James Drake said: “I have been passionate about sport since I was a young boy but I have seen in recent years how the power of sport has intensified and the very obvious effects that can have on elite athletes.

“I have invested in research into the relationship between head impacts in sport and player brain health for almost a decade because I have been concerned about the long-term brain health of sportspeople, including elite rugby players.

“Common sense dictates that the number and ferocity of impacts, both in training and actual play, need to be significantly reduced. These latest results add further support to this notion, particularly when coupled with existing findings across sport and anecdotal evidence.

“Since rugby was professionalised in the 1990s, the game has changed beyond all recognition. Players are now generally bigger and more powerful, so we have to be mindful of all the ramifications that increased impacts will have on their bodies.

“Seeing younger players suffer with the consequences of that – remember that for the ninth season in a row concussion was the most commonly reported match injury in professional rugby union – I am not convinced that the game is safer now than it was when I started The Drake Foundation in 2014. More must be done to protect players, and without delay!”

The results come from the neuroimaging wing of the Drake Rugby Biomarker Study, undertaken by researchers at Imperial College London in collaboration with UCL, the RFU and clubs across rugby union and rugby league in the UK.

The research team used advanced neuroimaging techniques to look at the brains of current elite rugby players versus controls and concluded that the findings indicate an association between participating in elite rugby and changes in brain structure.

Lauren Pulling, The Drake Foundation’s CEO, said of the findings: “At present, the long-term consequences of these brain structure abnormalities are unknown and require further research. However, taken together with existing evidence across different sports, as well as recent cases of rugby players being diagnosed with brain diseases in their 40s, they are painting a concerning picture when it comes to players’ long-term brain health.”

The RFU has also today announced that they will undertake more research into head impact exposure and long-term brain health as well as a number of other plans to address the risks to rugby players.

Lauren Pulling added: “The Drake Foundation would like to thank the RFU, rugby clubs and the research team for their support in this vital study.

“We welcome the announcement today from the RFU, PRL and RPA announcing their head impact prevention and management programme.

“The results of the Drake Foundation Rugby Biomarker Study are particularly concerning when taken in tandem with the wider current context.

“Given today’s research findings, we believe that the need to take proactive, common-sense action to protect the health of rugby players is urgent.

“Alongside the research and player clinics announced today, The Drake Foundation also wants to see additional updates to the game’s laws and protocols to further minimise players’ exposure to head impacts across both matches and training.

“As a Foundation, and as a nation, we love sport, so we all need to take head injuries and potential changes to the brain seriously in order to protect players as well as the future of the game itself.”

The Drake Foundation Rugby Biomarker Study started in 2015, involving elite rugby players from a number of Premiership and Championship rugby union and rugby league teams.

The study has involved the collection of blood, saliva and urine in an effort to uncover potential biomarkers of concussion injuries, as well as – in this recently published subsection of the study – using advanced neuroimaging techniques and cognitive testing to investigate any changes associated with participation in elite rugby.

Former England rugby international, Lewis Moody MBE, expressed his support for the work being undertaken by The Drake Foundation.

He said: “I would like to congratulate The Drake Foundation on the work they have done over the last seven years, especially around the lead role they have taken as an independent funder of head injury research, collaborating with academics and sports governing bodies.

“I am continuing to learn and educate myself on the impact of head injury in sport and the steps needed to make sport a safe and trusted place for its athletes to operate in.

“However, I feel player welfare is not always at the forefront of people’s minds. Therefore, we need to ensure that everyone involved in the game, from Premiership to grassroots, is educated to ensure that the priority is focused on player welfare, rather than returning to competition.

“I would like to see a clear set of standards outlined across the game, from Premiership to grassroots, informing the maximum amount of contact training (and protocols around this) permissible per season. From the findings released today, as well as the players coming forward with early signs of brain conditions, there is still much to do to ensure that the game, we love, is safe and enjoyable for all involved.”

The Drake Rugby Biomarker Study assessed 41 male players and three females with all results anonymised.



The Drake Foundation is a not-for-profit organisation committed to understanding and improving the health and welfare of people impacted by head injuries, including sports players and IPV (intimate partner violence) survivors, through scientific research and collaboration.

Founded in 2014 by James Drake, the Foundation has since invested more than £2.2 million into research funding and open access resources.

The majority of this funding to date has gone into research into sport-related head injuries and long-term health outcomes, with the objective of making sport safer and providing valuable insights into the processes underlying neurogenerative diseases, such as dementia. In 2021, the Foundation expanded its portfolio to include research into brain injury from IPV.

Amongst the projects that The Drake Foundation funds are the HEADING study, which is investigating the link between neurogenerative disease and a professional football career, and the BRAIN study, working with retired rugby players to understand the association between a history of concussion and neurogenerative disease.