The Drake Foundation urges review into laws of professional era rugby union as study suggests sport may have been safer in the amateur era

  • BRAIN study, funded by The Drake Foundation, finds no difference in cognitive function before age 75 between players in pre-professional era with three or more concussions and those with fewer
  • Results, coupled with Drake Rugby Biomarker Study of current elite players and recent cases of brain disease in retired professional players, suggests sport may have become more damaging to brain health since turning professional
  • Additional research by The Drake Foundation finds 62% of adults involved in grassroots rugby are concerned about long-term effects on brain health
  • 61% believe sport has become more dangerous since turning professional in 1995, and 66% believe fundamental law changes are needed to make it safer

LONDON, October 20, 2021 – The Drake Foundation is urging rugby authorities and governing bodies to consider immediate law changes to the sport at all levels following the publication of research today that suggests the game may have been safer in the pre-professional era.

The BRAIN study, funded by The Drake Foundation and published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, found that former elite rugby players who experienced three or more concussions during their career did not have worse cognitive function before the age of 75 than those who had experience no, or just one or two, concussions. The study found no overall group association between concussion history and worse cognitive function, but did find that over 75s who had suffered three or more rugby-related concussions during their career had significantly worse cognitive function.

The BRAIN study worked with 146 former elite rugby players in England aged 50 years and over, most of whom played in the pre-professional era, to examine brain health trends. The study saw the participants take part in an extensive set of tests capturing physical and cognitive capabilities, as well as questions about their playing and concussion history.

The research team notes that any decreases in cognitive function may have come at such an older age in part due to the fact the former elite rugby players involved in this study were generally highly educated and had higher than average cognitive function at the start of their playing careers.

The results from the BRAIN study call into question whether safety standards in the sport have worsened since the game became professional.  Several retired players from the modern era have recently been diagnosed with early-onset neurodegenerative disease and likely CTE. In addition, the neuroimaging results of the Drake Rugby Biomarker Study, published earlier this year, found that 23% of current elite adult rugby players tested had abnormalities in brain structure, and half showed an unexpected change in brain volume.

Further research is needed to provide comparative data for long-term brain health in players from both the amateur and professional eras, as well as to determine the clinical significance of the data from this study and that of the Drake Rugby Biomarker Study.

Additional research carried out this month on behalf of The Drake Foundation by Censuswide, via an online survey of 508 respondents in the UK who are involved in rugby union, finds that 62% of adults who either play amateur rugby or have a child who plays rugby are concerned about the long-term effects of the sport on their or their child’s brain health. This figure rises to 73% for parents who do not play the game themselves, but who have a child that does.

A similar proportion of those surveyed, 61%, agree that rugby has become a more dangerous sport at all levels since it turned professional in 1995, whilst 66% believe that rugby union would be safer if fundamental law changes were introduced to better reflect the way the sport was played in the pre-professional era.

James Drake, founder of The Drake Foundation, commented: “As a passionate sports fan who loves rugby, I’ve witnessed first-hand the way the game has evolved since turning professional. In my view it’s a sport that has become ostensibly less safe for the players involved and my concerns are reflected by our research this month, which reveals 61% of adults who either play the game or have children that do, are concerned about the sport’s long-term effect on brain health.

“A further two thirds of adults believe the sport could be made safer if law changes were introduced to return it to the game as it was played in the amateur era. The Drake Foundation is calling on rugby’s authorities to give this immediate consideration to protect the sport we love and the current and future generations who play it.”

Lauren Pulling, CEO of The Drake Foundation, added: “The BRAIN study, which we funded, yielded some interesting results and new insights into the long-term effects of rugby as it was played in the pre-professional era. These findings are broadly reassuring for players from the amateur era. However, given the findings of the Drake Rugby Biomarker Study and recent cases of early-onset brain disease in ex-players from the professional era, the new study results do call into question how long-term health might differ in players from the modern era. The evidence we have so far suggests that the sport may actually be travelling in the wrong direction in terms of player welfare and brain health. In addition to further research, we therefore also urge the sport’s governing bodies to review the modern game’s laws and protocols and take urgent, preventative action to universally reduce players’ exposure to head impacts both in matches and training.”

Former England international and Drake Foundation Ambassador Lewis Moody MBE, said: “This study funded by The Drake Foundation takes us another step further in our understanding of the links between rugby and later life brain health, and continues to widen the conversation in this area. It’s essential that everyone participating at all levels of the game is included and educated on the topic of rugby player welfare.

“The fact that two thirds of those involved in the amateur game are concerned about rugby’s effect on long-term brain health shows there is a big issue here that needs to be urgently addressed across both the grassroots and elite levels. As well as widening the conversation, I would like to see enforceable guidelines across all levels of rugby to limit players’ exposure to head impacts in order to protect players and the game that we love.”

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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.

For more information on The Drake Foundation’s sports projects, please visit: