Health report: NZ male ex-rugby players
NZ Rugby Health Report: the health of retired NZ male rugby players compared to non-contact sports and the NZ population
- General health study of the NZ Rugby Health Project commissioned by World Rugby to better understand the longer-term impacts of sport’s participation and to inform welfare advances.
- Findings determined rugby players more likely to have sustained more injuries, suffer osteoarthritis at greater levels and drink more alcohol at hazardous levels than non-contact peers, but also reported better overall health, relationships and wellbeing compared to the general population.
- World Rugby and New Zealand Rugby united in commitment to evidence-based approach to injury prevention, management and former player support via six-point action plan.
After a comprehensive study on the health of New Zealand retired rugby players compared to players of non-contact sport (data collected between November 2012 to April 2014]), researchers have identified that ex-rugby players have had more concussions, more injuries requiring surgery, more injuries forcing retirement, are suffering osteoarthritis at greater levels, and are drinking alcohol at more hazardous levels than their non-contact peers in New Zealand. However, retired players (elite rugby, community rugby and non‐contact sport) who completed the survey reported better health, were more likely to be in long-term relationships, generally had higher incomes, and were less likely to smoke cigarettes when compared to New Zealand males in general.
The study, published in the academic journal Sports Medicine compared the self-reported sport injury histories and current health statusof former New Zealand rugby players with non-contact players. Study authors Professor Patria Hume, Professor Alice Theadom, Associate Professor Gwyn Lewis (all AUT) and New Zealand Rugby Chief Scientist Dr Ken Quarrie say the exploratory study formed an important step in helping to identify health issues amongst former rugby and non-contact sport players.
“The physical nature of rugby results in more musculoskeletal injuries requiring hospitalisation or retirement from sport and an increased risk of osteoarthritis later in life”, says Professor Patria Hume.
“We recommend that New Zealand Rugby address the hazardous alcohol consumption by educating rugby participants about the effects and potential harm of alcohol use, and by removing alcohol sponsorship from the sport”, says Professor Alice Theadom.
World Rugby Deputy Chief Medical Officer Dr Martin Raftery says, “We want playing rugby to continue to be valued for the considerable lifelong positive wellbeing benefits it brings, as outlined in the NZ Rugby Health studies, while better understanding and minimising the risks associated with the game, for current and former players”
World Rugby Chief Medical Officer Dr Éanna Falvey says, “World Rugby welcomes any new research into the welfare of players past, present and future in line with our strategy to be the most progressive sport in the world when it comes to player welfare. The NZ Rugby Health Project aids our understanding of the health and wellbeing of former participants, in this case players who retired a decade ago, and we are proud to have supported it jointly with New Zealand Rugby and the Auckland University of Technology.
“As the science and research has evolved since this study was commissioned, so has our understanding and our actions to safeguard the immediate and long-term health of our participants. We will never stand still in our evidence-based commitment to player welfare, including the prevention and management of injuries. Advances in concussion education, identification, and management, including the Head Injury Assessment and Graduated Return to Play processes, and prevention programmes such as Activate, Tackle Ready and Contact Training Load Guidance, are all aimed at protecting and supporting players.
“We welcome the recommendations by the NZ Rugby Health Project authors to undertake further longitudinal studies determining longer term impacts of playing rugby.”
The NZ-RugbyHealth project, containing four studies, was developed in 2012 at the request of World Rugby and conducted in collaboration by New Zealand Rugby and AUT researchers. The purpose of the project was to describe the injuries sustained by players during their playing careers, along with self-evaluations of their health after retiring from their sport.
Methodology
In the November 2012 to April 2014 NZ-RugbyHealth study, 470 former rugby and non-contact sport players (127 elite rugby and 271 community rugby) and 72 non-contact (hockey and cricket) sport, (average age of 44 years), answered an e-questionnaire on a range of information including demographics, their engagement in sport, sport injuries, medical conditions that had developed, mood, alcohol and substance use. They also rated the state of their current physical, mental and psychological health. Alcohol use patterns (consumption, dependence, and problems) were assessed via the Alcohol Use Disorders Identification Test (AUDIT). Hazardous drinking (defined as a score >8 on the AUDIT) means the higher the score the more likely it becomes that the person is misusing alcohol (i.e., likely to be harmed or harming others by its use, or likely to be or become dependent).
Results
During their playing career, higher percentages of the rugby groups reported having sustained:
- concussion (94% for elite, 82% for community, 26% for non-contact)
- injuries requiring hospitalisation (73% elite, 46% community, 25% non-contact)
- injuries that stopped participation in sport permanently (28% elite, 28% community, 11% non-contact)
- sport related surgery (72% elite, 46% community, 32% non-contact)
Since retiring from competitive sport, both rugby groups had a higher prevalence of osteoarthritis (37% for elite, 19% for community) than non-contact athletes (6%).
Rugby players had higher levels of hazardous alcohol consumption (38% elite, 40% community) in retirement than non-contact athletes (25%).
There was little difference between rugby players and non-contact sports athletes in self-reported mood, substance use or ratings of overall physical or psychological health.
Retired players (elite rugby, community rugby and non‐contact sport) who completed the survey reported better health, were more likely to be in long-term relationships, generally had higher incomes, and were less likely to smoke cigarettes when compared to New Zealand males in general.
Conclusions
Former rugby players were at higher risk than the non-contact players for most injuries during their playing careers, and in retirement had greater prevalence of osteoarthritis and hazardous alcohol consumption. The relative youth of all three groups (44 years on average) means that health issues that typically do not emerge until later life may not have yet manifested.
Key points
- Community and elite former rugby union players reported a substantially higher number of concussions, injuries requiring hospital treatment, and injuries that stopped participation in sport permanently, than non-contact sport players.
- A greater percentage of former rugby players reported they had osteoarthritis, and consumed alcohol at more hazardous levels compared to former non-contact sport players.
- There was minor difference between rugby players and non-contact sports athletes in self-reported mood, substance use, or current overall physical and psychological health ratings. The elite rugby and community rugby retired players who completed the survey reported better general health, were more likely to be in long-term relationships, generally had higher incomes, and were less likely to smoke cigarettes when compared to New Zealand males in general.
Key recommendations
- Sports should continue to focus on embedding targeted injury prevention programmes (such as NZ’s RugbySmart and World Rugby’s Activate and Tackle Ready programmes) and injury management programmes for injuries leading to the greatest morbidity. For rugby, this focus should be on arthritis and concussion as leading causes of morbidity.
- Education on the harmful effects of excessive alcohol ingestion should be a core inclusion in all sports education programmes.
- Brain health education should be made widely available to players to increase awareness of the key factors behind promoting long-term brain health.
Discussion
Impact injuries and potential for osteoarthritis
The hypothesis that rugby players are at higher risk of injury than non-contact sport participants was supported by the results of the study. The prevalence of osteoarthritis was 37% for former elite rugby players, 18% for former community rugby players and was lower than the UK-RugbyHealth study. Using an identical question from the NZ-RugbyHealth study, the UK-RugbyHealth study reported greater levels of osteoarthritis for rugby players (51% for elite rugby players, 36% for amateur rugby players) but less of a gap with non-contact sports people (22%).
The study authors say that while they don’t know what to attribute these inter-study differences to, factors such as differences in typical game play and style, environmental conditions (pitch and weather), or the way the groups reported injuries in the two countries may all have contributed.
Alcohol use
Many participants in rugby drink large quantities of alcohol as part of the cultural rituals of the sport. Although heavy drinking has traditionally been associated with rugby, few studies have attempted to systematically describe alcohol use in cohorts of rugby players. The prevalence of drinking behaviour at hazardous levels in the two former rugby groups (38% to 40%) was higher than former non-contact sport players (25%) and New Zealand males of the same age range in the wider population (26%).
Hazardous drinking behaviour among retired rugby players has also been described internationally. A study describing alcohol use among players from France, Ireland, and South Africa reported prevalence rates of 62% for adverse alcohol behaviour.
A significant association between adverse alcohol use and osteoarthritis has been reported in a group of former UK elite athletes (rugby, football, ice hockey, Gaelic sports and cricket) and beer consumption has been associated with increased risk of knee or hip osteoarthritis in a case control study. In rugby, it is likely that the sport predisposes athletes to osteoarthritis because of the joint injuries that are commonplace in the sport.
Concurrently, they are drinking large amounts of alcohol. While a cause-and-effect relationship between alcohol and osteoarthritis cannot be ruled out, it seems more probable that hazardous alcohol use and the development of osteoarthritis are independently associated with participation in rugby union.
Comparison of the study period with current practice
“The majority of rugby players in the study began playing senior rugby in the 1980s and 1990s. Most of the elite rugby players finished playing at an elite level in the 1990s and 2000s, and most of the community players finished playing in the 2000s and 2010s” says Professor Patria Hume.
“The NZ Rugby injury prevention and rehabilitation initiatives have progressed since the ex-players were playing (1980-2011) and they reported their health data (Nov 2012 to April 2014)” says New Zealand Rugby Chief Scientist Dr Ken Quarrie.
Falvey adds: “In 2021, World Rugby launched a six-point action plan to further rugby as the number one sport on player welfare, which has steered welfare-driven law trials (goal line drop out, 50/22 and breakdown), the introduction of independent concussion consultants for return to play after a concussion in elite rugby, contact training load guidance, the Tackle Ready injury-prevention programme and independent brain health education for rugby and the general public.”
“The issues for retired players during the 1980-2011 era of play would hopefully be minimised for current players given current practices. Improved monitoring of players during their careers and in retirement would help us understand the association between playing factors and health post retirement from the sport” added Professor Patria Hume.
NZ Rugby Health Project studies
Further details are available on the NZ Rugby Health Project fact sheet at AUT’s Sport Performance Research Institute (SPRINZ) website.