CTE in Rugby | Symptoms, Claims, & Rehabilitation
Understanding CTE – What is it & How is it Caused?
Chronic Traumatic Encephalopathy is a progressive neurological disease caused by repetitive brain trauma, which is commonly seen in contact sports like rugby, MMA, boxing, and American football. Unlike a single traumatic brain injury, CTE develops over time from sub-concussive impacts, which may not cause immediate symptoms but still contribute to long-term brain damage.
The brain is composed of various cell types. Neurons are the cells that transmit electrical signals that generate thought, sensation, and movement. A neuron has a long section called an axon that extends from the cell nucleus and acts as a bridge between neurons, allowing signals to be transmitted throughout the brain and the wider nervous system.
The axon is the structurally weakest part of the cell. It is supported internally by a microtubule-based scaffold. These microtubules are themselves stabilised by a substance called tau protein.
Repeated trauma damages axons through a two-stage process involving initial mechanical injury and a subsequent, prolonged biochemical cascade that leads to widespread axonal degeneration.
- External force causes axons to stretch, twist, or even physically break at the time of impact. Microtubules are particularly susceptible to breakage when rapidly stretched.
- The subsequent biochemical cascade causes the majority of axon damage over time. This includes:
- Incorrect movement of ions across the damaged cell membrane, notably an influx of calcium
- This activates enzymes which break down intracellular proteins, including tau
- Tau detaches from microtubules, causing axons to deteriorate and become disconnected from the nucleus
- Damaged tau aggregates into large tangles, the hallmark of CTE seen on autopsy, which spread through the brain in a characteristic pattern and lead to further neurodegeneration and cell death.
How Rugby Contributes to CTE Risk
Due to the rules and fundamental nature of Rugby, it provides the perfect conditions that can contribute to the development of CTE. The sport’s physical demands involve frequent and unprotected collisions, exposing players to repetitive head trauma over time. Unlike in American football, helmets are not worn, and the game is continuous, resulting in fewer stoppages for recovery between impacts.
Scrums, rucks, and tackles create repeated scenarios in which players’ heads are exposed to sudden force, often without full awareness of impending contact. These subconcussive impacts, even when unnoticed at the time, accumulate and increase the risk of long-term neurological consequences.
Key Risk Factors in Rugby
Element of Play | How It Contributes to CTE Risk |
Tackles | Direct head contact or whiplash-type movements affecting the brain |
Rucks & Mauls | Accidental head, knee, or elbow impacts due to close physical contact |
Scrums | Repeated compression and rotational forces are applied to the neck and head. |
Training Drills | High-frequency sub-concussive impacts during repetitive contact drills |
Lack of Protective Gear | No helmet or head protection, increasing exposure to direct and cumulative head trauma |
Recent reports, including those referenced by the BBC, indicate that multiple elite-level rugby players have been diagnosed with probable CTE post-retirement, with some showing symptoms in their 30s and 40s.
Rugby vs. American Football - Which Sport Has a Higher Potential Risk for CTE?
Rugby and American football are both contact sports that are characterised by a high incidence of head impacts; however, these impacts differ in their mechanisms and effects on players over time. Although both sports are linked to CTE, new data studies suggest rugby may present a comparable or even higher level of cumulative brain trauma in some areas.
In rugby, players are involved in more continuous contact phases, often without the kind of protective equipment used in football. In contrast, American football features structured plays, shorter bursts of action, and mandated helmet use, which changes how and where impacts occur, though it doesn’t eliminate the risk.
Contact Sports Comparison - Head Trauma Risk
| Sport | Protective Equipment | Game Structure | Primary CTE Risk Factor |
| Rugby | None (optional soft headgear) | Continuous play | Repeated sub-concussive impacts during tackles, rucks, and open play |
| American Football | Helmet and full body padding | Set-piece plays | High-force collisions often lead to cumulative brain trauma despite helmets. |
| Football | Shin guards only | Continuous play | Repetitive heading of the ball and accidental head-to-head collisions |
| Boxing | Gloves and a mouthguard | Round-based matches | Intentional, repeated blows to the head cause cumulative neurological damage |
| Mixed Martial Arts | Gloves and a mouthguard | Round-based fights | Repeated strikes to the head, combined with rotational forces |
A group of over 400 rugby players is now involved in legal action, citing confirmed or probable CTE, early-onset dementia, and other neurodegenerative diseases. One university-led study found that elite rugby players had twice the risk of developing neurodegenerative disease compared to the general population.
Symptoms of CTE in Rugby Players
CTE presents a range of neurological and behavioural symptoms, some of which might only begin to surface years or even decades after a player’s career ends. Among former rugby players, symptoms can be mistaken for early-onset dementia, anxiety disorders, or depression, especially when they appear in individuals under the age of 50.
Recent case reviews involving former elite rugby players, as cited in the BBC’s reporting, show patterns of mood instability, short-term memory loss, difficulty concentrating, and impulsivity. Over time, these symptoms can progress into more severe cognitive impairment and loss of executive function, directly affecting daily life and decision-making.
Common CTE Symptoms in Retired Rugby Players
Chronic Traumatic Encephalopathy can cause a wide range of cognitive, emotional, behavioural, and physical symptoms that often worsen over time due to repeated head trauma.
Cognitive Symptoms of CTE
- Memory loss
- Confusion
- Difficulty concentrating or focusing
- Slowed thinking and reduced processing speed
Emotional and Behavioural Symptoms of CTE
- Memory loss
- Confusion
- Difficulty concentrating or focusing
- Slowed thinking and reduced processing speed
Motor & Mechanical Function Symptoms of CTE
- Problems with balance or coordination
- Unsteadiness when walking
- Speech changes, typically in later stages
Functional Impact of CTE
- Difficulty maintaining employment
- Strained personal and family relationships
- Social withdrawal and reduced independence
Legal and Medical Recognition of Rugby CTE
There has been a significant shift in how both legal systems and the medical community are addressing CTE in rugby. In the UK, more than 400 former professional and semi-professional rugby players are currently involved in legal action against rugby authorities, as reported by the BBC. The claims cite a failure to properly protect players from the long-term effects of head injuries sustained throughout their careers.
This rising legal activity reflects a broader movement towards accountability and recognition, as rugby bodies face scrutiny for what former players describe as systemic negligence. The litigation covers a range of conditions linked to CTE, including early-onset dementia, mild cognitive impairment, Parkinson’s disease, and motor neurone disease.
Our Commitment to Rugby Players
At Brain Injury Group, our team understand the serious and long-lasting effects that CTE can have on ex-rugby players and their families. Whether you’re a former player, a family member, or someone experiencing early symptoms, our goal is to ensure you receive expert guidance and access to the right support as early as possible.
We work closely with neurological specialists, legal professionals, and care providers to offer a pathway that addresses the medical, legal, and emotional challenges associated with suspected or confirmed CTE.
How Brain Injury Group Can Help
- Legal advice – Access to experienced brain injury solicitors
- Medical referrals – Connections to neurologists and cognitive assessment services
- Care planning – Guidance on care packages, housing options, and financial support
- Family support – Information, advice, and resources for relatives and carers
- Education and awareness – Raising awareness of CTE within the rugby community and the wider public
If you or someone you care about is showing signs of memory loss, behavioural changes, or other symptoms commonly associated with CTE, we encourage you to seek a professional assessment. Early intervention can help manage symptoms and plan for the future.
Related News & Articles
