A significant study has revealed a high prevalence of chronic traumatic encephalopathy (CTE), a degenerative brain disease, among former rugby league players. The research, based on examinations of donated brains, indicates that 31 out of 51 rugby league players studied had CTE. This condition, which can only be definitively diagnosed after death, was found in players who participated at various levels, from amateur to professional, and in some cases, at surprisingly young ages.
Scale of the Problem in Rugby League
The findings stem from the first 150 brain examinations conducted at the Australian Sports Brain Bank. Among the 51 rugby league players whose brains were donated for research, a striking 31 showed signs of CTE. This represents over 60% of the rugby league donors in the study. The disease was identified in individuals who played the sport across different eras and levels, highlighting a widespread issue within the code.
Among the cases identified was former NRL coach Paul Green, who died at 49, and Manly Sea Eagles player Keith Titmuss, who tragically passed away at just 20 years old. Titmuss’s diagnosis of Stage 2 CTE at such a young age underscores concerns that the disease is not solely an ailment of older athletes and that exposure risks can begin in junior years.
Understanding CTE: Causes and Symptoms
CTE is a progressive brain condition believed to be caused by repetitive head trauma and sub-concussive blows to the head and body over time. While the exact mechanisms are still under investigation, the cumulative effect of these impacts is considered the primary driver of the disease’s development.
The symptoms of CTE can be varied and often manifest as changes in mood, behavior, and cognition. These may include:
- Memory loss
- Increased impulsivity
- Episodes of anger and aggression
- Anxiety and depression
- Difficulty with decision-making
In some instances, CTE has been observed in athletes who have died by suicide. However, researchers emphasize that while a correlation exists, more extensive research is needed to establish a definitive causal link between CTE and suicide. Experts also note that the intelligence and resilience of athletes may allow them to mask some symptoms for a period.
Calls for Action and Increased Awareness
The findings have intensified calls from experts and families of affected players for greater protective measures within contact sports. Amanda Green, widow of Paul Green, has become a vocal advocate for increased awareness and action to safeguard the brain health of future generations.
“Now that we know what we do about this disease I feel a massive responsibility, as we all should, to protect the brain health of the next generation of young athletes,” Amanda Green stated. “I owe it to my kids and their sports-loving mates. We need to ensure they don’t make the same mistakes as our generation did.”
She expressed surprise at her own lack of knowledge regarding CTE, despite her husband’s involvement at the highest levels of professional sport. “I had been involved in the highest level of professional sport in this country and did not understand this disease we now know as CTE,” she said. “That was not OK. I didn’t know what CTE was, and since Paul’s diagnosis, I have constantly called for more education on the issue. People needed to understand this disease so no-one else suffered in silence.”
Professor Alan Pearce, a molecular biologist and data scientist at Swinburne University and an author on the study, echoed these concerns. “Given rugby league is a collision-based sport, it is not surprising that we found over 60 per cent of rugby league donors had CTE, but this tells us we need to start implementing modifications,” Professor Pearce said.
Recommendations for Junior Sports
A key recommendation emerging from the research and advocacy efforts is the consideration of age restrictions for contact in junior sports. Experts, including Professor Pearce, have repeatedly suggested banning contact in sports until the age of 14.
“Introducing contact limits in rugby league is a good start but rugby league and all contact and collision-based sports must also start modifying to non-contact versions for children to the age of 14 years of age,” Professor Pearce advised. Keith Titmuss’s case, diagnosed with Stage 2 CTE at 20, is cited as evidence that the risks begin much earlier. Titmuss played junior rugby league from the age of five and continued with schoolboy rugby union, accumulating significant exposure to head impacts over his 15 years of playing contact sports.
The parents of Keith Titmuss, Lafo and Paul, donated his brain for research, contributing to the understanding of the disease’s impact. Titmuss passed away in 2020 due to exertional heat stroke following a training session with the Manly Sea Eagles. His CTE diagnosis, revealed in 2024, has amplified warnings that major football codes may not be adequately protecting young athletes.
Broader Context of Brain Trauma in Sports
This study on rugby league players follows similar revelations in other football codes. A previous report highlighted that 33 Australian Rules Football (AFL) players had been diagnosed with CTE, prompting investigations by WorkSafe Victoria and WorkSafe WA into player safety incidents.
Internationally, research also points to concerning trends. A study from Boston University indicated that at least one in four former NFL players who died between 2016 and 2021 were found to have CTE. These cumulative findings across different contact sports underscore a significant public health concern regarding the long-term neurological consequences of playing these sports.
The ongoing research and the increasing number of diagnoses emphasize the critical need for continued investigation, greater transparency, and proactive measures to protect the brain health of athletes at all levels of sport.
