Rugby faces a pivotal moment as medical professionals and former players unite to address growing concerns about head injuries in the sport.
With the transition from amateur to professional rugby, players have become bigger, stronger, and faster—leading to more frequent and severe collisions. This evolution has resulted in an increase in both concussions and sub-concussive injuries, which experts warn could contribute to long-term degenerative conditions like dementia.
Former Ireland international and Ulster team doctor David Irwin emphasized the urgency of the situation. "The game has changed dramatically," Irwin stated. "We're seeing massive collisions that simply didn't occur in the amateur era. While scoring tries remains the objective, how we achieve that has shifted toward multi-phase attacks and power plays that increase contact risks."
Progress and Persistent Problems
World Rugby has implemented several safety measures, including Head Injury Assessment (HIA) protocols and rule changes targeting high tackles. Irwin acknowledged these improvements have "dramatically" enhanced player welfare over the past two decades but stressed that more must be done.
"The current professional game features highly organized defenses that leave little space for creative play," Irwin explained. "Instead of running through gaps, players often face head-on collisions with one or two defenders. To reduce injury risks, we need to return to a more fluid, off-loading style of play and further lower tackle heights."
Changing Attitudes Toward Toughness
Former Ireland center Luke Marshall, who experienced 15 concussions during his career, noted a cultural shift in how players approach head injuries. He highlighted Ireland international Garry Ringrose's decision to withdraw from a British and Irish Lions Test last summer as particularly significant.
"What Garry did was incredible—that was going to be his first Lions start," Marshall said. "If staying on the pitch is considered brave, then choosing to prioritize health represents another form of courage. His decision sets a powerful example for players at all levels."
Marshall emphasized that while medical and coaching staff never pressured him to play through injuries, internal pressures often influenced players' decisions. "There's pride in representing your team, and in professional rugby, your livelihood depends on performance. Sometimes you'd take a knock and think, 'I'll just see how I feel,' then push through to the final whistle."
Grassroots Concerns
Former Ireland international Kenny Hooks, who coaches at the school level, expressed particular concern about rugby's future at grassroots levels. "There's a problem developing," Hooks warned. "The sport used to welcome players of all sizes, but now there's a perception that you need to be physically imposing to succeed. Some young athletes are being told they won't make it because they're not big enough—that's a fundamental mistake."
Hooks noted that injury concerns are causing some parents to hesitate about allowing their children to play rugby. "If we don't take proactive steps to minimize risks, participation numbers could decline significantly," he cautioned. "We need proper medical personnel at every match and established protocols to ensure player safety. When communities see we're taking care of young athletes, they can make informed decisions about participation."
A Collective Call for Change
Irwin, Marshall, Hooks, and other former players have formed a group dedicated to making rugby safer. Their recommendations include:
- Encouraging a return to more fluid, creative playing styles
- Further reducing legal tackle heights
- Ensuring medical professionals are present at all levels of competition
- Continuing to destigmatize reporting concussion symptoms
As Irwin concluded: "The only way to reduce ongoing collision risks is to fundamentally change how we play the game. We need to move away from attritional, multi-phase rugby and prioritize player safety without sacrificing the sport's essence."